Pregnant women shun hospitals, turn to midwives for prenatal care

As the Covid-19 pandemic rages on, pregnant women are torn on whether to go to hospitals for prenatal care or not.

If they visit the hospitals, they wonder, will they be safe from the contracting the virus, which has turned the lives of millions of people in the world upside down?

On the other hand, they are worried about the risks if they choose not to go to hospital for the prenatal (also called antenatal) care, which is mandatory for their own health safety and for the foetus they are carrying.

Hafsa Said, a mother of one, is among the worried pregnant women as she expects to deliver anytime now.

She is a Tana River resident who had opted to move to her mother’s place in Bombolulu, Mombasa, where she was to start her ante-natal care. This is because it would be easier to access health services than in Tana River.

“I was lucky the cessation came when I had already travelled to Mombasa. I could not start the clinics in Tana River due to many reasons, among them accessibility," she said.

When she came, she went for the clinic at a local dispensary, where even though they were attended to, it came with a proviso.

“The hospital said we should only go to hospital if we are sick or have an emergency. That means we cannot go to hospital just to check on how our health is doing as we wait to receive our bundle of joy," she said.

TROUBLING HISTORY

Said’s worries are as a result of the history of her previous pregnancies, which were delicate and complicated.

She lost her firstborn after the baby developed complications when she gave birth at home some years ago.

On her second pregnancy, it was very delicate, such that she had to frequently visit the hospital for check-ups and antenatal care.

With all this in mind, Said is reasonably worried about what would happen if she went to the hospital or decided not to.

Susan Mkamburi, on the other hand, is still contemplating whether to deliver in hospital or look for a midwife. She is eight months pregnant and this will be her first child.

Mkamburi has not gone for her clinics for the past three months but hopes the baby is doing fine.

“I feel her kicks so I know she is fine. I am, however, skeptical of going to hospital, considering the risks I will undergo before I reach the hospital and at the hospital itself," she said.

Mostly, her fears are that she might either contract the virus from the matatu she will board while going to hospital or at the hospital itself.

Mkamburi said with hospitals treating Covid-19 patients, chances of contracting the virus from them are high.

“Several health officers from various hospitals have been confirmed positive after they were infected by their patients. What will happen if I am attended to by a medical worker who is positive but asymptomatic?” Mkamburi said.

Mkamburi, who still has a few weeks before her due date, is weighing her options on what to do if Covid-19 persists.

MIDWIVES TO THE RESCUE

But for Said, she already has an alternative, where she has been going for her maternal checks.

We met her at the home of a birth attendant, commonly known as “mkunga”, where she has been visiting ever since being cautioned against frequent visits to hospital.

She said the midwife, Nashehe Jidzo, has been checking on the progress of her foetus, blood pressure and pregnancy progress.

Jidzo has been a midwife for 40 years. She has walked the journey of pregnancy with many women and assisted hundreds in delivering their babies.

With her experience, Jidzo can as well check the progress of an expectant woman and her unborn child as well as conduct scanning by sense of touch.

Since the first case of Covid-19 was declared in Kenya, Jidzo said the number of pregnant women seeking her services has significantly risen up.

She said tens of women have been visiting her home, where they seek to know whether their pregnancy is progressing well.

Even though she has been reluctant to assist the expectant women, she cannot turn them away.

“At the moment, I receive like three pregnant women who just want to confirm whether their babies are doing well,” she said.

"I have experience and I can tell if they are well by looking at a patient’s eyes or by feeling their bellies."

Jidzo says she can only examine the women to assure them of the well-being of the unborn babies. She cannot take the risk of delivering them.

Jidzo is a certified midwife after she underwent training by the Mombasa Health department and therefore she is aware of all health precautions she has to take while attending to a patient.

She is also aware of the Covid-19 pandemic and the guidelines that come with it.

When you arrive at her home, a water bucket with running water has been placed at the gate of her house, and one has to wash hands with soap.

She also makes sure she washes or sanitises her hands and those of her patients before checking on them.

These precautions have enabled her to keep safe.

Jidzo said she usually gives an expectant woman the heads-up when they are about to go into labour.

“With Covid-19, I cannot risk delivering them by myself because I do not have protective gear. So once I notice she is about to go into labour, I always urge them to rush to hospital," she said.

EDUCATION CAMPAIGN

Mombasa Public Health chief officer Aisha Abubakar said the virus has affected everyone but it has hit pregnant women hard since their immunity is already low.

She said some of the women fear going to hospital because they either fear testing or getting infected.

“They also feel they will have to wash hands, get their temperatures taken and so many procedures, which they feel takes a lot of their time more than the normal process," she said.

Abubakar said pregnant women should be aware that the process is for their safety and, therefore, they should attend their antenatal clinics.

She further said the county has started educating expectant women on nutritious diets to boost their immunity.

According to Unicef, some 116 million babies have been born since Covid-19 was announced in the world in December 2019.

The children’s organisation said expectant women and new mothers worldwide, alongside their babies, have been faced with systems in crisis, including overwhelmed health centres, supply and equipment shortages.

It further said the situation is worse since the world lacks skilled birth attendants, including midwives.

“New mothers must prepare to bring a life into the world where expectant women are afraid of going to health centres for fear of getting infected or missing out on emergency care due to strained health services and lockdown,” reads part of their statement.

Unicef said even though pregnant women at not at high risk of being infected, the government needs to ensure this group of women has access to antenatal, delivery and postnatal services.

In other countries, authorities are already looking for alternative birthing centres as women are afraid of delivering in hospitals due to the risk of infection. An example is the US in the state of New York.

Unicef appealed to governments to enable healthcare workers to conduct home visits for pregnant women and new mothers and use mobile health strategies for teleconsultations.

Government were also urged to train, protect and equip workers with clean birth kits for home deliveries.

With the limited number of health workers in Kenya, the government is hard-pressed to invest in home care and deliveries.