Pandemic motivates midwives to give birth to new telehealth services

Shortly after Nicole-Ann Shery (right) gave birth to Kayla on March 3, the COVID 19 lockdown began. She used telehealth to stay in touch with her midwife, Kathleen McDonald (top of staircase), who is shown in the Côte-des-Neiges Birthing Centre with midwife Yvette Munezero (centre) and Maëcha Nault, Head of Midwife Services. (Photo at right courtesy of Reina Price.)
Shortly after Nicole-Ann Shery (right) gave birth to Kayla on March 3, the COVID 19 lockdown began. She used telehealth to stay in touch with her midwife, Kathleen McDonald (top of staircase), who is shown in the Côte-des-Neiges Birthing Centre with midwife Yvette Munezero (centre) and Maëcha Nault, Head of Midwife Services. (Photo at right courtesy of Reina Price.)

In mid-April, six weeks after giving birth, Nicole-Ann Shery cradled her daughter, Kayla, in her arms and huddled at home in front of her computer screen for her final—and sometimes joyously tearful—post-partum visit with Kathleen McDonald, the midwife who had coached her through her pregnancy.

Joined by her partner, James Dylan, Ms. Shery connected with Ms. McDonald via a Zoom video conference, where she was able to proudly show her midwife how well Kayla was doing.

“It would have been nice to actually be there with Kathleen and have her hold Kayla, but COVID-19 was keeping us apart,” Ms. Shery says. “At least we had Zoom; otherwise, it just wouldn’t have felt the same.”

The strong, in-person bond between Ms. Shery and Ms. McDonald was initially established in the months leading up to Kayla’s birth on March 3, while the spectre of the coronavirus was still a distant threat.

However, once COVID-19’s presence began forcing Montrealers to remain at home, mother and midwife had to rely on telehealth to stay in touch.

“I don’t know if anything can make up for the lack of in-person contact,” says Ms. Shery, “but seeing each other at the end was almost like being there physically. I’m grateful for that.”

“During normal pre-natal appointments, we develop an inter‑personal relationship with the family,” says Ms. McDonald. “We get to know their fears, they become comfortable talking to us, and we can realistically prepare them for what to expect during labour, delivery and new parenthood.

“Even though the pandemic forced us to make some major changes, video conferencing has been a big help. We can still include the partner, watch the parents’ non‑verbal interaction and have appointments with a personal touch.”

When the crisis began, pre-natal classes were temporarily suspended, says Maëcha Nault, Head of Midwife Services at the Côte-des-Neiges Birthing Centre (also known as la Maison de naissance).

However, she explains, once the situation stabilizes, the classes will again be conducted in person, because “our clients appreciate the interaction with other families that are all in the same situation.”

Before COVID-19, telemedicine was relatively scarce, not just in the facilities of CIUSSS West-Central Montreal, but throughout Quebec. According to Dr. Justin Cross, the CIUSSS’s Chief Digital Health Officer, this was because the Ministry of Health and Social Services did not provide widespread reimbursement to physicians for most telehealth activities.

The watershed moment came this past February, just before COVID-19 struck the province. The Ministry realized that to prevent the spread of the virus, most patients (and many members of staff, including some clinicians) had to stay away from hospitals and certain other healthcare facilities.

So, moving quickly, the government “approved reimbursement for most physician services that were delivered by video and telephone,” says Dr. Cross.

However, the Côte-des-Neiges Birthing Centre had to start from scratch, says Ms. Nault, because unlike some other CIUSSS facilities, it had had no experience with telehealth before the pandemic.

Telehealth—especially the video aspect—has caught on with clients and staff alike, since “it gives us a great deal of information about the baby’s health, such as the colour of the skin, which may change if jaundice is present.

“Also, video is really helpful for providing breastfeeding advice, because we can watch the interaction between the baby and the mother.”

Ms. McDonald adds that video can even convey a range of subtle visual cues about the mother’s general level of physical and psychological comfort after giving birth.

Ms. Nault says many of the Birthing Centre’s traditional services will probably return after COVID-19 has run its course. However, she adds, there’s no doubt that will telehealth continue to make its presence felt.

For instance, she says, “we might use Zoom if a pregnant woman contacts us with an urgent question and we need to determine if this is a real problem.”

Ms. McDonald also notes that since many clients travel during pregnancy, “Zoom is an ideal way of staying in contact with them, if a problem arises while they’re on the other side of the world.”

“In using telehealth, the midwife may have to work a little harder to build a relationship with the mother-to-be and the family,” says Ms. Nault, “but it has quickly become another practical way of providing mothers with the support they need, which is why I think it’s here to stay.”

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