'We'll have to FaceTime our parents': COVID-19 changes delivery plans for women about to give birth
New restrictions limit who can accompany a person in hospital
Juliette Filanowski remembers the birth of her son two years ago and the joy that greeted his arrival in the hospital.
"It was beautiful. Everyone was crying. They were so happy," said Filanowski, who gave birth in Mississauga, Ont., in April 2018.
Shortly after Ace arrived, relatives started pouring into her room to greet him.
"My husband, my mother-in-law, my brother-in-law, my two sisters-in-law and my mom, [they] all couldn't wait to see us."
Filanowski, 40, is pregnant with her second child and due to give birth in June. But she knows a family experience to rival the one she had when her son was born likely won't occur for her daughter.
"We'll have to FaceTime our parents."
Unprecedented times with the COVID-19 pandemic mean rapidly changing scenarios for everyone, including expectant families. Part of the new reality is no extra guests visiting the maternity ward.
Canadian health-care facilities have introduced new restrictions on who can accompany a person in hospital, whether it's for an ultrasound, a general appointment, labour or in the waiting room.
Unity Health, for example, which includes St. Joseph's Health Centre, St. Michael's Hospital and Providence Healthcare in Toronto, will be screening everyone who enters the main doors and restricting the number of visitors to one per patient until further notice.
The only exception is for patients who require end-of-life care. They will be allowed to have more than one visitor at a time. Similar rules are in place at B.C. Women's Hospital.
The changes at many hospitals apply to women delivering babies, too.
"We've limited it to one support person in the labour and delivery room," said Dr. Jon Barrett, chief of maternal fetal medicine at Sunnybrook Health Sciences Centre in Toronto.
Hospitals, he said, are doing their best to accommodate calls for social distancing.
"It can now have a significant impact on their childbirth experience, which is a shame really, because it's a once-in-a-lifetime thing really, and you may want your family around and now you can't have it. It's a pity."
But, he said, it's a necessary step to contain the spread of the coronavirus.
Birth plans will need revising
The new rules also present a challenge for people whose birth plans involved more support, for example a doula.
"The labouring person would have to choose who they want as their support person that's outside of their health-care team," said Elizabeth Brandeis, president of the Association of Ontario Midwives. "That could be a partner or a parent or a doula, but not all three."
Brandeis said that during the SARS epidemic, similar rules were in place, but since then, hospitals have been more flexible about who can be in the room in addition to the medical team.
"The main thing now," she said, is that "they don't want people gathering in waiting areas or just filling the hospital space any more than is necessary."
Rules can vary among facilities. At B.C. Women's Hospital & Health Centre in Vancouver, doulas are considered part of the care team and not visitors. The hospital says expectant mothers are currently allowed to have a doula in the delivery room as well as a partner or support person.
Filanowski said she hadn't heard anything about the changes until she read a Facebook post detailing someone's experience. She decided choosing between her husband and doula is simply not an option.
"Every day that I watch the news, it's more likely going to be a home birth. My husband is just worried if something happens, we live five minutes from the hospital. If something goes wrong we would go there directly."
Brandeis said during SARS, they did see an increase in demand for home births, and she is anticipating a similar trend now.
"[Coronavirus] is on every expectant family's mind right now."
Prenatal, birthing classes move online
Also on the mind of many expectant families is the safety of the hospitals where they're delivering.
Despite new mandatory screening for those entering hospitals, online forums for expectant mothers are full of discussions about whether they feel comfortable giving birth in hospitals potentially inundated with COVID-19 patients.
But it's not just delivery — preparation for the big day has changed, too.
Some Canadian hospitals such as Sunnybrook and Royal Columbian Hospital in New Westminster, B.C., have cancelled tours for expecting parents. Each hospital's rules could be different, and pregnant women should inquire about changes.
Barret said some appointments may even be moved online.
"Standard, routine prenatal visits are going to be affected but the key points of ultrasounds, for example the first trimester screen, screening for abnormalities or the anatomy screening — we're not going to change that."
Douglas College in New Westminster, B.C., and pregnancy preparation businesses such as Toronto Yoga Mamas have temporarily put their prenatal classes and birthing courses all online, too. Some midwife clinics, such as Community Midwives of Toronto, now ask pregnant women to show up alone to their appointments.
Virus effect on pregnancy not well known
All of these changes have happened quickly, but what has been slower to surface is any potential impact of COVID-19 on pregnancy. There is still little data available on pregnant women and the coronavirus.
To keep our patients, families and staff safe due to <a href="https://twitter.com/hashtag/COVID19?src=hash&ref_src=twsrc%5Etfw">#COVID19</a>, we are limiting the number of visitors entering our buildings. For details on visitor restrictions: <a href="https://t.co/s7HC49FJ5K">https://t.co/s7HC49FJ5K</a>—@BCWomensHosp
An investigation involving 147 pregnant women by the World Health Organization's China joint mission on coronavirus found "pregnant women do not appear to be at higher risk of severe disease."
Still, some health authorities are recommending women at certain stages of pregnancy get tested. Vancouver Coastal Health, for example has recently added women in their third trimester who exhibit COVID-19 symptoms to the list of people who should be tested for the virus.
Research on the virus and its impact on all demographics is still in the very early stages. Based on what is known so far, the Society of Obstetricians and Gynaecologists of Canada says "due to physiological changes that occur in pregnancy, when compared with their non-pregnant counterparts, pregnant women with lower respiratory tract infections often experience worse outcomes."
But Barrett said at this stage, what we think we know about the coronavirus could change quickly.
"There's new evidence coming in all the time," said Barrett, "so anything I say is based on the latest evidence."
That, he said, also applies to the question of whether a mother could pass the virus onto her fetus if she's infected.
"Not yet is there evidence [of that] — but this could be different tomorrow. As we continue to get new information, I wouldn't be surprised if it does come up simply because it's a virus and many viruses can cross the placenta."
So far, in young people and children, the virus appears to not be as severe.
Some fear hoarding of formula
Some expectant mothers have additional concerns flowing from the coronavirus pandemic.
Samantha Mireanu, whose second child is due in April, said the social implications surrounding fear of the virus are troubling.
"The other day I saw a post on social media of someone in Markham (Ont.) hoarding baby formula, and as someone who's going to be delivering in the next few weeks, and I'm not sure what my breastfeeding situation will be, it's concerning to think formula or essentials for a baby could be unavailable," said Mireanu, who lives in Richmond Hill, Ont., north of Toronto.
Public officials have assured Canadians that there is no need to panic buy or hoard products, and there's no current risk to essential supplies.
Mireanu also has gestational diabetes, and panic buying at grocery stores and recommendations to stay home have left her in a tough spot.
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"I have to be more careful with my food choices, and with grocery stores being affected the way they are, I have to really think through things a lot more, what am I going to eat, how am I going to get it."
It's unknown how long new restrictions in hospitals and clinics could continue. While there is some consistency across the country, all directives at health-care clinics are also based on each facility's resources, so patients are advised to check in advance.