Pregnancy and its challenges in times of COVID-19

The main challenges are posed during the first trimester and the third trimester

According to Niti Aayog's Health Index, sex ratio at birth is falling | Reuters Representational image | Reuters

As the world shuts down in the wake of the COVID-19 pandemic, Bhavana Sharath, 27, looks forward to welcome her first child. Presently in the ninth month of pregnancy, she is anxious about the delivery which is to take place around the end of April, and also that her baby will be born in a world which is grappling with life and death at the moment.

"I am in a dilemma. I will not be able to visit the hospital as frequently as before. I am constantly in fear that I might come in contact with a COVID-19 patient who is still in the incubation period, and how will it affect my baby. Whether transmission is possible or not? Such questions are freaking me out,” she says.

Bhavana is consulting Dr Sunil Eshwar, lead consultant, obstetrics and gynaecology at the Aster RV Hospital in Bengaluru. She has to travel approximately 60km every time she has to visit the hospital, but the police have been cooperative so far, letting her vehicle pass. The only regret is that she had to cancel the baby shower.

While Bhavana has had a smooth going so far, Pradeep B.V. and Neetha Sharma, who just welcomed their first child - a girl - on March 27, have not been so lucky. Until four days after their baby's birth, Pradeep was hunting for a shop where he could buy clothes and formula feed for his baby. "We literally had no clothes for our little girl for four days. We had not purchased anything for the kid beforehand because the due date was later. Due to complications, my wife delivered pre-term. We became frustrated because we could not find a single item in the market due to the lockdown," says Pradeep. Four days later, though, as the essential services were restored, the couple was finally able to get what they wanted. Despite the travails, the silver lining of the lockdown is that the pollution has reduced considerably in the city and, as a result, the family can take the baby for a stroll on their terrace for the much-needed Vitamin D, says Neetha.

Even as expecting mothers and new parents struggle with day-to-day challenges, scrambling to stock up on things while trying their best to keep their babies away from infections, doctors too, have their own set of challenges as they try and streamline deliveries and consultations in the wake of the COVID-19 pandemic. If a pregnant COVID-19 patient arrives, how do they manage her, and the newborn?

"I had a pregnant patient who had a travel history and she developed symptoms of the novel coronavirus after 14 days,” says Eshwar. “So, we need to really keep a watch on patients who have a travel history or have ever come in close contact of those with COVID-19.

“I have observed that patients are not forthcoming about their past details. Only if someone shows symptoms like cold, fever and a runny nose, do we conduct the test for COVID-19, else not," explains Eshwar.

But the main challenges are posed during the first trimester and the third trimester when the patient must undergo diagnostic tests, scans and investigations every week or so in order to confirm the pregnancy and check for abnormalities, bleeding, chances of abortions or miscarriages. During such times, the patient has to be called to the OPD section of the hospital and not to the casualty to make sure the chances of transmission of the infection is nil. "Bleeding and abortions are considered to be emergencies but those who must undergo regular scans and tests have been asked to come to the hospital only after April 15," says Eshwar.

Expecting mothers can monitor their blood pressure, baby movements at home, and for any other emergencies, they can use telemedicine that is being offered by most hospitals across the country.

On the other hand, Dr Sushma Tomar, infertility specialist and endoscopic surgeon at Fortis Hospital in Mumbai, who has been dealing with a number of infertility patients, has stopped the treatment entirely at the moment. "The treatment for infertility which includes IVF, test tube babies, etc. is very costly and if the woman gets pregnant during this time of the coronavirus pandemic and amid a strict lockdown, we may not be able to provide any service in case the virus catches on to the foetus. One never knows what side effects it may lead to," she says.

Hence, at the moment, no hormone stimulations take place and the eggs are preserved so that the treatments can begin after two months. All her patients communicate with her over video calls and she prescribes home isolation, a good diet and yoga at home for expecting mothers to make the most of their time. Quoting a news report on how three newborn babies turned positive for the novel coronavirus post delivery and a study conducted in China's Wuhan district showing that 33 per cent pregnant women who tested positive for the virus also passed it on to their newborns, Tomar says, "There is no real conclusive evidence as to how this transmission can take place. But one route is the placenta present inside the womb and the other is during the vaginal delivery when the secretion goes in the mouth, eyes and nose of the baby.

“So, we are being cautious in this regard,” she says. Also, Tomar also clears the confusion new mothers may have regarding breastfeeding. “There is no evidence that the virus can reach the baby through breastmilk. So, please don't stop feeding."