Things are moving very quickly, not just at national and state levels but on the Randwick Hospitals Campus. Both Prince of Wales Private Hospital (POWP) and The Royal Hospital for Women (RHW) are gearing up for this crisis rapidly.
As I said in my previous update, it appears that the significant majority of pregnant women with Coronavirus only suffer a mild illness – which is good news. However we need to maintain the highest levels of infection control to protect you and your families and – equally importantly – our staff.
Firstly, you need to understand that many of our traditional approaches will be changing as we will need to implement some very strict infection control measures when you come to hospital. This is not only to protect you but to keep the staff looking after you healthy. Remember that if one or two midwifery shifts is exposed to Coronavirus – even indirectly – our hospital maternity units will need to close. You will be asked the usual questions about your possible exposure to Coronavirus before you come to hospital and we will have temperature screening on arrival up and running soon. However, we have to operate (in hospital) from the assumption that you and your partner have at least been exposed to the virus).
The only person who can come in with you to hospital is your partner and while you are in hospital you will both be asked to stay in your room and not leave it (no ducking out to have a walk or grab a coffee). Your partner will not be able to come and go. Sorry.
The staff caring for you (including me) should be wearing – at a minimum – gloves and a mask when you are in hospital as we have no choice but to assume that you and your partner have been exposed to the virus.
And I’m sorry but more draconian measures may yet be necessary. We are not living in ordinary times.
Some updates to my previous advice
- Currently POWP will not be accepting women who are known to be Coronavirus positive. In this situation you will need to go to RHW and I will be able to care for you there.
- Notwithstanding my previous comments (and those of the RCOG) if you are Coronavirus positive you will probably be strongly advised to give birth by an elective caesarean section. I know this sounds harsh but it seems that managing labour in Coronavirus positive patients poses a very significant risk to staff that can be ameliorated by performing an elective Caesar. SO PLEASE DO ALL YOU CAN TO NOT BECOME INFECTED.
- Again, in contrast to my previous statements (and those of others) it appears that babies born to known Coronavirus positive Mums will be cared for in a special nursery that you can visit for 14 days. I will update you more on this as soon as I know more.
- Giving a General Anaesthetic (GA) is one of the riskiest procedures for hospital staff (anaesthetists, not me – fortunately). This situation needs to be avoided at all costs and the best way to do this is to perform emergency caesareans under epidural anaesthesia if possible. This means we will be encouraging timely epidurals for all women, particularly in situations where we think a caesarean might become necessary (e.g. slow labour or if there are concerns about your baby’s welfare).
- The use of Nitrous Oxide for pain relief is contentious and currently we are discussing whether or not it can be safely used in labour. I will update you when I know more.
Update on the office
Its not an update but you should know the drill by now. If there is ANY possibility you have been exposed to the virus or you and / or anyone you have been in contact with has been unwell IN ANY WAY do not come to my office. Full stop. Give us a call.
Do not bring your mother, your sister, your friend, your nanny, or your other kids to my office. Full stop.
This is just my personal opinion, but if it is humanly possible for you to do so (without suffering undue financial hardship) you should be working from home (or not at all) and your kids should not be going to school (I guess year 12 could be a sensible exception).
Testing for Gestational Diabetes (GDM)
As you know we currently test for GDM with a two-hour Glucose Tolerance Test (GTT) that involves sitting in a laboratory collection centre for two hours. I believe this poses an unacceptable risk to you given that – obviously – laboratory collection centres have sick people going there (by definition). And again, remember that many people who have Coronavirus have no symptoms and are not aware they have been exposed to the virus.
In the absence of guidance from my professional bodies I have made an executive decision to switch to performing a fasting and two our post prandial glucose level to screen for GDM in low risk women. We can discuss this in detail when you see me and I will post my latest GDM testing information on my website soon.
Lab testing in general
I will try to start doing routine lab testing (only) in my office with Vicki (one of the expert midwives in the practice) and me taking your blood instead of having you attend the lab.
Some women are concerned about needing to attend ultrasound practices for their scans because of the possible infection risks. We have the option of referring to you to my expert ultrasound colleague, Dr Alex Owen, for all of your ultrasound needs if you prefer because:
- He’s very good, and
- He practices in my office (with its nice big empty waiting room).
Check out his website at www.dralexowen.com.au
That’s enough for now.