COVID-19 and the Impact on Labour & Delivery in Ontario

There is not a single person who has not been impacted by the global COVID-19 pandemic at this point in time. It has altered who we can see, where we can go, and even whether we can continue to work or not. Everyone is concerned about the risks of contracting the disease or unknowingly passing it on to loved ones. In order to protect ourselves from each other, people across the country and around the world are self-isolating and practicing social distancing when they have to be outside of their homes. Effective social distancing means limiting the people you come into contact with and keeping a distance of at least six feet between yourself and any person who is not part of your household.

Social distancing is starting to become the norm in the public spaces that remain open, enforced by lines taped on the floor of a grocery store, or plastic guards separating retail workers from customers. It is also now being enforced in various ways in our hospitals and medical centers. Most hospitals have cancelled elective procedures and implemented strict visitation rules, allowing only those with loved ones in palliative care to enter.

In addition, hospitals are also beginning to place tight restrictions on support people allowed to be present during labour and delivery. Whereas previously one might have multiple support people present in the delivery room, such as their partner, a parent and even a doula, most hospitals are now limiting women in labour to one person only. In some hospitals in New York City, an epicentre of COVID-19 in the U.S., women are being told they can’t bring anyone into the delivery room with them at all.

This is causing a lot of additional anxiety for those who are expecting to deliver in the next few months. In addition to disappointment, many are scared of what the impact may be if they experience complications during the birth. Having people in the room in addition to the medical staff means having advocates who are paying attention to any changes. Especially in today’s new world, doctors and nurses may come and go, checking monitors and asking questions, but only a support person would be by the mother’s side the entire time. By limiting personal support in this way, particularly when medical staff are busier than ever, are hospitals potentially exposing mothers and babies to a higher risk of injury?

Balancing Risk

The risk of bringing additional people into the delivery room, or even waiting rooms, is real. It has been established that it is possible certain carriers of COVID-19 may be asymptomatic yet still be able to pass the disease on to others, so limiting unnecessary bodies in the room makes good sense. In an attempt to flatten the curve and reduce the strain on our medical teams and resources, it is important to slow the spread of the disease as much as possible.

However, there is another risk that must be considered: the risk of insufficient monitoring during labour, which can result in medical professionals missing signs that the mother and/or the baby may be in distress.

Even in the best of times, hospital staff can be stretched thin. Physicians are tasked with monitoring several patients simultaneously for signs of trouble, and ‘human error’ can mean that signs of danger are missed, resulting in severe injuries. However, hospitals are currently dealing with unprecedented numbers of patients owing to COVID-19 and are often short on staff due to mandatory quarantines or illness.

In New York City, where most hospitals have completely banned any support people from accompanying a woman in labour and delivery, this has left many patients concerned and anxious about their impending birth. In an article in the New York Times, a doula expressed concern about what elimination of support people could mean for women and babies:

I think it is deeply dangerous to have women laboring alone…Yes, there are call bells and monitors, but that does not replace having someone in the room 100 percent of the time.

She also expressed concern that these policies might disproportionately affect women of colour:

We see that, generally, black women are less believed when they are expressing pain or discomfort…They receive less face to face time with care providers and nurses.

The risk of missing signs of a baby in distress during labour and delivery are myriad and can result in serious and permanent injury or even death. Some of the most common birth injuries include cerebral palsy, spinal cord injuries and shoulder dystocia, any of which can leave a person requiring medical care for the rest of their lives.

What Are the Risks of COVID-19 to Pregnant Women and Babies?

At the present time, there is no known specifically-identified vulnerability in pregnant women or fetuses with respect to COVID-19, however, this is a new disease and any long-term effects will not be known for quite some time. A preliminary study carried out by the World Health Organization of 147 pregnant women in China found that “pregnant women do not appear to be at higher risk of severe disease”. However, as stated, this is a study of a limited number of patients over a short period of time and it may not tell the whole story.

Women Considering Alternative Options to Hospital Delivery

Owing to the recent changes regarding support people in the delivery room, and also to concerns around attending at a hospital during the current pandemic, many people are looking into last-minute home birth options. Without a hospital’s restrictions, it is possible to have both a partner and a doula and/or midwife present. However, home births come with risks as well. In the case of complications, women may still need to be rushed to a hospital if a midwife or doula is unable to safely deliver a baby in distress. There is also the additional risk of opening up one’s home to outside people, who may be infected with COVID-19 and not know it.

It is important to recognize that negligence or errors by midwives and doulas can certainly take place at home during a home birth. Midwives and doulas can also miss signs of a baby in distress during labour and can result in serious and permanent injury like cerebral palsy or even death. If there is an obstetrical emergency, it is impossible to do an emergency cesarean section at home. That is why high-risk pregnancies are supposed to be delivered in a hospital and not at home.

This is an unfortunate situation that presents a series of considerations for anyone facing an upcoming delivery. Home, or hospital? Spouse or doula? Women across the province will likely soon be facing a number of choices they didn’t anticipate with respect to the upcoming delivery of their child, creating additional stress around what should be a joyous event.

Patients who suspect that they’ve been the victim of obstetrical malpractice should consult with a lawyer as soon as possible. Depending on the specific circumstances, patients and their families could be entitled to significant compensation including damages to cover the injury itself, compensation for expenses related to the injury, and any costs of future care if necessary.

The highly experienced medical malpractice lawyers at Sommers Roth & Elmaleh in Toronto have helped hundreds of families whose lives have been affected by complications caused by improper medical care, including obstetrical malpractice or hospital error. Contact Sommers Roth & Elmaleh by phone at 844-777-7372 or online to schedule a free consultation.