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Posted March 25, 2020

Dear Maternity Care Families of the Sunshine Coast,

We hope that you are all staying healthy during this time of minimizing exposure to COVID-19. As your maternity care team, we would like to reassure you that your health is our top priority. As a community of health care providers, we are monitoring the government-released information throughout the day and adjusting our maternity care protocols.

Included in this letter, is a summary of local, national and international recommendations for pregnant women and mothers with new babies to help minimize the spread of COVID-19.

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 have concerns or questions regarding COVID-19 including possible exposure, please call the nurses line at 8-1-1.
  • This tool will help you decide whether you or a family member should get tested for COVID-19 or stay home and self-isolate: https://covid19.thrive.health/
  • If you are pregnant in the third trimester and you have symptoms such as a cough, fever or fatigue, it is recommended that you get tested for COVID-19. Please contact your primary care provider to arrange this for you.

Tips for Staying Healthy:

  • At this time, social distancing is advised. This means, it is advised that you stay home and avoid places where people gather.
  • Do not welcome visitors in your home, especially if they are sick.
  • Clean and disinfect your living area frequently.
  • Wash your hands with soap regularly.
  • If anyone in your family has cold or flu symptoms, keep them isolated in a room with good air ventilation and have another family member care for them if possible.
  • Take care of yourself with regular meals, rest and hydration.

Prenatal and Postpartum Appointments:

As a group of maternity care providers, we are reducing the number of prenatal and postpartum appointments in order to help reduce the likelihood of transmission of COVID-19. For prenatal and postpartum appointments, please refer to your primary care provider for information on how COVID-19 is impacting your routine appointments. At this time, only essential appointments will be offered and your prenatal and postpartum schedule will be adjusted to include phone call assessments and fewer in-person visits. This is to ensure that you and your family stay healthy.

For any hospital-based appointments such as ultrasound and other testing on the maternity ward, please advise the maternity nurse if you have any symptoms of a cold or flu: 604-989-6248

At this time, all of our group prenatal appointments are suspended.

Hospital Labour, Birth and Postpartum:

In order to keep you and your baby safe, we have introduced new measures to minimize exposure to COVID-19.

  • Please call maternity and advise the maternity nurse prior to arriving if you have any symptoms of a cold or flu: Maternity Nurse phone #: 604-989-6248
  • On arrival, all labouring patients will be admitted through the Emergency Entrance.
    • Those who present with any symptoms such as cough or fever, will be taken to a separate area for swabbing prior to admitting and escorted up to maternity on the 3rd floor.
    • Those who do not present with any symptoms such as cough or fever will then go directly to maternity on the 3rd floor.
  • During labour and your birth, only one primary support person will be permitted. No additional support persons will be permitted, such as doulas and family members. Please arrange for care for other family members as necessary.
  • Your support person will not be permitted in maternity if they have any symptoms.
  • No family or friends will be permitted in the waiting areas, lounges or family room at the hospital during your stay.
  • No visitors will be permitted in the maternity ward during your stay.
  • Nitrous oxide gas (“laughing gas”, “Entonox”) will not be available at this time as a pain coping tool in labour due to the potential for easily spreading viral droplets.
  • Please do not be alarmed if we are wearing personal protective gear, such as protective eyewear, masks and gowns. This is intended to minimize transmission of COVID-19 to you and other patients.
  • We will be discharging all our postpartum patients as soon as you and your baby are confirmed healthy and stable by your primary care provider.

As your maternity team, we care deeply for supporting you during your labour, birth and postpartum. We understand these measures may impact you and your family and we hope that you will appreciate the importance of taking extra precautions to keep you and your baby healthy. Check out our website for more updates: www.sunshinecoastmaternitycaregroup.ca

Sincerely,

Dr. Julie Baxter
Dr. Jack Bryson
Amanda Reid, RM
Dr. Karen Scott
Dr. Rayna Sivakova
Lehe Spiegelman, RM

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 and 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. We will be staying informed of all changes to recommendations for pregnant and postpartum women and ensure that you are updated.

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