Amid Covid-19 pandemic, hospital births fall by 18% in Mumbai
At 3am on May 12, 2020, Ishita Koli, a resident of a 170 sq ft chawl in South Mumbai’s Bhendi Bazaar, went into labour and started to bleed. With all nearby nursing homes closed, Sunil Mohan, her 32-year-old husband decided to rush her to Prince Aly Khan hospital, less than three km away in Mazagaon. But due to the lockdown, they could not find a vehicle to take here there.
“We tried calling an ambulance, but they told us that we’d have to wait for more than an hour. Private taxis were also unavailable. By 5am, my wife’s condition had deteriorated, so we decided to take the help of a midwife,” Mohan said. By 7am, the Kolis were parents to a healthy baby whom they named Rekha, delivered by a retired auxiliary nurse midwife.
Around the city, women like Ishita were forced to deliver at home on account of the lockdown and lack of access to medical facilities. Not everyone was as lucky as Ishita, who suffered blood loss and managed to get treatment at Cama Hospital (though it took five hours to find a cab that agreed to ferry her for over four times the normal fare).
According to data shared by the Brihanmumbai Municipal Corporation (BMC), institutional deliveries dropped by almost 18% between March and November 2020 compared to the same period in 2019. The number of childbirths registered in public and private hospitals between March and November 2019 stood at 111,411. During the same period in 2020, this dropped to 91,618; the lowest institutional child deliveries in March and April.
“By March, thousands of women had gotten pregnant. Their deliveries were scheduled over the next nine months till November. The drop in hospital deliveries therefore doesn’t indicate a fall in the pregnancy rate during the pandemic,” said Dr Jaideep Malhotra, president, Federation of Obstetrics and Gynaecological Societies of India.
Medical experts and doctors point towards two major reasons behind the drop in the registration of institutional deliveries in these nine months— rise in home births and mass migration during the lockdown when thousands of people lost their jobs.
Lakhs of people lost their jobs at the start of the lockdown, leading to a mass exodus of daily wage earners from Mumbai, which had, by mid-May, turned into an epicenter of the Covid-19 disease.
“During the Covid-19 pandemic, sexual and reproductive health and rights took a back seat. Overnight, as a precautionary measure, tertiary care hospitals were converted into dedicated Covid care centres. During an emergency, when pregnant women were rushed to the hospital for delivery, they were referred to another hospital. In the initial stages of the pandemic, there was too much confusion among the public,” said Subarna Ghosh, co-founder, ReRight Foundation, a non-government organisation (NGO) that works for safe child births.
Health experts discourage home births because it can lead to complications and fatality. Doctors said that even though midwives are experienced in internal examination and vaginal deliveries, they may not possess the expertise — or, indeed, access to medical equipment — to deal with complications like blood pressure fluctuations, obstructed labour, and resuscitation among others.
“Home deliveries involve extended labour hours and prolonged internal examination which may increase the chances of septic foetus. Rushing to the hospital after a failed home delivery may invite further risk to the life of mother and baby. Most hospitals like us ensure complete isolation from Covid-19 patients and staffers. So, it is recommended to choose deliveries in hospitals rather than homes,” said Dr Gayatri Deshpande, senior consultant, obstetrics and gynaecology, Nanavati Hospital, Vile Parle.
But during the pandemic, as the city came to a standstill, this was not an option for pregnant women.
Society for Nutrition Education and Health Action (Sneha), an NGO that works on public health issues conducted a survey among 436 women (during their pregnancy and postpartum period) between April and August. Their findings revealed that institutional deliveries during the pandemic varied from place to place depending on the availability of healthcare facilities.
“We saw that areas with better accessibility to hospitals have recorded almost 100% institutional deliveries. Whereas, the number dropped to 75-65% in areas with fewer medical facilities,” said chief executive officer Vanessa D’Souza.
During the initial days of the pandemic when families lacked knowledge about Covid and non-Covid hospitals, the NGO received several calls seeking guidance. “We then procured a list of hospitals across Mumbai with bifurcations, and started guiding callers to their nearest hospitals for deliveries.”
Taking note of the safety of pregnant women, BMC did not convert civic-run maternity hospitals into Covid centres. In addition to lack of facilities, many pregnant women avoided giving birth at hospitals due to fear of contracting the virus.
“Though there were no reports of vertical transmission of the virus from mothers to the new-borns during delivery, pregnant women were still worried of contracting the virus in hospitals. Thus, they opted for home births with the help of experienced women or midwives,” said Malhotra.