The countdown to your due date can be nerve-wracking at the best of times but in the midst of a global pandemic, with new restrictions being announced seemingly every few days, it can be hard to know what to expect and whether there’s any point in writing a birth plan at all. But rest assured that it’s still possible to have a fully empowered birthing experience – you just have to be prepared for the unexpected (which is actually par for the course with any birth).
“You should absolutely still put a birth preferences list together, but be open and flexible, and try not to set your heart on something specific,” says UAE-based hypnobirthing specialist Jasmine Collin. “But you can still ask questions and equip yourself with knowledge about your choices, even if a few of them have been put on hold for a while.”
Nicola Oliver (Thefitmidwife.com), a pre and postnatal educator and UK-trained midwife practicing at a Dubai hospital agrees: “There are some restrictions on birth and labour options now, but my advice to anyone expecting a baby soon is to stay strong – a healthy mum and baby is the best outcome for everyone.”
Will I still be able to have the water birth I’ve always wanted?
Although there are now several hospitals in Dubai that offer water births, these are currently on hold in most hospitals, says Dr George Michailidis, Consultant in Obstetrics & Gynaecology and Maternal & Fetal Medicine at Genesis Clinic: “Due to the risk of cross infection or contamination and the difficulty of using appropriate PPE (Personal Protective Equipment) for the caring staff, water birth and labour in water are not recommended at the moment and most hospitals have stopped offering it.”
But while water birth itself might be off the table, it’s still possible to use water during your labour, points out hypnobirthing specialist Jasmine Collin: "You can still make use of the shower, which is fantastic, and using your bath at home or possibly at the hospital are great ways to still use water in labour.”
Will I still be able to have my birth partner with me the whole time?
Dr George of Genesis Clinic says: “In the current setting of high prevalence in the population of COVID19 positive people, hospitals are trying to minimize possible exposure by reducing the number of people who are allowed with the labouring mother. At the current moment your birth partner is allowed to be with you during your labour and they are advised to minimize unnecessary movements in and out of the labour room.”
Midwife Nicola says: “Hospitals are reducing visitors to one or even none on the postnatal ward. Unlike in some parts of the world, birth partners are still allowed in the labour and delivery room.
"The UK’s Royal College of Obstetricians and Gynaecologists’ guidance states that a birth partner is allowed, but they must be asymptomatic. If anyone in your support network shows symptoms, please ensure they are not accompanying you to hospitals. Make a back-up plan!”
Can I still have more than one birth partner?
“Different hospitals have different rules but all advice to have the absolutely necessary people being with you,” says Dr George. “In general, most units will not allow more than two people while some are stricter and only allow one person to be with you.”
Will I still be able to have a doula with me at my birth?
“Hospitals have their own rules about allowing doulas to attend birth and in general each doula needs to be vetted by the Obstetric team. Whether they are allowed or not in the current climate depends on the individual unit but should follow the rules for the maximum number of people allowed to be with you during your labour,” says Dr George of Genesis Clinic.
Hypnobirthing expert Jasmine Collin adds: “Doulas do seem to be off the table at the moment, because in most hospitals you’re generally only allowed one person with you at the moment, which is usually the father.”
However, a number of doulas are offering their services online and can provide you with virtual doula support in the lead up to your birth, during labour and postnatally.
Will I still be allowed visitors in hospital after the birth?
“You should minimize the number of visitors to the hospital in order to minimize the risk of transmission of COVID19,” says Dr George. “Birth photographers are not normally allowed now, and most units will not allow small children to visit. You should check with your hospital regarding visiting policies as they are subject to change at short notice as a response to the COVID19 pandemic evolution.”
Nicola Oliver adds: “Hospitals are reducing visitors to one or even none on the postnatal ward. If you are birthing your baby in a hospital which allows visitors, please do not bring them. Control your family space, make sure that you are interacting with as few people as possible to protect yourself and your baby.”
But although you may not be able to have visitors in person at the moment, this does not mean less support for you, adds Nicola: “Not a day goes by at the moment when I am not on Zoom checking a baby’s breastfeeding latch or talking through a birth plan or just having a chat. Please use the support, make sure you are using properly qualified practitioners as any concerns over the phone or online need to be addressed using the right set of questions and clinical knowledge.”
See our list of the pre and postnatal support services which have gone online to offer virtual support for parents.
Is it more or less dangerous for me to have a C-section (CS) now?
“Your obstetric team will advise you on the need and risks of a CS depending on your pregnancy or labour progress. The risks of the CS are dependent on your personal risk factors and not on what is happening in the community with COVID19,” says Dr George.
Should I be worried that there may be a shortage of doctors by the time it comes to my delivery date?
Although other parts of the world are suffering from a shortage of medical staff during the pandemic, the experts agree that this is not currently the case in the UAE. “No, you should not be worried about this, your obstetric team will have – and is obliged to have - appropriate cross cover arrangement for all of their patients,” says Dr George. “The hospitals themselves will provide an extra layer of coverage if your obstetric team or you request them to. At Genesis, we are fortunate to have some of Dubai’s most sought after Obstetricians who can be available in emergency cover situations.”
