Following end of emergency situation, birth rules vary slightly by hospital ({{contentCtrl.commentsTotal}})

Births chart at South-Estonian Hospital in Võru.
Births chart at South-Estonian Hospital in Võru. Source: ERR

Throughout the coronavirus pandemic and related emergency situation in Estonia this spring, healthcare is one field that has been significantly impacted, with almost all but emergency medical and dental care suspended at the peak of restrictions. Pregnancy and childbirth cannot be put on hold, however, and so a group of several professional associations compiled guidelines to ensure as safe a birth as possible. As various restrictions continue to be eased in stages, ERR News reached out to several hospitals to find out how giving birth looks in practice today.

While the Estonian government has decided on and issued rules for the emergency situation and beyond after consulting with the Health Board and various experts, guidelines for pregnancy-related care and childbirth have been drawn up and subsequently updated by a group of four professional organizations working together: the Estonian Gynecologists' Society (ENS), the Estonian Midwives Association (EÄÜ), the Estonian Pediatric Association (ELS) and the Estonian Perinatal Society (EPS).

At the peak of restrictions, no birth partners whatsoever were allowed to be present at births. Beginning May 18, however, after the conclusion of the emergency situation in Estonia, hospital maternity wards and maternity hospitals once again began permitting one healthy birth partner to attend vaginal childbirths — although even now, various conditions remain in place, and birth partners still aren't permitted to be present at Caesarean section (C-section) deliveries.

ERR News reached out to several maternity hospitals and hospital maternity across the country this week to ask what current guidelines and restrictions look like in practice, and how birthing parents and hospital staff alike have coped with the unusual situation thus far.

Pelgulinna Maternity Hospital (West-Tallinn Central Hospital)
Tallinn

Pelgulinna Maternity Hospital tests all birthing patients for the COVID-19 virus upon arrival to the hospital as well as asks them to fill out a health declaration form. Birthing patients must wear a surgical mask until the results of their test are confirmed.

Birthing patients are permitted to have one birth partner with them — either the baby's other parent or another close family member. Upon arrival at the maternity hospital, the birth partner must fill out a health declaration form and have their temperature taken; they are not tested for the virus. The birth partner must wear a surgical mask at all times, and may not leave the hospital and come back.

Doulas and other alternative birth partners are not yet permitted, and no birth partners are yet permitted to be present at a C-section delivery.

After the baby's birth, the birth partner must leave the hospital once the birthing parent is transferred from delivery to the postpartum ward.

"The emergency situation was without a doubt a new and complicated one for everyone — for families and hospital staff alike," commented Piret Veerus, director of the Women's Clinnic at West-Tallinn Central Hospital. "Despite this, we saw that the women did great in these difficult conditions; we admire and acknowledge them for this. It was understandable that after restrictions were implemented, those about to give birth had a lot of questions and worries, but we launched a dedicated midwife hotline where women could get answers to their questions directly from midwives. We also tried to constantly update the information on our website."

According to Veerus, staff at the maternity hospital was and remains at maximum readiness to provide comprehensive support and help both during and after delivery.

"During the emergency situation, when birth partners were not permitted to be present at the birth, we offered women the opportunity to keep in touch with their partners via either phone or video chat," she said. "Following the birth, midwives always offered to help take photos of mothers with their babies."

Järva County Hospital
Paide

Järva County Hospital tests all pregnant and birthing parents for the COVID-19 virus upon arrival to the hospital. Patients must wear a surgical mask until the results of their test are confirmed, which takes approximately 40-60 minutes.

Birthing parents are permitted to have one birth partner with them — either the baby's other parent or another close family member who has filled out a health declaration form and has proven that they are not ill. The birth partner must wear a surgical mask at all times. No birth partners are yet permitted to be present at a C-section delivery.

After the baby's birth, the birth partner is permitted to remain with the family in the patient's postpartum room in the maternity ward on condition that they do not leave the ward until they are ready to go home and that if they must leave the maternity ward for any reason, they wear a surgical mask.

"In connection with the emergency sitation and changes to hospitals' operations, a second emergency department for patients suspected of having the coronavirus was established in our maternity ward, and the maternity ward was relocated to the rehab rooms on the third floor of the hospital's B wing, where we were located for 49 days," said Marju Raja, director of Järva County Hospital's maternity department. "All monitoring of pregnant patients and the operations of the maternity deparment had to be reorganized and all of our midwives, led by midwife director Aiki Mäekivi, did a great job handling this. A big thank you to them! Not one baby was left unborn, and not one pregnant patient unmonitored. Fathers were not permitted to be present at the birth during the emergency situation, but all birthing parents and midwives did a great job!"

The county hospital's maternity department relocated to its original rooms beginning May 21.

Viljandi Hospital
Viljandi

Viljandi Hospital tests all scheduled C-section patients for the COVID-19 virus; all other birthing parents are tested only if there is reason to believe they may be infected.

Birthing parents are permitted to have one birth partner with them — the father of the child or otherwise — on condition that the birth partner is not sick; no birth partners with a fever or exhibiting other symptoms will be permitted in the hospital. Birth partners must fill out a health declaration form, wear a mask at all times and remain in the delivery room.

Following the birth, the birth partner must leave the hospital and will not be permitted to return to visit.

Birth partners aren't permitted to be present at C-section deliveries or accompany pregnant patients coming to the hospital for treatment, induction or abortion.

Pärnu Hospital
Pärnu

Pärnu Hospital tests all birthing patients for the COVID-19 virus using a rapid test. Until the results are in, which takes approximately 30-50 minutes, patients and their birth partners are held in a dedicated delivery room.

