C-19 Updates in Birth and Postpartum Care in Regina

I’ve been keeping in touch with the good people managing the units at Regina General Hospital. Here are all of the recent updates of RGH Labour/Birth Unit and Mother/Baby Units here in Regina, Saskatchewan due to Covid-19. Please note that any of these may change on short notice due to the coronavirus pandemic.

Some additional tips for navigating your birth journey:

I lead RGH Tours live but online multiple times a month.

Article: How to Set Up your Birth Room (i.e. What Your Doula Would Normally Do!)

Easing Labour Pain: An online 2-hr class offered monthly that teaches partners how to provide hands-on birth-support, comfort, and decrease labour pain.

If anyone’s looking for online prenatal classes please contact me. I teach all the sessions live but online so you can ask questions.

*****

Hospital Update

◆ As of June 12, there are 2 support persons allowed in the BIRTH ROOM. From Saskatchewan Health Authority:

“Effective immediately, expectant mothers and families across Saskatchewan will now be permitted to have two designated family members/support persons present during their birthing experience. Designated family members/support persons are chosen by the mother and family and may include but are not limited to partners, family members, coaches, doulas or cultural support persons.

All maternal patients and their designated family members/support persons will be screened for COVID-19 upon arrival and be required to have a temperature check, wear a mask, participate in hand hygiene and follow physical distancing guidelines. Designated family members/support persons who are symptomatic for COVID-19 or who have other risk factors will not be permitted. The designated family members/support persons must be consistent during the duration of the patient’s stay. They may leave the facility but cannot be switched out for another family member or support person. Only designated family members/support persons will be permitted at this time, other visitors, including siblings, will not be allowed.

All maternal patients will be offered an optional COVID-19 swab upon admission. Family members/support persons will not be offered a COVID-19 swab.”

03A47318

◆ Support people coming in on their own, i.e. not with the labouring patient, can be screened 24/7 at the main RGH doors (14th St entrance). They do not have to go to the ER doors.
◆A 24-hr support person who’s joining a birth or going to MBU for a maternal patient that has already been admitted can enter through the main 14th St doors at any time, 24/7. No need to go through the ER.
◆ A support person entering the hospital with a maternal patient will be screened at whatever door the patient enters.

Please note that while the 14th Ave entrance is open 24/7 with a security guard that can screen and let people in, the registration desk is only open from 6am-6pm. Support people can enter this door 24/7 because they are not patients (don’t need to go through the registration process).
 
If you’re in labour and going to RGH as a patient, then you’ll have to go to an entrance that has an open registration desk. On weekends, holidays and evenings/overnights, that will be the ER.

If you have to step outside and get back in, here’s how:

◆ 14th St main entry has a security person around the clock. If you have your proof of screening and are wearing a band it’s easy to get back in 24/7. If you’ve not been screened yet, I recommend you start at this door. If they are unable to screen you, they will send you through the ER doors instead.
◆ The ER can screen 24/7 but please save the ER capacity for people who need it.
◆ 15th St admitting doors are locked overnight. The doors below MBU at 15th St parking lot are locked 24/7. You can not enter the 15th St side of RGH overnight. If you go out those doors, you’ll have to walk around to the 14th St entry.

If your 2nd support person is not at the birth but is invited to MBU, they will be screened on their way into the hospital. They must be named when you are admitted to LBU so remember to tell your nurse. You must get a coloured bracelet for them. I expect someone has to meet them outside the unit to give them the band that will grant them access to the MBU, but ask your MBU nurse about this.

“If the patient fails screening, she becomes a Person Under Investigation (PUI), therefore the support person now becomes a PUI as they have been in ‘close, prolonged contact with a PUI.’ The support will be sent home, however, the patient may have an alternative support person or people who pass screening. ” That means anyone who has been with the labouring woman for more than 2 hours will not be allowed in if she is suspected of C-19/exposure.

Folks – you need to plan for this. Plan C. New support people who have not been with you for more than 2 hours AND who pass screening will be allowed into isolation. They will be gowned, masked, gloved throughout and will not be allowed to leave the isolation room. Food will be brought in.

◆ Again, it’s up to you to ensure that a 2nd support person has been named so they can enter the unit. Ask your nurse about this.
◆ Supports must be 19 years and older. (No, I’m not sure what happens in the case of teen pregnancy, young doulas and so on. This is just what I was told.)
◆ The health region is not on the same timeline of relaxing restrictions as the SK gov’t. Restrictions are still in place at health care facilities.
◆ You’ll see staff wearing masks throughout your stay.
◆ Bring what you would normally bring for your birth and hospital stay. Support people will be given a wristband so they can go to car later for extras and car-seat. You are still allowed to bring your pillow, clothing etc – whatever you need for comfort.

