Covid 19 Updates, Information, and Resources

Below is information about Covid-19, including changes we’ve made to our clinic as a result of Coronavirus, changes made at VGH, current best practice guidelines, and additional resources. We will try to keep this page as up-to-date as we can. As always, the health and safety of our clients is at the top of our minds as we contemplate best practice during this time.

Our clinic:

We have made the following changes to our clinic in order to help slow the spread of Covid-19 – to protect all our clients and the entire community.

Prenatal and Postpartum Clinic Visits:

  • Your appointment will either be completely via Zoom or a combination of Zoom and a clinic or postpartum home visit. You’ll know which to expect depending on what you discussed with your midwife at the end of your last visit; if you aren’t sure, please call us at 250-590-7605 to clarify. (Please note all intake visits are via Zoom.)

 

  • If your visit is a Zoom/clinic or Zoom/home visit, we will first contact you via Zoom for the discussion portion of our visit.  If Zoom doesn’t work for you (for instance, if you’re in your car outside our clinic and cannot access wifi for Zoom), we will call you on your phone.  After we have answered all questions and provided relevant information for the visit, we will either invite you into the clinic (for a clinic visit) or come into your home (for a postpartum home visit).

 

  • Please know that prior to coming into clinic or into your home we will ask:
    • Do you have a fever, cough, shortness of breath or difficulty breathing?
    • Have you been in contact with someone known to have COVID-19 or who is sick after travel (outside Canada) in the last 14 days?
    • Have you traveled outside of Canada in the last 14 days? If yes, which city/state/country visited?
    • Have you been instructed in the last 14 days to self-isolate?
  • If you answer “yes” to any of these questions, we will need to make an alternate plan.

After each clinic visit we will disinfect all equipment to ensure our office and equipment is clean for our next client. In order to protect all our clients, we do ask you to come alone to clinic if possible.

 

  • We are reducing our visit frequency. To guide this decision, we are using the World Health Organization guidelines recommending the optimal number of prenatal appointments for a positive outcome. This includes:
    • One visit in first trimester at 12-4 weeks gestation (an intake visit via Zoom will take place prior to this)
    • Two visits in the second trimester (around 20 and 26 weeks)
    • Frequent visits in the third trimesters (30, 34, 36, 38, 40, 41 weeks)
    • Postpartum visits: hospital or home visits as needed during your first week postpartum. Follow-up clinic visits at 3 & 6 weeks postpartum.
    • Phone calls for any concerns in between visits as usual.

 

  •  We have also significantly modified the setup of and cleaning frequency of our clinic to minimize the chance of exposure for all. Equipment and furniture in the clinic room are being sanitized between every client, and all high-traffic areas are being wiped down with antiviral solution frequently throughout the day. We have removed all toys, books, cups & tea/water station, and unnecessary furniture. 

Births at VGH

  • For the health and safety of all hospital patients, VGH L&D has instituted the following changes:
  • Only 1 support person is allowed to attend each labouring person. Unfortunately, that currently includes doulas. This means you may have your partner or your doula, but not both. It must be the same person for the entire duration of the L&D stay.
  • No friends and family are allowed in the waiting area on L&D
  • No Nitrous Oxide (laughing gas) will be provided on L&D
  • No visitors are allowed on Mother-Babe. Only parents are allowed into the NICU.

Home Birth

  • We ask you to limit the amount of support persons at home. However, we are currently absolutely happy to have doulas as part of the home birth support team.

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. 
  • If anyone in your home has Covid-19 or is in quarantine for possible exposure, we will not be able to offer home birth or home visits – this is to protect all our clients.

 

Our MOA

  • Julia will be primarily working from home. However, she will be regularly checking the phone during the day to ensure we are able to respond promptly to any client phone calls.

 

Potential changes to your midwife team

  • The midwives at TMC (and in our larger Victoria community) work as a team and help each other in times of need. We prioritize continuity of care for our clients, and strive to provide your known care providers to you whenever possible. If one of your midwives becomes ill, you may receive care from another midwife in our practice in order to protect your health. If circumstances don’t allow this, then we will contact another midwife who practices in Victoria to help you.

 

General Pregnancy, L&D, and Postpartum Guidelines regarding Covid-19

 

  • Pregnancy
  • Pregnant people 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 people with Covid-19 should be have an ultrasound to monitor for growth restriction in the baby.

 

  • Labour & Delivery
  • In two case series in China, including a total of 18 pregnant persons 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 persons with COVID-19.

 

  • Postpartum
  • There is no evidence that the virus has been found in the breast milk of people 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 the infant, including washing 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 people testing positive for COVID-19 will need follow-up and ongoing check-ups after discharge from the hospital.

 

Other tips and information:

  • Wondering if you need to swab or self-isolate for Covid-19? Take this quiz: Covid-19 Self-Assessment Tool
  • If you think you may have any symptoms of Covid-19 including fever >38c, coughing, shortness of breath or difficulty breathing, and/or GI symptoms do not come to clinic but instead please call 8-1-1, where you will be able to speak to a nurse and be triaged to a testing centre if indicated. Anyone who is symptomatic & needing urgent obstetrical assessment will be assessed at VGH.
  • As a reminder, the best way to protect ourselves and our community from Covid-19 are really simple:
  • Hand-washing – Wash your hands with soap and water for at least 20 seconds before and after touching your face, before eating, and after using the washroom. This is the best way to prevent transmission of any virus. If a sink is not available, the next best option is hand sanitizer with 60% alcohol content.
  • Avoid touching your face if possible. COVID-19 and other viruses are spread through coughing and sneezing, but also by touching surfaces that the virus is living on and then touching your eyes, nose, or mouth. 
  • Cough or sneeze into a tissue and dispose immediately.  Alternatively, folks can cough or sneeze into their sleeve.
  • Social Distancing—As much as reasonably possible, keep two arms-lengths (one yours, one the other person) apart from others.

 

 

  • Sick notes for employers: As per instructions from the Minister of Health and the Provincial Medical Officer of Health, you will not need a note to miss work if you have symptoms.
  • Service Canada-applying for EI for Covid-19 related work closures or quarantine
  • Travel advisory notice: The B.C.’s Provincial Health Officer is still advising no non-essential travel outside of Canada, including to the United States. Anyone choosing to travel will be required to self-isolate for 14 days upon return. 
  • School closures: This is a great piece for all the parents out there who may be home with their kids and Social Distancing:  How to prepare for extended school closings – and not lose your mind.
  • Anxiety and coping with the COVID outbreak: Many of you may feel overwhelmed with the rapidly changing news reports about the spread of COVID. 
    • You can read more about coping strategies here, here, and here
    • Many local counselors offer remote consults – get in touch with one if you feel you need more support. 
    • Many people successfully use Mindfulness-based stress reduction to manage anxiety. 
    • Simplify your life as much as possible, and do what makes you feel healthy and happy (within the limits of social distancing!). Think about other strategies that have worked for you in the past to help you manage stress and anxiety, and try to adapt them to the current situation. 

 

Thank you for your understanding during this time. We recognize that this is a changing situation, and our guidelines may change to reflect best practice recommendations as they continue to evolve. Please do not hesitate to call our office at 250-590-7605 if you have any concerns.