C-19 Updates in our Local Birth & Postpartum Care

Here’s a list of updates for the RGH Labour/Birth Unit and Mother/Baby Units. These are significant. Anything is subject to change. 
 
Some tips for navigating this journey without your extra support people:  
  1. Article: How to Set Up your Birth Room (i.e. What Your Doula Would Normally Do!)
  2. Easing Labour Pain: An online 2-hr class this weekend (Sunday at 1:30) that teaches partners how to provide hands-on birth-support, comfort, and decrease labour pain.
  3. If anyone’s looking for online prenatal classes or virtual hospital tours, check out my site. I teach all the sessions live but online so you can ask questions.

I’ve been keeping in touch with the good people managing the units at RGH. 𝐇𝐞𝐫𝐞’𝐬 𝐚𝗻 𝘂𝗽𝗱𝗮𝘁𝗲 𝗼𝗳 𝐑𝐆𝐇 𝐋𝐚𝐛𝐨𝐮𝐫/𝐁𝐢𝐫𝐭𝐡 𝐔𝐧𝐢𝐭 𝐚𝐧𝐝 𝐌𝐨𝐭𝐡𝐞𝐫/𝐁𝐚𝐛𝐲 𝐔𝐧𝐢𝐭𝐬, 𝐝𝐮𝐞 𝐭𝐨 𝐂-𝟏𝟗.
Any of these may change.

Highlights & What’s New

◆ The health region is not on the same timeline as the SK gov’t. Restrictions are still in place at health care facilities. Only ONE support person for the entire process, from admission to discharge. i.e. whoever attends the birth also stays in MBU. No swapping. No visitors.

◆ Labouring women do not need to wear a mask IF they pass screening.

◆ Partners/support persons will be provided with a mask at the entry doors. It can only be removed once they’re in their own birth or mother-baby room. (Bring a big paperclip or string if you want to save sore ears.) Check out these tips for saving your ears from mask-pain.

◆ You’ll see staff wearing masks throughout your stay.

◆ There was a news report that pregnant women in SK will undergo testing for C-19, but that has not trickled down to local practice at this time.

◆ Everyone is screened at the doors; ER screening includes temperature. Staff is aware of allergy season and will screen appropriately.

◆ Bring in only what you would normally bring for your birth. Partner will be given a band 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.

◆ 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.

◆ No one in Regina area is renting birth pools. Midwives are not loaning theirs out. If you have your own then waterbirth at home is still an option.

◆ Food outlets in RGH are open for take-out. You may meet someone at the main doors for food delivery.

◆ 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.

Other things still happening from previous update:

𝐏𝐫𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞
● Pregnant women 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)
The previous section, plus:
● Hospital is locked-down. No visitors except for compassionate visits (no, meeting a cute new babe does not count).
● Everyone entering RGH at ER, main entry and 15th St Admitting door will be screened for C-19 risk factors.
● 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.
● Galleys (the kitchenettes) in the units are closed to patients/support person. There is no access to the microwaves, kettles, food, water-ice machines. There is no access to the fridges and freezers, except for the small ones in your room.
● Food Services is limiting snack delivery. Bring your own snacks and food! Maybe a little kettle if you like to make hot drinks. There’s a small fridge in every LBU & MBU room.
● Labouring woman and support person are both screened before entering the LBU. If the support person doesn’t pass screening, they will not be allowed in either unit. An alternate may be invited, who must pass screening and plan to stay for the duration of the admission. If the labouring woman doesn’t pass screening then her and her partner will be put into an isolation room for the birth and postpartum, and not allowed to leave the room for any reason. Food will be delivered by RGH food services.
● 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.
● Women 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.
● People who show up too early in labour will be sent home, as usual, then rescreened at RGH doors and LBU doors upon return.
● There will be no in-hospital water-birth for midwifery clients. The installed bath-tub is available for comfort in labour.
● 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!
● Screening questions:
1. Have you or anyone in your home been out of the country and returned to Canada prior to March 6th?
2. Have you or anyone in your home been out of the country and returned to Canada March 6th or after?
3. Are you, or someone in your home feeling sick? If yes, what are your symptoms?
4. Have you or anyone in your home been directed to self-isolate? If yes, by who? What date?

𝐏𝐨𝐬𝐭𝐩𝐚𝐫𝐭𝐮𝐦 𝐂𝐚𝐫𝐞
Previous 2 sections, plus:
● Families are being asked to stay in their room as much as possible.
● Partners 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.

Released Waters (aka Ruptured Membranes or Water Breaks) and What to Do!

Your waters just released – now what?  When you water breaks, it can be released as a few drops at a time or in a gush.  Only 10 per cent of women will experience waters releasing before labour has started.  When this happens, labour usually starts within 24 hours.  The other 90 per cent of women’s waters will release at some point during labour, usually in active labour.  Here is information on self-care and warning signs.

About 75 per cent of women with PROM at term (“premature rupture of membranes” i.e. before labour starts, from 37 weeks on) give birth within 24 hours. This increases to 90 per cent within 48 hours and 95 per cent by 72 hours.  People often worry about infection after waters release.  Note that risk of infection increases with internal exams (vaginal exams), fever in mother and being confirmed GBS-positive. So this is something to be aware of.