Doctor

◆ Nitrous-oxide (“laughing”) gas is available for pain management.
◆ If you or baby are at high-risk for birth complications, you may be asked to use an epidural during labour to avoid the need for a general anaesthetic in case of an urgent/stat caesarean. Best to discuss this with your OB ahead of time so you can learn your options and make a plan.
◆ Waterbirth is currently not an option in the hospital. Midwives are not lending pools out for home birth. If you have your own then waterbirth at home is still an option (contact me for info on where to get one).
◆ The installed bath-tub is available for comfort in labour.
◆ Breastfeeding is still being supported at RGH.
◆ There are plans and protocols in place so that mother-baby can stay together if mom is at risk or has symptoms of C-19 in the immediate postpartum.
◆ Even though some community restrictions are being lifted, great care should be taken with newborns once the family is home. Physical distancing and being only with members of the same household are still recommended. Anyone who enters the house can bring in pathogens/bugs.

◆ Paid parking has resumed in the RGH parking lots. You will need cash for the main lot. Also, the 15th street parking is reserved only for people who have appointments or are being admitted to the hospital. Vehicles are being ticketed again on the streets around the hospital so no more free parking that way.

◆ There is nowhere for the second support person to wait as all waiting rooms are closed. The second support person should wait at home or somewhere outside the hospital until the labouring person is officially admitted and moved to a birth room.

◆ Partners/support persons will be provided with a mask at the entry doors. (Bring a big paperclip or string if you want to save sore ears.) Check out these tips for saving your ears from mask-pain.  Everyone must wear masks in the hallways. Labouring people do not have to wear a mask once they’re in their patient rooms in the birth unit and the mother-baby unit.

◆ Food outlets now allow people to sit in.

◆ Galleys are still closed to patients in both units. The nurses will get food for you in the birth unit but not in the mother-baby unit so people have to bring their own snacks. There is no access to the microwaves, kettles, food, water-ice machines. There is no access to the big fridges and freezers, but every room has a small mini-bar fridge.

Birth Room

𝐏𝐫𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞

● Attend appointments, diagnostics (ultrasound, lab) solo. Routine appointments might be done over the phone or spaced out. High-risk and special circumstances will still get the extra care they need.
● Midwifery offices are doing the discussion part of the consult by phone and then a quick in-person appointment for the hands-on part. They prefer pregnant patients attend alone but will allow partners. No other family members/friends/support are allowed.
● Anyone under midwifery or GP care who tests positive for C-19 at any point in their pregnant, birth or postpartum will be immediately transferred to OB care.
● If you’re an early-bird you may be asked to wait in your car until your appointment time.

𝐀𝐧𝐭𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞 (𝐋𝐚𝐛𝐨𝐮𝐫 & 𝐁𝐢𝐫𝐭𝐡)

● Early discharge is being offered as an option for those that are healthy and feel comfortable with newborn care. That means to go home a few hours after your birth instead of staying 24-36 hours.
● Anyone getting a cervidil induction will be monitored and then sent home to wait for labour to start, as per usual, then rescreened at RGH doors and LBU doors upon return.
● Support people are allowed at homebirths but must be screened. If anyone in the home (residents or support people) doesn’t pass screening, then the birth must be transferred to RGH. In that case, the one support person rule applies. Home birthers – screen your people before they come over!

𝐏𝐨𝐬𝐭𝐩𝐚𝐫𝐭𝐮𝐦 𝐂𝐚𝐫𝐞

● Doors that don’t have an admitting desk are locked tight; security will not let anyone in. That includes the convenient door just below the MBU.
● Families are being asked to stay in their room as much as possible.
● Support people may not visit any other patient areas.
● Food trays are being provided for new moms in the MBU.
● Breastfeeding class in the unit is still running but only birth mother and baby attend (no partners) and only up to 3 participants.
● Midwives and public health nurses are still providing postpartum home-visits. Some may be done by phone or video, depending on your needs.

Please contact me if you have any questions about this information or any of my services.

Home Birth Supply List

Prepare Your Home Before 37 weeks:

