More than 1000 women will give birth during the next four weeks while New Zealand is in nationwide self-isolation due to the Covid-19 pandemic. Many are anxious and scared amid so many unknowns. Kirsty Johnston reports.
Katie Williamson's waters broke the morning it was announced the whole country was going into lockdown to try to stop the spread of coronavirus.
Her baby - her third child - was two weeks early. When she and husband Adam heard the news about New Zealand's nationwide isolation, they were on their way home from hospital because, despite the indication the baby was ready to come out, Katie hadn't yet gone into labour. The Wellington couple had 24 hours to wait before being induced.
"We saw the announcement and thought 'we don't know what that means for us,'" Adam says. "But on Tuesday morning we went back to hospital and had to just put it out of our minds."
Their two girls, Sophia, 6, and Madison, 4, were sent to their grandparents' house, with Adam aware he would have to pick them up before Wednesday midnight when the lockdown began, or risk breaking the pandemic protocol.
Katie, already unhappy about needing to go to hospital, rather than the planned birthing centre, said when they arrived at the hospital she felt overwhelmed.
"It was nerve-wracking, you're in the entry and you have to fill out a form with all your details, and there are people everywhere with hand sanitiser and wearing masks and it's like … is this safe?" she says.
"It was surreal. A surreal, weird time."
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For Katie, and the hundreds of others who will go into labour during the lockdown, the pandemic adds unwanted anxiety to an already stressful time.
Women are worried not only about catching the virus but about how it will impact their birth plans, their ability to cope and their babies' first vital days.
For example, when Katie gave birth, she was allowed only one support person during labour. Although the staff were amazing, the atmosphere in the hospital was very tense. Then, when Katie returned home with her little boy, the midwife could come for only 15 minutes, rather than an hour.
"Our baby is doing really well," Katie says. "And the birth once induced was actually amazing, it was really fast. It was the unknowns in between that were stressful."
Pregnant Auckland woman Sophie Moskowitz said she had the exact same feeling.
"I'm pretty anxious to tell the truth. Before this I was excited and looking forward to it all and now there's just a lot of unknowns."
Sophie, an early-childhood teacher who is 35 weeks pregnant with her second child, said she had never worried about germs before but had "done a 180" and was now carrying antiseptic wipes everywhere. She also started maternity leave early to go into isolation.
"The main thing is not wanting to be exposed to other germs," she said. "There are just so many questions. We're trying to figure out where the safest place to birth will be … I'd planned to go to Birth Care but now we are looking to birth at home … also if we have our midwife there ... if she's been to other births and hasn't been in our bubble."
Sophie said although she was relieved about the lockdown as it slowed the spread of the virus, its restrictions also added stress and she was worried that would affect her birth outcome.
"I wanted to have a relaxed birth, without intervention, but that's about keeping your anxiety in check and that's really hard right now."
Auckland obstetrician Michelle Wise said it was understandable that pregnant women were worried, but she wanted to reassure them that all maternity services were still operating.
"It's an anxious time for everyone - I can only imagine what pregnant women are feeling," she said. "There's so much out there on social media and it's scary. But pregnancy care in New Zealand is an essential service and all of us are working as usual."
Wise said that since the lockdown was announced - and well before - midwives and obstetricians had been working around the clock to ensure maternity services would stay open and would remain as normal as possible.
She said the most important message for pregnant women was to avoid being exposed to the virus in the first place. Pregnancy placed the body at higher risk because of the physiological changes during pregnancy to the heart, lungs and immune system.
Although research on pregnant women during Covid-19 was limited, there was information from the experience from Sars and Mers - previous coronaviruses - and from influenza.
"The good news is that from the Covid-19 data out of China we can't see that pregnant women are getting more severe symptoms than a normal adult. Most are mild to moderate cases. But some will be severe, so they need to avoid exposure."
The main changes to the maternity service would be during consultations. Wise said doctors were running virtual ante-natal clinics and check-ups, however if they needed to physically examine a patient, they would ask them to come in - while maintaining social distancing.
There was also more pre-screening for coronavirus symptoms before appointments or arrival for labour. The Ministry of Health has advised that if a woman has symptoms, hospital birth is her only option. If there were symptoms, staff dealing with those patients were given a mask and other protective gear.
"But this is to keep everyone safe - the screening is in no way designed to deny care," Wise said.
College of Midwives acting chief executive Jacqui Anderson said the same applied to midwives.
"We are very much trying to reassure women they will continue to receive care and that we will try to keep them in the community as much as possible rather than the hospital."
Anderson said any woman who had a complex pregnancy or had a caesarean section planned would still receive hospital care.
"Those are acute services. A baby has to be born. It's not a hernia that can be put off for six weeks."
Midwives would also honour physical distancing protocols, so some postnatal visits might become virtual, or be shortened, she said.
Anderson said she knew there were concerns about what might happen if a midwife became sick - particularly given shortages in some areas - but the college was working with the Government about extended locum cover and received extra funding for that.
"Where women are having babies and need care, it will be available," she said.
Both Wise and Anderson said a more important aspect for women to think about was their post-natal support.
Currently, while most hospitals and birthing centres are allowing a support person to stay with a woman during labour, many have implemented no-visitor policies. That meant women needed to be more prepared before birth began - with a bag of snacks and clothing, for example.
But they also needed to think about support at home afterwards.
"Where normally, many women might have had aunties or sisters or grandparents to help, you won't have that," Anderson said. But there were bright sides.
"Many women who might not have had partners at home normally, they might do now."
Wise said it was also vital to think about mental health - 70 per cent of women would have maternity blues - emotional ups and downs and mood changes - after birth.
"The important thing is to get support - the first line is their midwife - and then support from those around them virtually, like a post-natal coffee group through Zoom."
"And just focus on sleeping, eating, staying hydrated and looking after their baby."
Wellington woman Emma Cooke, whose first baby is due at the end of April, is one of the women who will be impacted by the new restrictions - her birthing centre does not allow visitors.
She said it was scary to think of having a baby and then being unable to have her partner with her.
"I saw those restrictions for the first time today and it got a bit more real," she said. "But it's understandable. It's crazy, but I know everyone is doing what they can."
She said it was weird to think her baby might go weeks without meeting anyone but her and her partner.
"But the baby won't know different, I guess. Lots of people have told me the newborn stage is kind of like self-isolation anyway. And I know the midwives will be there doing their best."
At home in Upper Hutt, Katie Williamson said her new baby was doing well. He was yet to be named. They had video-called friends and family to introduce the new arrival but were missing having visitors.
"I'm sad other people can't meet him and have newborn baby cuddles, but I'm lucky to have Adam home and spend time with him and other kids," she said.
"We have lots to be thankful for. It's hard but we are all experiencing it and all in it together."
•To find your hospital or birthing centre's policy on support people during labour or birth, check their website. Not all sites have the information, however. You may need to ask your midwife or call the service.
•To read the latest RANZCOG advice for pregnant women, click here
•To read the WHO information about the affects of Covid 19 on pregnancy, click here
•The New Zealand College of Midwives have regularly updated information here
•Join the Facebook support group for pregnant New Zealand women during Covid 19. This group has been created for women by women and is not a group for medical advice but for social and emotional support.
• The Ministry of Health's guidelines for breastfeeding during Covid 19 are here