When Sonia Bhushan left her parents' home on Sunday night, emotions were running high.
"It was kind of like, the next time I see you I might have a kid and she was crying as I drove away," said Bhushan of her mother, who was scheduled to return to work on Monday after being at home for a few weeks.
Bhushan is 38 weeks pregnant, with her first child due on April 17. As the COVID-19 crisis continues to spread throughout Ontario, Bhushan is one of many women now having to alter their birthing and post-delivery plans because of the pandemic that has upended health-care systems and economies across the globe. These expectant mothers are facing stricter policies such as only being allowed to have one person with them during the delivery, fears over the possibility of a change in such policies and their partners not being by their side, postponed first meetings with family, heightened stress and tough decisions such as switching hospitals.
Bhushan had planned for both her husband, Hamid Fozdar, and her sister who lives in the Netherlands to be with her during the delivery at Milton District Hospital. Her sister had been looking up doula videos online to get some tips to support Bhushan.
"We don’t even know when she’ll be able to come and see the baby now because their flights have just been postponed indefinitely," said Bhushan, adding that she's been told she is now only allowed to have one support person with her, but that it needs to be the same person for the duration of her stay. So far she hasn't been told that Fozdar will have to leave a few hours after she gives birth and she hopes that won't be the case.
After being discharged from the hospital, they will be self-isolating for two weeks in case they were exposed, she said. That means their parents — who are all over 60 and more vulnerable to COVID-19 — won't be able to meet the baby during that time.
"Obviously not having any of the grandparents able to come to the hospital is really sucky [or] not knowing when the grandparents will even get to see the baby," she said. "A lot of it is dealing with the family side of it and all that excitement and support that we were always kind of relying on, which is gone now, that’s the biggest impact."
The prenatal yoga class she had been attending has moved online, which has provided Bhushan with a "sense of community" since she's still interacting with the people she was regularly seeing for the past several months. But other appointments she had booked months ago in order to help her in lead-up to the delivery, like massage, chiropractor and acupuncture sessions, have all been cancelled.
Her last day of work as a Grade 2 teacher with the Peel District School Board was on March 9 and since then both Bhushan and Fozdar have spent time reorganizing their entire home.
"Everything is ready to go, diaper bag is packed, my hospital bag is packed, Hamid’s hospital bag is packed, I even have a bag of snacks packed for the hospital," she said with a laugh. "We’re just waiting."
Bhushan and Fozdar went for her now-weekly appointment with the obstetrician yesterday. Due to COVID-19, only patients were allowed to enter the doctor's office.
"The [obstetrician] did mention yesterday they’re expecting the peak to happen in two weeks and that’s when I’m due, so that part is kind of scary that what if something happens and the hospital’s overloaded and the resources are strained at that point?"
One of Bhushan's fears is what would happen if the hospital changes its policy and her husband isn't allowed to accompany her.
"I think beyond anything, I just want them to not take away the ability to have your partner there, you can’t do it alone," she said.
Ontario's Chief Medical Officer of Health Dr. David Williams said health officials are trying to be sensitive to this. He recommended two weeks ago that hospitals only allow essential visitors into their facilities.
But the constantly evolving policies to tackle this health crisis has some, including Bhushan, hoping their babies arrive early.
"Knowing that it's getting worse day-by-day, it's almost like, 'come on baby, come early, let's get this over with,'" she said. "Hopefully baby comes next week and it's all done. I just want to get it all over with and just be home and then just figure out the rest...from there."
Dian Chan, who is due on April 6, echoed Bhushan's thoughts.
"Honestly I just can’t wait at this point, just because things are changing, it's very fluid, and I'm like 'just come out now,'" she said.
Chan was scheduled to give birth at Credit Valley Hospital, which is part of the Trillium Health Partners (THP) network, but the hospital declared an outbreak in an inpatient unit on March 30 after four patients tested positive for COVID-19. Chan is now requesting to be transferred to the Mississauga Hospital, which is part of the same network, because she's concerned about delivering in a hospital with an outbreak since she has a two-year-old son, Matthew.
Chan met her midwife two days ago; her appointments, which would typically be each week after the 36-week mark, have been moved to every two weeks because of COVID-19.
"They were discussing my options and my anxiety level yesterday just shot up," she told QP Briefing on April 1, saying that the COVID-19 crisis has been an "added stress at this point in [the] pregnancy."
"When I stopped working and I started focusing on the upcoming weeks of delivery, that's when it actually hit me [that] things are changing, this will affect delivery, this will affect our plan, I may have to change hospitals," said Chan.
One of the uncertainties she now faces is what happens if the second hospital also has an outbreak and she needs to go elsewhere, especially since her midwife is connected to the Mississauga facilities.