Warning Signs

If any of these occur, seek medical attention in a timely manner.

  • If waters release before 37 weeks, contact your medical care provider and/or go to hospital.
  • If fluid is coloured (yellow, green, brown) or has a strong smell, then contact your medical care provider.
  • If you have any signs of fever contact your medical care provider.
  • If your baby isn’t moving normally, then contact your medical care provider.
  • This is a 911 call! If you feel a cord between your legs or at the vaginal opening, assume a “child’s pose” with bum in the air (on hands and knees with chest on the ground) and call 911.
20200408_121420
“Child’s Pose” with bum in the air

Self-Care

  • Nothing inside! That includes internal examinations unless there’s a good reason to do one. There’s a correlation between time on first internal exam and onset of infection; the earlier the initial internal exam, the higher the risk of infection.  Risk of infections goes up with number of internal examinations.
  • Baths in your own tub at home are fine. Once you’re in active labour then baths are also fine in your private birth room.  Use showers instead when in public spaces (e.g. hotel, hospital assessment washroom).
  • Be aware of signs of infection such as fever. Take your temperature every 4-8 hours during awake hours.
  • Stay hydrated. Consider if you’ve had a steady stream of fluid or just that early trickle.  It’s also possible to have a little “high leak” without membranes fully  releasing.  A healthy mama/baby will continue to make amniotic fluid.
  • Take care of hygiene:
    • Wear a clean pad and change it often
    • When using the toilet, one wipe from front to back per tissue
    • Wash hands before and after using toilet or changing pads

Go to Hospital… or Not?

This should be discussed with your midwife or doctor at prenatal appointments ahead of time in case they have specific instructions for you.  If fluid is clear then you may have the  choice to stay home or contact your medical care provider for options. Generally there are 3 things assessed at hospital:

  1. Baby’s health (by listening to fetal heart tones)
  2. Maternal health (vital signs and interview)
  3. Presence (or absence) of amniotic fluid (the “waters”) present

If you go to hospital and you’re not in active labour, you will likely be offered a sterile-speculum exam (think PAP test); the purpose being to confirm your waters actually released.  This is optional, although it’s not usually presented as such.  Other ways to determine if waters actually released may included simply asking the pregnant woman or dipping the testing swab into her wet pad.

  • If you previously tested “GBS positive” then your medical care provider may recommend induction.
  • If you previously tested “GBS negative” then may be offered induction but will more likely be sent home to wait for labour to start.  If labour hasn’t started within 24 hours then your medical care provider may recommend induction.

Your Options

  1. Go to hospital for maternal and baby assessment but decline internal examination.
  2. Go to hospital and consent to all of it – sterile speculum exam, maternal and baby assessment.
  3. Stay home and wait for labour to start, barring any warning signs or health complications.  Practice good self-care, be aware of warning signs, and pay attention to your baby’s movements.

Further Info:

Here is an excellent article about obstetrical care of women with Premature Rupture of Membranes (PROM) at term (37+ weeks), including discussion of differences in outcomes with GBS positive and negative, options, and when labour typically starts.

You can also contact me with any questions you may have about your upcoming birth!

Pregnant Woman by ocean

I teach a variety of Child Birth Education classes and prenatal workshops online for students all over.  I have been a birth doula since 2002, and have helped over 300 mothers with their births and over 1000 through prenatal classes. Learn more about my birth doula services, and contact me with any questions you may have.

Avoiding Post-Dates Pregnancy

Post-term or post-date pregnancy is one that exceeds 40-42 weeks gestation, depending where you live.  If a woman is healthy and well nourished then her placenta is likely to thrive and nourish the baby at any gestation.  If there are signs that mother or baby will be healthier with baby Earth-side, then induction is warranted; otherwise it’s a much overused intervention that leads to a Cascade of Intervention.    

Cytotec Induction Dangers: What if Viagra Made Penises Explode?

(There is a connection – stay with me here!)

Cytotec (misoprostol) is a drug for stomach ulcers.  However, it is used “off-label” in the USA, (and has recently been approved in Canada too) to induce labour, per obstetrical guidelines.  It’s not approved by the FDA for such use.  In fact the manufacturer issued a written warning against use of Cytotec for labour induction as it can cause hyper-contraction of the uterus, which can lead to uterine rupture, which can obviously lead to death.

So, when Cytotec is used as directed by the ACOG (American Congress of Obstetricians and Gynecologists), a well documented, possible side effect is uterine rupture.

Ina May Gaskin started a quilt project in which each square represents a woman who died in childbirth.  Many of these squares are dedicated to women who received Cytotec induction.

This issue was raised by some classmates today.  Many good points were made; the most obvious being, why are Cytotec inductions allowed, despite ample evidence to show it’s a dangerous practice.  It was suggested that this demonstrates the extent of disregard for women and their bodies.  My friend and classmate, Kelly Graham, a passionate advocate for women’s health, speculated, “I wonder how many (of these same) doctors would prescribe Viagra if a side effect was penis explosion.”  Or – another analogy – would we use a drug to help asthma if a possible side effect was ruptured lungs?

Enough said.

Want to explore further?