How curfew in war on pandemic risks pregnant women

Even though there is limited data on the impact of Covid-19 on pregnant women, experts have expressed concerns that the curfew and lockdown measures were taken around the world to slow down the spread of the viral disease, could spike an increase in the number of maternal deaths. FILE PHOTO | NMG 

By PAULINE ONGAJI

Summary

• Even though there is limited data on the impact of Covid-19 on pregnant women, experts have expressed concerns that the curfew and lockdown measures were taken around the world to slow down the spread of the viral disease, could spike an increase in the number of maternal deaths.
• This is drawing lessons from the surge in the maternal mortality ratio that was experienced during the 2014-16 Ebola epidemic in some parts of West Africa.
• In 2015, the UN Population Fund (UNFPA) projected the outbreak would cause 120,000 preventable maternal deaths.

It is barely two weeks since Mati Nyamai, 45, buried his wife, Lydia Nduku Mati, 41, but he hasn’t got any time to mourn.

For Nyamai, a construction sub-contractor who hails from Kiimani village, Mbui-nzau sub-location, Makueni County, apart from having mouths to feed, he must help his six children — aged between four and 21 — come to terms with the abrupt death of their mother.

Lydia died on March 31 after she bled to death while giving birth to their seventh child, who also died.

“My wife’s due date was March 31, according to clinical appointments, but a day earlier at around 11pm she started having abdominal pain, which we believed to be labour pains. However, because it was already within government’s dusk to dawn curfew hours, we realised we couldn’t get to the hospital, some three kilometres away, also considering that even transport was not available,” he explains.

To curb the labour pains, he says, his late wife told him to look for a renowned midwife within the village whom they believed with her traditional therapy, could help the pain subside, as she waited to get to the hospital the next day.

“We had to make our way to her home through the bushes to her house, where she succeeded in helping her with the pain, and we went back home. Things went back to normal but at around 3am on March 31, while we were still in the house, she started bleeding,” he recounts.

According to Nyamai, this went on until around 5am — at the end of curfew hours, and it is then that they managed to call a boda boda rider who took her to Kibwezi sub-county hospital.

“She was placed on the bed for one hour after which they took her to the theatre. Unfortunately, after some time the doctor came back with the bad news that the blood had choked baby to death,” he says.

The doctor also said Lydia was in a critical condition as she had lost a substantial amount of blood and needed a transfusion.

“But he again said there was no blood at the hospital. They needed to look for it and at around 2pm they said they had got the blood from Voi and the ambulance had been sent for it,” he explains.

Unfortunately, he says, at around 4pm, even before the ambulance brought the blood, the doctor informed them that Lydia had died.

“The doctor wrote a permit to take her body at home, and the next day — on April 1 — barely 24 hours after her death, we buried her at around 2pm, without any mass service, nor photo session, as per our traditions,” he adds.

Nyamai says even though he is yet to come to terms with his wife’s death he is focusing on his family.

“My children are my priority right now as I have to do her work as a caregiver and a farmer, as well as mine as the provider. Although I haven’t yet gone back to work (as a sub-contractor), in high seasons my work sometimes requires me to be away for long hours and I wonder what will happen when that time comes,” he ponders.

Nyamai believes things would have turned out differently had they been able to leave for the hospital immediately his late wife began experiencing labour pains or if she had got the blood transfusion when they immediately arrived in the hospital.

“I strongly believe she wouldn’t have died. She would have been alive,” he says.

Even though there is limited data on the impact of Covid-19 on pregnant women, experts have expressed concerns that the curfew and lockdown measures were taken around the world to slow down the spread of the viral disease, could spike an increase in the number of maternal deaths.

This is drawing lessons from the surge in the maternal mortality ratio that was experienced during the 2014-16 Ebola epidemic in some parts of West Africa.

In 2015, the UN Population Fund (UNFPA) projected the outbreak would cause 120,000 preventable maternal deaths.

Last week, Dr Natalia Kanem, the executive director of the UNFPA, termed sexual and reproductive health as one of the services severely disrupted by the coronavirus outbreak.

Dr Jemimah Kariuki, an obstetrician and gynaecologist, says high maternal mortality rates will be unavoidable if someone doesn’t step in to ensure that pregnant women get the services they need.

“Pregnant women are likely to get to the hospital late or won’t go at all for fear of contracting the disease. This means there will be an increase in home deliveries and putting them even into more danger,” she says.

That’s not just it, Dr Kariuki says often in a pandemic, resources are directed from sexual and reproductive services, towards targets perceived to be more pressing.

“Already the Mbagathi County Hospital has been set aside for dealing with coronavirus cases. The same goes with some parts of Kenyatta National Hospital, which have been turned into Covid-19 isolation centres. I understand where the government is coming from but same hospitals take quite a chunk of women going for such services, a fact that will affect sexual reproductive services delivery,” she adds.

At this point, Dr Kariuki says, community dispensaries and clinics should come in handy to handle normal delivery cases, while only patients with complicated situations are taken to referral and other higher-level hospitals, to avoid congestion in these facilities at this time.

Dr Kariuki, who on April 7 started an online initiative to help pregnant women access reproductive services during this time, says, hospitals could also witness a surge in pregnant women coming despite not experiencing any labour complications.

“I’ve heard of panicked pregnant women who have gone to the hospital at night but are not in labour. They end up stranded in hospital after being turned away,” she says.

According to Dr Kariuki, to avoid such scenarios, patients could go for telemedical services where pregnant women can communicate with their doctors on health issues they face via telecommunication technologies, avoiding unnecessary contact.

She also reiterates the need for educating the masses, especially pregnant women on what they should do when they feel in a certain way so that they can get to the hospital early before the curfew hours.

To avoid catastrophic outcomes witnessed in several West African countries during the Ebola outbreak, Dr Kariuki advocates the employment of not only doctors but also other health workers from different cadres of the sector.

“One coronavirus diagnosis forces the health providers who handled the case into mandatory quarantine, thus dealing a blow even further to such an overwhelmed society. For this reason, there should be more medical practitioners absorbed at county levels, immediately they finish school,” she says.