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Hospitals have been reeling under the pandemic. How was healthcare for pregnant women in COVID, especially those dependent on govt hospitals?
In the wake of the Coronavirus pandemic, the world, especially India, witnessed various other sorts of crises as well — humanitarian, financial, and other medical crises. The treatment of other medical issues was put significantly on the backburner, with most medical practitioners and treatment facilities being focused primarily on the cases of Coronavirus.
Maternal and neonatal care are areas that were affected significantly by the pandemic.
Many private hospitals and nursing homes in cities and metros closed down temporarily owing to lack of staff, as most of the staff flocked to their homes in other towns as soon as news of the lockdown came pouring in. Fear of infections also led to private institutions being closed for months. In many cases, district authorities themselves asked for private facilities to close down.
Government hospitals reeled under the burden of an increasing number of cases coming to them, both COVID and non-COVID.
A gynaecologist from Era Medical College, Lucknow, speaking on the condition of anonymity, explained how ten of the private medical colleges in the city were turned into COVID-only hospitals March onwards, at the behest of the government. The government medical colleges, including King George Medical University and Ram Manohar Lohia Institute of Medical Sciences, continued to treat patients of both types.
This led to a strange situation in which pregnant women who were COVID negative had to be turned away from the private medical colleges, and asked to seek treatment in government hospitals instead. Private medical colleges generally cater to women from both the middle class and the underprivileged segments of society.
“Pregnant women who were non-COVID suffered a great neglect. We could only admit the COVID positive ones, and it was extremely sad for us to turn away so many follow up patients just because they were COVID negative.” she said.
On the other hand, private nursing homes, which cater mostly to women from the salaried and professional classes, had to turn away COVID-positive patients, who were referred to government hospitals. Government hospitals, which handle the bulk of cases from underprivileged sections, now had to deal with influx of cases from the middle classes as well.
“Private nursing homes all asked for COVID certificates, which in themselves took 3-4 days to be prepared, sometimes even longer. As a result emergency cases could not be treated,” she explained further. “OPDs were all completely cancelled in the initial months. Without physical examinations, many crucial tests were missed. If a patient complained of lack of movements in the foetus, we couldn’t even find out if the baby was alive.”
Dr Rekha Ambegaokar, senior gynaecologist at a private nursing home in Santa Cruz West, Mumbai, revealed that during lockdown, many of her staff couldn’t come to work because local trains remained closed. Those from the neighbouring areas had to walk for over 45 minutes every day to come to work.
“Since we could only do video consultations, we had to resort to the methods of the olden days. All routine procedures had to be cancelled. It was very difficult (for both the doctors and the patients).” Sonographies were happening only in major centres, and routine work, except for emergencies, was at a standstill. This led to problems such as inability to detect foetal abnormalities. “It had become like the olden times, where you just hoped for the best.”
Despite this, women from the professional, salaried classes did not speak of experiencing major difficulties, although the ways in which they received maternal care changed drastically owing to COVID—with all consultations moving online.
Jehantab Humaira, a lecturer from Patna, expressed how ‘horrifying’ it was when her gynaecologist herself came down with Coronavirus. She had to then move her treatment to the care of another gynaecologist.
Although no official figures are available yet, doctors from Lucknow and Aligarh informed on the condition of anonymity that in Uttar Pradesh, there was a rise in maternal mortality cases along with still births during the pandemic.
In Ghaziabad, Uttar Pradesh, Razia, a domestic worker, informed this reporter that her child was stillborn but the cause was pegged to gestational diabetes in the mother.
The cases were not restricted to Uttar Pradesh, though. Shalini, the wife of a daily wage labour in Purnea, Bihar, lamented how she had to witness the unexplained death of her newborn child the very next day after bringing him home from the hospital.
Anjali, a sanitation worker from Ghaziabad, had to rush from a government hospital to a private hospital in the middle of labour pains, because the government hospital turned her away citing lack of facilities.
And these are just a few examples.
Even before the pandemic, India had contributed a massive 15 per cent of global maternal deaths, which were considered largely preventable and treatable. Foundation of Reproductive Health Services India (FRHS), a non-profit organisation that works in the area of reproductive and sexual health, had earlier estimated that at least 1,400 to 2,000 maternal deaths might occur due to the lockdown.
