Demand for home births in N.S. spikes, but experts say don't fear hospitals

Facing tightening restrictions and the possibility of added strain at Nova Scotia's hospitals, registered midwife CJ Blennerhassett said more pregnant people are thinking about delivering their babies at home.

As the COVID-19 pandemic continues to spread, locally and abroad, the Association of Nova Scotia Midwives has had a spike in requests for information about birthing outside hospitals.

Blennerhassett, the president of the association, said demand for home births in Canada increased with the 2003 SARS outbreak, so the coronavirus spike was no surprise. 

"It seems that in our country, during a pandemic, people quickly remember that hospitals are for sick people and those that need medical care," Blennerhassett said in a phone interview.

Most births in Canada take place in hospitals, and giving birth is the number one reason for hospital admission, according to the Canadian Institute for Health Information.

Blennerhassett said pregnant people shouldn't shy away from hospitals for fear of contracting the coronavirus, and should make informed decisions about their birth plans. She recommended against making any last-minute changes to plans.

Typically, more than half the births Nova Scotia midwives attend are in hospitals. Blennerhassett said any change to those numbers won't be apparent until more coronavirus-era babies come due.

As Nova Scotia hospitals try to curb the spread of the coronavirus, they've applied restrictions to visitors, including on labour and delivery units. 

Labouring patients are limited to one support person who must stay from early labour through to recovery. The support person can't be swapped out, and doulas — trained birth companions — count toward the limit.

In New York state, where there have been tens of thousands of confirmed COVID-19 cases, at least two hospitals have barred all support people from delivery rooms. 

Dr. Robyn MacQuarrie, an obstetrician/gynecologist in Bridgewater, N.S., said she didn't envisage that happening in Nova Scotia, where there were fewer than 100 known cases of the disease, as of Wednesday.

But MacQuarrie said she knew the current limitation on support people would be "frustrating and disappointing" for some women. By way of consolation, MacQuarrie said labour and delivery nurses are trained to quickly strike up supportive relationships with their patients.

She added that, at appropriate times, patients could use FaceTime to involve friends and family who can't enter the hospital.

"We're going to have to be creative in the same way that we're creative in all of our social interactions right now," MacQuarrie said from her home, where she's self-isolating after travel.

"Ultimately it is for the best of women, their children and our health-care providers, who we also need to protect; they're a very precious resource right now."

MacQuarrie, like Blennerhassett, said she hoped pregnant people wouldn't opt for home births based on fear.

Risks to pregnancy unclear

While in isolation, MacQuarrie said she's offering some patient care remotely, but she's also spending much of her time planning for the impact of COVID-19 — a responsibility she has as head of women and children's services for the Nova Scotia Health Authority's northern zone.

Her preparation includes reading the latest science on the virus, which she said she does for at least an hour a day. 

Because COVID-19 has only been infecting humans for about three months, MacQuarrie said there isn't enough data to fully understand the potential health effects on pregnant people, fetuses and babies. 

"We don't have a great deal of information. We don't even have anybody basically who would have started and made it to the end of their pregnancy."

As of Wednesday, Health Canada said "there is insufficient evidence to suggest that pregnant women are at a greater risk for more serious outcomes related to COVID-19."

MacQuarrie pointed out that this was different from other viruses, such as H1N1 and influenza, which are more likely to cause complications for pregnant people than for the general population.

Still, MacQuarrie said "how well a fetus does depends on how well that fetus's mother does," and some babies have been born prematurely because their mothers were sick with COVID-19.

MacQuarrie said pregnant people should take the same basic precautions to avoid contracting or spreading the virus health officials recommend for everyone: good hygiene including regular hand washing with soap and water, and physical distancing.

MacQuarrie said there's also no evidence that COVID-19-positive parents can pass the virus through the placenta to fetuses.

Some newborn babies have tested positive for the virus, MacQuarrie said, but researchers believe the babies contracted it after birth.

Changes to pregnancy care

MacQuarrie said pre- and postpartum health care is changing quickly as the pandemic and the scientific understanding of the virus progress. 

She acknowledged the rapid changes can be "confusing and disconcerting" for patients, but encouraged them to keep up with the latest information from public health and bring additional questions to their health-care providers.

If recommendations change, she said that "doesn't mean that health-care providers are trying to trick people or give them misinformation; it's simply that the information is changing."

Now in Nova Scotia, health officials are encouraging doctors and patients to use phone and video conferencing to limit contact. MacQuarrie said some obstetricians are now fielding more questions by phone, but pregnant people require physical exams. In-person doctor visits during pregnancy are being spaced out more than normal for low-risk pregnancies.

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