World Patient Safety Day was commemorated globally on September 17, 2021. The theme this year was “Safe Maternal and Newborn Care”.
Mothers and their newborns have and continue to be exposed to risks and harms when the care provided before and during childbirth is unsafe.
Although there has been some progress, challenges remain for Malaysia in attaining the targets of Sustainable Development Goal 3, which is to “Ensure healthy lives and promote well-being for all at all ages”.
This has been compounded by the Covid-19 pandemic, which has led to disrupted essential maternal health care services due to factors that include the impact of Covid-19 on pregnancy, women’s inability to access care, disrupted supply chains and diversion of skilled professional maternity staff for care of Covid-19 patients.
Furthermore, the extent to which maternal care has been affected by gender equity and violence issues consequent to Covid-19 have still to be elucidated in Malaysia.
The experiences of women during pregnancy and childbirth have the potential to either empower or to cause damage and emotional trauma.
The slogan for the 2021 campaign, “Act now for safe and respectful childbirth” is an exhortation to all stakeholders to ensure that all women are provided care that is safe and respectful not only during childbirth but also antenatally.
Covid-19 And Pregnancy
Shu Qin Wei, et al conducted a review of 42 studies of Covid-19 in pregnancy published up to January 29, 2021. It included 42 studies that involved 438,548 pregnant women.
Compared to those not infected, Covid-19 was associated with preeclampsia, preterm birth, stillbirth, intensive care unit (ICU) admission, lower birthweight, and neonatal ICU admission.
When compared with mild Covid-19, severe disease was strongly associated with preeclampsia, preterm birth, gestational diabetes, and low birth weight. Covid-19 was not associated with gestational diabetes, Caesarean section, postpartum haemorrhage or neonatal death compared with those without infection.
Compared with asymptomatic Covid-19, the symptomatic were associated with increased risk of preterm birth and Caesarean section. Symptomatic Covid-19 was not associated with gestational diabetes.
Compared with mild Covid-19, severe disease was strongly associated with preeclampsia, preterm birth, gestational diabetes, ICU admission, mechanical ventilation, Caesarean section, low birth weight, and newborn intensive care unit (NICU) admission.
Information about almost all pregnant women hospitalised with Covid-19 in the United Kingdom is recorded in a registry called the UK Obstetric Surveillance System.
The data shows that pregnant women are no more likely to get Covid-19 than other healthy adults. However, they are at slightly increased risk of severe disease if they do contract Covid-19, and are more likely to have pregnancy complications like preterm birth or stillbirth.
About two-thirds of pregnant women with Covid-19 have no symptoms at all, and most of those with symptoms have mild cold or flu-like symptoms. However, a small number can become unwell.
Pregnant women who contract Covid-19 are at slightly increased risk of becoming severely unwell compared to the non-pregnant, particularly in the third trimester.
There have been no reports of Covid-19 affecting foetal development so far. There are also no reports that infection in early pregnancy increases the likelihood of miscarriage.
Transmission of Covid-19 from mother to foetus during pregnancy (also termed vertical transmission) appears to be uncommon. Whether a newborn baby gets Covid-19 does not appear to be affected by the mode of delivery, breast or bottle feeding or whether the baby rooms in with the mother.
There have been some reports of newborn babies developing Covid-19 soon after birth. The babies have been well in most of the reported cases.
The likelihood of preterm birth i.e. before 37 weeks, is increased two to four times in instances when there is severe Covid-19. In most instances, preterm delivery was recommended for maternal reasons.
As is the case with all preterm babies, there is increased likelihood of breathing, feeding, temperature control, gastrointestinal, metabolic and other problems. The earlier a preterm baby is delivered, the greater the likelihood of problems occurring.
The Ministry of Health (MOH) provided some information about Covid-19 in pregnant Malaysian women on August 11, 2021. ().
There were 3,396 pregnant women who tested positive for Covid-19 tests between March 2020 and June 2021. An estimated 1 per cent of pregnant women contracted Covid-19.
The increase of Covid-19 in pregnant women began in October 2020 until May and June 2021, when it surged to 850 and 899 cases respectively, in tandem with the national surge.
The need for intensive care for pregnant women with Covid-19 rose from 3 per cent on July 10 to 5.3 per cent on August 7. This was one in 20 of the total Covid-19 patients who were critically ill.
There were 70 maternal deaths from Covid-19 complications as of August 9, compared to none in 2020. There was a marked increase in deaths since June with 17 deaths — of these, two had received one dose of the Covid-19 vaccine and 15 were unvaccinated. 47 Per cent of the mothers who died had comorbidities, the nature of which were not disclosed.
Objectives Of World Patient Safety Day 2021
The above has been well stated by the World Health Organization (WHO):
- Raise global awareness on the issues of maternal and newborn safety, particularly during childbirth.
- Engage multiple stakeholders and adopt effective and innovative strategies to improve maternal and newborn safety.
- Call for urgent and sustainable actions by all stakeholders to scale up efforts, reach the unreached and ensure safe maternal and newborn care, particularly during childbirth.
- Advocate the adoption of best practices at the point of care to prevent avoidable risks and harm to all women and newborns during childbirth.
All health care professionals make decisions based on evidence. The more information they have, the better the decisions will be for the recipients of care.
This is particularly so with Covid-19, with which information is still evolving.
Needless to say, all health care professionals involved in maternal and newborn care await more transparent, detailed and updated data from the MOH.
It goes without saying that such data will be helpful in the provision of safe and quality care for mothers-to-be and their newborns.
The World Health Assembly (WHA) adopted a resolution, “Protecting, safeguarding and investing in the health and care workforce”, on May 28. The WHA called for action “to guarantee that investments in our workforce ensure they are skilled, trained, equipped, supported and enabled. It stresses the need for decent pay, recognition, a safe working environment and protection of their rights”.
As the government is a party to the resolution, it has a responsibility to implement what it has signed on. A prerequisite in the provision of safe and quality care to mothers-to-be and their newborns are investments stated in the resolution.
In summary, all mothers-to-be and their newborns and health care professionals await the MOH’s plans and actions for ensuring a safe and respectful childbirth at all times.
Dr Milton Lum is a Past President of the Federation of Private Medical Associations, Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.