Make sure your birthing support person is the person you feel safest around. Make sure you trust and click with your midwife.
If you are low risk, consider a home or primary unit birth
Take control of the parts that belong to you.
that you can control, let go
of and grieve for what
you can’t.
Learn and be empowered.
And remember that
on the other side of birth,
you’ll get to take your baby
home to your bubble.
M: Yes. Not only is it safe - it's recommended. We now know (September 2021) that the consequences of COVID-19 are more severe for pregnant people. Furthermore, from studying hundreds of thousands of pregnant people, that the Pfizer BioNTech vaccine is not only safe, but also gives good immunity to both you AND also to your unborn baby!
In what ways is COVID-19 worse in pregnancy?
M: Pregnant people are more likely than non pregnant people to develop severe covid, be admitted to hospital, and be admitted to ICU.
What is the Covid Preterm labour risk.
M: We know from the last 18 months that there IS an increased risk of pre-term labour if you develop COVID-19. You are about 60% more likely to have pre-term labour than a pregnant person without COVID-19.
There is also evidence of placental damage from COVID-19. Your best protection is to get vaccinated before, or during pregnancy, and take precautionary measures to minimise your chances of contracting COVID-19 in pregnancy
If you have gestational diabetes can you have a home birth?
K: Your body, your baby, your birth, your choice.
In saying this, many midwives wouldn’t be comfortable providing HB in the presence of that risk factor and we recommend blood glucose testing on baby post birth.
H: There are a few additional risks that come with having gestational diabetes that are worth considering when you plan your birth. Talk through these with your LMC and make a plan together for the safest birth for you and your baby.
Where can I get information on home birth?
K: Home birth Aotearoa + your midwife
H: Informal sources like the Kiwi Birth Tales podcast are also a great way to get information. Remember some LMC midwives don’t do planned homebirths, but they will be able to help direct you to those who do.
Epidurals - Are they Hospital only
K: Yes. Because they are “sited”/administered by an anaesthetic doctor.
H: There are lots of other great pain relief options that are available at home or in a primary birthing unit (like water, TENS, gas and air), but opioids and epidurals are hospital-only.
M: Yes! Click up on the “epidural” tab above to learn more about epidurals.
What about Elective sections in lockdown?
K: Still happening but quite possible your LMC midwife won’t be allowed to attend.
H: At this stage your birthing partner will be able to attend your Caesarean with you, but will have to leave once your baby is born (either while you are in post-op recovery, or when you go to the postnatal ward).
The process to getting to your Caesarean may also look different - your appointment with the obstetricians may be by phone, or shorter than you would be expecting. If you have an appointment in person, you won’t be able to bring a support person.
Access at different isolation levels.
H: This is a constantly evolving area, and may have subtle differences depending on DHB. At this stage, one of the consistent messages is that labouring women will be able to have one specific support person to be with them in active labour and birth, and that person will have to leave the birthing suite when the mother and baby do. There are no visitors to postnatal wards (and sadly this does include baby’s other parent) at this time.
Risk in pregnancy
M: Pregnancy is a time when your body is more susceptible to infection. You are in an “immunosuppressed” state - your immune system downregulates so that it doesn’t try to fight off the tiny human/s growing inside you! Because of this reason, we (and the Ministry of Health) consider pregnant women to be in the “at risk” group when it comes to a COVID-19. New evidence shows that pregnant women and newborn babies may be at greater risk of poor outcomes if infected with COVID-19. Pregnant and recently pregnant women (defined as within 6 weeks of birth, miscarriage, or termination) may consider taking extra precautions.
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What does ‘active labour’ mean?
K: Most of us consider the “active” phase of labour or “established” labour to be from when your cervix is fully effaced (shortened) and 3-4cm dilated along with strong, long and regular contractions.
H: Active labour is when your labour really gets going. It gets you from around 3-4cm to fully dilated, with powerful waves of contractions. Active labour includes the transition phase, which for some women is the last few cm of dilatation and for others is when they are just becoming fully dilated, where your body changes its pattern of contractions from dilating and moving baby to really starting to try to get that baby out. It’s where some women feel overwhelmed, and where some women start to get an urge to push. When you start pushing, that’s the second stage of labour - getting your baby down and out!
Postnatally - How can we get help or support after baby’s birth
H: Your LMC is the perfect starting point to connect you with local supports. There are a number of online support groups set up recently where you can connect with other expecting mums or new mums, as well as people with local connections. Ask around. Your GP is also always available if you need them - it may be by phone consultation at the moment, but we are always willing to help and connect you
with the right people. If you are struggling with low mood or anxiety, there is always someone to talk to by texting or calling 1737.
How to cope on the postnatal ward after a section without your support person
K: The midwives will be there to provide practical and emotional support but for a c section or complicated a great idea to stay really on top of pain relief, early mobilisation and consider discharging to a local birthing unit or home after a day or two (where possible).
For a straightforward birth, consider a planned early discharge either home or to a birthing unit.
H: Keep connected with your support network online via video as well.
How long after your birth can you go home safely?
K: Generally for a really straightforward, unmedicated birth we like you to stay 2 hours. This is to make sure that your bleeding isn’t too heavy. If you have an instrumental delivery or epidural we recommend 4 hours.
M:For a caesarean section you can go home from about 24 hours, especially if this is a repeat elective caesarean. Otherwise 36-48hrs might be more realistic.
How can I help my own recovery from my Caesarean?
M: There's a lot of research around this topic! We know that if you
- Get up after about six hours
- Eat and drink as soon as you feel like it
- Get your urinary catheter out as soon as you can
- Use pain relief so you're comfortable
Then you're more likely to have a better recovery (and get home to your supports sooner).
How do I get support for baby blues?
K: Your midwife and GP! Your midwife will still provide postnatal care for 4-6 weeks post birth. Some of this may be over the phone but you will definitely still have access to care and support.
Should I still try and conceive a baby?
K: I would say safety wise: yes.
Sometimes babies can take awhile to conceive. I wouldn’t wait.
Availability of services (referrals for scans/complications etc) wise: no
H: This is a tricky one and one that we as a group are a bit conflicted on. On one hand, we don’t know how long this period of lockdown and disruption is going to last for - it may be months or longer, and this is a long time when you are desperate to be pregnant. On the other hand, this is a hard time to be pregnant, and brings a lot of worries with it (as demonstrated by these questions). There is also the concern of the added health needs of pregnant people at a time when the health system may face great pressure. I think this is a very personal call, as it is at any time.
What is the risk to babies under 1?
H: We haven’t seen any good evidence that babies are at high risk from this illness. But, we do know that little babies as a whole are vulnerable and that they need our protection. There are the added issues for small babies of feeding - when they get sick, it can be difficult or impossible to keep them fed and hydrated, and this is often the reason that sick babies need medical attention. I’m sorry I can’t be more specific than that, we just don’t have the answers.
M:The problem with this virus is that there is so much we don't know about it! There is one study that observed patients in Wuhan and noticed that babies under 1 might be higher risk than children aged 1-14years. In that group, only babies who had quite serious underlying health conditions became seriously ill however.
New Zealand focussed information
to help pregnant people have an empowered and positive birth *Views are my own and don't replace medical advice*