  1. Midwife & doula contact info entered into cell-phones.
  2. A contact page on your fridge or pinned to a wall, easy to find, in case we have to call for fast help. (Trust me – brain-freeze is a thing!)  Please print, fill out and post this Homebirth Contact Form, or add the extra info to the page your midwives provide and ask you to post.
  3. Other “Important Phone Numbers” list on your fridge.
  4. Some cleared surfaces for equipment set-up.
  5. Plan for birth-attendant parking.
  6. Outside lights working, house # visible at night (may require a temporary # to be put up).
  7. Clear a path to door and through halls in case we have to quickly run in equipment for set up or quickly depart.
  8. Child-care plan (unless they’re attending birth; MW & doulas can offer tips).
  9. Pet-care plan – pets with teeth / claws absolutely need to be locked up or sent elsewhere as even the most gentle animal can become over-protective and stressed while mama’s in labour.
  10. If you’d like candles then please use only beeswax or battery-candles. The rest are toxic and can give your support people headaches.
  11. Get your bed “birth-ready” – make bed in this order (from bare mattress): extra mattress pad, sheets for after the birth, then a plastic liner/sheet or water-proof mattress pad, a regular mattress pad if you’re using a plastic sheet (optional but nice, because plastic gets hot and sticky; an extra flannel sheet works too), “birth” sheets, blankets & pillow cases that can be used for birth.  Have pillow cases and blankets for after the birth nearby.  Note: if you don’t wish to sleep with plastic in the days/weeks before birth, please have all this ready near bed so someone can quickly make the bed during labour.
    Note: Waterproof plastic liner/sheets can be a clear shower curtain liner or plastic drop-sheet (like a thin tarp). Mattress stores sell nice waterproof mattress pads that feel like normal bedding.
  12. If you’re planning a water birth then ensure hot water temperature is turned up
  13. Birth-Kit from MW (if she provides this; otherwise purchase and assemble yourself):
    – Package of 10 or more large absorbent under-pads / “blue pads”
    – Peri-bottle for postpartum perineal care (one per washroom)
    – 4 -6 pair disposable mesh underwear
  14. If you have a guest-room, it’s nice to have it ready for birth-attendants, just in case.
  15. Extra bits if you’re planning a water birth:
    Note: I am a water birth expert and can offer all kinds of guidance if there are issues with any of this, but we need to know ahead of time!
    – Purchase / rent birth pool (unless your bath-tub is appropriate) and all related supplies.
    – Determine where and when to set up the pool.
    – Tarp to protect the floor. Padding under the tarp is nice.
    – Hot water temperature is turned up.
    – Ensure the hose for filling the birth pool fits one of your taps and reaches your pool. Seriously, you can not imagine how often this isn’t done and foils waterbirth plans! Do not just assume it all fits. If the hose won’t connect then you’ll need an adapter or extra pump; ask me.

Birth Containers

Please prepare in plastic tubs or reserved laundry baskets; boxes work in a pinch.

 1) Dryer Items
These items will be warmed in the dryer prior to birth.  Place in a separate bag or container, stored near dryer or with Birth Container). Washed and ready for use; will get soiled or stained so consider Thrift Store purchases.

  • 6 towels (make it 8-10 for waterbirth!)
  • 6 receiving blankets
  • 2 hats for baby
  • 3 flannel sheets/blankets for mother (4 for for waterbirth)

2) Other Linen
This is in addition to the Dryer Items above.  This linen is kept in a separate container please, near birth-spacee e.g. in bedroom, by birth-pool.  Washed and ready for use; will get soiled or stained so consider Thrift Store purchases.

  • Newborn outfit incl. diaper, undershirt, sleeper, socks, hat and blankets
  • Nighty / PJs for mother
  • Set of sheets to fit bed
  • 1-2 flannel sheets/light blankets for waterbirth
  • 6 old washcloths, old diapers, etc. for hot compresses
  • 10 washcloths for mother comfort
  • 6 towels; make it 12 minimum for waterbirth!
  • 10 cloths/rags for clean-up after

3) Other Items
Keep this in a container close to or in birth-space.
Note: There may be some repeats from the Birth Bag Suggestions list, which you’re encouraged to check out for some great ideas of things you can use at home, hospital or birth centre.

  • Large plastic sheet to protect bedding – e.g. drop sheet or plastic shower curtain liner (see above for how to prepare your bed for birth)
  • 4 large, strong garbage bags (2 for garbage, plus replacements)
  • Large laundry bin or an additional large strong garbage bag to collect soiled linens
  • 1 large roll paper towel (please – no matter how much you love Mother Earth
  • Plastic ice cream pail or other suitable container with lid for placenta
  • Flashlight with new batteries
  • Large pkg. maxi pads, extra long (the bigger, thicker the pad the better). Avoid pads with a “dry-weave” topping as they can be irritating to your perineum
  • Small bottle of peroxide – best thing ever to clean blood from surfaces and fabrics
  • Flexible straws
  • Cookie sheet or other large firm portable surface
  • Bottle of hydrogen peroxide (cleans blood stains)
  • Digital thermometer
  • Q-tips, in case of care of umbilical cord
  • (optional) Small unopened bottle of food-grade oil e.g. coconut for crowning
  • (optional) Large saucepan or Crockpot for heating compresses and oils

4) Waterbirth
Your pool should have come with a supply list.  Please ask if you need more info.  If you’re lucky enough to have a big comfy built-in tub, the only extra thing you’ll need is a floating thermometer and a small fish-net or sieve.

Nourishment

Think about lots of healthy foods and drinks (Labour-Drinks) you and your family might enjoy during and after labour and birth, and stock up.  HINT– birth attendants LOVE tea and snacks too! 😉

Make a few trays of ice-cubes (can keep cubes in a zip-lock).