Laboring patients refused obstetric care at public hospitals

Low-income women in labor are forced to give birth in the supervision of unqualified doulas

KARACHI:

For any mother-to-be experiencing the uncontrollable pangs of labor, the very thought of having to trudge frantically from hospital to hospital in search for medical help would be nothing short of a nightmare yet for thousands of low-income women in the port city the dreaded imagining is a far too familiar reality as doctors at public hospitals continue to abandon pregnant patients right at the height of their vulnerability.

Despite the presence of obstetric facilities across various public hospitals in Karachi, a growing influx of pregnant women seeking cheaper maternal care has overburdened the scarce resources of government health centers, which are refusing medical help to thousands of laboring women in need of immediate obstetric care, thereby forcing them to choose between taking on a loan to deliver at a pricey private hospital or taking on the risk of giving birth at home with the assistance of an unqualified doula.

Gulzar Begum, a new mother from Musa Colony, narrated her experience delivering at the Jinnah Hospital's Gynecology Unit, which was brimming with patients.

“The female doctors and staff had a derisive attitude towards all pregnant and laboring women. While some birthing patients were refused even basic check-ups others were told to bring delivery supplies from outside.

The labor unit was chaotic,” recalled Gulzar.In an attempt to evade the hassle of delivering at a public hospital, Rida, another new mother, had hoped to deliver at a private hospital. “Unfortunately, the rates for both normal and cesarean deliveries at the private hospital were completely unaffordable for us. Hence, I had to find space at a public hospital for delivery,” shared Rida, whose husband works as a food delivery rider.

“Private hospitals charge up to Rs50,000 for a normal delivery while the standard fee for a cesarean section is Rs200,000,” confirmed Jamila Sohail, a women’s health activist.

Aware of the chaotic state of affairs at public hospitals and the high costs of care at private health centers, Mehwish Khatun, another first time mother sought a third alternative by mustering the courage to have a home birth.

“At first I was very scared but luckily I was successful in safely delivering my son at home. Even though the doula was experienced, the risk of unforeseen complications arising was always looming,” shared Mehwish.

According to Saeeda Khatun, a social worker from Surjani Town, the overcrowding of government hospitals and unaffordability of private healthcare facilities had forced pregnant women to seek the assistance of unqualified doulas during childbirth.

“Doulas who deliver babies in most areas have no formal training or certification in midwifery. Fatal complications like post-partum hemorrhage cannot be handled by a doula. When women start turning to unqualified doulas for delivery, the maternal mortality rate will surely increase,” asserted Dr Shahnaz, a renowned obstetrician and gynecologist.

Dr Shahnaz's revelations are alarming given that Pakistan already reports the highest maternal mortality rate in South Asia with the World Population Report of 2019 claiming that 186 out of every 100,000 laboring women die due to childbirth complications.“Women are forced to risk their lives by relying on doulas since public hospitals keep delaying delivery dates due to an overflow of patients,” commented Saeeda.

According to data obtained by the Express Tribune, a combined total of approximately 24,509 pregnant women seek obstetric care every month across four major public hospitals in Karachi including Civil Hospital, Jinnah Hospital, Sindh Government Liaquatabad Hospital and Sindh Government Saudabad Hospital, out of which only 3,436 women are safely delivered.

Speaking to the Express Tribune on behalf of public hospitals, Kulsoom Somroo, a spokesperson for the Gynecology Unit of Civil Hospital said, “Dozens of laboring patients are turned away since they had not registered for delivery during their first trimester. Patients cannot deliver at a government hospital without prior registration.”