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Pregnancy in the time of coronavirus

Pregnancy in the time of coronavirus

Pregnant women struggle so much already with isolation and loss of control over their birth plans — coronavirus has brought even more challenges.

I found out I was pregnant the day of our friends’ wedding. That morning, before getting ready to leave for the ceremony, I saw the blue plus sign looking back at me from the drug store test my husband and I had bought the day before.

This would be the first wedding I attended and didn’t drink, requesting the non-alcoholic rose to toast the bride and groom. I’d been feeling extra tired for the couple weeks leading up to the wedding, so we called it an early night just as everyone started busting out their moves on the dance floor.

My husband had started his first job out of grad school less than two months prior, and we had immediately started trying to have our first child. For the first time in several years, our lives seemed to be on the up and up — my husband had only his thesis to complete and would have his degree in hand by summertime, we were now a dual income couple, and we were going to be new parents in less than a year.

The early weeks of the pregnancy were exciting — filled with experiences and memories I’ll never forget. We found a midwife to deliver our baby, went to our first trimester ultrasound, heard her heartbeat for the first time, and shared the news with our families.

Not long afterwards, the trajectory of my pregnancy would change, as the coronavirus pandemic erupted around the world, and I lost control of my ability to navigate my pregnancy on my own terms.

In early March, we started receiving notices at work that anyone feeling unwell should not come in, and that any staff returning from travel should work from home for 14 days before coming back to the office. Less than two weeks later, we received a full work-from-home order, triggering the feelings of isolation I would experience as my pregnancy progressed.

Working from home wasn’t hard at first, and in fact I enjoyed being able to sleep in that extra hour instead of riding the bus into work. Being able to fit in smaller chores throughout the day was also a plus. But during the first couple of weeks working from home, changes to my prenatal plan were beginning to manifest.

My husband and I had signed up for group classes through our midwife, where we would have the opportunity to connect with other couples expecting around the same time we were. I had looked forward to meeting with other new moms and sharing our pregnancy journeys together, especially as this is my first pregnancy and I do not know many other new parents for in-person support. These group classes were cancelled immediately following our first session due to the social distancing measures adopted by our midwife, which aimed to prevent the potential spread of the coronavirus amongst patients, their families, and the staff at the midwife practice.

This same week, we were informed that many of our upcoming appointments with our midwife would be conducted virtually, rather than in-person, based on guidelines from the World Health Organization. Our in-person appointments would now only occur based on the 12, 20, 26, 30, 34, 36, 38, and 40 week algorithm. Additionally, in-person visits were now limited to patients only, meaning my husband could not attend these appointments with me.

Fortunately, I am in my second trimester, but for women in the earlier weeks of their pregnancies, this means they would now have no in-person appointments during their first trimester. At a time when the risk of miscarriage is at its highest, and many women are beginning to experience physical symptoms very strongly — nausea, throwing up, food aversions, fatigue, insomnia, and spotting concerns, among many others — not having face time with one’s midwife or doctor hinders many women from putting their minds at ease during this vulnerable period, and inhibits the early formation of a bond of trust between expecting mothers and their caregivers.

With many of our appointments now to take place via Telehealth instead of physical checkups, my midwife recommended I purchase a home blood pressure monitor. I spent the $60 so I could test my own blood pressure ahead of our next appointment.

The following week, the ultrasound clinic called regarding our scheduled 20-week anatomy scan. Our appointment had been scheduled for that coming Saturday, but because of the coronavirus, they were cancelling all weekend and evening appointments, so ours was rescheduled for the next Monday morning. The week prior, my workplace had scaled back everyone’s hours to four days a week instead of five, and my department had to stagger the days everyone worked to ensure adequate coverage. I was unable to move my new ultrasound appointment around my updated work schedule, which meant that I had to further reduce my work hours that week to attend my 20-week scan.

As with the in-person appointments with our midwife, my husband was not permitted to attend the ultrasound. We had planned to find out the sex of our baby during the 20-week scan, and were looking forward to the ultrasound as a positive event to share together — especially after weeks of self-isolating, seemingly non-stop news coverage of coronavirus death rates, PPE shortages, overworked healthcare workers, and endlessly worrying about being laid off like the millions of other workers across the country. To then be deprived of the ability to learn we were having a daughter while watching her heartbeat and movements on the ultrasound monitor together was soul-crushing. I broke down crying while making lunch that day.

Now over halfway through my pregnancy, I’ve spent the last two months essentially only seeing my husband due to self-isolation and social distancing. My bump is now very noticeable; we have updated ultrasound photos we want to share with our families, friends, and coworkers; and I crave visiting and bonding with female family members as I mentally prepare myself for labour, finalize plans for my daughter’s arrival, and see my four-month-old niece, who I’d only been able to see a handful of times before this all unfolded. With both our families living in the same city, I never would have anticipated feeling so detached and withdrawn from loved ones during the happiest journey of my life. Facetime is no replacement for the face-to-face connections I would otherwise be relying on as a first-time mom.

The measures being adopted to combat the coronavirus spread have also put a halt on preparations for when our daughter arrives. Whereas most soon-to-be parents typically begin shopping for the essentials following their 20-week ultrasound, the stores we were planning on going to for testing out strollers, car seats, etc. are not open for in-store shopping, meaning we’ll either have to hold off indeterminately until they re-open, or potentially risk exposure to the virus, buying items secondhand on Craigslist or Facebook marketplace.

