Pregnancy care in the times of Covid19

The Coronavirus pandemic continues to engulf the world and the world, in its way, continues to carry on. 

As the scientific and medical community battle this disease, hospitals that were once havens of safety also come under the umbrella of fear as a hotspot to catch this virus. While those who can avoid hospital visits and non-emergency procedures steer clear of these premises, a very vulnerable demographic, that of pregnant women, gets caught in the dilemma – to visit, or not to visit, that becomes the question.

Pregnancy and COVID risk  

Hospitals aim to offer the best care and treatment for expecting mothers and new-borns and have several practices in place to ensure their safety. 

However, the spread of the virus makes it essential to become even more prudent to ramp up these practices during this time. Having general safety precautions upon entering the hospital, PPE kits for medical staff and sanitisation protocols along with social distancing are essential. 

In a time like this, maternity hospitals have to not only be careful during labour and post-natal care but have to watch their ante-natal interactions with equal alertness. This becomes essential since pregnant women are at a higher risk of infections owing to the lower levels of immunity during this phase.

While data on COVID-19 and pregnancy is inadequate at the moment, experts are cautiously optimistic that fetal infections later in pregnancy are rare and that the coronavirus won't wrap early fetal development. At the same time, there is data that shows that pregnancy makes women's bodies more vulnerable to severe COVID. This is because of the uniquely adjusted immune systems of women in this phase. It is also partly because of the virus's point of attack, the pulmonary and cardiovascular systems, which are already stressed during pregnancy.

Viral infections are more severe in pregnant women because the mother's entire immune system works towards making sure there is no anti-fetal immune response and, hence, the immune response to the infection carries the potential to cause complications. 

According to data published by the Centres for Disease Control and Prevention (CDC) late in June out of "…91,412 women of reproductive age with coronavirus infections, the 8207 who were pregnant were 50% more likely to end up in intensive care units (ICUs) than their nonpregnant peers."

Another research propounds that "pregnant or immediately postpartum women with COVID-19 were nearly six times as likely to land in ICUs as their nonpregnant, COVID-19–infected peers."  

While visiting the doctor's office or the hospital for an antenatal check-up was exciting before, now most are filled with trepidation. It is understandable to have these concerns amid the pandemic as women don't want to jeopardise their health or the health of the unborn baby. 

However, putting off health checks during this time is also not wise. Pregnant women have to stay alert and safe and should be particularly more attentive towards their health and towards social distancing when outside of their homes.

What are hospitals doing to ensure the safety of their patients?

Over the past few months, hospitals have fine-tuned their practices to make their spaces safer for patients. Medical care is essential and now has to be provided under carefully calibrated guidelines. 

Hospitals have had to implement several protocol changes, including:

• Discourage symptomatic patients from making personal visits without clear instructions
• Have designated treatment facilities for mild and severe COVID-19 cases along with critical care capabilities
• Cancel non-urgent procedures, have telemedicine facilities and enable telemedicine and teleconsultations
• Remove/severely limit hospital access to visitors accompanying patients and screening all visitors for symptoms.
• Enable proactive health management, disseminate quality and timely information to limit hospital visits
• Use health data to tailor healthcare plans for pregnant women according to antenatal age
• Monitor high-risk patients such as those with gestational diabetes, etc. proactively, disseminate advice, and send smart alerts to take care of high-risk pregnancies without any physical interactions.
• Ensure that the hospital ticks all the 9 Quality of Care (QoC) indicators as set by the World Health Organisation (WHO) to ensure that mothers and their new-born receive high-quality care during childbirth and provide a positive delivery experience

Hospitals also need to remember that labour can be a traumatic and stressful experience. Apart from ensuring the physical cleanliness of the space, the hospital staff has to be comforting and reassuring to reduce the emotional stress, ensure that they are treating the patient and the companion with utmost respect and empathy. 

Along with all this, hospitals need to provide valuable counselling services before discharge to make the mother aware of all mental health triggers, as well as signs of infection and illness for herself and the new-born. 

We are stuck in the grip of a pandemic that doesn't seem to slow down especially in countries like India. 

• Hospitals need to make sure that they enable out-of-hospital specialist care. This ensures that mothers, both expecting and new, do not have to go back for the smallest of concerns. However, a small problem can be a signal of something huge (a slight fever can be the first sign of sepsis, or a bad headache can be anything between gas to pre-eclampsia). Therefore, hospitals have to leverage high-end technology solutions to communicate with patients proactively, capably, and securely track patient journeys to provide timely information and enable timely interventions.
• The focus on cleanliness, hygiene standards and sanitisation protocols of hospitals will come into the scanner in this COVID world. Much like the food industry where hygiene ratings are a common practice, hospitals also might have to provide the same to assure people of elevated safety and hygiene levels and communicate the same to them effectively. 
• With advanced, high-end technology solutions hospitals can communicate more proactively, deliberately, and clearly with their obstetric patients and give them all the details they need to stay safe. These solutions can also be leveraged effectively to showcase the hospital and doctor information, procedures they have in place to make the space COVID-proof for maternity patients and communicate the protocols mothers (new and expecting) need to follow during their hospital visits.

From the looks of it, the COVID-19 pandemic will be in our conversation for a long time. 

It is imperative to make the necessary adjustments in the safety protocols and enable the shift in interactions between hospital staff and patients. It is time to make information exchange regarding patients and patient safety more seamless, targeted, contextual, and easier. 

But what is evident is that the cleanliness meter will matter and continue to matter more than ever before, even when we have the pandemic behind us.