Hospital delivery wards in the Greater Toronto Area have tightened their rules for visitor access and have implemented new screening measures in an effort to slow the local spread of COVID-19.

Mount Sinai, the Toronto Birth Centre, the William Osler Health System and Michael Garron Hospital are among the health-care facilities now allowing only one support person to attend a delivery.

In an emailed statement, Aliya Darvesh of Sinai Health communications wrote that only "one asymptomatic visitor over the age of 16," would be able to accompany an expectant mother checking-in to give birth or any pregnancy related clinic appointments.

The hospital will be screening all visitors for cough, stuffy nose, fever, sore throat and the process will be repeated upon re-entry.

Dr. Elin Raymond, an obstetrician/gynecologist at Michael Garron hospital said the rule regarding limited visitors would also apply where she practices with "one designated person" from delivery through post partum. She added it's in line with the province's mandate to limit hospital visitors during the pandemic planning.

This applies to checking in to give birth or any pregnancy related clinic appointments.

The natal intensive care unit at Mount Sinai will only allow one parent and one partner, which can be a designated alternate caregiver, a person to support the parent, or the partner of the parent.

Mount Sinai also says if patients have arranged to have a doula present at delivery, "patients will have to contact their care provider to discuss their unique circumstances as the COVID-19 situation evolves."

Mount Sinai Hospital is one of the health centres tightening restrictions to protect pregnant women and infants in the GTA. (David Donnelly/CBC)

"There will be no access for anyone with respiratory symptoms," the email stated.

At the Toronto Birth Centre, women in labour will also be limited to one support person from their family and their website states that staff will screen everyone at the door. Those with symptoms will be turned away.

The centre has cancelled hospital tours and programming for expecting parents.

Protecting 'our smallest and most vulnerable patients'

At hospitals in the William Osler Health System, only one support person is permitted to attend the baby's birth.

"This person can stay 24/7 and is able to accompany their partner/loved one to the Postpartum/Mother and Baby Unit," Donna Harris, Osler's spokesperson, confirmed by email.

Etobicoke General Hospital is part of the William Osler Health Network, which is among the GTA health facilities taking steps to limit the spread of the novel coronavirus on maternity wards.

"Osler considers midwives and doulas as valued members of its Labour and Delivery care team, and has not limited their attendance in the labour/delivery room," Harris wrote.

However, it will restrict other visitors to "further protect our smallest and most vulnerable patients and their loved ones."

'Limited' evidence of impact on pregnant women

Raymond, an obstetrician/gynecologist at Michael Garron Hospital who has her own practice at Open Arms Medical Clinic, has been following about 60 cases of pregnant women with COVID-19 in China that have been shared by international colleagues.

"It's limited evidence so far," she said.

All but one had mild to moderate symptoms and there was no impact on pregnancy.

"Again, evidence is limited but what it seems is that it corresponds with maternal illness."

She said expectant mothers have a lot of questions about COVID-19.

Dr. Elin Raymond delivers babies at Michael Garron Hospital in Toronto and has her own practice at Open Arms Medical Clinic on Danforth Avenue near Pape Avenue. She has been following cases of pregnant women with COVID-19 in China. (CBC)

"They want to know, 'Does COVID-19 affect early pregnancy, does it cause miscarriages or early problems in babies?'"

Raymond said there isn't enough evidence to suggest it does or doesn't but "if you look at any coronaviruses, they don't cause miscarriages."

She said "at this point we are not seeing any evidence of vertical transmission," meaning the disease is not transmitted from mom to baby before birth.

Pregnant women with symptoms similar to COVID-19 are urged to call their healthcare team immediately, she said.

Raymond also suggested Toronto Public Health as a resource with a lot of information and videos for families awaiting a newborn. She said with the cancellation of prenatal classes, the website is a recognized source of accredited pre and post natal information.

Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynecologists of Canada, said there is no evidence right now that the virus is more severe in pregnancy than it is in the population as a whole.

"That is quite different from the experiences we've seen in the past with flus like H1N1, where pregnant women were particularly affected," Blake said.

"I think that part is reassuring."

She said she advises pregnant women to practise social distancing and to frequently wash their hands to reduce the risk of exposure or illness. If an expecting mother works in a hospital or healthcare setting, Blake said to seek advice from their family doctor to get the best possible protection.

"It's going to be very different for everybody," she said.

Midwives expect increased demand

The Association of Ontario Midwives (AOM) said it's too early to tell for sure, but it does anticipate an increased demand for out-of-hospital births.

"If our experience with SARS is any indication, the interest in out-of-hospital options for delivery become more appealing in a situation like this, where people are trying to avoid being in hospitals, " said Elizabeth Brandeis, president of the AOM, and a midwife affiliated with Mount Sinai and the Toronto Birth Centre.

She said there already was a high demand for midwives before the pandemic and they're going to have to be creative in meeting the need.

As for home visits, Brandeis said the AOM has implemented strict screening protocols, including questions about travel histories midwives should ask before entering a client's home.

"That's definitely a change in our practice — ensuring we take that really thorough history before going into a client's home and making sure we're equipped with personal protective equipment."