COVID-19

March 20, 2020 COVID-19 UPDATE

As things change on an hourly basis, we want to reassure you that we are taking special precautions at Pomegranate and adapting our services because your health is our priority.

As you are aware, we have suspended all our classes, workshops and drop-ins in an effort to focus on essential care only at this time at our clinic and minimize people-traffic within our space. We are taking careful, clinic-wide precautions to sanitize all equipment, surfaces and areas that you may come in contact with.

If you have concerns about exposure to COVID-19, please call the nurses line at 8-1-1. If you have any symptoms such as shortness of breath, please call 9-1-1 immediately.

  • If you are in the third trimester and exhibiting any symptoms such as a cough, fever or fatigue, it is recommended that you are tested for COVID-19

Routine Appointments:

We have adapted our routine prenatal and postpartum schedule to focus on essential visits only in-person, and the remainder via phone with your midwife/midwife team.

· A midwife will be calling you 1-2 days prior to your appointment to determine whether you need an in-person visit. Please make sure you are answering your phone and checking your voicemails so that the midwife can reach you. We will be happy to answer your questions and have discussions over the phone, so please keep your list of questions with you in preparation for this phone call.

· Essential prenatal and postpartum visits will be reduced to approximately 10 minutes in length to ensure we have time to clean all equipment between clients and to prevent overlap between clients in our office.

· Do not arrive early for your appointment and make sure to clean your hands upon entering the clinic.

· Please attend your appointment alone if possible. We usually love to meet your families and friends but at this time we request that you bring no more than one support person to your clinic visit.

Before you arrive for your appointment:

  • PLEASE do not come to the clinic sick – you will be asked to leave. We need to be able to adequately prepare to treat you and keep everyone else safe. Arriving to the office sick may result in a shutdown of the entire clinic.
  • PLEASE do not come to the clinic if you or anyone in your immediate family is experiencing symptoms such as fever, cough, shortness of breath, sore throat, fatigue etc.
  • PLEASE Do not come to the clinic if you or anyone in your immediate family has been, or is concerned they’ve been, exposed to Covid-19.
  • Call the office if you are not sure whether you should come to your appointment based on unclear or vague symptoms.

Births at Hospital

For the health and safety of all hospital patients and staff, our hospitals have instituted the following changes:

· Only 1 support person is allowed to attend each labouring person.

· Doulas are permitted to attend births at BC Women’s as an additional support person but are required to show requires proof of doula certification.

· No friends and family are allowed in the waiting area at the hospital or as visitors to the postpartum units.

· http://www.bcwomens.ca/health-info/covid-19-information-for-patients

Home Birth

· We will continue to attend clients at home for labour and birth. We do ask you to limit the amount of support persons at home and to advise your midwife if any residents or visitors to your home have symptoms of Covid-19.

· Make sure you have adequate handwashing supplies in your home including soap (preferably in a pump dispenser) and paper towels.

Postpartum Home Visits

· We are happy to continue to provide postpartum home visits during the first 7-10 days at home. We will call prior to the visit to answer any questions so that we can keep our visits briefer to limit any possible exposures.

· Make sure you have adequate handwashing supplies in your home including soap (preferably in a pump dispenser) and paper towels.

· Advise your midwife if any residents or visitors to your home have symptoms of Covid-19.

Your midwives are committed to providing excellent care to your families during this challenging time. As frontline health care providers we also need to keep ourselves and our families healthy and well. When we aren’t at work taking care of you, we are following public health recommendations to minimize our in person and social contacts.

The midwives at Pomegranate are working as a large team to plan and manage our pandemic response. Each team of midwives plans to attend clinic, labours and home visits for their own clients, as usual. However due to the extenuating circumstances we are facing, it is possible that you will meet a midwife from another team during your care.

INFORMATION RESOURCES:

COVID-19 and YOUR PREGNANCY

We have reviewed information from Canada and internationally, regarding COVID-19 and pregnancy, including the SOGC, RCOG and ACOG. Below is a summary of the recommendations for pregnancy, birth and postpartum:

PREGNANCY

  • Pregnant women should be considered an at-risk population due to physiologic and immunologic changes in pregnancy
  • Covid-19 transmission to the baby in pregnancy seems unlikely. There has been a single case report of possible transmission in pregnancy. Again, there is very limited data.
  • As there is no evidence your baby can get infected while in the uterus it is currently considered unlikely that there will be congenital effects of the virus on your baby’s development.
  • To date, there is currently no conclusive data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19. Case reports from early pregnancy studies with SARS and MERS reported pregnancy losses but did not demonstrate a convincing relationship between infection and increased risk of miscarriage or second trimester loss.
  • As with SARS and MERS and drawing upon our knowledge of other respiratory illnesses in pregnancy, adverse outcomes are likely to be strongly correlated with degree of illness – most pregnant people who contract Covid-19 will experience only mild or moderate cold/flu like symptoms.
  • If you are immunocompromised, have asthma or lung disease, diabetes, renal disease, or chronic illness, be extra vigilant in pregnancy with hand hygiene and Social Distancing.
  • If you do have the Covid-19 virus in pregnancy it is recommended you have an ultrasound 14 days following the resolution of acute illness.

There might be a greater risk of the baby’s growth being restricted in the uterus and being born smaller than usual – based on data from other coronaviruses (e.g. two-thirds of pregnancies with SARS were affected by small intrauterine growth). Therefore, pregnant women with Covid-19 should be have an ultrasound to monitor for growth restriction in the baby.

LABOUR + BIRTH

  • In two case series in China, including a total of 18 pregnant women infected with COVID-19 and 19 babies (one set of twins), there were 8 reported cases of fetal compromise.
  • Given this relatively high rate of fetal compromise, continuous electronic fetal monitoring in labour is currently recommended for all women with COVID-19.
  • If you have any symptoms, such as a fever and flu-like symptoms, your health care team may be wearing protective gear such as protective eye-glasses, a mask and a gown. Please do not be alarmed – this is a mandatory measure for health care providers to help us prevent spreading a virus.
  • Beyond this we don’t have enough data to make further recommendations for labour.

POSTPARTUM

  • There is no evidence that the virus has been found in the breast milk of women infected with Covid-19. The primary concern is whether an infected mother can transmit the virus through infective airborne droplets during the period of breastfeeding. A mother with confirmed Covid-19 or who is symptomatic with flu like symptoms should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while breastfeeding. In the light of the current evidence, it is advised that the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk.
  • All babies born to COVID-19 positive mothers should have appropriate close monitoring and early involvement of neonatal care, where necessary. Babies born to mothers testing positive for COVID-19 will need follow-up and ongoing check-ups after discharge from the hospital.

This guidance may change as knowledge evolves.

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