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Midwives, patients push for clarity on companions during childbirth

Quebec Premier Francois Legault speaks during a news conference on the COVID-19 pandemic, Monday, April 6, 2020 at the legislature in Quebec City. THE CANADIAN PRESS/Jacques Boissinot
April 06, 2020 - 4:14 PM

A Montreal hospital's decision to ban a companion from the delivery room during childbirth has sparked an outcry from expectant moms across the country.

But childbirth amid the COVID-19 pandemic raises complicated health issues, say some of Canada's experts on the subject. There's no easy answer. And it's a challenge virtually all Canadian hospital labour and delivery units are facing.

"Hospitals are not going to be taking this decision lightly," Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynaecologists of Canada (SOGC), told The Canadian Press in a telephone interview. "The important message is that everyone is hoping that we get through this quickly, but right now things are changing so quickly that everyone needs to know and understand that . . . everyone's first priority is to keep you safe."

Jewish General Hospital has banned "the partner of a designated person" during delivery and the postpartum period, according to CIUSSS West-Central Montreal, the regional health authority whose network includes Jewish General. The decision came after a partner of a woman about to give birth at the hospital was infected with COVID-19 and showing symptoms.

Quebec Premier Francois Legault said the ban won't extend to other hospitals in the province, saying "We are looking at, for women who want to change hospitals, to be able to change hospitals.

"But, at the Jewish General Hospital, there are many cases of COVID-19, so there are good reasons for this rule, but I want to be very clear, there is no intention of the government (to) extend these bans to other hospitals," Legault added at his Monday news conference. "So I want to reassure all the women who are pregnant. Besides the Jewish General Hospital, you will be able to bring your partner with you during childbirth."

The hospital's policy received swift reaction from patients and care providers who say the prospect of delivering a baby alone is traumatic for some women, and having a companion present during childbirth is part of the World Health Organization's COVID-19 guidelines.

A petition asking Legault and Prime Minister Justin Trudeau to reverse the ban had garnered over 86,000 signatures by Monday night.

"It's so profoundly sad in so many ways, to find ourselves in this situation," Blake said. "But what everyone knows is that these are extraordinary times, and we have to make sure that we're safeguarding the safety of our moms, the other women who are in labour, our staff and then their support people."

The WHO's guidelines on COVID-19 and pregnancy from March 19 state that all pregnant women have the right to a safe and positive childbirth, including "Having a companion of choice present during delivery."

But Nathalie Pambrun, president of the Canadian Association of Midwives, said people need to remember these are far from ordinary times.

"With these pandemic moments arise a whole complexity of issues," she said. "You're getting these intersecting themes: there's the human rights aspect, there's the clinical evidence with support people, and then there's the realities of the pandemic and all three of those don't easily reconcile themselves."

Pambrun and Blake both pointed out that shortage of personal protective equipment (PPE) complicates the issue.

Plus, additional people in the labour and delivery room not only increases the health risk to mom and baby, but to medical staff as well, particularly when many people show no symptoms of coronavirus.

"At what point are we going to say no support people?" Pambrun said. "Reproductive health care is an essential service and needs to continue throughout a pandemic. So (there's a risk) of dropping your human resource numbers because they're being exposed to twice as many people."

Studies have shown that less medical interventions such as C-sections occur when women have a partner present. The childbirth experience is also a positive bonding moment for the spouse and baby.

And while it's far from the ideal solution, Blake pointed out that hospitals have the technology to connect moms with their partners during labour.

"And the staff are going to be knowing that you don't have your support person there, they're going to be there for you for sure," she said.

Jewish General, said Legault, implemented the rule because it's dealing with "many" novel coronavirus cases. The hospital didn't respond to a request for comment.

Quebec Health Minister Danielle McCann said Saturday that she understands why the hospital instituted the ban.

"It was a very, very, very difficult episode," McCann said. "Other hospitals in Quebec and, in general, people can accompany the woman who is giving birth but I think the Jewish General was completely taken aback and very concerned about this situation."

The number of confirmed COVID-19 cases in Quebec had reached 8,580, with 121 deaths, health authorities announced Monday.

Labour unions and several associations representing Quebec midwives pleaded with the provincial government to take a strong stand on the issue of allowing companions at the time of delivery.

In a news release published Sunday, the groups said having someone in the room with a woman in labour is critical for a smooth delivery. The groups said professionals in the health care system were ready to resign if the hospital's decision isn't reversed.

"We are raising an alarm: this directive goes too far," the news release stated. "It serves neither the population nor professional health workers."

The groups said they understand the anxiety of health care workers being exposed to COVID-19 but they said the proper response is to provide workers with more protective equipment as opposed to introducing punitive and controversial measures.

This report by The Canadian Press was first published April 6, 2020.

News from © The Canadian Press, 2020
The Canadian Press

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