Giving birth in the COVID-19 era,
Discharge after 12 hours halves time in hospital for healthy families
Like most expectant mothers, Emy Darragh grew increasingly nervous in the final days of her pregnancy.
But for this birth — her third — Darragh was more afraid of getting infected with COVID-19 while in hospital than of the exhaustion, pain and uncertainty of labour.
But Darragh’s fears gave way to joy and relief after she met her baby — a healthy girl named Peyton — and found out they both could go home 12 hours, not days, after giving birth at Mississauga Hospital.
“I couldn’t believe I could go home to my family so quickly,” said Darragh, who lives in Etobicoke with her husband and children. “To have everything work out, and to get out of hospital so fast and introduce her to everyone else in my family, that was a huge relief.”
Darragh, whose daughter was born late at night on May 24, is among the first families to benefit from a new program at Trillium Health Partners (THP) that allows healthy mothers and their babies to leave hospital within hours after birth. Typically, mothers who deliver with an obstetrician must remain in hospital for at least 24 hours for followup care, including a newborn hearing test and blood work that screens the baby for 25 rare diseases.
Now, mothers and babies who qualify for the Early Discharge Clinic can leave hospital straight from the birthing suite and return the following day for their checkups and critical tests. THP has an Early Discharge Clinic at Mississauga Hospital and Credit Valley Hospital.
Doctors who launched the clinic two weeks ago believe it’s the first of its kind in the province. They say it’s a solution for those who are wary of being in hospitals during the pandemic, even though hospitals are a safe space, and for families who want to remain together after birth.
Currently, THP does not allow a birthing mother’s support partner to stay with her in the postpartum ward — a policy in line with its hospital-wide visitor restrictions during the pandemic. A THP spokesperson said exceptions are made for some patients, such as those who are critically ill or who those who need communication supports that can’t be done virtually.
“We know patients want to be home with their families if they possibly can,” said Dr. Catherine Taylor, a pediatrician and THP’s service medical director for the NICU and neonatal services. “The clinic is a creative solution; it brought a lot of different people together to make it happen. We know it matters to give the right care for mothers and babies in this special time.” Even as many aspects of health care have been put on hold due to COVID-19, the number of babies being born in the pandemic hasn’t slowed.
At THP, which delivers about 9,000 babies across its two hospital sites every year — more than any other community hospital system in the province — obstetricians and midwives are heading into their “busiest season” for births, said Cathy Walker, interim director of THP’s Women’s and Children’s Program.
“On top of planning for a pandemic, making the best possible experience for a patient and their family is something that all our interdisciplinary care providers are constantly thinking of,” she said. “It’s a challenging time and we want to provide the best services for them. It’s such a milestone event in their life.”
At the Early Discharge Clinic, staff check the health of mom and baby, including vital signs, offer breastfeeding and other care advice, and answer any questions that have come up during the time at home. The team performs the required newborn screens and tests — and provides some results — all within the short time the parent is in the hospital.
In addition to the clinic, THP’s Women’s and Children’s team has identified and found solutions for other potential gaps in postpartum care that have emerged during the pandemic.
Some family physicians in the region have temporarily stopped seeing patients in their offices because of a lack of personal protective equipment. So pediatricians and midwives at THP stepped up to care for patients unable to see their own family doctor; newborn visits are critically important to identify health concerns and feeding issues, Walker said.
With physical distancing measures in place, new parents don’t have the help of extended family in the difficult days and weeks after birth. So THP’s Women’s and Children’s Program quickly added additional in-hospital breastfeeding supports and started calling families 48 hours after discharge for a further checkup, said Walker.
“We ask if the baby is sleeping, how the baby is feeding, if there are any concerns with mom or baby, any signs of jaundice, and if there are issues we can refer them back to a family care provider,” she said. “We really want to safeguard every mom and baby.”
The Midwifery Division at THP has helped solve one of the bigger challenges for delivering postpartum care during the pandemic. The group of 24 midwives is going into the homes of new mothers with COVID-19.
So far, the midwives have provided postpartum and well-baby care for three women with the virus who were in the care of obstetricians at THP. These women were well enough to be discharged from hospital, but could not see their own family physicians because they have to self-isolate. The midwives have also provided care to a pregnant woman and a new mom with COVID-19 in their own practice.
Registered midwife Avni Garg volunteered to care for a new mom with COVID-19 during her first week working with Midwives of Mississauga. At first, Garg was hesitant to come into direct contact with a patient with COVID-19, but she said her trepidation was soon overtaken by her desire to help.
“I kept thinking, if I was in her shoes, with a newborn baby, quarantined at home with this virus, it would feel so isolating. If I could provide, in any way, some level of comfort and care, to make her feel like she’s not entirely alone, that was a turning point for me.”
Garg visited her patient twice in her home, each time connecting before and after with the new mom’s family physician. The mother, who had tested positive but had no symptoms of the virus, was able to see her own physician once she had quarantined for 14 days.
Like Garg, registered midwife Mariah Flynn was also nervous ahead of seeing her first patient with COVID-19. THP provides the midwives with full PPE, and Flynn was careful ahead of each visit to don and doff it properly.
Still, she said, best practices during the pandemic are to do the majority of care virtually and only go into a patient’s home for the hands-on portions, including an assessment of the mom’s health and weighing the baby and taking his or her vital signs. Even though she only saw this patient during her two-week quarantine, Flynn said she did her best to develop a rapport and be available anytime she had questions or concerns.
“They are isolated in their homes and quarantining with their babies and don’t have supports around them. Doing everything we can do to meet their needs is important.”
Remi Ejiwunmi, a registered midwife with Midwives of Mississauga, said while the COVID-19 outbreak has undoubtedly brought new challenges to prenatal and postpartum care, the virus has also forced health workers to find creative ways to help families — something she hopes will continue after the pandemic ends.
“Parents are worried. They ask: Am I safe, is my baby safe. All of these questions and their anxiety are heightened in the current circumstances,” Ejiwunmi said. “But it’s also this unprecedented time of innovation and collaboration where we’re finding new or different ways of doing things.”
Two weeks after its launch, Walker said obstetricians are now telling pregnant patients about THP’s Early Discharge Clinic so parents, should they qualify, can plan to take their baby home hours after birth. With the pandemic stretching into the summer and beyond, Walker expects it will be a welcome option for many new families.
Darragh, the Etobicoke mom of baby Peyton, said the clinic eased her fears of giving birth during a pandemic. Not only was she scared of catching the virus at the hospital, but she dreaded being in the postpartum unit without her husband. “He had to go home about two hours after Peyton was born,” she said, adding that she understands visitor restrictions are in place to protect patients and hospital staff from getting COVID-19. “It is what it is. But it’s still really stressful. Labour is such a heavy thing. It would have been nice to have him there to help me.”
Darragh found out about the clinic three hours after Peyton was born — and one hour after Michael went home. She quickly opted to go home early and only had to spend one night, not two, in hospital.
The next day at the Early Discharge Clinic, Darragh and Peyton received postpartum and well-baby care and found out how to receive additional help, if needed. Darragh, grateful her third child is healthy, said she wishes the clinic had been available after her previous births.
Obstetricians are now telling pregnant patients about THP’s Early Discharge Clinic so parents can take their baby home hours after birth