Strathcona Midwifery COVID-19 Update

Hello Strathcona Midwifery families,

We hope you are doing well and are continuing to stay home except when essential. Here are some important updates from the clinic as well as for your general safety and knowledge. Please know that you can always page your midwife with any urgent concerns.

The counsellor who works at our clinic, Lara Ellison is now offering all phone and web based appointments. If you are needing extra support you can contact Lara via her website at https://www.laraellisontherapy.com/

Clinic plan:

We need to keep visits short in clinic in order to reduce the possibility of transmission. We know that transmission increases after 15-30min in close contact with another person.

We are continuing to see people in clinic but in a limited way that allows the midwives to stagger the visits, to reduce traffic in the space and keep the clinic disinfected. When you come for your visit, we ask that if possible, you come alone. Please wash and dry your hands as soon as you enter the clinic. We also continue to ask that you stay home and let us know if you or someone in your household has any cold or flu symptoms and/or have travelled outside of Canada in the last 14 days.

The visit schedule we are following is in line with the World Health Organization and Center for Diesease Control prenatal schedule. It will be slightly different for each person but overall looks like this:
    - Intake- phone call
    - Short clinic visit at weeks, 12, 20, 24, 28, 32, 36, 38, 40, 41w and more as needed.

You will be receiving a call from one of your midwives before any booked appointment to review your needs over the phone, answer your questions, plan for testing and confirm when you need to come into the clinic. You will then be seen in clinic for a quick visit do any physical checks.

Please check your voicemail, we are leaving you messages when we call and can’t get through. We ask that you please do not call your midwives or the clinic to ask about your next appointment. We are working round the clock to call everyone, rearrange clinic all while still catching so many babies!

Home visits:

We are still seeing people at home after the baby is born, but again are adapting that visit schedule and plan. For home visits we are conducting the visit by phone from our cars and then having a short visit in your home.

To keep you, your family and your midwives safe when we visit you at home, either in early labour, for a home birth or for postpartum home visits, we have a few new requests.

- We need you to tell us if you or anyone in your household is sick or has travelled in the last 14 days.
- We need you to have in your home, liquid soap, paper towels or clean dish clothes for us to dry our hands.
- We may request that you wear a mask that your midwives will provide. We cannot visit you at home if anyone in your household is in quarantine.

If you are planning a home birth:
- We need you to have a thermometer.
- We ask that you limit the number of people at your home birth to essential supports only, this can include your immediate family and one support person of your choice, who may or may not be an official doula.
- Before we come in your home, we will be screening you and your household members for any COVID-19 risks.
- We will also have a lower threshold to transfer into the hospital in order to ensure we can access the care we need in a timely manner.

UPDATE ON PREGNANCY AND AFTER THE BABY COMES
The increased risk for older people and those with chronic health issues has received a lot of coverage, but there has been less information for people who are pregnant or just had a baby. 

On Thursday Mar 19, BC Women’s Hospital experts updated care providers at web-based rounds and The BC Centre for Disease Control also released guidelines. Below are some highlights:


Pregnancy
* Pregnant patients are NOT more susceptible to contracting Covid-19
* It is expected the large majority of pregnant people will experience only mild or moderate cold/flu like symptoms.
* Less than 20% will develop severe symptoms
* Pregnant patients with mild COVID 19+ symptoms should be kept at home in self-isolation when possible. Most pregnant people will only experience mild or moderate cold/flu like symptoms. Visitors should be kept to a minimum
* Care should be done by Telephone or other Virtual health options where possible
* Pregnant people should be advised NOT to come to hospital unless they are in need of urgent obstetric or medical care
* While pregnant people with symptoms should self-isolate at home, if these symptoms are in the 3rd trimester, swab for Covid-19 and influenza. Page your midwife if you are in the 3rd trimester and experiencing the above symptoms.

Hospital Labour
* Only one support person may accompany you in labour at the hospital (Doulas with hospital ID/appropriate certification are allowed)
* At St Paul’s currently for a C-section, the midwife and partner will be allowed in for planned c-sections, in the event of an emergency c-section, only the midwife will be allowed in the OR.
* Currently entonox (laughing gas) is not available in hospital due to lack of an adequate filter to screen airborne particles

Postpartum
* There are no visitors allowed in the hospital during your stay
* If the birthing parent is Covid-19 positive, keeping them and baby together is recommended
* Birthing parent to wear mask and utilize strict hand washing protocol for nursing and skin to skin 
* Nursing is encouraged because the protective effect of nursing is particularly strong against infectious diseases through directly transferring antibodies and other important immune factors to the baby
* Test infant for COVID-19 No isolation of infant from birthing parent unless clinically indicated by disease severity
* Where appropriate, early discharge of the baby with a parent or caregiver, should be facilitated

Covid-19 - Symptoms
* Incubation of Covid-19 is 1-14 days but mostly 3-7 days (average 5 days)
* Most will get a mild respiratory illness: 89% fever; 68% cough; 38% fatigue; 34% sputum production (thick mucous when coughing); 19% shortness of breath; 14% sore throat; 14% headache
* Uncommonly, there will be diarrhea and vomiting
* Sore throat, runny nose, and muscle aches are uncommon, so it is not typical of the flu or a cold

New Provincial Covid-19 Symptoms Self-Assessment Website Launched
This site is updated as recommendations from the BC Centre for Disease Control evolve.
https://www.thrive.health/covid19

WORK ABSENCE & EMPLOYMENT INSURANCE
Thanks to Dr Jennifer‌ ‌Robson, at ‌Carleton‌ ‌University for putting together this comprehensive document regarding Employment Insurance.
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:
https://news.gov.bc.ca/releases/2020HLTH0077-000484

People in quarantine (including those who are not sick and those whose workplace is closed to enforce social distancing) can apply for Employment Insurance Medical Leave. You do not need a medical certificate from your doctor, NP or midwife:
https://www.canada.ca/en/employment-social-development/corporate/notices/coronavirus.html

OTHER RESOURCES:
The Midwives association of BC has an info page that is always being updated at, https://www.bcmidwives.com/covid-19-updates-for-midwifery-clients-pregnant-people.html?fbclid=IwAR2sH3mwUDoLKKEH_fG6gPPVvb9PC7NiAY6YYKM41n_HjnBN8R-rEFBL4h0

The BCCDC is also always being updated, http://www.bccdc.ca/health-info/diseases-conditions/covid-19?fbclid=IwAR2dIYxEpNe6g9R0OGjyVi-mCYhnMl5YqoJxvB1nZapDcguA-wGjzFIetCE


We hope this information is helpful to you,

Take care,
The Strathcona Midwifery Team