Mohali: Thirty-two-year-old Shakuntala Devi is expecting a child after having suffered a miscarriage last year. While the experience can be testing for anyone given the nature of the pandemic and the precautions required, it’s rather worrisome for Devi, already a mother of one, who tested positive for Covid-19 last week. She is now stressed about whether her baby could get infected.
Devi is at the Mohali Civil Hospital, the only government institute admitting Covid-19 patients in Sahibzada Ajit Singh Nagar, better known as SAS Nagar, a high-burden Covid district in Punjab.
Housed in the hospital’s isolation ward for pregnant women, Devi has discovered she isn’t the only one with such troubles. However, there is cause for some cheer.
In the past two months, as many as 34 babies born to Covid-positive women have been delivered at the hospital, and all of them are healthy, senior medical officer Dr Areet Kaur told ThePrint.
Punjab has so far seen 84,482 cases of coronavirus, and 2,514 deaths. In SAS Nagar alone, there have been 7,171 cases and 139 deaths. Both sets of figures are as of Wednesday.
The Indian Council for Medical Research (ICMR), the country’s apex medical research body, notes that vertical transmission of the highly infectious virus is probable between mother and foetus. But at this Punjab hospital, they are yet to see such a case.
The ICMR’s ‘Guidance for Management of Pregnant Women in Covid-19 Pandemic’ — drafted in collaboration with the National Institute for Research in Reproductive Health, Mumbai — states that “with regard to vertical transmission (transmission from mother to baby antenatally or intrapartum), emerging evidence now suggests that vertical transmission is probable, although the proportion of pregnancies affected and the significance to the neonate has yet to be determined”.
Separate wards, Covid registry & special labour rooms
At the Mohali Civil Hospital, all pregnant women undergo a rapid antigen test when being admitted. A registry of positive cases is maintained by the hospital, with full details of maternal and neonatal cases.
Regular symptomatic pregnant patients are kept in isolation wards, while the more crucial patients are referred to Gian Sagar Medical College and Hospital in Banur, about 22 kms from Mohali. Each pregnant patient is kept in a separate ward.
“In cases where a woman’s infection is not as severe and we feel she can manage on her own, we are requesting such patients to remain in home isolation and only get admitted when they get labour pain, since we don’t have so many beds,” Dr Baban, hospital administration in-charge, said.
Once a baby is born, it is tested for Covid-19.
Dr Kaur added, “The child is ideally given to the family of the woman after delivery unless they’ve tested positive too, in which case, the newborn is also kept in a separate ward.”
Mothers are also being allowed to breastfeed the babies as long as they have sanitised their hands and wear masks during the feeding session. At Patiala’s Rajindra Hospital, a tertiary Covid-19 care hospital where 81 deliveries took place during the pandemic, babies are being fed breast milk artificially.
According to the Unicef, the evidence is “overwhelmingly in support” of mothers breastfeeding babies. The UN body says there hasn’t been a reported case of transmission of the active Covid virus through breastmilk and breastfeeding.
Nevertheless, stress levels among such pregnant women are pretty high.
“The first thing we do is ensure they are counselled properly since any kind of stress is not good for someone who goes into labour,” Dr Baban said. Depending on what stage of the pregnancy a patient is in, the team decides on whether to send them to a septic labour room or a normal labour room. A septic labour room is used for deliveries of women who might be infected with any disease or have shown prior medical complications.
“If we are short on time and say, some referred case or some woman has suddenly arrived without any prior information, and we don’t even have time to test her, then we take such a case to a septic labour room wherein we have a doctor and LMOs (lady medical officers) with advanced protective gear and equipment,” said Dr Baban.
There have been some exceptions too, wherein patents didn’t believe their Covid positive reports and did not agree to remain in isolation. They were allowed to leave with a doctor’s consent, but the hospital administration had alerted the local police. “This way the police steps in to ensure that the woman is isolated in her room … and the neighbourhood needs to be informed,” Dr Baban explained.
Doctors, nurses testing positive add to staff crunch
Staff providing care to pregnant women are in PPE kits, a nurse at the civil hospital said. Despite the precautions, the Mohali Civil hospital’s gynaecology ward is short on staff since doctors and nurses have tested positive for the novel coronavirus.
So far, 25 health care workers including doctors, nurses and paramedical staff, have got the infection, according to sources in the hospital administration. Nurses said they come back to work almost immediately after the quarantine/isolation period.
“We have written to the higher authorities multiple times, but we haven’t received any specialised doctors to fill the vacancies,” Dr Kaur said. The hospital got only three additional general medical staff but no specialists in the past three months.
“While three LMO can carry out natural deliveries, they aren’t equipped to conduct a caesarean, and many cases of Covid-19 positive women end up being caesareans,” Dr Kaur added.
According to her, there is currently a requirement for at least six gynaecologists since the department carries out at least 350-400 deliveries every month. In August, the hospital carried out 573 deliveries. The department currently has just two gynaecologists who handle both Covid and non-Covid patients.
Overall, the hospital has 32 doctors on roll, which has resulted in the administration hiring non-specialist doctors to fill the gap.
A senior doctor, requesting anonymity, told ThePrint that such is the shortage that a single doctor on emergency duty at night has to look after at least 75 patients.
“Since Chandigarh hospitals aren’t taking patients from Punjab, many cases are referred from PGI or other institutes, increasing our workload,” Dr Kaur said.