With an estimated 6.4 million babies to be born in Nigeria during the Novel Coronavirus (COVID-19) pandemic, many expectant women who should be glad at the figure have rather become apprehensive.
The figure released by the United Nations Children’s Fund (UNICEF) shows that the babies will be born up to 40 weeks from March 11, when COVID-19 was recognised as a pandemic.
Although, the World Health Organisation (WHO) maintains that, at present, there is no evidence that pregnant women are at higher risk of severe illness than the general population, pregnant women in Nigeria are bothered about bringing life during a pandemic, considering the associated risks, strained healthcare and fear of infection.
Before the outbreak of COVID-19, high-quality and timely maternal healthcare services were deficient, inaccessible or unaffordable for thousands of women in Nigeria, a factor that contributes to maternal mortality in the country.
To exacerbate trepidation, reports of pregnant COVID-19 patients who died in Ekiti, Jigawa and Ogun states went viral on social media and the mainstream media.
UNICEF warns that about 6,800 more maternal deaths could occur in Nigeria in six months as the COVID-19 pandemic disrupts routine services and threatens to weaken the health system.
“We have made steady progress in reducing preventable child and maternal deaths in Nigeria over the last 20 years.
“It would be devastating – if that progress is lost or reversed – for Nigerian families, communities and the country as a whole,” Peter Hawkins, UNICEF Country Representative in Nigeria, says.
Nigeria’s maternal mortality ratio of 512 per 100,000 live births, as contained in the National Demographic and Health Survey 2018 Report, shows no major reduction from the 545 per 100,000 live births in the NDHS 2013 Report.
With this, it becomes important to provide lifesaving support to pregnant women, especially COVID-19 positive ones.
Among those who have taken up the challenge of giving hope to pregnant women, who tested positive for COVID-19, is a multidisciplinary team of obstetricians, anaesthetists, neonatologists, nurses, psychiatrists and infectious disease control experts at the Lagos University Teaching Hospital (LUTH), Idi-Araba.
The team of specialists has delivered five COVID-19 pregnant women of babies, including a set of twins. Prof. Chinyere Ezeaka of the Neonatology Unit, Department of Paediatrics, College of Medicine, University of Lagos, believes that COVID-19 infection is not a death sentence even for pregnant women.
Ezeaka, a member of the team of LUTH specialists, however, regrets that many pregnant women, because of fear of stigmatisation, are avoiding antenatal care and child delivery in hospitals.
“Some are delivering in their houses, calling nurses to come and treat them at home, while some use traditional and religious centres for delivery. “I am using this opportunity to appeal to pregnant women to stop devising various means of avoiding hospitals.
“They should attend antenatal clinics and come to hospital to deliver babies with the help of skilled birth attendants,” Ezeaka urges.
Affirming that being pregnant and positive for COVID-19 is not the end of the world, or a reason to despair, she notes that medical practitioners have successfully delivered pregnant COVID-19 patients of their babies.
Highlighting measures that will assist Nigeria to achieve safe delivery for pregnant COVID-19 patients, Ezeaka advises that every state should have a designated centre for treating and delivering pregnant COVID-19 patients.
The professor says a dedicated centre for pregnant COVID-19 patients is the best practice globally, arguing that not all COVID-19 treatment centres can take deliveries.
“COVID-19 will be a threat for a while. I would advise proper planning, coordination and communication at the national, state and local levels to ensure effective response.
“There must be the full protocol for antenatal, pre-delivery care; centres for birth should be well equipped with full monitoring, theatre and diagnostic equipment for mothers and babies.
“There should be plans for where the stable babies with symptomatic mothers will be, and also plans for babies that might test positive; designated and isolated areas should be created,” she urges.
On the pregnant COVID-19 patients at LUTH, Dr Christian Makwe, Consultant Obstetrician and Gynaecologist, discloses that four of them were asymptomatic.
According to Makwe, their COVID-19 status was detected based on their exposure and contact with people who tested positive for the virus.
Makwe, Delivery Coordinator, Pregnant COVID-19 Patients, LUTH, says, however, that the fifth patient exhibited symptoms of COVID-19: coughing, fever and breathlessness.
On whether all pregnant COVID-19 patients should be restricted to Caesarean Section (CS) for delivery, Makwe says the delivery option should be individualised. “One of the patients had done two Caesarean Sections; automatically she doesn’t qualify for vaginal delivery.
Another patient had done a fibroid surgery. “For the multiple birth, the first baby was breech, and was blocking the birth canal, definitely such a delivery has to be CS,” he says.
According to the obstetrician, one of the patients requested for CS, saying she didn’t want to go through the stress of vaginal delivery. “For the fifth patient, her symptoms were worsening and we felt it might compromise the baby’s status; we had to conduct the delivery preterm – 37th week – to save her and the baby.”
