Covid

chilliwack midwife
Photo: Tracy Armstrong

Up to date information on COVID-19 and your pregnancy

NOTHING IS MORE IMPORTANT THAN THE SAFETY OF ALL OUR PATIENTS –
PLEASE HELP US TO ACHIEVE A ZERO TRANSMISSION RATE IN OUR COMMUNITY

We deeply care about your health, the health of your baby, and our own, and as such we are doing the best we can to provide the safest care for you as possible! As ⁠Covid-19 information continues to change hour to hour, we are trying to keep you updated on what is happening at our clinic, and provide a synopsis of trustworthy information.

On our end, both professionally and personally, we are staying home as much as possible and socially/physically distancing ourselves and frequently sanitize anything and everything we come into contact with. At work, surfaces and equipment are being cleaned between every visit. We will not be offering beverages at appointments and magazines and children’s toys have been removed. During your clinic/home visits- we will  be dressed in personal protective equipment to maintain safety. On your end, we respectfully ask you to: ⁠

⁠1) Minimize who you come into contact with and place a distance of 6 feet between you and others.
2) DO NOT come into the clinic with any symptoms of being sick. ⁠
3) Please do not bring family along to appointments including children. ⁠
4) Wash your hands before and after your clinic appointment. ⁠
5) DO NOT come early to your appointment. Remain in your vehicle until your scheduled appointment time. ⁠
6) Please take every health precaution recommended- wash hands frequently, disinfect touch surfaces throughout the day. Carry disinfectant in your car to sanitize your door handles, steering wheels etc after being out in public.
7) Stay away from social gathering places.

**As our health care system becomes overwhelmed with COVID-19 positive cases and the number of our valued health care workers begin to decline we will be called upon to help out other midwifery clinics and our physician colleagues in Fraser Valley. We ask you to PLEASE do everything possible to stay healthy, in order to not only reduce your chances of getting sick but to protect us and our colleagues from getting sick as well. This commitment will help you have a safe and healthy pregnancy and birth, with us as your midwives!.

UPDATES ABOUT APPOINTMENTS

At this time, the Refinery House is open, so the clinic is now busier, though still meeting the requirements for social distancing.

Appointments will be a mixture of virtual appointment, and in person appointments. Currently appointments remain between 15 and 30 minutes in length. If COVID numbers continue to go up significantly, in person appointments may return to being on the phone for the majority of your visit, with an in-person assessment to listen and measure the baby, and take your blood pressure at the end of your visit.

During in-person check ups, we will be wearing personal protective gear including masks, and goggles. This is for your protection to reduce rate of transmission from being in close contact with us. You are also requested to wear a mask for the protection of both of us.

Our new online video network provider is called Doxy.me. You will receive an email or phone call with details on how to use it. It is very simple to use and only requires you to sign in and wait for us to invite you into your virtual appointment. Please sign into the system 5 minutes before your appointment time.

The CMBC (the College of Midwives of BC) has now provided guidance for the schedule of visits. It is as follows:

Visit #1 – up to 12 wks (virtual visit)
Visit #2 – 14 weeks (in person)
Visit #3 – 20 wks (virtual visit)
Visit #4 – 26 wks (in person)
Visit #5 – 30 wks (virtual)                                                                                                                                              Visit # 6- 32 weeks (in person)                                                                                                                                        Visit #7 – 34 wks (virtual )
Visit #8 – 36 wks (in person)
Visit #9 – 38 wks (in person)
Visit #10 – 40 wks (in person)
41 week visit if needed

Clients do have the option of not coming in for physical assessments until 36 weeks. Please be aware that if you chose to be seen virtually until 36 weeks, we are unable to assess the growth of your baby which may impact the management of your pregnancy.  

Please note that we will not be  paps as these are not a critical part of care.

Please note that partners and children are not permitted to attend appointments. Partners are however more than welcome to call in during the appointments. 

For postpartum care: 

Our hospital or clinic visits will be held at approximately:

Visit #1 & #2 – in Week 1 (in person at home)
Visit #3 – in Week 2 ( in person)
Visit #4 – Week 4 (virtual)
Visit #5 – Week 6 (in person)

If more visits are needed for weight assessment, a scale will be provided for you to weigh your baby. 

This can be adjusted if more care is needed by you and your new baby.

Many of you have been asking if you should be doing your blood work and going for ultrasounds. We are recommending people to proceed as normal with blood work and ultrasounds. Blood work and ultrasounds give us the information to guide your care and help to ensure the health of you and your growing baby are maintained.

