A Canadian hospital has requested all labouring women receive an epidural amid the coronavirus pandemic, with those who don't consent asked to birth elsewhere.
In a letter dated April 6, Almonte General Hospital's Chief of Perioperative Medicine, Dr Heather Abremenko, Chief of Obstetrics and Gynaecology, Dr Bahaa Awwad and Chief of Staff, Dr Chris Deschenes outlined the policy to obstetricians, midwives and family doctors.
"We have found a markedly increased preparation time required for donning PPE (personal protective equipment) and setting up the OR," the letter reads. "As our operative team is not in-house there are concerns about performing an emergency C/S (caesarean section) in a timely manner.
"To expedite emergency surgery should it be needed, we are requesting that all patients have an epidural (exception being rapidly labouring patients that progress to delivery before anaesthesia is required."
And the hospital's directions for those who don't agree are clear: " We request delivery be planned in another facility so that the safety of the mother and baby can be optimized."
Almonte General Hospital has a new policy. Epidural for every mother or choose a different hospital. Thoughts?!?! #ForcedEpidural #NoChoice? #ThoughtsAndOpinions #Debate #StrongStand #WomensRights #HumanRights pic.twitter.com/vK9akgXJ4s— Autumn Belnap (@BelnapAutumn) April 8, 2020
The directive has prompted an outcry from expectant mothers, clinicians and advocacy groups, who argue that it ignores the rights of labouring mothers to choose how they deliver their babies.
"We're concerned that a blanket policy is not the best approach," Suzanne Draper, head midwife at Almonte General Hospital told Ottowa Sun. "As midwives, we continue to advocate for the rights and autonomy of labouring people and to support their choice of birth place and their right to care close to home."
According to Ms Draper, several of her clients have now chosen to have a home birth in response to the hospital's request.
Registered nurse Jennifer Torode, who co-authored the guidelines for birthing patients in Toronto during SARS, told the Ottowa Sun, "I feel this is a human rights violation. It's against a woman's right to self-determination. We have the right not to choose things under duress that we would not otherwise choose.
"People go to midwives because they want less intervention at birth."
Almonte General Hospital in the Ottawa Valley has issued a new policy stating that every labouring patient must receive an epidural during COVID-19. Write to them to share how you feel: https://t.co/ifu9Es4DRr— The Obstetric Justice Project (@ObstetricJP) April 9, 2020
The request has prompted a call to action from the The Obstetric Justice Project in Canada, who have labelled it "obstetric violence".
"Almonte General Hospital in the Ottawa Valley region of Ontario has issued a new policy that attempts to remove a patient's legal right to informed consent and refusal during childbirth," they note. "The announcement issued April 6th states that all patients in labour are now "requested" (required) to receive an epidural, or go elsewhere to give birth. For many families in the area, it is not a choice to simply go elsewhere. This is not a choice, period."
As of 12 April, there are 7,049 cases of COVID-19 in Ontario, Canada.
Current advice from the World Health Organisation (WHO) notes that when it comes to delivery amid the coronavirus, "The mode of birth should be individualised and based on a woman's preferences alongside obstetric indications."
In Australia, current guidelines from Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) note that for pregnant woman diagnosed with COVID-19, their experience of labour and vaginal birth, or caesarean section, "should not be significantly impacted and women should be encouraged, and supported, to approach this extraordinary time of their lives without fear or apprehension."
According to RANZCOG, "Medical intervention, other than that specifically related to infection control, should not differ significantly from usual practice. Active mobilisation, use of water immersion in labour, and epidural analgesia are not affected."