Makwe says vaginal delivery will be done for COVID-19 patients who request for it, and whose medical conditions are deemed clinically satisfactory.
“All the babies delivered tested negative and their clinical status stable,” Makwe adds. According to him, LUTH Obstetrics and Gynaecology Department is committed to eliminating maternal morbidity and mortality.
He, however, says, that the department needs better facilities to function more effectively. He urges governments to invest more in maternal and child care, noting that maternal health, neonatal morbidity and mortality are indices used to measure a country’s health status.
“The healthcare team is willing and has demonstrated the capacity; we just need the support. “Provide us with more PPE, equipment, and make everything standard, and we will see more people join the fight against COVID-19,” he adds.
According to one of the five pregnant COVID-19 positive women, each patient’s experience differs. “I was not sick throughout and I tested negative to the virus in less than two weeks. The medical personnel were very kind, understanding and supportive.
“However, facilities in the hospital are very poor. Imagine being in a room without air conditioners, and the doctors performing surgery dripping with sweat in their PPE. “It is not a good experience, the hospital management and government should improve facilities in LUTH,” she urges.
The survivor also calls for improvement in the way patients’ COVID-19 status is being relayed to them. According to her, she was traumatised at the news until medical personnel at an isolation centre counselled and encouraged her.
Dr Olutola Olatosi, Consultant Anaesthetist, is, however, confident that the medical team establishes rapport with patients and allays their fears. He adds that patients are monitored through telemedicine to provide psychosocial support and ensure their wellbeing.
On the anaesthetic techniques deployed for surgery for pregnant COVID-19 patients, Olatosi reveals that regional -based techniques are used. According to him, the techniques have better post operation outcomes and rapid recovery among patients.
He calls for an urgent increase in the number of anaesthetists in the country, as a strategy to reduce maternal mortality. He notes that there are about 200 specialist anaesthetists serving Nigeria and about 600 undergoing training.
“It is important that we grow the number if we are to reduce the rate of maternal mortality, because most patients with complications will require surgical interventions and safe anaesthesia.
“We have to address that with emphasis on manpower development because some patients will present with COVID-19 and other co-existing medical problems. “It is an existential challenge for us to provide critical care,” he adds.
He appeals to the Federal Government to support LUTH with more critical care equipment options that will enable it to function efficiently toward saving more lives. Prof. Wasiu Adeyemo, Chairman, Medical Advisory Committee, LUTH, points out that oxygen is critical in the management and survival of patients with severe cases of COVID-19.
Adeyemo emphasises that oxygen saves lives, adding that its provision is a critical component for emergency respiratory resuscitation globally. Mr Rotimi Dada, Head of Theatre Nurses, is of the opinion that implementation of Infection Prevention and Control (IPC) and other safety measures for healthcare workers and patients is of great importance to the team.
Dada urges that the hospital’s IPC Committee should map out the dedicated theatre and delivery area, and decide on work flows for a unidirectional area. Corroborating, Makwe says proper training of every member of the team on IPC, wearing and removal of PPE, and emphasis on hygiene are done constantly to reduce exposure of health workers and patients to infections.
“We have a dedicated operating space and we streamline the number of operational staffs in the operating room to reduce the number of people that might be exposed to infection.
“We place a priority on IPC because it is key. We know that if we have a member of the team infected, it will demoralise other members and affect our capacity to function effectively,” he argues. On the role of the pharmacy department in supporting delivery of pregnant COVID-19 patients, Mrs Olabisi Opanuga, Head of Pharmacy Department, LUTH, says the department must always be on ground to ensure the medical team gets all the required supplies for a successful operation.
“We give the patients medications depending on their comorbidities.” She is, however, worried at the challenge in getting Personal Protective Equipment (PPE) for health workers on the frontline of the fight against COVID-19. She notes that PPEs are scarce and expensive.
“The procedure itself for normal Cesarean Section is N65,000, but the PPE to be worn by health workers is over N300, 000,” she says. Opanuga appeals to the Federal Government to intervene through adequate funding.
“Local production of PPE should be explored and encouraged, with the government providing financial support. “Nigerians are ingenious, we should be able to produce standard PPE which will help to reduce cost,” she urges.
Dr Tunji Akintade, Chairman, Association of General and Private Medical Practitioners of Nigeria, is optimistic that concerted efforts will save more pregnant COVID-19 patients and their babies. Akintade advises that advocacy and awareness should be sustained to enlighten pregnant women and the general public on the preventive measures against the virus pending discovery of a vaccine.
Analysts hail Nigeria’s giant steps in the fight against COVID-19 particularly in giving hope to pregnant patients. They urge more support for health workers and institutions to achieve a stronger response.