The new moms I know have all told me how lonely and isolated they felt in the early weeks of their postpartum, as they navigated being sleep deprived while establishing a routine with their new infants alongside recovering from giving birth. So I’ve been preparing myself for this postpartum period and planning ways of reducing these potential feelings of isolation and loneliness as much as possible. However, I hadn’t been prepared for how alone I would feel while still being pregnant, and for the loss of control I’ve experienced.

I’ve found myself curious about the impacts of coronavirus on the birth plans of other pregnant women, since hospitals are taking measures that are both limiting and restricting the choices women are able to make during their deliveries. Royal Columbian Hospital in New Westminster, the hospital nearest to me, and where my midwife has privileges, currently only permits one support person (in addition to the midwife) from the same household to accompany a woman during delivery, which means a woman who had previously planned to have her partner as well as another family member, or her partner and a close friend supporting her during her delivery now has to change her birth strategy to only include her partner or another person that she lives with.

As a result, the number of pregnant women seeking to have home births has increased, perhaps even doubling, according to the Midwives Association of B.C. Alix Bacon, a midwife who works out of Terra Nova Midwifery and president of the Midwives Association of B.C., told Richmond News, “People are concerned about who they can bring to support them in hospital when they give birth,” which has played a large role in prompting women to inquire about home births. I also share this concern, as I had planned to have both my husband and my sister supporting me during my delivery, particularly since this is my first pregnancy and I would find a lot of comfort in being supported by them both during the process.

The labour and delivery choices of women are also presently being restricted and challenged. The Almonte General Hospital in Ottawa, for example, is requiring labouring mothers to receive epidurals “in case they have to have an emergency Caesarean section.” In a statement, the hospital noted:

“If a patient does not want to have an epidural, she has a choice. There is an option to deliver at another facility where midwives also have privileges.”

But if a woman’s choice to have an unmedicated birth is only accommodated by requiring them to deliver their baby at another hospital, is it really a choice?

The impact of epidurals on the labour and delivery experience ranges from the lowering of the mother’s blood pressure, headaches after delivery, difficulty urinating or walking after delivery, fever, and even seizures in rare cases. Because epidurals create a numbing effect to the spinal nerves of the lower back region, they can decrease a labouring mother’s ability to effectively push, which can lead to additional interventions being required to deliver her baby (for example, forceps and vacuum assistance). The decision of whether or not to include an epidural as part of one’s birth experience should be up to the labouring mother, after receiving full communication regarding the pros and cons, enabling her to exercise informed consent should she choose to accept an epidural. If a hospital insists that labouring mothers receive epidurals in order to be granted care, women may feel pressured to accept the intervention without being fully aware of the accompanying side effects of the anesthesia on their delivery and postpartum experience, and thereby not be able to fully exercise informed consent.

In a later statement following a meeting between the hospital and Ottawa Valley Midwives, it was noted that “[the communication regarding epidurals] was a request and not a requirement or policy and that ‘all women who wish to deliver at Almonte General Hospital can do so.’” This sort of mixed messaging, inconsistency, and unsympathetic language does not help instill women with the confidence and assurance they need as they approach their delivery dates, particularly for women who are planning on unmedicated births, and could cause additional unnecessary anxiety and fear surrounding their upcoming birth experiences. Planning an unmedicated birth for myself, I would no longer feel comfortable delivering at Almonte General Hospital if I had previously planned to do so, as I would worry my birth preferences would be unnecessarily challenged and that staff would attempt to persuade me to accept interventions I did want.

In Nova Scotia, a suspension has been issued on home births during the COVID-19 period, in the provincial government’s attempt at slowing community spread of the virus and to protect healthcare workers. This decision will directly hinder many women from following through with their birth plans, particularly since requests for home births have increased as a result of coronavirus. The suspension on home births also places midwives in a challenging position, as they will not be able to attend to home births without directly subverting the directive set forth by the provincial government.

Pregnancy is already a vulnerable period for women, accompanied by a multitude of physical, mental, and emotional challenges. The consequences of measures adopted in response to COVID-19 have compounded that stress and sense of isolation, and has also resulted in a loss of personal autonomy in terms of prenatal care and women’s delivery experiences. While efforts to prevent the spread of COVID-19 are necessary to protect pregnant women, their babies, and healthcare workers, consideration of the full ramifications these measures have on pregnant women has not been addressed, particularly with respect to the potential longer term physical and mental health consequences.

Further, because every pregnancy progresses differently and every pregnant women has her own birth preferences, concerns, support system (or lack thereof), and support requests — as well as varying physical and emotional needs — a cookie cutter approach to pregnancy in response to COVID-19 neglects how personal the experience of pregnancy and giving birth is, leading to a reduced level of primary care and a decreased ability to navigate pregnancy on one’s own terms.

When I sought out the prenatal care of a midwife back in January rather than sticking with my family doctor, I did so out of desire to receive a more open-ended and personal approach to my primary care, which I’d hoped to carry into the labour and delivery journey of my daughter. Now nearing my third trimester, and after facing so many restrictions and potential infringements on my birth choices during COVID-19, I am now contemplating home birth as a way of being able to experience birth based on my own preferences and reassert a level of control I feel I have lost throughout this pregnancy.

Tara Nykyforiak is a freelance writer, editor, and occasional poet. She is the author of the children’s book Canadian Air and Flight Technology. Her writing has been published by Quillette.

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