Prenatal problems: At PIMS, no place for late-stage pregnancies

Hospital not taking third-trimester women to avoid blame for complications, reduce patient load

ISLAMABAD: The policy of a major government hospital to not take up treatment of women coming in with late-stage pregnancies leaves many with no option but to go to private facilities or use traditional birth attendants.

The Maternal and Child Health (MCH) centre of Pakistan Institute of Medical Sciences (Pims) has been refusing to take on women in their third trimester of pregnancy as new patients due to lack of capacity and to avoid complications during births as the women did not receive antenatal care at the centre.

The centre only accepts women who registered themselves with the centre near the start of the pregnancy and got antenatal care there.

Those who have some connections, however, can influence the policy and get maternal care even if they come at later stages of pregnancy, complained Khadija who says she was turned away because she went to the centre when she was seven-months pregnant.

Khadija works as a maid in Sihala and said she cannot afford to go to a private hospital. She said she would either borrow some money to go to a small clinic near her home or give birth at home with a traditional midwife.

Many women who are either unaware of the registration rule or shift away from private clinics due to affordability at later stages of pregnancy end up being turned away, admitted a senior doctor who requested not to be named. Although the centre accepts emergency cases, it refuses to take responsibility for any complications in such cases, the doctor added.

“The centre already handles thrice as many births as its stated capacity. We have to accommodate three women per bed already, and this would jump to four women per bed and if we start taking late trimester cases,” remarked another gynaecologist from the centre.

About 30 expecting women are registered and issued cards for antenatal care every day. The centre recently started refusing to cater to women coming from Rawalpindi, arguing that the city has good government hospitals of its own and the patients should be treated there.

Health experts were divided over the policy, with some saying that major public sector hospitals should not refuse poor patients as most of them do not know about the registration rules and are left with no option but to give birth at homes with the help of untrained birth attendants.

Ideally, normal delivery cases should be handled at rural health centres and only complicated cases should be referred to tertiary centres, said White Ribbon National Campaign Manager Dr Asma Badar. “As the health system does not function properly due to inadequate services at the first and second tier, women are often taken to tertiary care hospitals. Hospitals are then overburdened with normal delivery cases and the quality of care is compromised.”

She added that rural women still show a preference for home-based deliveries because they are not aware of birth preparedness, various danger signs during pregnancy, and possible birth complications. She said they are only taken to bigger hospitals in the cities when the traditional attendant is unable to handle the case and may die on the way or at the hospital. “We need to intervene on both, the supply and demand sides to improve our maternal and child health services. Having said that, if a critical patient comes in, it is ethically inappropriate to send her back just because she was not registered at a particular health facility.”

Shaheed Zulfiqar Ali Bhutto Medical University Vice Chancellor Prof Dr Javed Akram also asserted that healthcare facilities in the surrounding areas are not catering to the needs of area residents, forcing them to go to hospitals, which conversely are overloaded.

The centre has the capacity to deliver 30 babies, while the daily average varies between 80 and 100.

“Expansion of the centre is on the cards, he said, adding that the expansion would double capacity.

Published in The Express Tribune, July 17^th, 2016.