The COVID-19 pandemic has caused many health issues not directly related to the virus. From access to basic healthcare to sexual health and reproductive health, all have been affected. One of the biggest health issues has been the pandemic’s effect on antenatal and postnatal care for women.
The world marks more than eight months of the coronavirus. There still remains much that is not known about the virus. One of the areas where this lack of knowledge is especially concerning is the care of pregnant women. Pregnancy can be a stressful period, health-wise for many women. The coronavirus is amplifying that. There is no definitive evidence about the effects of the virus on pregnant women. The Centres of Disease Controls says “pregnant people might be at an increased risk for severe illness from COVID-19”.
Milan study of pregnancy and coronavirus
Last week, a study by the University of Milan found that the coronavirus and antibodies against it in the umbilical cord blood, breast milk, placentas and vaginas of some pregnant infected women. The small study suggests the virus could be passed on to the fetus and newborns. Claudio Fenizia, an assistant professor of immunology at the university who led the study, said it was early to draw conclusions but the study should be considered a “ringing bell”.
There aren’t any interventions for pregnant women who are infected with the virus, he added, the best thing is prevention.
South Africa’s coronavirus infant mortality
On May 20, South Africa recorded its first infant death related to the virus. A two-day-old baby passed on after being born prematurely with breathing difficulties. The mother and baby tested COVID-19 positive. Speaking to The Daily Vox, obstetrician Vuyelwa Baba says many of the outcomes around infant mortality related to COVID-19 depends on the health of the baby and mother. Baba is currently working both within the public and private healthcare sector.
She pointed out that in South Africa, there are a number of babies testing positive for COVID-19 at birth and a few days after delivery. The data around this is still being assessed to see whether the transmission happens in the womb or shortly after the delivery. There is a need to see what the data shows as what is happening in South Africa seems to be very different from what is happening in the rest of the world, she added.
In France last week, doctors have described what they call the first confirmed case of a baby being infected with COVID-19 in the womb. There have been other cases in other countries with suspected cases, but much of the evidence remains circumstantial.
Preparing for birth
With all the uncertainty surrounding the virus and the birth process, this is likely to be a very stressful time for expectant mothers. There are a number of steps and procedures that women can take to ensure their own and their baby’s safety. Baba says one of the precautions put in place is the cutting down of antenatal visits. Expectant mothers won’t be visiting their doctor or gynecologist as much as usual. Even with this advice being given by doctors, the National Income Dynamics Study – Coronavirus Rapid Mobile Survey (NIDS-CRAM) found antenatal and follow-up visits after birth dropped significantly during lockdown. Many of the women said their fears of coronavirus led to them not attending those visits.
There will be less people in the consulting rooms and the doctor is likely to be wearing scrubs and personal protective equipment (PPE) instead of casual clothes.
Within the public sector, Baba says many of the women take public transport for the appointments. That’s another reason why the visits are being cut down: to protect the mothers being exposed in the transport and to other patients at the clinic. The expectant mothers are given bigger doses of medication to ensure their visits to the pharmacy are reduced as well.
What about the actual birth?
The department has put together a guide for how to prepare for birth during the time of COVID-19. One of the best and most important things is prevention. In order to prevent getting infected with the virus before birth, it’s been advised that expectant mothers should self-isolate for fourteen days before the expected due date. They should avoid going out unless absolutely necessary.
Baba says before a woman goes in for the delivery, she will be tested for coronavirus. Depending on the result, different protocols will be followed. However, whether it’s a negative or positive, the attending nurses and doctors will be wearing full PPE. Baba says this can be a little scary as women will be giving birth in a room where all the staff will have their faces covered.
As for having a partner during the birth process, only some private facilities will allow a COVID-19 negative partner to be present. No partner will be allowed under any circumstances at a public healthcare facility.
For women using public state healthcare facilities, the process is a lot more complicated. They will be led through the birthing process by doctors who they do not know and might have never met. For those going to private facilities, even if the doctor is completely covered, they might recognise their doctor’s voice.
Baba says she tries to warn and prepare her patients for what they can expect.
Once the birth process is over and if the woman and newborn are fine without any complications, they will be allowed to leave the hospital. This is regardless of whether the mother or/and child are positive.
In order to minimise the risk of infection, the mother and newborn are not allowed to use their own transport. Instead they will be transported home in the hospital’s transport with a nurse and driver – both wearing full PPE. The nurse is supposed to show the mother how to take care of the child with breastfeeding and so on to prevent infections. The mothers are encouraged to self-isolate and alert the healthcare professionals if they are unable to do so.
Baba says while there are days when the process doesn’t work perfectly, most of the days it does.
The final advice Baba gave for expectant mothers is to make sure they get tested and come into the hospital if they feel like they have any symptoms. “Any flu is considered COVID unless proven otherwise,” she explains. It’s better to be safe and stay home.