Obstetrics During the Pandemic – Interview with Dr. Shore

Image of Dr. ShoreDr. Eliane Shore is an obstetrician-gynecologist at St. Michael’s Hospital. She is on the founding team for the Pandemic Pregnancy Guide, which offers current and reliable information about pregnancy during COVID-19. Their Instagram account has gained over 7,500 followers and has created a community for pregnant women to ask questions about their pregnancy and their babies in the context of the pandemic.

Follow the Pandemic Pregnancy Guide on Instagram (@pandemicpregnancyguide) or Twitter (@PandemicPreg).

How has the care for pregnant women changed during COVID-19?

There have been changes for all types of healthcare but particularly for obstetrics, because it’s one type of medicine that can’t be put on hold. One of the biggest changes in the clinic during antepartum appointments, is that patients now have to come to their appointments by themselves, whereas before they could bring a family member with them. Now it’s restricted to having only the patient at the appointment. The other big change is that we are doing a combination of in-person and virtual appointments. We’re staggering the appointments for low-risk healthy patients, where every other appointment is in-person and then the intervening appointments are through Zoom, telephone, or the Ontario telehealth network.

On labour and delivery, the biggest change is also around support people. It’s hospital-dependent, but at St. Michael’s Hospital, right now, you are allowed to have one support person throughout the labour, delivery, and postpartum process, assuming that you and your partner are healthy. If there are any concerns or infections that develop in labour, your partner is still allowed to stay, but we are very strict with all of our patients that they need to stay in the room the whole time. Gone are the days where we used to tell patients to go for a walk around the labour unit or send the partner to get something from the fridge, etc – we are really trying to restrict all of that movement.

The other big change is around masks. We are encouraging patients to wear masks for their in-person clinic appointments. In the hospital, generally masks are given to all the partners, and to patients if they are under investigation, have presumed COVID-19, or are COVID-19 positive.

One safety concern that expectant women may have during this pandemic, is whether it is safer to deliver their babies in the hospital or at home. As a frontline obstetrician, what are your thoughts on this?

I feel quite strongly that the safest place to have a baby is the hospital, regardless of whether there is a pandemic or not, because any delivery can go from being a low-risk delivery to a high-risk delivery in a matter of seconds. To me it’s not really considered low-risk until the baby and placenta are safely out, there hasn’t been a postpartum hemorrhage, and we know everything is all done. I know patients do have concerns about whether a hospital is a safe place in a pandemic, and my biggest reassurance is that a hospital is prepared for this. We have the personal protective equipment, we have the cleaning supplies, and we have everything in place for patients who are healthy and patients who are sick. Additionally, in a pandemic, getting an ambulance to the hospital in an emergency can be a slower process. Even getting a cesarean section done urgently takes a little bit longer, given the different requirements for personal protective equipment. To have to transfer someone from outside into the hospital in an emergency and then potentially proceed with an emergent delivery would be a very risky proposition – so I think the hospital is the safest place to have a baby.

Recently it was World Maternal Mental Health Day. Given that pregnancy can be a particular time of risk for mental health challenges, how do you think services and care for these women can be improved, especially during a pandemic?

Social isolation can be hard for anyone’s mental health, and particularly for pregnant and recently postpartum patients. We have started to provide resources for this population through the Pandemic Pregnancy Guide through movement and meditation classes through livestream sessions. We have also recently launched a research study looking at what the most common sources of distress are in pregnant or recently delivered patients. This way we can actually see what are the areas of distress and then target some initiatives to address our followers’ concerns.

The Pandemic Pregnancy Guide is very interdisciplinary, featuring content from a diverse group of experts. Given the large volume of information that can be offered to pregnant and postpartum women, how does your team go about deciding what content to share in the guide?

We knew early on that it would be important to hear from someone with an expertise in infectious diseases, which is why we invited Dr. Mark Yudin to do a segment. We also knew that patients would have many questions about the health of their babies, which is why we invited Dr. Douglas Campbell, who is a pediatrician. We know that not all patients choose an obstetrician or family medicine obstetrician as their care provider, which is why we had Linda Moscovitch, who is one of our midwives at St. Michael’s, come and do a segment as well. We have a running list of what we think patients and followers are interested in. We also receive a lot of comments into our account, so we try to group those messages into themes and then have a running tally of what our followers are asking about. There are also general concerns that pregnant patients have questions about, that aren’t necessarily related to COVID-19 but are things we talk about in clinic all the time, like constipation, sleep position, or exercise. Usually at the end of a clinic day I message the group with a few ideas for posts or stories, as those are the things that I spoke the most about that day in clinic.

Have you had any discussions about the Pandemic Pregnancy Guide with your own patients?

Definitely the guide is something I talk about with my patients, because it’s something that I’m putting a lot of work into and want to make sure that as many people can use it as possible. I’ve had a few interactions with my patients who heard about the guide from friends from different hospitals, who went on and realized “that’s my doctor!” Another one of my patients heard about the guide when it was first starting, and then 3-4 weeks later when I had another appointment with her, she said “I finally actually went on the guide and I can’t believe how good it is. I just feel like there is this community that you’ve created that I didn’t know about. All of the questions I was wondering about are there.” She started to cry and felt so touched by the existence of the guide. So generally people have been very supportive of the guide and think it’s a great tool. I don’t think we really predicted what a big impact the guide would have and that we would be able to achieve so many followers in such a short period of time.

There has been great leadership and initiatives undertaken by physicians to support patients during this pandemic. In your experience how can physicians stay well and make sure their own needs are also met during this challenging time?

I think it’s a hard time for everyone. Different people have different ways of finding wellness and finding time. There are a lot of physician wellness and mindfulness groups that are running in response to COVID. In some ways life is more stressful with learning all these new things and trying to stay up to date on information, but in other ways we are at home a lot more and might have even a little more time for wellness activities. Certain parts of our workday schedules aren’t happening anymore and meetings are virtual instead of in-person, so although it is a very hard and stressful time, there have been some adaptations as a result of COVID-19 that have allowed for a little more of work-life balance.

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