How does COVID-19 modify pregnancy monitoring and childbirth?
March 23, 2020 | The propagation of the SARS-CoV-2 virus has forced the health care system to rethink several procedures. How can the COVID-19 pandemic modify pregnancy monitoring and childbirth? Two doctors answer our questions.
The information presented here was current as of April 23, 2020.
What happens with regards to pregnancy monitoring? Will certain appointments be cancelled?
First, it is important to mention that the COVID-19 situation varies from one hospital to the other and it is evolving hour by hour. Recommendations can change very rapidly.
According to Dr. Chantal Ouellet, physician at L’Autre maison clinic and at the Pierre-Boucher hospital in Longueuil, doctors have received guidelines from the Collège des médecins and the Fédération des médecins omnipraticiens du Québec. “Right now, pregnancy monitoring is maintained and no appointments have been cancelled,” she explains. “They could, however, be spaced by a slightly longer period of time if everything is going well. For example, a patient could be seen every 5 weeks instead of 4.”
According to a document from the ministère de la Santé et des Services sociaux, pregnancy monitoring is essential and must be maintained. It is, however, recommended to carry out the majority of these appointments over the phone or by videoconferencing. Tests and interventions that need to be done in person could also be grouped in a single appointment. Moreover, some exams could occur outside of hospitals. Such is the case of the 20-week sonogram.
If it is a high-risk pregnancy, the frequency of the appointments should remain the same. “We are trying to move those follow-ups to clinics in order to avoid hospitals, says Dr. Beaulieu.”
Patients who have COVID-19-like symptoms such as a fever, coughing, sudden loss of sense of smell or taste or difficulty breathing could see the pregnancy monitoring to a hospital. “Clinics are not as well equipped as a hospital to avoid the spread of the virus,” Dr. Ouellet adds. “We obviously want to avoid that an infected patient is in the same cabinet as a symptom-free patient.”
Vaccinating pregnant women against measles is not considered a priority by the MSSS. Consequently, if the vaccination does not coincide with an already planned in-person appointment, it will be delayed.
According to the MSSS, pregnant women who display symptoms and have tested positive could be directed to a designated hospital according to the severity of their infection.
Partners can no longer be present at pregnancy follow-ups. “Our clinic asks that partners do not accompany the future mom when she comes for a follow-up exam,” Dr. Beaulieu confirms. “At the hospital, partners can no longer accompany a pregnant woman for a sonogram. It is also true in private clinics that offer this service.” Indeed, the MSSS has confirmed that no visitors are allowed in appointments except in exceptional circumstances. This includes partners, children or companions.
What measures will be taken if a mother is infected with COVID-19 at the time of childbirth?
“Our hospital, with the help of public health authorities, has implemented procedures with regards to childbirth and according to the health condition of the mother,” Dr. Ouellet explains. “When the patient calls or shows up at the maternity ward because she is in labour, there is a triage step, first.”
- The patient displays no symptoms and is not identified as being at risk of carrying the virus: childbirth will happen as usual.
- The patient is healthy but was in contact with an infected person or she has travelled: the personnel will take precautionary measures and isolate her. Certain rooms, for example, are reserved for women with a higher risk potential.
- The patient has tested positive or displays COVID-19 symptoms: currently, the patient’s situation will be evaluated by specialists and, depending on the severity of her health condition, she could be transferred to another hospital with confinement precautions. “If delivery is imminent, it might not be possible to transfer the patient, Dr. Ouellet nuances, but if we do have time to do so, she will be transferred to make sure she receives the best care possible.” If the mother is indeed transferred, she will be looked after by a specialized team that includes an obstetrician-gynecologist.
The MSSS recommends to women who have respiratory symptoms to wear a mask as soon as they arrive at the hospital.
Could there be changes in the case of planned C-sections?
According to Dr. Beaulieu, elective C-sections are maintained. “The exact date might change, but the delay will remain within a safe time period both for the mother and the baby,” she adds. Moreover, in certain cases, it is possible that the partner cannot be present during the surgery.
In the case of mothers who have COVID-19, MSSS recommends postponing the C-section until the mother has recovered. It is, however, important to note that according to MSSS, C-sections should be reserved for the usual obstetric indications, regardless of the mother’s health condition.
