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The world celebrated this year’s Mothers’ Day indoors. But for many expectant mothers, this is a time of anxiety. Dr Mirana Zaman talks about how the pandemic is affecting women in low-income households physically and emotionally.
Mirana Zaman is a senior regional medical officer working in BRAC’s Manoshi project. She looks after 12 maternity clinics in Dhaka, Gazipur and Mymensingh, all of which continue to remain open to offer emergency maternal healthcare to women in low-income households.
In an interview over the phone, Dr Zaman explains how pregnant women in low-income groups are affected by the pandemic.
How are the centres currently operating?
They are being run by midwives. We, the doctors, are advising the midwives and patients directly through telemedicine – either through video calls or phone calls. There are increased safety precautions at the centres, from sanitising the premises to ensuring hand washing and disinfecting for everyone who enters.
Patients are calling the centre for appointments before coming. As part of safety precautions, midwives have been instructed to ask questions during those phone calls to identify whether the patient is showing symptoms of COVID-19 or not. If the patient does not, for example, have a fever or a dry cough, they are given an appointment.
Has the pandemic brought about challenges for the maternity centres?
There are two challenges. A big one is when a patient has a fever, and is already going into labour. In these cases, if the patient is in the early stages of labour, we have her transferred to one of the hospitals BRAC has an agreement with. However, if a woman comes in during the third stage of labour, we proceed with the delivery, but with extra precautions. Infection protection prevention is strictly maintained, midwives are in full protective wear including double masks and gloves, all of which are carefully discarded after the delivery.
Another challenge is that sometimes patients are not inclined to truthfully tell of their symptoms, in fear of not getting treatment. If a midwife identifies symptoms of COVID-19 in a patient, they call us immediately for counsel. We often refer the patient to a tertiary hospital and ensure follow up on the patient, while the midwife who was in contact with the patient is sent to quarantine.
How is the pandemic disproportionately affecting pregnant women?
Expectant mothers are fearful of how this situation will affect their babies. For instance, many ask our midwives whether the baby can catch the virus if the mother gets infected. On top of that, many are experiencing financial shocks at home, due to the lockdown. Nutritional intake has lowered for many of our patients.
Older patients who are pregnant have a higher chance of having hypertension, which leads to eclampsia, which is a severe bout of seizures. They are also more at risk of postpartum hemorrhage. The stress of the pandemic is aggravating these factors.
Have you noticed any difference in the complications pregnant women are experiencing?
We are seeing an increase in premature deliveries. Patients who we have been tracking as healthy throughout their pregnancies are now going into labour just after their second trimester. This can be a result of stress, which raises blood pressure and increases the chances of premature birth.
Is there a changing pattern in patients’ complaints?
Prior to the pandemic, our patients were well aware of the side effects of a pregnancy. Now, each time they feel a bout of nausea or fatigue, expectant mothers call to set up appointments. They panic thinking they might have caught the virus and ask us if their babies are healthy.
Women who are in their early stages of pregnancies are considering abortions. They are cautious about their own health, as pregnant women are more susceptible to infections.
We are advising new couples to strictly follow family planning measures. For couples who are wondering if this is a good time to start a family, we are advising to wait.
How is telemedicine helping?
Expectant mothers are already mentally strained due to the anxiety of being pregnant during a crisis, as well as the stress factors of the pandemic. Talking to their doctor over the phone is not only providing us a clear understanding of their pregnancies, but it is giving them a sense of reassurance and relief.
It can be difficult to come to a conclusive diagnosis in the absence of a physical examination, particularly in case of something complex. What do you do then?
BRAC has signed memorandums of understanding with tertiary hospitals, to which we refer our patients in case of severe complications which we are unable to take on.
A rise in intimate partner violence is being reported as the pandemic worsens. Have you heard any of this from patients coming into the maternal centres?
Yes. A patient recently came in with complaints of abdominal pain. She eventually told us that her husband physically abused her. Thankfully her health was not compromised, but in these cases, the midwives make the patient aware of her options (such as calling the national hotline 109), and give counselling to family members to ease the tension.
Doctors also offer counsel, and we remind the family members that this can be treated as a crime punishable by the law if abuse continues to take place. In difficult cases, we contact BRAC’s human rights and legal aid services programme to look into the matter.
How can family members help look after pregnant women in their homes during this time?
This is a time for extra care. Nutrition and cleanliness cannot be compromised. It is best that only one person attends to the expectant mother to ensure social distancing of some form within the household. Pregnant women should avoid going out themselves to collect relief.
Most importantly, pregnant women should not take on extra stress. We are seeing its impact right now – increasing numbers of premature births. Attendants should be mindful of reassuring expectant mothers that taking safety precautions can keep her and her baby healthy.
At a time when the healthcare sector is overburdened, it is essential that normal healthcare services continue to provide services, especially to vulnerable people. BRAC has kept 41 of its maternity centres across Bangladesh open throughout the lockdown period.
Luba Khalili is Deputy Manager, BRAC Communications.