What to expect when you’re expecting: The pandemic version

A guide for pregnant patients in Ottawa in the time of Coronavirus

*** Last updated: June 22, 2020 ***

“These are strange times” is something we’ve been hearing a lot lately. Stranger still when you’re growing a tiny human. My name is Jillian Bardsley and I am family doctor who practices low-risk Obstetrics and delivers at The Ottawa Hospital – General Campus. I decided to write this blog post to help give expectant moms some factual information on their risks with regards to COVID-19, as well as some idea about what to expect about their appointments and time in the hospital.

Going to the hospital in the time of Coronavirus

First things, first: Hospital registration

Please call ahead to register. Do not visit the hospital to do this.

Anyone due from March – June can register by phone now. To avoid a giant rush, please aim to register around the 32 week mark.

Call the Admitting Department Monday to Friday from 8am – 4 pm at the hospital where you are having your baby.

  • Civic Campus - 613-798-5555 ext 13599
  • General Campus 613-737-8200

Have the following pieces of information ready:

  • Name, address, date of birth
  • Name of prenatal care provider, name of your usual family physician
  • Next of kin information
  • Health Card number and any Supplementary insurance for semi private or private.

Patient & Visitor Restrictions at The Ottawa Hospital during the COVID 19 Pandemic [PDF]

The Ottawa Hospital does not do birthing unit tours at the best of times, so you’re out of luck on that front. If you have questions about what’s available at the hospital for labouring women, please ask your prenatal care provider.

Not sure if you’re in labour or have a question about something that’s happening after 20 weeks?

Call the hospital and speak to the Obstetrics triage nurse at the hospital where you will be delivering. She will give you instructions about what to do and tell you if you need to come in. Available 24/7!

  • Civic Campus 613-761-5112
  • General Campus 613-737-8012

Many first time mums come to the hospital in early labour and are told to walk around for a few hours and come back to be reassessed because their cervix is not yet dilated enough for admission. Many are sent home in the end until labour becomes more active. I would recommend waiting at home until you are having painful contractions (and I mean, you can’t walk, you can’t talk) that last a minute, every 4 minutes for an hour. You don’t want to be waiting around the hospital if you don’t need to be.

An important resource for the most up to date information is the The Ottawa Hospital Department of Obstetrics, Gynecology, and Newborn Care Website. They also have videos of a virtual tour for both the General Campus and the Civic Campus.

Now actually going to the hospital.... dun dun dunn!

This really won’t be as scary as it might seem. I actually feel much safer at the hospital than I do at the grocery store. You will not be walking into a cesspool of COVID germs. That being said, use common sense. Wash your hands frequently, keep your distance from other people and if you are sick, please wear a mask and elbow cough.

The Ottawa Hospital recently updated their policy on visitors and support people for labouring women. The pandemic restrictions are lifting so the hospital has made some changes to their visitor policy to make it easier for women and their families. These policies may reverse if the pandemic picks up again. I will do my best to keep you updated.

Take home points:

If you are sick or have travelled out of the country, please let your nurse know as soon as your arrive. Please wear a mask.

The Ottawa Hospital usually allows more than one support person in labour. During the pandemic, only one support person is permitted and this person has to be completely well and not have travelled out of the country in the last 14 days. I would suggest having a back up support person in case your #1 is not able to come with you.

Your support person will be screened by a nurse for symptoms and fever when they arrive. The birth of your baby is a sacred and amazing moment. Please honour that by being honest in answers and acting with integrity.

As of June 22nd as long as you do not have a cough/fever/COVID, doulas are now allowed in addition to a chosen support person. If you are cared for by a midwife and she has to transfer care to OB, your midwife will now be allowed to stay with you for the duration of labour and delivery.

Support persons will:

  • NOT be permitted until you are admitted to the hospital AND in active labour (contracting regularly, at least 3-5 cm dilated). They are not able to wait with you in triage :(
    • An exception to this is if you are admitted for induction of labour, your support person will be able to come up to your room once you are admitted.
  • WILL be able to come into the operating room during a caesarean section.
  • WILL be able to leave the hospital and return, on a limited basis. As of June 22nd as long as you do not have a cough/fever/COVID, they may leave your room to go the cafeteria or outside the hospital briefly. Bring lots of snacks and an overnight bag for your support person.
    • An exception to this is if you are discharged and then readmitted. Your support person will also be allowed to come back with you.

Other friends and family, including your other children will sadly not be allowed to visit you while in hospital. This may mean your are separated from your older children longer than you and them would like, but everyone will be okay in the end.

On a personal note, my husband and I introduced our second child to our 2 year old son at home in June and are really glad that we did things that way. He got to see his mom in her usual environment and we went together to ‘meet’ his baby sister in her crib.

