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How COVID-19 is affecting antenatal care

Medical experts have always advised pregnant women to attend antenatal care (ANC) to monitor their health and that of their unborn babies. However, with the…

Medical experts have always advised pregnant women to attend antenatal care (ANC) to monitor their health and that of their unborn babies.

However, with the emergence of COVID-19 in Nigeria, many pregnant women have not had a pleasant experience going to the hospital for their ANC.

Muinat, a pregnant Lagos resident who is due for delivery soon, said, “I am a first-time mum and I use a General Hospital for ANC.

“I am getting closer to my delivery, so they attend to me, as well as others who are over 32 weeks.

“They told us that anyone who is 36 weeks will be attended to on a weekly basis, but I was surprised that during my last visit, I was denied seeing the doctor; and I am over 36 weeks.

“They insisted that I did not have any complaints, so I was rescheduled for another week.

“I noticed that if I said I had a complaint, they would allow me to see the doctor anytime as I am very close to delivery, but anyone who is not close to delivery or does not have a complaint will not be attended to.”

Muinat said she noticed that the majority of the pregnant women who usually had their ANC at the hospital had stopped coming because they were not attended to.

She explained that before the COVID-19 pandemic, those who attended ANC were usually over a hundred, but that the number had reduced to only 20, and that out of the 20, many were sent back home because they had no complaints while few others who had issues with their pregnancy were attended to.

She alleged that nurses were preventing pregnant women from seeing doctors.

In a chat with another pregnant woman, Uche Ibeh, who uses a private hospital in Lagos, she said COVID-19 had not affected her ANC in any way as she still goes for her checkup every two weeks.

She, however, noted that since the inception of COVID-19, before entering the hospital, hands must be properly washed, a form requesting for certain details to ascertain exposure to COVID-19 must be filled and it would be taken in, the temperature would be checked.

She said if the hospital was okay with the response, they would allow the patient to enter, but with a face mask, after using a hand sanitiser at the entrance.

Mrs. Ibe further said, “We all don’t go in at once, rather, only four pregnant women are allowed in at a time to ensure there is social distancing.

“When a pregnant woman is with her doctor, he will wash his hands or use sanitiser.

“The doctor will ask the usual questions and check the baby.

“They don’t allow any friend or family to enter with a patient.”

Another pregnant woman in Isolo, Lagos, Kafila Tiajni, said in the private hospital where she attended her ANC regularly, she saw other pregnant women but that since COVID-19 started, the hospital stopped taking new pregnant women and only focused on the pre-COVID-19 registered women.


‘No directives to stop attending to pregnant women’

Defending the doctors and consultants, the Secretary-General of the Society of Gynecology and Obstetrics of Nigeria (SOGON), Dr. Chris Aimakhu, told our correspondent that the association had not given its members the directive not to treat pregnant women.

Dr. Aimakhu said, “We want to limit the visit of patients to the hospital so that exposure is less.

“To see patients, a doctor has to protect himself; it is not all about face mask.

“It is not all pregnant women that are tested for COVID-19, so we don’t know who walks into the clinic, whether the person is positive or not.

“Some hospitals have been closed for attending to patients with COVID-19 and some patients don’t even know their status.

“Alternatively, some hospitals are doing ANC through telemedicine, but they are very few.

“Most hospitals are limiting the number of times that patients visit the hospital for ANC, if possible, patients can discuss any issue on the phone or go to the hospital if they have any issues or they can visit the hospital often if they are getting close to delivery.

“Women should be seen regularly for antenatal care, especially those at risk.”

Aimakhu, who works at UCH Ibadan, said the pandemic had not deterred him from seeing patients and taking delivery.


ANC goes online

The Apex Nurse at Lagos Island Maternity Hospital, Cole Adebukola, said at the onset of the pandemic and the eventual lockdown, it was easy for the facility to kick start online ANC, videos and slides.

“In her explanation, health education was given online with active participation by all patients.

She said, “Various questions were attended to and the emergency section of the hospital was operational 24/7, with mobile phone numbers to talk to doctors.

“Our delivery suites recorded the highest number of deliveries.”

A Consultant Obstetrician and Gynaecologist/CEO of Lagos Island Maternity, Dr. Femi Omololu, on his part, said with COVID-19, the hospital had made new arrangements to safeguard the lives of health workers and patients.

He hinted that part of the new activities at the hospital for giving birth were increased interval of clinic visits, minimised physical contacts, testing of women for COVID-19 prior to delivery and masking of women in labour.

Other modifications at the hospital according to him include modification of ventilation and increased use of PPEs in labour ward, stressing that the hospital used technology more by adopting telemedicine/telenursing on social media.

A front desk health worker at the Isolo General Hospital who gave his name as Waheed, said though the hospital still attended to patients for their antenatal, things were no longer the same as only few were given appointments over a short period compared with when there were usually over 80 to 100 women at a time.


Average visitation reduces from 15 to 6

A consultant Obstetrician and Gynaecologist at the Lagos University Teaching Hospital (LUTH), Dr. Adeyemi Okunowo, admitted that with COVID-19, the normal way of caring for pregnant women had been modified to reduce the spread of the disease.

The consultant emphasised that, “What has changed in LUTH’S ANC clinic is that the number of unnecessary visits has been reduced to essential visits, wearing of face mask and use of sanitisers is mandated, patient to patient chit chat is reduced, and the normal health talk by the nurses before a doctor can be seen has been suspended to avoid people gathering.

“We want to package the health talk into telemedicine which will be in the form of a TV where everyone can hear.

“The number of hospital visits has been reduced to essential visits to avoid exposure, but we cannot totally stop the care of pregnant women.

“Pregnancy has its own duration and it will not wait because there is COVID-19 infection; when it is time for a woman to deliver, she will put to bed; we cannot delay that.

“Those in their early pregnancy have been urged to come once in eight weeks rather than once in four.

“Depending on when a woman presents for ANC, a woman may have about 10 to 15 visits throughout her ANC.

“But this has reduced with COVID-19 to an average of six for those who presented late.

“No hospital will stop ANC, they can only reduce the number of visits.

“We communicate with our patients through telemedicine, especially telephone conversation.”

He stressed that the number of visits has not been reduced for women with complications in their pregnancy such as diabetes, hypertension and others and insisted that despite the reduced visits, women still did their sugar level and blood pressure tests.

According to Dr. Okunowo, LUTH usually attended to over 200 ANC patients in a week but that the number has reduced drastically.

He emphasised that doctors were working on achieving physical distancing during ANC visits.

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