“What is your biggest fear about giving birth?” a fellow classmate asked me during an open chat in my first prenatal class. Looking down, holding my swollen belly, I responded: “Having a baby during a world-wide pandemic.”
Gathered in a downtown Toronto midwifery, the group, about half a dozen of us, nod. We have realized this is no longer the far-off plot of an apocalyptic movie, and instead our new reality.
We are all having babies, as countries around the globe battle the spread of COVID-19.
At the time of this article, I will be just over 36 weeks pregnant. For those who don’t speak in weeks, that is nine months.
Over the weekend, Canadians were encouraged to practice social distancing and if they have traveled, self-isolation.
By Monday, Prime Minister Justin Trudeau said he was closing Canada’s borders to all non-citizens and permanent residents (with some exceptions).
A day later, Ontario declared a state of emergency.
Having spent the majority of my last trimester begging our little one to come out early, it’s now the last thing I want.
A feeling likely shared by many, with approximately 60,000 women set to give birth in our country over the next two months.
“When there are unknowns, that will increase anxiety and this is a scary time because of the unknowns,” said Dr. Gail Robinson, a professor of psychiatry and obstetrics/gynecology at the University of Toronto.
“Just know these are understandable concerns.”
In China, where the virus originated, pregnancy outcomes of the reported COVID-19 cases have been largely good.
However, as with other coronavirus’ such as SARS AND MERS, The Society of Obstetricians and Gynecologists of Canada reported it is “likely to be strongly correlated with the degree of maternal illness.”
In more severe instances, outcomes included “spontaneous and iatrogenic” (or medically indicated) preterm labour, and in one case, stillbirth.
On March 14, media in the UK confirmed a mother and her newborn baby were among the latest affected by the virus, leaving doctors to try to understand if the infant was infected during birth or before.
According to reports, the Royal College of Obstetricians and Gynecologists said there was no evidence COVID-19 can be passed from a pregnant women to babies before birth, but admits, there is still so much we don’t know about the virus and how it works.
Canadian infectious diseases specialist Dr. Issac Bogach told Global News that because of this, the data too, could change.
In the meantime, Robinson said it’s about mitigating the risks before baby shows up.
“You can’t just say ‘everything is fine’ and expect it will be. For many, this is causing ‘situational anxiety.’ And so, you should try to improve the situation, through following expert advice. In this case, social-distancing and self-isolating.”
And if you do fall ill and test positive for COVID-19, Ontario midwife Sara Cooper told Global News there are now procedures in place.
“Being confirmed positive, there is no additional risk to the labour. However, you will have to give birth in a hospital,”she explained, adding home or birthing center plans would be altered.
“You will be limited to one support person and they can’t leave,” Cooper said. For many, this means the option of having a Doula in the room, alongside a partner, would not be possible.
“For infection control (the midwives) are in full protective gear. This includes masks, goggles and gowns. We are also recommending fetal monitoring and an epidural.”
The latter, she explained, is in the case of an emergency cesarean section.
“The epidural lowers the chance of airborne transmission versus having to intubate.”
Postpartum, Cooper reassured, at this point, the decision to quarantine a newborn from a COVID-19 positive mother is not being mandated.
“We would ask mom to wear a mask,” she said. “Breastfeeding is still OK. It is considered routine care.”
But in this climate, the meaning of what is routine and what isn’t, can shift.
“Things are changing daily,” Cooper explained. “We have no idea what two days from now could look like.”
For this very reason, Cooper is also advising families with newborns to minimize visitors.
“Public health is recommending full social isolation until that recommendation is lifted,” she said. “I know this will be very hard for a lot of people. Physical health is only one part (of postpartum recovery) and this will test the emotional part.”
With our family cross-country and abroad or having recently traveled, this was a tough but necessary pill for me and my spouse to swallow.
“It is a good idea to avoid visitors until we all know the risks have gone down,” Robinson agreed. It’s a decision, she added, families should be understanding about.
“We have to err on the side of caution.”
The expert consensus during what Canadian officials have called an ‘unprecedented health crisis.’