Midwife knows best: mums-to-be can relax despite coronavirus

Pregnancy is a special time full of excitement and anticipation. But for expectant mothers facing the outbreak of COVID-19, fear, anxiety and uncertainty are clouding what should otherwise be a joyously life-changing event.

This anxiety and fear is often amplified by social media, where misinformation can run rapid and unchecked – especially at a time of social distancing when many individuals are scarcely leaving their houses and are more reliant than ever on the internet to stay updated on the latest developments, particularly on the health and safety front.

But gynaecologist Mark Sant is urging expectant mothers to not skip their antenatal appointments, especially given that Malta has yet to experience a worrying surge of COVID-19 patients in its midst.

Mark Sant

“The only time we postpone appointments is if the patients themselves show symptoms. In that case they are swabbed and if found positive, the idea is to follow them remotely until they are fit to come in – unless, of course, they need to be seen anyway, in which case the long-term plan would be to set up a COVID-clinic. However, that hasn’t proven to be necessary as of yet,” Sant said.

He also debunks the myth that caesarean births are automatically the safer option for women in light of the pandemic. “Caesareans may be safe for the people attending to these women, but not for the women themselves. So while we did have a discussion on whether or not we should encourage more caesareans for the sake of health care workers, this has not yet become an official recommendation and we’re not applying as a policy… and neither are the UK, for that matter,” Sant added.

Contracting COVID-19 during pregnancy

Sant also regales us with a small bit of good news: so far, there has been no evidence of vertical transmission of COVID-19. Which means that the babies in the uterus do not appear susceptible to the virus. “There haven’t been signs of any anomalies developed from the virus. And even though we still classify pregnant women as a vulnerable group, as a whole they have not reacted to the virus in any worse a way than non-pregnant people so far.”

Sant says all women in the labour wards are being tested for COVID-19 on arrival, with women divided into those pending swab results and those with known status.

“A ward we’re calling the ‘COVID ward’ has also been set up. In here you’ll find those who have tested positive for the virus, those who have been quarantined and those awaiting a swab test. So it’s pretty safe, and it’s also worth mentioning that the number of people on the wards has declined by quite a bit.”

Meanwhile, midwife Pauline Borg says that midwives and doctors alike are following infection control guidelines as issued by the infection control team at Mater Dei Hospital.

“This includes, among others, hand washing, social distancing when possible and wearing personal protective equipment. So it might be that midwives look a bit different since we are wearing masks and visors but rest assured we are smiling with our eyes and the care is there nonetheless.”

Paediatricians are advocating for the separation of mother and child if the mother tests positive for COVID-19. “Currently the policy adopted locally is that the mother and child are separated,” Sant says.

He also cautions against comparing local practices to international ones. “In the UK, if you go into the hospital and say you have a fever and a cough, and it doesn’t seem like you need admission, they don’t even swab you – they just send you home. So if you look at the UK and the situation they are in, and the data has shown that babies aren’t badly affected, they may choose not to separate the mother and child.”

Sant however argues that if Malta had the necessary facilities that would allow for separation to be made possible, it would be the recommended course of action to take as it may decrease the risk of infection in the labour ward.

Partners in the delivery room

To date, partners were only allowed into the birth room during the second stage of labour, and for a short time afterwards.

“Once the midwife sees that the second stage is approaching, the partner is called to be with their wife/partner during the birth,” Pauline Borg says.

“The couple may decide whether the partner is to then wait outside in the car, say, or at home. But it’s worth noting that should this not be the patient’s first birth, the second stage may occur rather quickly. For this reason, some partners may opt to simply wait in the car should the woman still be in active labour.”

While Sant acknowledges that this may not be an ideal situation, he stresses that the protocol was being adopted in the best interest of the population.

“Midwives and doctors are not happy that the partners are not there with the mother… it’s not nice, and quite often a partner can be very helpful during delivery. But this is a situation that has come upon us, and we need to get on with it.”

Sant also highlighted that when it came to COVID-19, contact hours did make a difference, so the idea of allowing partners to stay – even for a short while – cannot be medically justified.

“The idea that if someone is allowed in for half an hour then they may as well be allowed in for eight hours simply does not hold. Because the risk of exposure depends on a number of factors: the space you’re in, how close together you are and yes, how long you’re in there for.”

Managing anxiety

Borg says that a big part of the anxiety and fear expectant mothers were experiencing was due to social isolation, and as such, it was important for mothers-to-be to keep in touch with their social network, family and other mothers.

“We all need to keep ourselves socially connected despite physical isolation. However, it’s also the case that new and expectant mothers should limit their exposure to social media and television. Should they wish to remain updated on the latest news on the virus, they should rely on established sources like the World Health Organisation, and the mainstream local media,” she says.

Borg advises that exercise is essential by increasing endorphins, decreasing anxiety, preventing and treating aches and pains common in pregnancy and helped mums-to-be sleep better.

“Sticking to a healthy food regimen and drinking plenty of water is a must to avoid complications in pregnancy and to support mental wellbeing. It’s also helpful to keep a daily routine and to plan the day, keeping the mind active and even doing some work at home or any projects which are of interest, but which can be done without leaving the house.”

In particular, Borg recommends indoor hobbies that are creative and therapeutic. “Speaking to a midwife and taking an online childbirth education class will provide much-needed empowerment and the necessary tools for birth. Babies will continue to be born irrespective of COVID-19, meaning that women need the same level of preparation, support and positive determination to get them through this challenging miracle of bringing life into the world.”

She adds that a balance had to be reached between being well-informed and sometimes letting “babies make their own story,” as some choose to come into the world in ways that many mothers may not expect.

“It is always good to be open and maintain a positive outlook.”