At 37 weeks' pregnant, Amanda Edwards feels like she's had to navigate much of the last nine months on her own.
"We found out about this baby the week before lockdown in June, and since then, it's been a pretty isolating pregnancy," the 30-year-old Sydney mum said.
COVID-19 restrictions in NSW have meant Amanda's husband hasn't been able to accompany her to any appointments or scans.
She says she "completely understands" why certain restrictions are in place, but that not having her partner there to support her has been tough.
"We had two very early miscarriages before we found out we were pregnant with this one … so there was obviously a lot of stress and anxiety around that first scan."
Now, just a few weeks from her due date, Amanda and her husband are trying to minimise their risk of exposure to COVID-19 as much as possible.
"If I test positive for COVID and my husband tests negative, he can still attend the birth," she said.
"But if he tests positive, he's not allowed to be there.
Amanda says the self-imposed lockdown that she and her husband are undertaking isn't easy while parenting another young child.
"We have a two-and-a-half-year-old daughter and she's a mini tornado," Amanda said.
"She has to go to day care – I can't keep her home while I'm heavily pregnant and exhausted … so that's a risk we have to take."
Maternity services adapting to COVID-19
Heightened feelings of stress during pregnancy and in the lead-up to birth are being felt by many expectant parents, says Sue Walker, a specialist in maternal foetal medicine and director of perinatal medicine at Mercy Hospital for Women in Melbourne.
"They're grappling with trying to balance having a reasonably normal life — especially with young children — and at the same time, trying to minimise the risk where they can," said Professor Walker, who also leads the Department of Obstetrics and Gynaecology at the University of Melbourne.
Professor Walker said maternity services in Australia, like other parts of the health system, were feeling the impacts of the recent surge of COVID-19 cases.
"Whatever the [COVID] numbers are, we continue to have to provide those services, irrespective of what the demands might be on the health service staff."
To reduce the risk of COVID-19 and protect patients and medical staff, telehealth appointments are being prioritised where possible, and in some cases, external pathology providers are being used instead of hospital clinics.
"We want to safely reduce the number of people who are coming through the health service … but also make sure that women know if they're worried and they want to come in, they must come in, and they're absolutely safe to come to the hospital," Professor Walker said.
At the Mercy Hospital, a maternal health hotline has been set up to support pregnant women in the community, including those who contract COVID-19.
"For low-risk women, we give them all the resources they need for safely managing at home … and they can call us if they need advice or actually have more symptomatic disease [than expected]," she said.
Restrictions on birth partners and support
When it comes to visitors in birthing units and hospital nurseries, Professor Walker said restrictions were in place to reduce foot traffic and minimise the risk of COVID-19 transmission.
"Partners, however, aren't visitors — they are co-parents, and so partners can always come, however difficult the situation is," she said.
In Australia, restrictions around whether a pregnant woman can have a partner or support person present during birth depend largely on the hospital or maternity care provider.
Generally, state and territory health departments advise that all women giving birth, even when COVID-positive, are allowed (at least) one support person during labour and birth.
But this is complicated if their preferred support person is also COVID-positive, or considered a close contact.
Kellie Wilton, principal midwifery officer at the Australian College of Midwives, said although she was hearing of "pockets of places that are doing it well", there were some hospitals enforcing strict rules "despite directives in policy".
"We know in Queensland, for example, there are clear policies: you can have two support people in labour," Ms Wilton said.
"Yet we're hearing stories from hospitals that birth support people aren't being allowed if they or the woman are COVID-positive, or mums and babies are being separated until mum returns a negative COVID test."
'I just burst into tears'
For Sally Grant, 36, who gave birth to her son Vinny just two weeks ago, the lead-up to the birth was "nerve wracking" and "isolating".
Like Amanda, Sally was told that if her partner Jack tested positive for COVID-19, he wouldn't be allowed to attend the birth.
"I was told I could bring another support person who was COVID-free, but that just wasn't something I could get my head around," she said.
The couple bunkered down at their home in Canberra and tried to avoid any exposure to COVID-19.
"It had its benefits of being able to sort of be at home as a family, but then as we got closer to the birth, we did get more anxious," Sally said.
A couple of weeks before Sally's due date, she was notified by her midwife that the location of her birth had changed.
Instead of delivering her baby at a hospital birthing centre (which typically aims for minimal intervention), she would be taken to the main maternity ward, due to the birth centre being used for COVID-positive pregnant women.
"I totally understood that they needed that space … but I was just so close to my birth and I wanted it to be this sacred time."
In the end, Vinny's birth was everything Sally and her partner Jack had hoped for.
"We were really lucky that everything went so beautifully to plan … but I was just telling myself to surrender to what's ahead, because I felt like I had no control over anything."
Midwifery sector under pressure
The effects of COVID-19 are being felt across maternity health services, Ms Wilton said, not just in birthing suites.
"Some of the other areas that we're seeing service impacts are midwifery group practices … where one midwife looks after a small caseload of maybe three or four women, and they have one-to-one care," she said.
"Because of the [staff] furlough situation, a lot of those midwives who would be working in that system are being asked to move across to fill gaps in acute or hospital settings.
"So women who have been having one-on-one care with a known midwife are now also being shifted across into more mainstream services."
Additionally, she said access to home birth programs had become more restricted in some places because midwives had been sequestered to other areas of health care.
"Pregnant women would be suffering significantly because, through no fault of their own, they're having their birthing choices taken away," Ms Wilton said.
Like other healthcare workers, midwives have also come under increasing pressure.
"Some midwives have not really had much leave at all in two years, and that's because of staff shortages, because midwives don't want to leave their mates on the frontline unassisted, and they don't want to leave women birthing alone," Ms Wilton said.
"The thing that needs to be spoken to the most is the moral distress that midwives are under at the moment.
"I think we're going to see unprecedented numbers leaving the profession due to moral injury and burnout."
Seek help and get vaccinated, expert urges
Professor Walker agreed that many healthcare workers were feeling worn out after a long stretch of dealing with the challenges of COVID-19.
"Across the health sector, people are really having to dig deep on the background of already having dug deep for a while," she said.
But she stressed that it was always safe for people to come to hospital, and that pregnant women should never feel reluctant to seek help.
"We want to see women, and we welcome their phone calls."
She also urged pregnant women, who were at an increased risk of severe COVID-19, to get vaccinated if they hadn't already.
"We've got new data coming in all of the time showing that it's very effective at reducing hospitalisation and severe disease in pregnant women, and that it's safe."
NSW Health was contacted for comment but did not respond in time for publication.
