Many women in our community are worried about how their maternity care will be affected by practices put in place when giving birth during Covid-19.
These protocols and procedures are due to hospitals and medical centres preparing for potentially large numbers of infected patients. Fortunately cases of Covid-19 have remained manageable in Australia.
For the pregnant, birthing and postnatal women in our community, Covid-19 has thrown them a curve ball. Even a straightforward and healthy pregnancy and birth comes with some apprehension. Now, women are concerned about how the new protocols and procedures will affect them and their connection within the health system.
So what does maternity care and birth during Covid-19 look like?
We asked Dr Danielle Wilkins, obstetrician and Director of Maternity Services at Cabrini Health, to give us an insight into what it is like for the women in her care during this pandemic.
Dr Wilkins answers all of our questions with an open and honest frankness relaying the message that pregnancy, birthing and the postnatal period can still be a beautiful and calm experience amidst Covid-19.
For women who are concerned about how their maternity care and birth during Covid-19 will look, this information can be a starting point to research options and make an informed decision about maternity care providers.
How are you coping during Covid-19?
What a roller coaster this year has been! The highs are seeing how optimistic, adaptable and focused pregnant women are when their lives are turned upside down.
The challenges are working with those who are finding these changes overwhelming and the lows are not knowing what is around the corner.
What’s it like for you as a doctor in the current situation?
This is such an emotional time. I found myself, like so many Australians, watching the international news in abject horror, unable to look away as my colleagues around the world try to fight this virus without protection, without rest and without success. I was losing sleep thinking about them day after day and night after night. So I had to listen to the same advice I have been handing out and I had to stop watching.
What’s it like for your prenatal clients in this time?
I have approximately 90 women who I am actively caring for at the moment. Since the restrictions in Australia started I have been keeping in touch with them much more closely than usual via a fortnightly email update. Through this I have kept them abreast of all the work that Cabrini has done to keep them safe and to keep them informed, negating any surprises.
I have introduced telehealth into Obstetrics which previously we thought would be of little or no benefit, and this has been pleasantly well received by those that have chosen to use it. I have encouraged all of my clients to make the informed choice themselves and to use the telehealth system as the safest option but if they prefer they can still come in for a face to face appointment.
I believe that providing them with relevant local information and also giving them options is helping them to navigate the situation.
What is the experience of women giving birth during Covid-19?
Fortunately we have yet to have a Covid-19 positive pregnancy in Victoria, nor have we had a positive partner or support person. Our women are able to have their one support person with them throughout their labour and their postnatal stay.
We are continuing to provide them with one-on-one midwifery support. The big changes have been for those women planning to have more than one support person with them, and for some women this was a very sudden change. But women are resilient!
We have received feedback about how comfortable it was just having the 4 people present for the birth. They are reassured they still have all the pain relief options available as needed.
Many of my clients were emotional about the postnatal stay, when relatives and friends would normally come to the hospital to meet the newborn. What has been striking is how rested the mums are, how connected they become with their midwife who has less juggling to do around visitors and how much easier they are finding it to breastfeed on demand.
What are the procedures in place for Covid-19 positive cases?
We have a statewide guideline for any Covid-19 positive pregnancy cases which we have adapted for Cabrini.
We have modified our largest room in the birth suite to accommodate anyone who is positive or suspected to be positive during labour and we have a guideline for partners and support people as well. These guidelines ensure the full support of the couple as well as the safety of all of our staff.
The trickier situation is the symptomatic Covid-19 positive partner or support person – this person will not be able to enter the hospital if they are symptomatic. This is a huge incentive for self isolation close to term.
Would the new mother stay together with her baby to breastfeed?
There was a wonderful success story out of Brisbane last week relating to this. The couple would need to wear gloves and a surgical mask when handling their newborn whilst they were considered to be infectious, but as long as they are well their baby will stay with them and they will be assisted with breastfeeding and encouraged to do so if that is their desire. We will encourage these families to return home as soon as it is safe to do so and provide them with telephone support once home.
What could a birthing woman expect during her time in hospital?
Women can expect one-on-one midwifery care, a large room to mobilise with an ensuite with shower. They will not be able to use nitrous and air for pain relief as it may increase the viral load in the room and put other staff at an increased risk.
The staff who provide their care will all be wearing full PPE (personal protection equipment). Whenever the woman and her support person move through a public part of the hospital they will be escorted by staff, will be required to wear a surgical mask, and asked not to touch anything along the journey.
We will discuss their wishes for pain relief and explain that there may be benefits to an epidural if they are considering one. This is because all procedures will take a little more time to be performed as safely as possible, and in the event of any emergency in obstetrics we like to be as prepared as possible.
A paediatrician will be present at the birth, as overseas data has suggested that the babies to Covid-19 positive women sometimes need some initial support to transition from inside to outside the uterus. This is only for a brief period in the vast majority of cases.
What is giving birth during Covid-19 like for women who are healthy and well?
Unchanged! We are wearing a little more PPE for births but that is not affecting our communication or support for women, nor our ability to provide one-on-one midwifery care. You can expect us to be wearing a clear visor, a surgical mask and a gown during the pushing stage of labour.
What are the main challenges women face with these new protocols? How are you finding their adaptation?
Women are finding their strengths, they are finding their way. Those that had different plans for support through their birth are spending prenatal time telehealthing with their support team and working together to develop strategies and plans for the different stages of labour and birth.
There is so much support for them already online and I have included a lot of this information in my newsletters to help support them. I am constantly impressed but not surprised by their determination and ability to adapt.
What is it like for women after they give birth during Covid-19?
This is a challenging time for first-time mums who are very nervous about not having the support of maternal and child health nurses, mother’s groups and in many cases their parents and families.
I am encouraging them prior to their labour and birth to make plans for accessing support, to be prepared and to know they can continue to link in via the phone and via telehealth. We may soon see an easing in restrictions which will put our first-time mums at ease I think.
Your final thoughts on what you believe it is important for people to know…?
Keep doing the right thing. Read what is relevant and don’t get overwhelmed by what isn’t. It is really important to remember that we are all in this together and we are all getting through it together because we are doing what is best. And remember to look up.
About Dr Danielle Wilkins
Dr Danielle is an obstetrician and the Director of Maternity Services at Cabrini Health. Her practice rooms are located at Cabrini Mother and Baby Centre. She offers individualised care to the twelve women she sees each month through her boutique obstetric practice.
Danielle graduated with honours from Monash University, trained at Monash Health and gained twelve months of obstetrics and gynaecology experience working in a busy unit in Ireland.
She spent nine years as the Director of Women’s Health training at Monash Medical Centre, and six years as the Discipline Coordinator for Women’s Health for Monash University. She was the Head of the Multiple Pregnancy Unit at Monash Health before moving to her current role at Cabrini.
Danielle has extensive experience caring for twin pregnancies and supporting women wishing to have a normal birth after a caesarean birth.
Dr Danielle Wilkins can be found at Cabrini Mother and Baby Centre, Cabrini Hospital Malvern, Level 2, 183 Wattletree Rd, Malvern