“No woman should enter the labour ward with that worry,” adds Nicola Oliver. “We are protecting our staff as much as we can, we all wear PPE, we all socially distance when not at work. Honestly the biggest thing people can do to ensure they have healthy hospital staff is to stay at home. We don’t have that option, but people who do can stop the spread.”
I have a high-risk pregnancy - are there any extra precautions I should be taking on the lead up to my birth?
This will depend on your background medical conditions, says Dr George: “The ‘social distancing’, handwashing advice, wearing a mask etc are universal and should be adhered to by everyone. Your obstetrician will discuss with you particular risk factors that may make you more vulnerable, as well as possible actions that should be taken to mitigate them.” Pregnant women in general are classified as vulnerable during the pandemic, not because they are any more likely to catch Covid-19, but because there is some evidence that they may suffer worse symptoms and that there is a link between having the disease and adverse pregnancy outcomes, such as preterm birth. We are still learning about the effect of Covid-19 on pregnancy, but in general you should take care to limit interactions with other people and work from home if you can.
What if there are complications during my birth - are there likely to be a shortage of ventilators or other equipment were I to need them?
“It is very rare for a mother to need ICU / ventilator support due to complications of the delivery,” says Dr George. “The UAE has a high per capita ratio of ICU beds and ventilators. Furthermore, the government has been very proactive in taking measures to control prevent and manage the spread so considering what is happening in the world UAE is a good place to be during this pandemic crisis.”
Has Covid had any impact on the way things happen in NICU now?
“Yes, the already strict measures of infection control in the NICU have become even more strict,” says Dr George. “Although restrictions may be frustrating sometimes, they help for the greater good so please adhere with the instructions of the NICU and help them keep their units clean and free of COVID19.”
Is there anything else that I can expect might be different now in my experience of birth and after care?
“Yes, other than the restrictions on visitors and birthing partners you will notice that the team looking after you will wear extra protective equipment,” says Dr George. “Certain types of birth that are more prone to infection spread like waterbirth are currently not allowed.”
Nicola Oliver adds: “One of the main changes for us as midwives is that one of the first questions we ask when we talk to a woman calling the labour ward is, ‘Have you travelled recently?’ We have to be hyper-vigilant because we cannot take any chances. Our women are more anxious than ever (understandably so) and we are mainly just attempting to remain up to date with the latest evidence so we can have some answers when women ask us what the current situation is.”
These changes mean that staying calm and using coping mechanisms such as hypnobirthing are more important than ever, says Jasmine Collin. “I would say hypnobirthing is probably more useful than ever to gain those tools and gain control over your emotional state using the breathing and the visualisations. Letting go of external control and mastering control of your state is a lesson not just for labour but for all of us right now as it dawns on us that we don’t have any control over the external world.”
Will I still get hands-on breastfeeding help post birth?
“Yes, all large hospitals are offering now breastfeeding support either via the nurses of by dedicated breastfeeding counsellors,” says Dr George. “However, they should have cancelled the group teaching / breastfeeding support sessions. At Genesis we offer antenatal and post-natal support services to help mothers with breastfeeding and lactation, these can be done by video conferencing now to minimize contact if preferred.”
What if I am experiencing symptoms that could be Covid-19 - how would this affect my treatment during birth? Would I be isolated from my baby?
“It is important to give a good and detailed history to your caring team regarding your symptoms as this has very important implications for your baby’s and your family’s health,” says Dr George. “Screening for COVID19 is becoming more easily available. The government has gone to extraordinary lengths to ensure that patients have access to screening and the turnaround time of the results is as fast as possible (about 24-48 h in most cases and is getting increasingly better). If your symptoms are suggestive of a possible COVID19 infection the following steps may be followed:
- The caring team may need to do extra tests like chest x-rays and extra blood tests
- If possible, you will be kept in an isolation room with specific restrictions on visitors and rules on the protective gear people who are with you must wear.
- COVID19 infection is not a contraindication for vaginal delivery but your Obstetric team will discuss with you possible changes in you care depending on your condition and symptoms. In general, continuous fetal heart monitoring is recommended during your labour.
- If you COVID19 results are positive the data is very limited as to what is the best approach to protect the baby from being infected. Early data from China has advised precautionary separation for 14 days. Many units in Dubai have adopted this approach. The current advice from WHO is not be separated by the mother but instead to adhere to strict respiratory and hand hygiene. WHO also advises for the mother to breastfeed again with strict respiratory hygiene, hand cleaning and wearing a mask if possible.
The plan of care needs to be very carefully discussed with your obstetric and paediatric team in an effort to balance the psychological and physical impact of separation of mother and baby against the risk of a possible infant infection. Resource availability would be another issue in those setting that separation is advised as it might be very difficult to offer if there are large numbers of positive mothers. The data is very limited, and the advice is likely to updated regularly
1. If your COVID19 test results are not available by time you deliver the current advice is to be treated as positive until proven otherwise.”
If you are concerned that your symptoms may lead to you being isolated from your baby and you do not want this to happen, the Evidence Based Birth website has a template of a waiver you can print out to say that you do not consent to your baby being taken away from you