One birth partner is permitted on condition that they are a close family member, such as a spouse, partner, father of the child, mother of the birthing patient. Birth partners are not tested for the virus, but are required to wear a mask for the duration of the birth, replacing the mask after every four hours.

Following the birth, the birth partner may remain with the family until the birthing patient and baby are transferred to a postpartum room approximately two hours later. Guests are not permitted in postpartum rooms.

Birth partners aren't permitted to be present at C-section deliveries, but fathers are permitted to spend time with the newborn immediately following delivery, prior to the birthing patient's transfer to a postnatal room, to ensure the opportunity for skin-to-skin contact.

"Everyone who has been asked has agreed with the situation thus far," said Kadri-Liina Vahula, director of the Women's and Children's Clinic at Pärnu Hospital. "There have been no complaints, people have been very understanding and in many cases the birthing environment has even been more peaceful than it would be with birthing partners."

Central Maternity Hospital (East-Tallinn Central Hospital)
Tallinn

Birthing patients are permitted to have one birth partner present, on condition that they are a close family member who lives with the birthing patient. The birth partner must not be sick, must fill out a health declaration form and have their temperature taken upon arrival at the hospital.

Birth partners must wear a surgical mask at all times, and may not leave the delivery room. The birth partner must leave the hospital once the birthing patient is transferred from delivery to a postnatal room.

Doulas and other alternative birth partners are not yet permitted, and no birth partners are yet permitted to be present at a C-section delivery.

"All our mothers were incredibly brave and did great during birth during the emergency situation, when no birth partners were permitted to be present at the birth," East-Tallinn Central Hospital spokesperson Marko Mägi said. "The midwives at the maternity hospital have been there for the women in every way to help make up for any support the presence of a birth partner would have provided."

Kuressaare Hospital
Saaremaa

Kuressaare Hospital tests all birthing patients for the COVID-19 virus using a rapid test upon arrival at the maternity department. If the patient is exhibiting symptoms of the virus, they are requested to call ahead and inform the department so that hospital staff can be prepared to handle the patient in accordance with specific guidelines issued for coronavirus-positive birthing parents.

Fathers will be permitted to be present at the birth beginning June 1. Similarly to other hospitals in Estonia, Kuressaare Haigla will begin permitting one birth partner who is not exhibiting any symptoms, has filled out a health declaration form and is wearing a surgical mask to be present at the birth and remain with the family for up to two hours following the birth.

A birth partner may be someone other than the baby's father or birthing patient's partner as chosen by the birthing patient, but only one birth partner will be permitted per patient.

Birth patients are not permitted to be present at C-section deliveries. Initial skin-to-skin contact, however, will be ensured in the postpartum room, where a birth partner may remain with the family for up to two hours on condition that the baby is healthy.

Kuressaare Hospital will also allow fathers to take a paid coronavirus test for €63 which, if negative, would permit the father to remain with the family in the postpartum room until the birthing parent and baby are discharged. The hospital will also accept negative test results listed in the birth partner's electronic medical records if the test was conducted for other reasons within 48 hours of arrival at the maternity ward.

"The reason why Kuressaare Hospital did not make this decision at the same time as other hospitals is due to the specifics of our maternity department, where delivery rooms and postnatal rooms are located in one hallway, and it seemed illogical that if a husband is already present at a birth, then they couldn't accompany the family in the postnatal room afterward," managing midwife Marje Altrov explained.

"As a majority of our maternity department staff belongs to risk groups, freedoms offered to birth partners will remain on the limited side until the situation completely stabilizes to ensure that department staff can continue to feel safe in their daily working environment," she added.

Ida-Viru Central Hospital
Kohtla-Järve

Ida-Viru Central Hospital tests all birthing patients for the COVID-19 virus using a rapid test, which produces results in approximately 40 minutes. Coronavirus-positive patients deliver in an isolated operating room; the hospital's first experience with a coronavirus-positive birth was in late March.

One birth partner is permitted, which may be someone other than the baby's father. The hospital itself also offers personal midwife services.

The birth partner must not exhibit any symptoms of illness and must undergo triage before being let in to the hospital, including filling out a health declaration form and having their temperature taken. They must wear a surgical mask at all times in the hospital, and may not leave the hospital until they are ready to go home. The birth partner must leave the hospital once he birthing patient is transferred from delivery to their postnatal room.

Birth partners aren't permitted to be present at C-section deliveries; in other cases, arrangements are to be coordinated with the doctor.

As was the case during the emergency situation, patients with special needs are permitted to be escorted by one assistant (such as a sign language interpreter).

Beginning June 1, pregnant patients will be permitted to be accompanied to ultrasound appointments by one healthy person who has undergone triage and is wearing a mask. Minor patients may also have one person accompanying them to gynecological ultrasounds or other appointments. Entire families, i.e. spouses and children together, are still not permitted.

"Our midwives have done a great job," communications director Ülo Veldre said. "If an unprepared birth partner is present at delivery, they need to be dealt with separately too. Whether a birthing patient follows the rational recommendations of experienced medical staff or their own unpredictable emotions in the moment depends a great deal on their birth partner. In certain situations, things are easier and there are fewer problems arising from communication without the presence of an unprepared birth partner."

According to Veldre, several fathers got creative during the ban on birth partners as well, including one who used candles to trace out the shape of a heart below their family's window and another who used a drone to fly a stuffed Winnie-the-Pooh up to their family's hospital window.

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Editor: Aili Vahtla

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