KARACHI: Being under lockdown in the middle of a deadly pandemic is surely a stressful experience for people across the globe. And while the fear and anxiety about the Covid-19 disease can take a toll on people's mental health irrespective of age and gender, the situation has been additionally burdensome for pregnant women.
When Fazila Soomro, 27, first heard about the coronavirus outbreak in Wuhan, China, she never thought it would reach her hometown of Sukkur, Sindh, some 360 kilometres North-East of Karachi.
By the end of March, however, when she was 12-weeks pregnant, the virus hit her city hard as infected pilgrims started returning from Iran.
“When I heard how fast Covid-19 was spreading in Sindh, my anxiety level had started going through the roof,” she said. “Since then, I have not only been fearing for my own life but also for my unborn baby. This feeling of uncertainty is killing me.”
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A tough situation
With about 11,000 nationwide Covid-19 cases, and about 3,700 in Sindh as of April 23, many pregnant women in the country are watching the headlines and wondering, “What is going to happen next?”
The Express Tribune recently surveyed 110 pregnant women from all across Pakistan to find out about the concerns that they have regarding giving birth amid the pandemic. Out of the total, 62.5 per cent of women aged 25 to 30 revealed that they have been scared of visiting the hospital and clinics for regular checkups.
About 70 per cent of the respondents said that they are required to visit their doctors only once a month, while about 12 per cent of them revealed that they have to make more frequent visits to the hospitals because of pregnancy-related complications.
“I am 24-weeks pregnant and have been diagnosed with preeclampsia, a pregnancy complication characterised by high blood pressure,” a 38-year-old woman from Faisalabad, who chose not to be named, stated.
Due to her condition and the possibility of giving birth prematurely, she is required to take three to four visits to her gynaecologist every month.
“I am really scared of going to the hospital. My complicated pregnancy is already giving me sleepless nights and now I have to live under the constant threat of contracting the disease. I don't know how to manage my stress.”
When asked about their biggest fears about giving birth these days, 58.3 per cent of the respondents said that they are scared about catching the disease. Some 20.8 per cent said that they fear about giving birth to their babies in the hospital because of Covid-19 patients visiting the facilities. Meanwhile, 16.7 per cent said that they are sceptical of the hygienic condition of the hospital and how their newborns will be handled by the hospital staff.
Noor Fatima, 26, who is 10-weeks pregnant, said that if she had known what the situation was going to be like, she would have used birth control methods and not conceived at all.
“I got married in December and my husband and I were not planning to have a child anytime soon as we were only focusing on our newly-married life,” Noor said. “With the ongoing situation and my [unexpected pregnancy], I have been really depressed. Being in this lockdown together with hormonal imbalance has worsen things for me,” she lamented.
Noor said that it's natural to worry about contracting the virus but both she and her husband have been strictly following the guidelines and are relying on their faith.
“Our hospital is adamant about only calling me in for necessary appointments like blood tests or scans. All other appointments are carried out remotely on the phone. So we're pretty relaxed with that.”
As for the future, Noor said that she is worried about several things after giving birth to the baby.
“How [will I] take care of the baby? Will the hospital be taking mine and the baby's hygiene seriously as they already have so many Covid-19 cases to deal with? Even one mistake could be crucial for us. What about the baby's visits to the hospital afterwards?” she questioned.
"There's so much to think over and the scariest thought is that anything can happen. I am mustering up all my courage and just praying day and night for a vaccine to be developed or for the disease to miraculously die down. At the end of the day, faith is all I have to rely on.”
Precautions for pregnant women's well-being
According to Dr Naushaba Malik, member of the Royal College of Obstetricians and Gynaecologists (MRCOG) and a practitioner from Birmingham, UK, the risk for a pregnant lady to contract the Covid-19 disease is similar to that of the general population. However, because of pregnancy and the changes taking place in a woman's body, her immune system is slightly compromised.
“If a pregnant woman contracts the disease, her response can be severe due to low immunity, but she is not at increased risk of contracting Covid-19 per se. Therefore, we give the same advice to pregnant women as we give to other individuals in terms of safety," Dr Naushaba stated.
Aisha Waleed, 33, from Lahore, who is eight-weeks pregnant with her first child, said that her gynaecologist has asked her to stay at home as much as possible.
