Pregnant women have been left confused and worried by the lack of clarity over hospital restrictions related to the Coronavirus pandemic.
While water births have been on hold since the early days of the pandemic, reports that some Dubai hospitals are now also disallowing the use of gas and air – a pain relieving gas mixture also known as Entonox – has seen some pregnant women switching their birth hospital at the last minute.
Dubai-based university professor Hayley Andrews* was 39 weeks pregnant when she found out via a Facebook group that her preferred birth hospital was no longer allowing gas and air as a form of pain relief for labouring women. After calling the labour ward to confirm, she decided to switch hospitals at the last minute to one that is still allowing the use of Entonox, which also meant switching from the ob-gyn she had spent nine months building up a rapport with.
“At 39 weeks I didn't want to risk not having this pain relief and decided it was worthwhile changing, even though the new hospital I switched to takes more than double the time to travel to from our home in Marina.”
Gas and air is a popular, non-invasive form of pain relief for women in labour, and is often the first port of call for women who are hoping to have a birth that is as free of medical interventions as possible.
“Originally I was planning a water birth, but that was the first thing to go,” says Hayley. “Then partners weren't allowed in for antenatal appointments and in-person birth classes were cancelled. I suppose these are things all women are experiencing right now, but so much of the information isn't clear, and many of us in the third trimester are relying on Facebook groups to hear what different doctors have said to different patients.”
Nicola Oliver of The Fit Midwife is a UK-qualified midwife currently practicing at a hospital in Dubai. She says that she hasn’t heard of any reason why Entonox should be banned during the Coronavirus pandemic. “The virus is spread through aerosol particles and we know from research that use of Entonox is not an aerosol-producing procedure, it’s a droplet producing procedure – so when you are breathing the Entonox in and out, you get condensation. We know that if hospitals were able to stick to their normal personal protective equipment (which we are already doing) and patients are sticking to their hand hygiene as best they can then, especially if they are a Covid-negative patient, there is no reason why it cannot be used.”
Nicola believes that further restricting women’s options during labour could put them at a higher risk of a more complicated birth: “It means taking a method of pain relief away from women, which leaves them with more invasive, more costly interventions, that can lead to complications.”
However, the majority of private birth hospitals in Dubai are still allowing the use of gas and air, so it’s important that a pregnant women checks directly with the hospital she has in mind to find out the policies before committing, and bear in mind that policies may also change as the pandemic continues. “We can only comment about the hospitals we are working in, which is Mediclinic Parkview and Mediclinic City, and both of these are allowing gas and air,” say the obstetric team at Genesis Medical Centre. “Epidural is still available, as are gas and air.”
However, water births have been suspended since the beginning of the Coronavirus outbreak due to safety reasons, add the Genesis doctors: “During a water birth, neither the patient or healthcare workers are able to appropriately wear protection equipment. This means both your baby and the staff may be exposed to more risk of Covid -19 transmission. The most recent guidelines state that water birth pools can increase the risk of transmission through bodily fluids in the water. Therefore until further notice, water birth services are suspended.”
In addition to policies on pain relief options, pregnant women should check directly with the hospital for policies on birth partners (in the case of either a natural birth or a C-section, as the policies vary) and also on whether or not you might be required to wear a face mask during labour itself.
Dr Jennifer Kasirsky, Consultant Obstetrician & Gynaecologist at Mediclinic Parkview Hospital, says: “At Mediclinic Parkview Hospital if you have Covid-19 and are in labour then we will ask you to wear a mask. However, we know that this is quite cumbersome and if you are unable to wear a mask we will work with you to make your experience as easy and pleasant as possible.
“If you are not Covid-positive, we encourage you but do not require that you, the patient, wear a mask during delivery - again, we know that this is quite cumbersome and are committed to your safety and comfort. We will require that your husband or birth partner wear a mask when our staff is in the room with you.
“Your partner is allowed to accompany you during a C-section as long as you have regional anesthesia. If you are going to sleep for your C-section (not a usual practice) then your partner will wait for you outside the operating theatre. The idea behind having your partner in the operating theater with you is to support you. If you are asleep then you won’t need the support during this time.
“If you are having a normal delivery then you are allowed a support person to be with you- husband, mother, sister, doula, etc. We do have special requirements for doulas and you should discuss this with your physician.”
We contacted the other major birth hospitals in Dubai for an official comment on their latest policies for laboring women but did not receive any response.
For women like Hayley, being pregnant during the pandemic has been bittersweet: “I have been working from home for the last three months, which means I've saved a ton in maternity clothes, but it's sad not to be able to share this moment with family and friends. No baby shower, no pregnancy Pilates (I couldn't concentrate on Zoom) and obviously no visitors from home. I am grateful to be in a country that acted so fast to look after us all, but sometimes it would be great to have more communication from the hospitals. I know quite a few mums-to-be are worried about this.”
*Name changed on request