Institutes which were not accepting any ante natal bookings admitted only those women who came to them in labour. However, these last minute admissions often led to distressing scenarios of numerous women delivering babies on the way as well.
“Women were delivering left, right everywhere!” says a visibly anguished gynaecologist from Lucknow. “It was terrible.”
Dr Asna Ashraf from Ujala Medical Centre in Lucknow, expressed concern at how patients could often not be given emergency care owing to being COVID positive, and had to be sent away, often in critical conditions, to government hospitals. The number of deliveries in government sector saw a significant increase.
Dr Ambegaokar from Mumbai also highlighted another major area of concern: the blood bank crisis, as all blood donation drives had been cancelled. An effective blood transfusion service is dependent on consistent all-year round availability of safe blood from donors with different blood groups, which was completely disrupted during the lockdown.
This did not prove critical in the first phase of the lockdown, as all regular surgeries—cardiac, cancer-related and so on—had been postponed, other than emergency cases. The problem became visible prominently in June-July, when surgeries started resuming. “Now there’s a very major, full-blown blood bank crisis, since most of the back-up is gone.” Ambegaokar explained.
One of the most common and preventable causes of maternal death is Postpartum Haemorrhage (PPH), meaningexcessive bleeding after childbirth. PPH accounts for about 35% of all maternal deaths globally and about 30% of maternal deaths in India. Access to safe and adequate blood for transfusion, therefore, is a very important factor in preventing maternal casualties.
The medical fraternity devised various ways to deal with the unprecedented issues. Ambegaokar said that instead of 3 hours of OPD, they have now extended OPD visits to 5 hours, staggering the appointments to prevent crowding and allowing for sanitisation between visits. They also discharge patients earlier than before, sending normal delivery cases back after 24 hours, and C-section cases after 3 days, so as to prevent any exposure to infection.
In Hyderabad, a senior gynaecologist from a major government hospital at the tertiary level was of the opinion that maternity care was less affected when compared to other specialities.
“Special control rooms at State level, district level were formed with 24/7 helpline numbers, ambulances worked nonstop to transports patients to hospitals. One major hospital was designated as COVID Care centre and the other 3 hospitals shared the burden of non COVID pregnant patients,” she informed.
In the government hospitals maternity staff were not directed towards COVID. New senior residents were recruited in big numbers to add to the existing staff, she said.
Gynaecologists emphasised how most of the resident doctors did their best to be sympathetic and gentle towards patients, however most doctors were reeling from burn-out due to overwork and in many cases lack of facilities. Infection cases among doctors also went up rapidly owing to lack of availability of adequate PPE kits. Even later, the kits that were provided were far less than required, given the steep number of infections. [SL1]
And yet, despite all the difficulties and the grave concerns, many pregnant women from the underprivileged sections of society reported having received adequate medical attention at hospitals, after being tested for Covid first.
According to the gynaecologist from Hyderabad, post natal care suffered as field staff were involved with the pandemic 24/7. As a consequence, new mothers had to bear the brunt of the situation.
Mothers also faced difficulties in the vaccination of their children. Varsha, a homemaker from Bangalore had to call an ambulance just to get her newborn vaccinated.
Jehantab Humaira from Patna revealed that COVID situations prevented her from opting for stem cell banking for her second child, despite having availed of it for her firstborn earlier. Another reason was that the prices had been raised significantly due to COVID.
An interesting aspect that came to the fore was how myths and misinformation during COVID had an impact on breast feeding.
According to Dr Asna, breast feeding suffered during COVID, because of the myth that it can lead to infections or increase the chances of infections. There was a decline in early initiation and continuation of breast feeding, not just in COVID positive mothers but also in COVID negative mothers, due to the myth of infection.
The impact of COVID on maternal care has proved to be quite a shadow pandemic in itself, quite a bit like the shadow pandemic of violence against women and girls during COVID, a term given by the United Nations.
Image source: shutterstock
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Zehra Naqvi is a journalist who has been writing for a decade on gender, literature
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