“My doctor told me that with the relaxation of the lockdown, there are chances that the disease will further spread. Therefore, I must avoid going out of the house unnecessarily. When I went for my checkup last month, I took extra precautions by wearing a mask, carrying a sanitiser with me, and avoiding contact with other patients or touching the hospital furniture,” she said.
Speaking to The Express Tribune, Dr Madiha Iqbal, consultant gynaecologist from Peshawar, said that apart from taking the general precautions [issued by the World Health Organisation], pregnant women should also consume immunity-boosting food.
“Try including foods like yoghurt, milk, leafy green vegetables, and fruits in your diet to boot up immunity,” she said.
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What are hospitals doing to ensure safety?
Urooj Hasan from Karachi, who is 27-weeks pregnant, said that her gynaecologist has assured her about her safety while visiting the hospital.
“Fortunately, I've had only one appointment scheduled during the ongoing lockdown. My gynaecologist, who practices at a renowned private hospital in Karachi, informed me that the facility's coronavirus testing centre is outside of the hospital premises and they haven't had a single Covid-19 patient so far,” Urooj said. “I am taking their word for it but they're testing so many patients every day, so I am scared but can't do much about it.”
Regarding the precautionary measures that hospitals are taking when dealing with other patients and pregnant ladies, Dr Madiha Iqbal said that most health facilities in Peshawar have allocated red, yellow, and green zones within their premises to keep coronavirus and other patients segregated.
“All the Covid-19 positive patients are kept in the red zone, those who are suspected are placed in the yellow zone, meanwhile, all other patients or pregnant ladies are confined to the green zone of the hospital,” she said. The doctor added that precautions must still be taken whether one is visiting a hospital or a small clinic.
Dr Sadia Rashid, a gynaecologist and obstetrician at the Medicare Cardiac and General Care Hospital, Karachi, said that apart from suggesting patients to clean their hands using soap and water or an alcohol-based sanitiser before and after their visit to the hospitals, many gynaecologists and doctors are also facilitating their patients through remote asssitance.
“The routine scans and appointments can be rescheduled. Some appointments may be conducted via telephone or videoconferencing too [so that pregnant ladies don't have to physically visit the hospital unless necessary].”
Managing stress and anxiety
Speaking about the stress and anxiety that pregnant women are undergoing due to the lockdown and the rapid spread of the disease, psychologists say that it is understandable to have a certain level of concern and one cannot be completely carefree. However, stress is manageable.
Mrs Majid from Karachi, who is 39-weeks pregnant, said that regardless of everything, the emotional toll the virus has taken is greater than she had imagined.
“New additions to the family are a time of celebration and while it still is going to be a celebration, there is still a worry to keep the baby safe – more than ever now,” she said. “Parenting at this time will be more difficult because there are not a lot of people who have given birth during a pandemic. Having said that, I am trying to keep myself sane and not worry too much."
She added that she is trying to be grateful for being in a better position than many women out there.
“I can still afford a good doctor, a private hospital for delivery, and manage to get food on the table. I'm sure there are many women out there who have given birth, let's say, in war-torn zones. Likewise, there must be many underprivileged women who would surely also want to keep their babies safe during this pandemic, but don't have the means to. "
" They might have to give birth in areas that are not properly sanitised or pose a risk to the mother and baby. It's a difficult time for all.”
Adeeba Shakil from Karachi, who is 16-weeks pregnant with her first baby, said that she is religiously taking all the necessary precautions, therefore, she is not too worried about the pandemic.
“I know the virus is highly contagious so there is naturally some fear in my heart, but I am trying to keep a positive attitude to reduce undue stress,” she said. “I am also struggling with my pregnancy cravings because all the restaurants are closed. This often leads to irritability and mood swings,” she said.
In terms of managing stress, clinical psychologist Syeda Batool Najam recommended that pregnant women should try to limit excessive, unfiltered information that they might receive regarding the virus [mostly via social media] as overexposure could also increase anxiety.
“Stay in touch with the doctor and speak to them as to how they want to proceed. So far, research suggests that although pregnant women may have lower immunity, no evidence of complications or transmission to the child have been encountered in Covid-19 patients who delivered a child,” she said. “Perform some light exercises in consultation with your doctors, think about positive things. Moreover, one should maintain social distancing but not social isolation to keep the support system intact. Pregnant women should utilise the ongoing quarantine as a way to spend quality time with their families and taking extra care of themselves."
*With additional reporting by Shaheera Anwar from Karachi