IMPACT OF COVID ON PREGNANCY/BIRTH AND VACCINATION

Vaccination does not provide 100% protection, nothing will, but it is our best tool at this time.
– There is no evidence of harm to fertility.
– Research thus far is showing it to be safe in pregnancy and while breastfeeding.
– Vaccination provides protection against severe disease (ie. ICU admission and ventilation) and death.
Covid infection in third trimester of pregnancy has been associated with increased risk of:
– Placental complications
– Low birth weight infants
– Fetal distress in labour
– Preterm delivery
– Maternal ICU admission
– Maternal invasive ventilation
As well as the risk with any Covid infection of developping “Long Covid”, a series of ongoing respiratory, cardiac and neurological complications, the duration of which is uncertain.
Is there a small possibility that we will discover an unintended long-term consequence with this vaccine? Yes, that is possible but less likely than all of the above mentioned complications, if one is not vaccinated.
Long-term population wide data is not fully available, yet. I had a wise midwifery professor who used to say that where research is lacking or you have less research than you would like, such as those who are uncomfortable with the lack of long-term population-wide use, you should examine the physiology in order to determine the likelihood of benefit/harm from a given intervention. The science on which the mRNA vaccines is based dates back 2-3 decades and there is no physiological reason to believe it will do anything other than what is intended.
With the Delta variant being more transmissible, our masks, hand-washing and physical distancing will be less effective as we move forward. It also seems likely that children will be more likely to be adversely affected with the Delta variant.
I respect everyone’s right to an Informed Choice about their health care decisions. For me, Informed Choice should not be an individualistic pursuit of “the best choice for me” so much as a complex weighing of risks and benefits individually and as a collective. May we all care for one another and include each other in our decisions as we move forward. May we access loving-kindness. May we recognize our place in the human collective.
HELPFUL ARTICLES:
A scientific article:
A news article describing why the Delta variant is of concern:

 

If you are confirmed as having COVID-19:

Home care and quarantining yourself is appropriate if your symptoms do not require a higher level of care.
You will be required to quarantine for 10 days. During this time, your appointment (if you had one scheduled during that time, will be virtual).
Once out of quarantine, the Society of Obstetrics and Gynecologists recommends monthly ultrasounds to assess growth and well-being of baby.

Labour
Anesthetists (expert doctors who place epidurals, etc) are encouraging early epidural for labour pain relief in order to reduce the risk of giving a general anesthetic (GA) for an emergency cesarean section. GA allows for the highest risk of transmission of the virus. Of course, the decision to have an epidural, or not, rests with the labouring person.                                                                                                                     Nitrous Oxide is NOW permitted for pain relief in labour.

If you are confirmed as having COVID-19:
You will be required to deliver at the hospital.
It will be recommended that you are placed on electronic-fetal monitoring or EFM.
Early epidurals will be recommended.

Visitor/support person update:

Siblings of newborns and a maximum of 2 visitors are welcomed back to the Maternity floor.
What does this mean?
ONLY siblings and 2 visitors over the age of 12 can visit at one time.
ONLY 2 visitors at a time. If you have more than 2, visitors will need to change out in the lobby of the hospital, NOT within maternity.
**At this time, no vaccine passport is required**
What do I think?
It feels a bit early to expose a newborn to visitors during a 4th wave and although vaccine passports are not required, it is a privilege to visit a new baby!
So please, move forward with caution and do what feels right for you and your family.
A silver lining of not having early hospital visits has shown to improve breastfeeding🤱and recovery rates!
Unfortunately, this does NOT mean partners and siblings are able to come back into Thrive Midwifery’s office space because we have not yet been directed to allow this, and our clinic rooms are much smaller than a hospital setting. Opening our doors too quickly to too many bodies will add additional stress to some of our other clients, and staff.
We miss partners and siblings soooo much and are anxious to bring everyone back as soon as it is really safe to do so. I will be happy to have your partner or chosen support on speaker phone during part or all of your visit. This has shown to be really effective for some clients.

