Covid-19 Could Trigger Increase In Maternal Deaths — Dr John Teo

By CodeBlue | 13 May 2020

Pregnant women may have transport difficulties, fear of going out, or have no money to attend their antenatal checkups.

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It had been said that pregnancy can be one of the most health threatening times in a woman’s life, more so if the woman is from marginalised, poor or rural communities. In Malaysia, these group is termed the B40 or Bottom 40.

The wedge between their health care and other mainstream population widens even more especially during crisis and pandemic. Even the experiences of M40 (Middle 40) and T20 (Top 20) are not necessarily spared from the consequences of Covid pandemic.

During the lockdown and even after restrictions are eased, movements may still be restricted. Pregnant women may have transport difficulties, fear of going out, or have no money to attend their antenatal checkups.

Default rate are noticeably higher as reported by health care providers. Tracing of antenatal defaulters may be also compromised with lack of health care staff, many working extra hours and even restrictions of home visits.

Pregnant women attending government health centres may find themselves in a system overwhelmed with Covid-related efforts, overcrowding of screening centres, challenge of PPE (personal protective equipment) supplies, long waiting times, and enhanced screening procedures, making attending antenatal checkups for many women tiring and challenging.

Attending private GP clinics are not without difficulties with similar screening procedures, shorter operating hours or even closure of some clinics.

Women in labour are facing many challenges. Some may deliver at homes, risking their lives as well as their babies.

Often, these home births are attended by untrained person with no lifesaving medicines. In non-pandemic times, home delivery is already prevalent among the undocumented immigrants and on occasion, in some rural remote communities.

During the Covid pandemic, increased police and army presence, raids by immigration authorities, and lack of ready transport and money makes the likelihood of home delivery even more inevitable.

Even those who make it to hospitals may find themselves faced with multiple problems. Many hospitals may have both their human and medical resources diverted to Covid activities.

Many doctors and nurses may be overstretched, working in long shifts, uncomfortable sweat-drenched full-suit PPE which may affect the level of care.

This is especially so if their colleagues may be quarantined for suspected Covid or been deployed to the “Frontline”, not withstanding that every healthcare worker is a frontliner.

Some mothers who are suspected to have Covid may be separated from their babies from days with the intention to avoid infection, but not necessarily for the betterment of maternal-infant bonding or breastfeeding initiation.

Even those who deliver privately may faced similar challenges with higher delivery bills due to the need for extra procedures, PPEs and even ” routine” Covid tests.

Access to private deliveries will consequently be more challenging for many.

The mismatch between the antenatal and delivery needs of many women and how much the health care system, overwhelmed with the Covid pandemic, can safely provide is a major point of concern.

The possibility may be less care, less quality of care, and increasing risk of unsafe practices in many instances, threatening the lives and health of mothers.

It pertinent that as part of our Covid response, care for pregnant women must be zealously guarded. This entails remote antenatal care and defaulters tracing.

It also includes deployment of additional staff to critical areas and pregnancy or delivery care must be the forefront areas alongside ICUs or Covid wards that staffing levels are always optimal.

Most importantly, it is paramount that we remind all pregnant women that their care is essential care and scheduled appointments should be adhered stringently.

The usual way of antenatal or delivery care provisions must be overhauled to meet the rapidly changing demands, as the pandemic evolves and consumes our health care system or resources.

We also must do all these with utmost urgency, leaving no mother behind and making every delivery safe.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
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