Challenges in pregnancy and neonatal health during COVID-19

Published in

Swastha Naari

6 min readSep 20, 2020

The novel coronavirus outburst was so unprecedented that with the limited information available of its effects on maternal health, clinicians and patients are forced to make uninformed decisions. The outbreak of coronavirus disease (COVID‐19) is a major public health issue and the increasing cases of infection are being reported during pregnancy. Even when the pregnant women are not tested positive for the disease, the fear has resulted in adverse effects on maternal as well as the fetal health. The COVID-19 pandemic response is affecting maternal and neonatal health services all over the world. Nepal, being a South Asian country itself has a very low rate of health service utilization. But with the pandemic, there has been a drastic lowering in birth at health facilities and an increase in neonatal death and stillbirth during the lockdown along with the decrease in quality of care.

The effect of pandemic in maternal health however cannot be overlooked. According to a recent survey by the Department of health services, after initiation of lockdown period by The Government of Nepal, 60% of pregnant women have lost their lives within 24 hours of reaching the health service. A sharp increase was seen in maternal mortality during the 2-month lockdown period between March and May, 2020, including the first COVID-19 related death in Nepal. Within 5 months of lockdown (end of shrawan), 80 nursing mothers have lost their lives. And the unrecorded counts could even be more. The rate of C-section birth compared to vaginal birth has also increased to some extent. The joy and excitement of pregnancy has now turned to fear among mothers and their families with movement restrictions, transport issues and anxiety over possibly being exposed to the virus being the major challenges. Antenatal care visits are the most affected ones and the distress has become unavoidable among pregnant women and their spouse. The challenges were more likely faced by disadvantaged ethnic group compared to advantaged ethic group resulting in inequity in the community as well.

A very inferiorly treated and overlooked topic in this regard could be maternal mental health. What isn’t considered is the interwoven relationship between a mother’s reproductive health and mental health. Lack of proper counseling, stress, panic after hearing the news, fear of uncertainty and worrying about the health of oneself and the newborn aftermath has resulted in a poor maternal health. And this could even be worse during the postpartum period leading to postpartum depression and postpartum psychosis. And gets worsted if the mothers receive suboptimal care during these periods, both physically and mentally. Sharing responsibilities among spouse and family members, reducing the burden of household chores of pregnant women, video call meetings for antenatal care and mobilization of female health volunteers in rural areas could be some interventions.

Picture credit: NuNu Tv — Nursery Rhymes YouTube channel

Amidst the chaos of terror created by COVID-19, concerns for neonatal health cannot be significantly ignored. The occurrence of the novel coronavirus to a newly born could be acquired either through vertical transmission (transmission of a disease-causing agent from mother to baby during the perinatal period, the period immediately before and after birth) or horizontal transmission (spread of an infectious agent from one individual to another, usually through contact with bodily excretions or fluids, such as sputum or blood, that contain the agent). However, the results for neonatal infection have been found to be very low by various researches. Many researches have also found no relation between infected mothers and newborns, meaning that infected mothers are still capable of giving birth to a non-infected or a healthy child.

But despite these facts, neonatal deaths increased from 13 deaths per 1000 live births before lockdown to 40 deaths per 1000 live births during lockdown, and institutional stillbirths increased from 14 per 1000 total births before lockdown to 21 per 1000 total births during lockdown. These increases are indicative of either very late arrival at a health facility or reduced quality of care, or both. The breastfeeding rates immediately after birth decreased from 49% to 46%. Breastfeeding immediately after birth gives babies colostrum (first milk). Colostrum contains Immune cells, and other components like lactoferrin, lysozyme, lactoperoxidase, proline rich polypeptides, cytokines and other important components to help infants grow healthy. The perfect mix of vitamins, proteins and fats provide antibodies to the infants to lower the risk of allergies and other diseases. This should be continued to infants exclusively till 6 months of their lives and it has been well understood that it is safe to continue breastfeeding even if the mother has symptoms of COVID-19. However, the benefits of breast milk have been overshadowed with the increasing risk of infection. According to an article published by UNICEF South Asia,

Mothers who have confirmed or suspected COVID-19 can breastfeed safely by:

Washing their hands frequently with soap, for at least twenty seconds, especially before touching their babies.
Wearing a facemask.
Regularly cleaning and disinfecting any surfaces.
Sneezing or coughing into a tissue. After, they should immediately dispose of the tissue and wash their hands with soap and clean water.

If a mother feels too unwell to breastfeed, there are a few options:

She can express milk that she, or someone else, can then feed to the baby with a clean cup and spoon.
Another breastfeeding woman can breastfeed the baby.
She can seek advice and support from a health worker.

Nepal was at tipping point with 60% of births occurring in the health facility by the beginning of 2020, which is triple the data of 2006 (18%). But due to pandemic, trust issues have emerged among patients and their companions regarding the precaution practiced against novel coronavirus in health services. Fear and the effect of lockdown on public transportation has meant that more women are compelled to give birth at home. The trust can however be regained by providing adequate protection for health workers, women and their companions, and resolving transport challenges by establishing measures to enable women to access referral-level hospital care. Government should look into this matter with serious concern and collaboration with local bodies and helping institutions in providing proper antenatal care services, transportation facilities to women with full term pregnancies and safe deliveries in health facilities. The proper utilization of information technologies in providing the best health tips to pregnant women including the importance of supplements, nutrition, diets, exercise and yoga and facts about neonatal care during pandemic should also be a prime concern among social servers.

References:

Challenges in pregnancy and neonatal health during COVID-19

Written by Shreya Dhungana