Once you are fully dilated and pushing (lots of huffing and puffing there!), you will be asked to wear a mask to protect our workers. Dislike surgical masks? Try to bring a cloth mask with you. Way more comfortable!

13% of women who had no fever or cough at admission to Labour and Delivery at New York Presbyterian Hospital were positive on their COVID swabs (NYPH now swabs all admitted pregnant women). While New York has a much larger epidemic than Ottawa, this highlights the importance of ‘asymptomatic spread.’ Thank you for wearing your mask and help keeping my colleagues and I safe.

If you have a cough or a fever, confirmed or possible COVID, you will be asked to wear a mask while in the hospital, including while in labour (this will be a bit annoying for you but is necessary to keep our health care workers and your baby safe).

  • If you are in this category, your support person must be someone who does not live with you and who have you have not had contact with for 14 days (because presumably, they have what you do….again, more concerns about ‘asymptomatic spread.’) All the more reason to make sure you have a good back up support person.
  • If you develop a fever while in labour and your doctor thinks that this is most likely not related to COVID-19 (for example, if you develop a womb infection called ‘chorioamnionitis’), your chosen support person will remain with you until after your baby is born and on the post-partum unit. Only if your doctor is concerned that you have developed COVID while in hospital will your original support person have to leave. A new support person who does not live with you and who have you have not had contact with for 14 days, will be able to come and help you with the baby on the postpartum ward until you are discharged. They will be given gloves, a mask and a protective hospital gown and be asked to try to stay 6 feet away from you but will be able to hold, feed, change and rock your baby while you rest (basically, whatever you need them to do).

Babies born to mothers with a cough or even with proven COVID-19 will not be separated from you unless you, as a parent, think that it is safest if someone else cares for them. If you choose to keep your baby with you, you will be asked to wear a mask and wash your hands well prior to holding and handling your baby. One exception is that if your baby needs to be admitted to NICU and you have COVID, you and any household contacts will not be able to enter the NICU (but your back up support person can!) so that we can keep the other babies safe. For more information, refer to this note from the NICU team at TOH on your options for baby care if you have any cold symptoms, fever or confirmed COVID. If you do not have COVID or COVID symptoms, you will be able to come and go from the NICU nursery.

A few notes on pain management:

Nitrous oxide (laughing gas) will not be an option during the COVID outbreak

If the hospital gets busy with sick patients, anaesthesia may not be able to come as quickly (or at all) for your epidural. Take a deep breath now and in labour. You will get through it. I am always amazed at how well women who were planning on an epidural do when for whatever reason (their platelets are too low, labour is going to fast, or anaesthesia is tied up with an emergency) they are not able to get one.

On both a personal and professional level, I highly recommend having a plan for coping with natural labour prior to showing up at the hospital. Don’t be that lady who researched strollers for days but isn’t aware of how labour progresses and doesn’t have an approach to dealing with labour pains. Knowledge is power! I highly recommend the book “Birth Partner” for all pregnant women (despite the title saying it’s for someone else). “Hypnobirthing” is another good one.

If you have COVID-19, you may be encouraged to get an epidural on the earlier side if anaesthesia is available. This is because if stuff really hits the fan and we need to get your baby out ASAP via C-section, if you don’t have an epidural, you will need to get a general anaesthetic which comes with intubation (a breathing tube). As you can imagine, inserting a breathing tube generates a lot of aerosolized spit and germs, which puts your health care providers at greater risk. We are trying to avoid that situation.

Going Home

To minimize your exposure to health care workers, and because home is always nice (especially during a pandemic!), we are doing our best to get mummies and babies out of the hospital as soon as possible. My personal target is around the 12 hour post (vaginal) delivery mark. Women who have Caesarean sections used to stay for about 48 hours. My understanding is that is also been reduced to about 24 hours, if your obstetrician thinks that is safe for you.

Necessary tests can be done at the Monarch clinics. This will get you out of the hospital and back to your usual environment faster. Babies born to mothers with respiratory symptoms or with proven/suspected COVID will have their first few doctor’s appointments at the new Monarch C+ Clinic that will hopefully be up and running at the General by April 1st. Hats off to the Monarch staff and Dr. Dave Millar, family doctor extraordinaire, for making sure our system takes good care of these families!

Many if not most family doctors are continuing to see newborns in person. If your family doctor or paediatrician is not seeing live patients during the pandemic (ie. they are just doing phone/video visits), talk to the staff at Monarch or the hospital. There is a list of family doctors in the city who are still open for business and who have volunteered to see these ‘orphaned’ babies during the important few weeks and months after birth.

Additional resources from TOH:

For your convenience I have collected some of the pertinent information about policies during COVID from The Ottawa Hospital. As this is a developing and changing situation, policies may change over time. TOH may publish updated policies on their website.

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