Postpartum

If the new parent is Covid-19 positive, keeping parent and baby together is recommended
New parent is to wear mask and utilize strict hand washing protocol for breastfeeding and skin to skin
Breastfeeding is encouraged because the protective effect of breastfeeding is particularly strong against infectious diseases through directly transferring antibodies and other important immune factors to the baby
Test infant for COVID-19 No isolation of infant from parent unless clinically indicated by disease severity
Where appropriate, early discharge of the baby with a parent or caregiver, should be facilitated

PLACE OF BIRTH

If your pregnancy remains healthy and you’re considered low risk for complications during labour and birth at term (37-41 weeks), you may consider a home birth. For some people this feels like a safer choice. During this pandemic, choosing to stay out of hospital frees up space to treat the influx of patients infected with the CoronaVirus. However- if you are choosing to have a home birth, we will need you to strictly commit to self isolation and proper sanitization, for the month before your due date. For us, coming into a home, possibly infected with a virus will not only put our own health at risk but we can easily transmit the virus to the outside population. In keeping with safety precautions, we will be wearing personal protective gear into your home and while you birth and will discard these items when we leave. We currently have enough PPE to provide home births.

Please be aware that if you have tested positive for Covid-19 at any time in your pregnancy, you are not eligible to give birth at home.

If you have more questions around the place of birth we will be happy to discuss this more in detail during your visits.

VACCINATION AND  RESOURCES

With the vaccine now available, it is normal for families to have lots of questions. You may find the following helpful:

Here is a document that is intended for pregnant and breastfeeding people: 

http://www.bccdc.ca/Health-Info-Site/Documents/COVID-19_vaccine/COVID19_Vaccine_Perinatal.pdf

If you are looking for more research-like articles: 

Here is a statement from the Society Of Obstetrics and Gynecologists: 

https://www.sogc.org/common/Uploaded%20files/Latest%20News/SOGC_Statement_COVID-19_Vaccination_in_Pregnancy.pdf

Here is something from the CDC: 

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html

WORK ABSENCE & EMPLOYMENT INSURANCE

As per instructions from the Minister of Health and the Provincial Medical Officer of Health, you will not need a note to miss work if you have symptoms: https://news.gov.bc.ca/releases/2020HLTH0077-000484

People in quarantine (including those who are not sick and those whose workplace is closed to enforce social distancing), can apply for Employment Insurance Medical Leave. You do not need a medical certificate from your doctor, NP or midwife:
https://www.canada.ca/en/employment-social-development/corporate/notices/coronavirus.html

If you are a pregnant health care worker
https://www.rcog.org.uk/en/news/updated-advice-for-pregnant-healthcare-workers-and-employers-during-coronavirus-outbreak/

COVID-19 – HELPFUL LINKS FOR GROWNUPS

How you can help protect your health care worker
https://www.newyorker.com/news/news-desk/keeping-the-coronavirus-from-infecting-health-care-workers

Anxiety Canada
https://www.anxietycanada.com/articles/what-to-do-if-you-are-anxious-or-worried-about-coronavirus-covid-19/

Calm – Take a deep breath. Train your mind to sleep more, stress less and live better https://www.instagram.com/calm/?hl=en

Talking to your kids about coronavirus and social distancing
https://www.forbes.com/sites/tarahaelle/2020/03/18/talking-to-your-kids-about-coronavirus-and-social-distancing/#45a594d32c15

I visited 18 countries today – how about you?
https://www.messynessychic.com/2020/03/19/i-visited-18-countries-today-how-about-you/?

If you are on FB, here is a link to a very useful article on taking care of your mental health.

Mental Health Tips

RePose Newsletter

20 things to do at home instead of banging your head against a wall
https://www.messynessychic.com/2020/03/12/hobbies-at-home/

COVID-19 – HELPFUL LINKS FOR KIDS

Pluto the Dog’s Message to Kids – we are following Pluto!
https://www.youtube.com/watch?v=eiBYw3bDFro

Cats teach kids how the virus spreads https://twitter.com/ziyatong/status/1240303392188248070

Children Stuck at Home Can Still Explore the Zoo or Aquarium. Some Penguins Could, Too.
https://www.nytimes.com/2020/03/18/us/coronavirus-zoos-webcams.html

If you are on FB, here is a great link on things to do with kids.

With children home for potentially longer than anticipated, you may be wondering what to do with your kids. Here is an AMAZING and LONG list of things you can do.

Please keep checking our IG and FB feeds for the latest updates, as well for local reliable resources to pull information from. We are trying our best to stay on top of the ever changing situation.
Stay healthy and safe, and rest in a place of hope and love, and together we will ensure we get through this challenging time.

With love from your midwife, Carolyn