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Expectant mothers alone, anxious amid COVID19 support partner restrictions

Clara Legault lays on a hospital bed in Jewish General Hospital after giving birth to her daughter Violet during the COVID-19 pandemic on Apr. 24, 2020. (Photo courtesy of Clara Legault)

Clara Legault lays on a hospital bed in Jewish General Hospital after giving birth to her daughter Violet during the COVID-19 pandemic on Apr. 24, 2020. (Photo courtesy of Clara Legault)

Expectant mothers across Canada are feeling increased anxiety and isolation in their pregnancy and childbirth during the COVID-19 pandemic. The necessity for emotional support at these stages comes at a head with the critical need to protect not only the mother and child, but everyone else, from the COVID-19 virus.

Clara Legault is one of many women who have had to face these competing demands during their pregnancy.

The first change that Legault had to adapt to was in mid-March, when she was told her husband couldn’t join her during any pre-birth appointments.

Legault had planned to give birth at the Cotes-des-Neiges Birthing Centre in Montreal, Quebec, which is also affiliated with the Jewish General Hospital. She was cared for by midwives at the centre who facilitate natural births and give primary care throughout pregnancy.

At that time, she was 36 weeks pregnant. Under normal circumstances at that stage, one appointment per week is necessary to monitor the growth of the baby.

Her appointments were halved as she was deemed low risk, but she was anxious about measuring smaller than average for her stage. Legault worried that she might miss key information given to her during these appointments without her husband present as a second ear.

“Having that kind of partnership that you can share the vulnerability with the entire time, to me, was quite important,” she said.

Legault didn’t experience nervousness about the contagion itself. Rather, she was most concerned that Jewish General Hospital had started barring support partners from their delivery rooms, due to a previous incident with a COVID-19-positive support partner. The health ministry had left the decision up to each hospital respectively on whether they would allow partners during childbirth.

If a woman giving birth at the birthing centre requires an epidural or a specific procedure, they have to be transferred to a hospital. That’s why the new restriction meant an added pressure for Legault to stick to a natural birth plan or else her husband would have to miss the birth of his child.

The Quebec Midwives Association took a stance against the hospital’s decision in a press release on Apr. 5, 2020. They said they saw increased interest in home births, which can pose a risk to a healthy childbirth and a strain on ambulance services. They also pointed to the World Health Organization’s directive that even COVID-19-positive patients giving birth have a right to a support partner.

The Society of Obstetricians and Gynecologists of Canada also reflected this stance in a joint statement on Apr. 24, saying that a support partner is an “essential participant in the birth.”

In Ontario, hospitals are allowing one support partner in the delivery room, with the exception of C-Section procedures. The demand for home and natural birth options has increased regardless due to general concerns about hospital births during the pandemic.

Jessica Riley is a midwife working out of the Thames Valley Midwives clinic in London, Ontario. She says she’s seen an uptick in questions about home births since the pandemic began.

With more women feeling limited in their options, Riley worries about those who may not be able to make informed choices about their birth plans. She says a keystone of midwifery is providing options to women who can make personalized choices about where and how they will give birth.

“I think a lot of people don't know that it's their health, it's their body,” Riley said. “They have the right to refuse or decline anything as long as they understand their benefits and risks.”

Luckily, Legault’s birthing centre had made an agreement with another hospital which allowed one support partner in a delivery room at a time, so emergency cases could be transferred there. Jewish General Hospital had also reversed their policy against having support partners in the delivery room on Apr. 22, two days before Legault went into labour.

It was only a short relief from Legault’s anxiety about her birth plan, because the following week she was told that her midwives were being reassigned to long-term care facilities in need of COVID-19 support.

Legault was upset because she’d chosen her birthing centre to be able to build a bond with her healthcare professionals before giving birth. The months she’d spent connecting with her midwives could not be done again in a matter of weeks or less.

Legault had never met the midwife who was on-call when she went into labour. She didn’t feel comfortable with her. She said by then it had felt like a rollercoaster of changes and disappointments.

Legault decided on using an epidural, so she had to be moved to Jewish General Hospital.

“At some point I said to myself, what's the point of putting myself through this pain when it's not even the right atmosphere,” she said. “I'm not having a beautiful birth.”

As a midwife, Jessica Riley believes what goes on in a mother’s mind and the level of comfort between a mother and her midwife is just as important as the physical requirements of birth.

She has seen more women lately who experience complications during their home birth who have to transfer to a hospital. She says they become anxious about how they’ll make it through the experience and become scared they might be exposed to COVID-19.

“I think they have almost like a mental block that they can't fully let their mind rest and let their body do what it needs to do to go into labor,” Riley said.

According to Sharron S. Humenick and Olivia S. Howell in the Journal of Perinatal Education, there is an undeniable body of research suggesting that social support in the prenatal stage helps create positive birth experiences. Meanwhile, stress is said to contribute to negative birth experiences. They also say that ensuring social support should not be viewed as separate to maternity care.

The doctors informed Legault that she needed a C-Section after she had been in labour for about 40 hours. A C-Section is a surgery during which most women are awake but have regional anaesthesia for the procedure. They also come with more risks than traditional vaginal births.

Legault’s husband was not allowed in the delivery room at first, but the doctor on duty that day had made an exception for the couple. For women across the country who aren’t able to have their partner in their delivery room, they go without emotional support during their C-Section.

Post-partum visits to the mother and child in labour wards are also restricted to reduce opportunities to contract COVID-19. Legault had remained on her own for a day and a half after her birth.

Riley agrees it’s a difficult situation to be in, but for midwives and all medical professionals, safety has to take priority.

“We need to protect not only the person who's laboring and their partner and their baby, but also the other clients and our whole community,” she said.

While practices protecting the community’s safety are crucial at this time, experiences shared by pregnant and laboring persons during the COVID-19 pandemic challenge us to consider how emotional support and well-being might be linked to safety.

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