Expecting during the pandemic

A pregnant woman went to Gaibandha Mother and Child Welfare Centre in Gaibandha district when her labour pains began. However, the Family Welfare Supervisor of the clinic, Towhida Begum, refused to admit her and referred her to another hospital without performing a checkup or tests.

Refused by the clinic, the woman delivered her child in a CNG-run auto-rickshaw on her way to another hospital.

The nationwide shutdown amid the Covid-19 outbreak has made it hard for Bangladesh's expectant mothers to be admitted to hospital and give birth to their children – as experienced by the woman in Gaibandha.

As a result, the pandemic has increased the level of fear and anxiety among pregnant women. These women are not just worried about catching the virus but also what would happen during delivery if Covid-19 is not brought under control.

Nure Disha is six months pregnant with her first child. She is a housewife and lives with her husband in Mirpur. A constant fear of catching the virus has engulfed her senses as Mirpur's locked-down buildings are not very far from her place.

During her first trimester of pregnancy, she was diagnosed with diabetes. Her doctor prescribed her some medicines to take regularly and told her to relax during her pregnancy to avoid complications.

However, given the situation of the Covid-19 outbreak in Bangladesh and the countrywide shutdown, she is unable to follow the instructions completely. Soon after the shutdown was declared, she noticed her household helper had a cold and cough.

Everyone suggested she let her household help go – and not allow in anyone who comes from outside – to avoid transmission, but her husband mostly stays outside for work so Disha depends on the helping hands.

Panicked, she called her gynaecologist and her doctor. The doctor assured her that pregnant women are not particularly susceptible to the virus but recommended she be careful about interactions and skip her check-up next month unless there is a case of emergency.

Now she is worried about the days ahead.

Farzana Laiju had a cesarean section, recently, during this shutdown period. Her baby's umbilical cord had wrapped around the neck of the fetus and Fazana's doctor recommended she undergo a cesarean delivery immediately.

Out of fear, panic and childbirth stress, she did not wait for an ambulance. She went to the hospital by her own transport.

"I was lucky that my doctor was available. I did not face any problem because of the shutdown," said Laiju.

Taking care of mental health

Taking care of mental health is important for a pregnant woman on regular days. It is even more important in the current situation.

Saima Akhter, clinical psychologist at Dhaka University, advises pregnant mothers avoid watching novel coronavirus news. She suggests they practice yoga, meditate or listen to music – anything that relaxes their minds.

For the women whose due dates are approaching, Saima suggests they make backup plans, for instance, they can have two or more transportation options to get to the hospital. They should talk to their doctors and arrange everything at the hospital beforehand.

"For every pregnant woman, family support is important but for the new mothers, a little extra care is more important. Love, care, attention from the family boosts confidence and relaxes a mother," Saima said.

Arrangements at the hospitals during shutdown

Doctors are advising expectant mothers to stay home and skip checkups if there are no emergencies. Some doctors are available over the phone and some are providing online counselling.

Professor Dr Kaniz Fatema, a gynecologist at Bangladesh Specialized Hospital, regularly attends to her patients at her chamber but she advises her patients not to visit her unless there is an emergency. She is available over the phone.

"We are regularly counselling the patients over the phone and recommend emergency patients be admitted to the hospital. Our hospital is very careful about the current situation. If our hospital finds a suspected case, it refers the patients to the selected hospitals for Covid-19 testing and treatment," said Dr Kaniz.

"At the emergency unit, they investigate all the patients. They keep only those who have tested negative. They send the other ones to the recommended hospitals," she added.

Shelina Parvin, junior consultant of gynecology department at Dhaka Medical College, said the Obstetrical and Gynecological Society of Bangladesh (OGSB) has ordered hospitals to refer pregnant patients infected with the novel coronavirus to Kuwait Bangladesh Friendship Government Hospital.

An assistant professor, seeking to remain anonymous, from Shaheed Suhrawardy Medical College and Hospital, said the hospital has introduced an isolation unit for mothers with a cough and fever.

Doctors will collect the samples from patients for testing. If they test positive, they will be shifted to the Kuwait Bangladesh Friendship Government Hospital – where there is a special Covid-19 unit for pregnant patients.

Nahreen Akhter, professor of feto-maternal medicine of Bangabandhu Sheikh Mujib Medical University (BSMMU), said, "We are consulting them over the phone or giving suggestions online. As pregnant women do not have a strong immune system, we are suggesting they stay home if there is no emergency."

"Still, those whose delivery dates are approaching must go to the hospital. We are treating them with the utmost care. Even the ambulance drivers are maintaining the codes of wearing masks and gloves," said Dr Nahreen.

Dr Kazi Foyeza Akhter, who has her chamber at BRB Hospitals Limited, said she has a separate labour and delivery unit to take care of mothers. The unit is following the fundamental guidelines for those who are not Covid-19 positive. She, along with her attendants, always wear personal protection equipment to reduce the risk of virus transmission.

She said, "There are a few doctors who have closed their chambers to reduce the risks of transmission. Patients are suffering because of that."

However, she has kept the services open. The team takes a short history of every patient coming to her chamber.