Although the pandemic does not directly affect the pregnancy outcome, it had adverse effects on the mother’s and infant’s health due to delayed or reduced access to healthcare services in various parts of the country. Pregnant women are advised to follow their routine prenatal scans and checkups at the discretion of their maternal healthcare provider. 

Impact on healthcare delivery 

The following factors may have affected healthcare delivery for new mothers and babies during the pandemic:

• Reluctance to seek healthcare facilities: The fear of contracting coronavirus infection keeps pregnant women, new mothers, and infants away from healthcare facilities. 
• Diverting or lack of resources: The healthcare system in the country is cracking under the overwhelming pressure put on it due to the pandemic. While the staff and resources are being diverted to take care of the Covid cases, the other non-emergency health services are taking a backseat. But the negligence of maternal and newborn care can have long-term consequences such as malnutrition, poor health, and weak immunity. 
• Transport disruptions and lockdown measures: Restrictions on transportation means limited access to hospitals. Women in remote areas are more likely to lack adequate prenatal care due to the unavailability of tertiary care centres. Although telephonic and video consultations are availed by women in urban areas, their reach is mostly limited to the educated and upper-income groups. 
• A decline in immunisation: There has been a notable decline in childhood immunisation during pandemic compared to previous years. Hesitations to visit healthcare facilities due to the pandemic, unavailability of vaccination services in the containment zones, and lack of transport has been the significant reasons to miss routine vaccinations. Immunisation gaps may increase the risk of infant mortality or morbidity due to vaccine-preventable diseases (VPDs) such as diphtheria, measles, polio, etc. 

In addition to gaps in healthcare delivery, economic impacts, lack of nutrition, prenatal vitamins, and supplements could also be a reason for unfavourable maternal and infant outcomes during the pandemic.

Outcomes of reduced access to healthcare 

A study from a tertiary centre in India had reported a 45.1 per cent reduction in institutional deliveries and a 2.5 fold rise in intensive care unit admissions among pregnant women during the pandemic. Inadequate antenatal visits also resulted in several pregnancies with complications. 

Despite the explicit recommendation that all pregnant women tested positive or presumed to have COVID-19 can access healthcare for antenatal care and deliveries, there have been reports that many pregnant women lacked proper prenatal care at medical facilities. Some deliveries were supervised by untrained persons and forced to opt for home birth in some parts of the country, risking maternal and infant health. 

Way forward for maternal and newborn care during COVID-19 

Mothers are advised to stick to their daily exercise plans, healthy diet, folic acid, Vitamin D, and iron supplements to have a healthy pregnancy. Changes in the immune system during pregnancy can make pregnant women and new mothers more vulnerable to respiratory infections. 

Although the mother is Covid positive, newborns get routine care and screening in the delivery department. The risk of Covid transmission through the placenta or breast milk is uncommon. Skin-to-skin contact and early breastfeeding are recommended by the World Health Organization (WHO) since this helps the baby to thrive. Mothers are advised to wear masks and sanitise their hands before contacting the baby. 

Dr Bisny T Joseph, Medical Doctor, MomJunction.com