Pregnancy In a Pandemic: How Are Delhi’s Pvt Hospitals Preparing?
FIT reached out to hospitals and clinics in Delhi to know how they are preparing to cater to pregnant women,
A 28-year-old woman gave birth on the way to a hospital in Delhi, after waiting for hours for the ambulance to reach her house.
Another pregnant woman in Moga, who was denied care in two private hospitals, eventually ended up delivering on the roadside.
On June 6, a pregnant woman in Greater Noida, died waiting in an ambulance, after 6 hospitals refused her admission.
The months of April and May saw an unsurmountable number of such instances, where pregnant women in need of medical assistance were forced to resort to unsafe and life-threatening measures in order to simply deliver their babies. Many of them lost their lives running from one hospital to another in the middle of a state-imposed lockdown - put in place to contain the COVID-19 pandemic - as other 'essential’ services took a backseat.
But now, as the country slowly ‘unlocks’ and as clinics and OPDs resume services, pregnant women’s access to healthcare is expected to improve. We reached out to hospitals, clinics and nursing homes in Delhi to know how they are preparing to cater to these women, and what protocols are being followed in light of the pandemic to ensure their safety.
Pre and Post Pandemic: What Has Changed
Even as a kind of normalcy resumes for non-COVID health services, the hospital landscape in terms of consultations, visits and treatment has seen some significant changes. Almost all doctors FIT approached spoke about minimising in-person consultations, scheduled appointments instead of walk-in visits, tele-consultation and a revised policy regarding attendants who can accompany the women.
Dr Madhu Goel, Associate Director, Obstetrics and Gyneacology at Fortis LaFemme, Delhi, said, “If you compare it to the pre-pandemic time, we’ve significantly cut down on physical visits and converted non-essential visits into tele-consultations. The duration of the visit is also kept minimum. All ultrasounds are being done at around 10-weeks, 20-weeks and sometime before the delivery. We try and align the ultrasound appointments with the in-person doctor’s appointments to avoid unnecessary visits.”
Dr Jyotsna Gupta, Gynaecologist and Obstetrician, is associated with two hospitals in West Delhi and also runs her own clinic. “Every patient comes after a prior appointment, and the subsequent patient is given a time slot for after 15-20 minutes so that there is no overlap. If a patient does come early, they are expected to wait outside.”
“We are treating every patient as a suspected COVID patient. Contact is minimal among other patients and between the doctor and the patient. In fact, I even avoid sharing the soft copy of the prescription. I tell the patient to take the picture of the old prescription and get it to her next visit, and the current prescription I write, click a picture of and send it to her over mail or WhatsApp. There is no physical contact until necessary - no paper or report.”Dr Jyotsna Gupta
Like for other patients walking into a hospital, pregnant women are required to go through thermal screening, get their oxygen saturation checked, fill up self-declaration forms and reveal their exposure history. Dr Gupta adds that since at the clinic, most patients who come are follow-up patients, only their thermal screening is done and the medical history is taken on the phone before they visit.
Dr Deepa Dureja is a gynaecologist associated with multiple hospitals such as Apollo Cradle, Fortis LaFemme and Rosewalk Healthcare, and also runs her own clinic, Pulse Medical Centre, which offers consultations, lab services, ultrasounds and X-rays. Adding on to the shift towards telecommunication, she said, “I try to train them to monitor their BP and sugar at home and share the results with me over messages or video calls.”
“In fact, there are a few pregnancies from the beginning of April whom I have not met yet. I access the blood tests and BP reports online and tell them what is to be done next. One of my patients is eight months away. I have taught her how to keep a chart of her health and share the updates with me regularly. We are adapting to the new situation by ensuring that in-person visits for antenatal care are made only when necessary.”Dr Deepa Dureja
At her clinic’s entrance, there is a temporary set up with a chair, table and a basin for people to wash their hands. They are also supposed to remove their footwear outside and not carry any unnecessary objects. A vigilant officer takes them for thermal scanning, helps them sanitise their hands and provides them the masks and face-shields, she adds.
The policy on the number of attendants accompanying the woman to the hospital has also been tweaked for all hospitals. Only one attendant is allowed per patient, and even then, they are only supposed to enter the OPD if absolutely necessary.
Dr Ranjana Sharma, senior consultant gynaecologist, Indraprastha Apollo Hospitals, Delhi, says, “We don’t know if the people walking into OPD are positive, so we need to minimise the number that we allow to come in as well as the time we spend with them. If, for instance, the partner wants to come in, my advice to the patient is: Let me examine you. Let me be ready with all the information that your husband may need. So that when he comes in, I spend just a few minutes to brief him and answer his questions. Till then, he can sit in the waiting area.”
“As for deliveries, we used to allow one attendant during the deliveries, but not now,” she adds.
Are All Pregnant Women Being Tested for COVID-19?
Most hospitals we approached are recommending COVID testing for women around five days before their expected delivery date or 38 weeks into the pregnancy. Depending on the status, they are either referred to a designated COVID hospital or shifted to the COVID ward in the same hospital. In cases of emergencies, the delivery takes place at the facility she is at, where doctors wear full PPE kits and follow all necessary precautions as they would for a COVID positive patient.
Dr Madhu Goel told FIT, “If the patient turns out to be positive, then she has to go to COVID designated hospitals to deliver. Very few are being accepted in private hospitals. As far as I know, pregnant women testing positive are having a hard time. There is a lot of grey area, a lot of patients have said that they are having trouble.”
“There are a lot of issues involved. When women are asked to shift to another hospital at the last moment, it may get challenging for them to reach the same level of comfort with their new doctor. They have been under a different person for almost nine months, and now, they don’t know who will take over their case, or the level of facilities they will get at the new place. For a pregnant woman, these are all really important factors.”Dr Madhu Goel
At Sawan Neelu Angel's Hospital in Delhi’s Saket, testing is mandatory for all pregnant women 4-5 days before delivery. “If she is positive, the doctor decides what is to be done. Until then, she is kept in the isolation ward.”
Dr Jyotsna Gupta, however, adds that the hospitals she works in are only testing pregnant women who have symptoms. Others who are willing to get tested and can afford it, can get it done, but it can turn out to be challenging as the labs are being extremely careful in conducting tests. “For all deliveries, we are wearing full PPE kits. When a patient is admitted, she will be kept in the isolation ward. If she is symptomatic and tests positive, we shift her to the coronavirus ward. We have two labour rooms which are fumigated every few hours. We usually advise a positive patient after delivery to stall breastfeeding until she tests negative.”
Dr Ranjana Sharma explains that her hospital follows a similar protocol. The aim is to test all patients before they are admitted. COVID positive patients are put in one block and suspected in the other, so that the two are never mixed. “We have separate blocks of OTs for COVID patients. Depending on the status of the women, our PPE levels differ.”
This is of course only possible in larger hospitals with separate COVID areas.
On breastfeeding, she says,
“We have to counsel the mother about it. Yes, breastfeeding is important, but for a COVID positive woman, it could get very very tedious to do it every two hours following all the precautions. We inform and counsel them about the protocols, about sterilisation and masks, and if they still want to do it, they can go ahead. If not, the baby will be kept in a separate room.”Dr Ranjana Sharma
According to the health ministry’s guidelines, “Mother and baby are to be nursed together as far as possible and breastfeeding is to be initiated within one hour of delivery, irrespective of COVID status. However, she should put on a face mask and practice hand hygiene before each feeding.”
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