"I know there are options, but you can never really prepare," said Chan, who is a pharmacy technician at Oakville Trafalgar Memorial Hospital, adding that her fears include reduced staff at the hospital, the availability of specialists if needed or potential drug shortages.
Chan said if the baby doesn't come on time, her preference would have been to wait until the baby was ready, but that would require more ultrasounds, which would need to be done at the hospital.
"I don’t want to do that, I want to limit my exposure to the hospital because of COVID-19," said Chan, who added that the alternative was to set a date — April 14 — to be induced.
Chan and her husband Jonathan even considered the option of delivering at home, which was starting to sound more "appealing" given the pandemic, but the drawback, she said, is that there would be limited pain management options compared to in a hospital.
Following the birth of their first child, the Chans had several family members visit them at the hospital, but it will be different this time around — no visitors in the hospital and none at home.
"Unfortunately there’s no visitors, we’re not accepting any visitors," she said with a soft laugh, speaking of their plan once they return home. "It would just be the four of us adjusting; as to what that would look like, we have no idea...we're going to take it day by day and see."
She said she's allowed to have one person with her during the delivery and if both mother and baby are fine, they could be discharged between three to six hours after the delivery.
That's not much of an issue for Chan, who would prefer to go home even sooner and without being transferred to a recovery room, which could end up being a shared space.
"I told them I do not want to be transferred there as much as possible just to limit the exposure," she said.
But more of a concern is the possibility of her husband being sent home earlier than her or not being allowed in at all.
Having her husband with her during her first delivery was both an emotional and physical comfort, Chan said.
"Just him being there, (the) emotional comfort, knowing that I’m not going through this alone," she said. "He was doing the hot compress on my back, because that’s where the pain was, doing the hip squeezes and a little bit of massage and then going to get some ice chips for me and just holding my hand and trying to calm me down through every contraction."
Stories have emerged of women preparing to give birth without any loved ones beside them in places like New York City, but on March 28, New York Governor Andrew Cuomo issued a new order requiring hospitals to allow women giving birth to be accompanied by "one support person who does not have a fever at the time of labor/delivery."
This came after two private hospital networks said they wouldn't allow anyone to accompany women during their deliveries, a move that prompted more than 600,000 people to sign a petition opposing this restriction.
On March 19, Ontario's chief medical officer of health issued a memo to all hospitals in the province saying officials "strong recommend" that acute care settings "only allow essential visitors until further notice."
Williams identified essential visitors as "those who have a patient who is dying or very ill or a parent/guardian of an ill child or youth, a visitor of a patient undergoing surgery or a woman giving birth." He also recommended that hospitals conduct proper screening of these visitors including asking whether they have any COVID-19-related symptoms, have recently travelled outside of Canada or have been in contact with someone who has COVID-19 or has travelled and is experiencing symptoms.
"Those who fail screening will not be permitted to enter," Williams wrote. "No other visitors should be permitted to enter these premises, instead they should be asked to keep in touch with loved ones by phone or other technologies, as available."
Following Williams' memo, hospitals across the province started updating their policies on visitors, saying they would no longer be admitting visitors except in certain situations.
Mackenzie Health in Richmond Hill, said they would allow "one consistent visitor for the duration of their hospital stay" for women giving birth.
It was similar for THP, according to spokesperson Lyndsay Carter, who said the current policy was one visitor in the birthing suites and that the health-care team would determine the length of time a new mother could stay in hospital post-delivery. Asked whether the outbreak at Credit Valley would result in a change of policies, Carter said "as the situation around COVID-19 rapidly evolves, we will continue to assess our policies and make changes as necessary."
Williams labelled the memo as a "guidance document" during a media briefing on Thursday, saying he wanted to give each institution "enough latitude" to make their own decisions to place limits, but also be "sensitive and ethically principled as far as dealing with people in unique challenges."
Each hospital is dealing with their own issues and circumstances, like outbreaks, he noted.
"I didn’t want to prescribe it...outright, because I wanted to leave the administration and the health-care professionals at the institution to use their better judgement to decide who they should allow or exempt from it at that time, perhaps with some proper personal protective equipment on, or for certain periods of time, or in certain rooms and certain areas," he said.
Asked whether he plans to tighten his recommendations to hospitals or whether he would step in if a hospital decided to go the same route as the ones in New York City, Williams said he's trying to be sensitive to that.
If a large outbreak happened in a hospital and there was a chance of infection being transmitted, the facility "may want to take some steps depending on the advice of your infection control committee to really get limiting," he said, adding however that those would be "pretty unusual circumstances."
"We’re not there today and I guess we’re going to have to face it if it comes up at that time, but again we’re going to be advised by that institution and what circumstances they’re in, working with of course the regional (and) Ontario health level to see if there are other ways to deal with it," he said, including finding another facility where an individual could give birth.