Monitorings carried out by midwives
On March 24, MSSS issued a document prepared alongside the Ordre des sages-femmes and the Regroupement Les sages-femmes du Québec. According to those guidelines:
Childbirth in birth centres should be privileged. Childbirth at home can be an acceptable option under certain circumstances.
Only one person can be present during childbirth, either the partner or another companion.
Monitoring of women with COVID-19 symptoms or who night have been exposed to the virus must be transferred to medical personnel.
Can partners still be present for childbirth and during the postnatal stay?
According to MSSS, all parents and their baby must remain in their room during their stay at the hospital. Stepping outside is prohibited.
“Here at Pierre-Boucher, it is out of the question that fathers cannot be present for childbirth,” Dr. Ouellet insists. “They live in the same home as the mother. We are therefore not preoccupied by contamination. Women can rest assured of this.”
The MSSS does, however, specify that the partner or companion can only be present during childbirth and the postnatal stay if they do not represent any infection risk. Moreover, according to Dr. Beaulieu, should a mother infected with COVID-19 need to be transferred to an intensive care unit, her partner cannot be present. It could also be the case for emergency C-sections.
Certain hospitals may have forbidden the presence of a companion during childbirth, this is no longer the case. In an update published on April 21, the MSSS explained that “all reasonable measures must be taken to allow the presence of the second parent of a significant person during childbirth (including C-sections) and during the postnatal stay.”
The companion must wear a mask, however. Certain hospitals require the companion to leave immediately after childbirth is over. This is the case at the Jewish General Hospital and Sacré-Cœur Hospital.
What about birthing coaches?
For the time being, birthing coaches are prohibited from the delivery rooms of several hospitals. “We understand their presence is important, admits Dr. Ouellet, but since they don not actually live with the mother, they are not admitted, for now.” The situation might change, however, because the Association québécoise des accompagnantes à la naissance has adopted the position that birthing coaches should be allowed in delivery rooms.
In the meantime, some birthing coaches offer virtual monitoring. “Our presence is different, admits Josette Charpentier, a birthing coach. We do remain available for the well-being of our clients.”
Will it still be possible to practise skin-to-skin contact with the baby? Is cohabitation still allowed?
Babies born of a mother infected with COVID-19 must automatically be tested at birth.
“There is good news on that front,” says Dr. Ouellet. “Based on what we have seen elsewhere in the world, the current recommendation is to not separate mother and child if the mother is healthy or has light to mild symptoms.” Skin-to-skin contact is also allowed.
If the mother is infected or at risk of being infected with COVID-19, she has to wear a mask at all times when she is in contact with her baby. She also has to wash her hands before holding or breastfeeding her baby.
This has been confirmed by the MSSS who says it is not recommended to isolate newborns whose mother is infected with COVID-19. “If it comes to that, it has to be because it is necessary for the health of the mother or of the baby and we are trying to provide them with better care,” Dr. Beaulieu adds.
This is due to the fact that, according to the MSSS, newborn care must be carried out in the mother’s room. If, however, the baby needs to be transferred to the neonatal unit for special care, only one parent at a time can visit and they must wear a mask. Parents infected with COVID-19 or suspected to be cannot visit their baby, except for humanitarian reasons.
Are certain measures in place to minimize the risk of pregnant women and babies becoming contaminated when they visit a hospital or a clinic?
“We do everything we can to separate healthy patients and their babies from patients that are at risk,” Dr. Ouellet explains. “We have, for example, separate rooms and equipment. The same is true in our clinics. There is also a separate entrance for pregnant women and mothers with their newborns. That way they do not have to come into contact with walk-in patients or those who might have some symptoms.”
“All patients are triaged before they arrive at the clinic for their appointment,” Dr. Beaulieu adds. “This allows us to put patients with symptoms in one zone and those without in another. We can also plan for specific periods where we see people with symptoms.”
Stress and Pregnancy
Being pregnant can, even under normal circumstances, be a source of stress and anxiety for certain women. With the current COVID-19 situation, this stress can increase considerably. Here are a few pieces of advice to get through this difficult period: COVID-19: managing your stress level while you are pregnant
Sources : MSSS, Association québécoise des accompagnantes à la naissance, MSSS, Regroupement Les sages-femmes du Québec, CIUSSS du Centre-Ouest-de-l’Île-de-Montréal
Kathleen Couillard – Naître et grandir