Like everything else in Nelson during COVID-19, childbirth has changed.
Doctors, nurses and midwives attending births at Kootenay Lake Hospital are wearing full protective gear.
Women are allowed only two guests for the birth: a partner and qualified doula (certified birth support person).
These are standards set by Interior Health, and they are welcomed by Tanya Momtazian. She’s a registered midwife and executive director of Apple Tree Maternity, a multi-service agency that handles about two-thirds of Nelson’s 25 to 50 births per month.
She is also the president-elect at the College of Midwives of BC and adjunct professor at UBC Midwifery.
Momtazian said the limited numbers of guests in the delivery room is less than what people may be used to.
“Sometimes we will have full birth parties with four, five, six people. But not now. You can have your partner and if you have a doula who is accredited, they are allowed, but everyone has to follow strict infectious disease policies.”
Partners and doulas have to bring their own food in a cooler, since there is no longer a communal kitchen or fridge in the hospital, and there are no food deliveries. And once they arrive, they can’t leave.
“That has been one of the most challenging things,” Momtazian says. “The hospital does not feed the dads, so they have to stay there and feed themselves without a fridge or microwave.”
During the birth, the number of hospital staff (midwife or doctor plus nurse) remains the same, “but we look different,” Momtazian says. “We are always in scrubs, glasses, gloves and masks for any patient contact, for any time we might be touching them.”
After the baby is born, no one can visit.
“If they have young families, the children cannot come and the grandparents cannot come. One of the recommendations is early discharge, to reduce possibility of exposure, so we are following them more closely at home and encouraging them to go home sooner than we might normally.”
Momtazian said the same rules about number of attendants and wearing of personal protective equipment also apply to home births conducted by Apple Tree midwives or doctors.
The number of home births in Nelson has increased slightly since the pandemic began, Momtazian says, but not as much as in other parts of the province where the B.C. Midwives Association has reported increases of 20 to 50 per cent.
If COVID-19 is the only reason for choosing a home birth in Nelson, parents should not choose it, she says.
“Generally home births are for people who really feel safe at home and feel that is their best place to deliver. I understand the hospital might feel a bit less safe in the time of COVID but generally people have to be quite committed to have a home birth. The hospital is a safe and clean place to have a baby.”
In addition to physicians and midwives, Apple Tree employs nurses, a lactation consultant, a registered psychiatric nurse and a social worker for new parents and their babies, before, during and after birth.
During the pandemic, Apple Tree has cut back on the number of pre-natal visits, doing some of them virtually instead. Classes and groups have been cancelled or altered to allow for social distancing and enhanced hygiene.
Judith Fearing, a registered nurse, certified lactation consultant and retired Selkirk College nursing instructor, provides infant feeding care for Apple Tree.
Before COVID-19 she would run groups and people would turn up if they had questions. Now she connects with a phone call or, if necessary, a home visit wearing gown, mask, eye cover, and gloves.
Fearing says the experience has taught her something about groups, even though she has been running a variety of childbirth-related groups for decades.
“Normally when people come to a group they get to watch the other mothers, and hear how their baby is doing this or that, and they hear what I am saying to one mother, and realize ‘Oh, my baby does that too, that must be normal.‘
“So they get to understand by watching and hearing this huge, wide range of normal. But when they don’t go to a group that means every single little question they have needs an explanation.”
She says a drop-in class with parents and newborns would be impractical to set up as an online group meeting.
Momtazian says many new parents are worried about COVID-19, but she points out the risk of contracting it is no greater than for the larger population.
“If they are young and healthy, then the risk is quite small. SARS and H1N1 were not like that, and pregnancy was higher risk.”
She said clients and those anxious about COVID-19 can talk with a counsellor who is part of Apple Tree’s care team.