Jessica Bourke is 18 weeks pregnant and can't remember the last time she kissed her husband Ian.
When Ian Bourke comes home from his job as a millwright in Calgary, he strips and showers and tosses his clothes in the wash before Jessica lets him near her, and they avoid physical intimacy because of her fear of catching COVID-19.
Less than three weeks ago, Paris Semansky planned to give birth in the Toronto hospital that's just a four-minute drive from her house. But a "switch flipped" when the World Health Organization declared the coronavirus a pandemic on March 11, and so Semansky decided from a "risk mitigation perspective" to give birth at home. Daughter Mira was born on March 22.
Hannah Mitchell had enjoyed a problem-free pregnancy until COVID-19 put Toronto under lockdown, and when the 33-year-old admitted to a sore throat at a prenatal appointment last week, she was quickly masked and quarantined and then sent for a coronavirus test. The appointment was kept brief. Mitchell's doctor was dressed in full gown, gloves, mask and face shield. The test was negative.
Pregnancy and childbirth can be fraught with worry at the best of times, but the exploding global health chaos has cranked up fear and uncertainty to sky-high levels. Carefully drawn-up birth plans are being scrapped, and women have no idea what might be in store for them when they give birth in a chaotic world that is changing at whiplash pace.
"The unique aspects of prenatal care are the fact that we're dealing with two patients at the same time, and the risks for both patients really changes at each stage within the pregnancy and postpartum," said Dr. Dustin Costescu, an associate professor in McMaster University's Department of Obstetrics and Gynecology.
"The other part that makes it a challenge is that prenatal care in particular with the birthing experience is something that a lot of patients and their families prepare for in advance."
One of the issues is distributing accurate information because it's changing rapidly. Costescu, who is also a practising obstetrician-gynecologist, said that within four hours last Friday he received two emails documenting major changes in practice because of COVID-19.
"So the fact that it's changing hour by hour, let alone day by day, makes it very hard for us to give an overall assessment of what that birth experience will look like for a patient in the office and that also adds a level of stress for people," Costescu said.
Some 400,000 babies are born each year in Canada. A key part of pregnancy and childbirth that's changed is the number of support people allowed at appointments and in the delivery room.
Bourke was told Monday her husband isn't permitted to come to her ultrasound appointment.
"This is hard for me because he still hasn't heard the heartbeat," she said. "I'm sure it's just as hard on him. You go into having a baby as a team, and half your team can't be there."
Laura Fournier is scheduled to have labour induced because of gestational diabetes on Wednesday in Calgary. She expects to be discharged within 12 to 24 hours to avoid staying in hospital unnecessarily.
"It is often safe to (send new moms home quickly) for a low-risk birth," Costescu said. "However, there is a higher rate of readmission for newborns. And so we do want to be careful because we don't want babies having to come back through an emergency department for reassessment."
Fournier is only permitted to have one support person — her husband — in the delivery room, and no visitors at the hospital or after they arrive home. How long they need to self-isolate, Fournier said, is anyone's guess.
"And then I'm worried about aftercare too, right? After you're home usually a nurse comes to your house and checks you out. Are they still gonna be doing that?" she said.
Mitchell, who is due April 9, had planned to have both her mom and husband in the delivery room. Now it will just be her husband Will. It's their first baby.
"It's the uncertainty of 'Ok, when can family visit?' If you knew it was two weeks, then you could survive. But if you don't know how long then I think it makes it a bit harder."
Bourke is concerned about being isolated from her support group. She worries about postpartum depression.
"We're physical human beings, and we thrive on being around other people, and hugs, and being joyful and seeing other people's expressions," she said. "And my fiance is still working, so he's gone all day. So I'm basically by myself all the time . . . it's going to be really hard."
Costescu said isolation is indeed a huge challenge. In Canada, women are more likely to die due to perinatal mood disorders, he said, than complications from pregnancy.
"Postpartum depression is a major contributor of morbidity and mortality," Costescu said. "And we know that when parents don't bond with their children early on, it can have long-lasting effects."
He urged new moms to maintain virtual contact with family members and friends, and to recognize when they need help and reach out to the health service workers.
Costescu added that "one could argue . . . for another person to come stay with (new parents) to help look after the child or to provide respite, and so families need to decide what is the risk that they're willing to expose themselves to, to make sure that new parents and children are well cared for. And there's no right or wrong answer for that."
Semansky's days are even more hectic since she and husband Mike have three-year-old daughter Anna at home who would normally be in daycare.
"The newborn is the easy part. The hard part is that keeping a three-year-old from crawling up the walls, and no one to help with that," she said.
Costescu said pregnant women can draw some comfort from the fact that they'll be well-served by labour and delivery nurses who know that things don't always go as planned, but will be with them every step of the way.
"That relationship develops very quickly with your labour and delivery nurse . . . we're still here for you, regardless of how many support people get to be there during the birth experience."
Semansky said her anxiety leading up to the birth was significantly higher than how she felt during the actual delivery or since.
"In the middle of all of this (chaos), there has been something kind of magical about life continuing, about meeting somebody that you love before they were here," she said. "And having people from all over — whether it's calling or texting or Facetiming — show how much they love you and love your family and love your baby and how much space there is for newness and happiness and how much energy that gives people . . .
"In the middle of something that feels really scary and really hard, having this little bit of light is pretty special and normal and wonderful."
This report by The Canadian Press was first published March 31, 2020.
Lori Ewing, The Canadian Press