Postpartum support for mothers in Newfoundland during COVID-19

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April 3, 2020 (Updated April 9, 2020)

Honourable Dr. John Haggie, Minister of Health and Community Services

David Diamond, Eastern Health CEO

Honourable Siobhan Coady, Member of the House of Assembly for St. John’s West

 

Dear provincial leaders,

I am writing with respect to the recent change in Eastern Health policy regarding support persons on the post-partum unit at the Health Sciences Centre as a result of the COVID-19 pandemic. The current policy, from April 8, 2020, states that a support person may be present for labor and delivery but must leave the hospital within 4 hours of being moved to the post-partum unit. 

As a Paediatrician, I have grave concerns about the potential impact of this policy on the short and long-term physical and mental health of families in our province.

In the short term, we see many reports of families considering unattended home births. The risks of an unattended home birth are obvious, especially without proper advanced planning and medical advice. We have also heard reports of women who plan to leave the hospital against medical advice immediately after their child’s birth. This would mean no normal newborn care by Paediatricians for babies and no obstetrical care or monitoring for mothers. Either of these scenarios will certainly result in increased emergency room visits as families encounter complications or concerns that they are not able to manage in the home without medical support.

There is also extensive research to show that breastfeeding initiation and duration rates are negatively affected both by maternal stress and by the absence of a supportive partner. Our province has historically struggled to adopt a culture of breastfeeding. Although our rates have been increasing in recent years, they continue to be among the lowest in the country according to Stats Canada. The benefits of breastfeeding are manifold and include prevention of both paediatric and adult-onset diseases. While the short term effects of failure to breastfeed will be evident in terms of mother-infant bonding, the long term repercussions will be felt by the healthcare system for years to come.

It is well-known that up to 80% of mothers may develop some form of postpartum depression and that the absence of a supportive partner is a significant risk factor. Mothers who develop postpartum depression are at increased risk of future depression. Our province has already seen the devastating impact of mental health concerns and lack of resources. With the current effect of the COVID-19 pandemic, mental health concerns are increasing and existing resources are already at risk of being overwhelmed. It is sobering to consider how the current policy change could impact the future of mental health in Newfoundland and Labrador.

It is important to note that under the current Eastern Health visitor policy, paediatric patients are allowed a support person during admission. A newborn is a paediatric patient and the mother is an obstetrical patient. A mother who is recovering from a delivery, which may involve surgery or other complications, should not be expected to be a support person for another patient when she is a patient herself. An additional support person specific to the newborn is appropriate. Many hospitals across Canada have implemented this approach, as long as the support person does not leave the hospital for the duration of admission.

As a province, we must all join together in the fight to stop the spread of COVID-19. As a Paediatrician, wife, and soon-to-be mother, I would do anything to protect my family, and by extension, the future of this province. I urge the Government of Newfoundland and Labrador to consider alternate strategies to keep our families safe and healthy during the COVID-19 pandemic.

 

For our families,

Joy Clements, MSc., MD, FRCPC

Developmental Pediatric Subspecialty Resident

University of Toronto