In the latest issue of the Massachusetts General Hospital (MGH) Global OB-GYN Newsletter, obstetricians and midwives from several countries, including The Bahamas, shared their stories of caring for pregnant women during the pandemic.
Regardless of the setting – whether in Kenya, Uganda, Peru, Bangladesh, India, the United States or even The Bahamas – several universal themes emerged.
Pregnant women experienced increased sickness and death from COVID-19 compared to their non-pregnant counterparts. In regions where there were limited ICU beds and respirators, death rates were higher.
Resources siphoned from prenatal clinics and maternity care facilities further compounded matters and likely drove up maternal mortality rates on a global scale.
“I was moved immensely by the universality of the challenges in caring for sick pregnant women,” said Annekathryn Goodman, MD, the newsletter’s editor and a professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.
“The differences, if any, had more to do with what resources a particular location had… In Boston, we had more personal protective equipment, more ICUs, more life support machines – and yet certain neighborhoods were more hard-hit by COVID than others. Those neighborhoods were poorer and had people who had migrated from other countries, many of whom did not speak English, many of whom lived in crowded apartments and worked jobs such as public transportation, cleaners, waste disposal that increased their exposure to COVID. But how COVID impacted pregnant women was the same,” said Goodman, a fulltime practitioner in gynecologic oncology at MGH, the original and largest teaching hospital of Harvard Medical School.
She applauded health care professionals for their fortitude in treating wave after wave of sick pregnant patients.
“The healthcare providers did not know if they would get COVID and die themselves, and that happened around the world. I personally saw some physicians who refused to care for COVID patients because they had a medically vulnerable relative at home and they feared infecting them. But, for the most part, doctors and nurses were right there in the firing line.”
COVID sparked an unprecedented maternal death rate in The Bahamas, according to a piece authored by Bahamian obstetrician/gynecologist Dr Shamanique Bodie-Williams and professional writer, Tosheena Robinson.
The authors noted, the country’s pregnancy-related deaths rose from 92 deaths per 100,000 live births in 2020 to 379 deaths per 100,000 live births in 2021. In all, there were 139 confirmed obstetrics COVID cases throughout The Bahamas, with 10 maternal deaths—eight in New Providence (Nassau) and two in Grand Bahama.
“Maternal health outcomes began deteriorating shortly after the first COVID delivery case in the public health care system presented itself on July 28, 2020, at the Princess Margaret Hospital (PMH) in Nassau, the country’s capital,” wrote Bodie-Williams and Robinson.
“The first case at the Rand Memorial public hospital in Grand Bahama, the nation’s second city, occurred in August 2020. It’s noteworthy that most pregnant women in The Bahamas were asymptomatic, in line with what was happening in the general population. In fact, two-thirds of them did not display any symptoms.”
Post pandemic, Dr Bodie-Williams believes The Bahamas still has work to do. She maintains that a growing number of women are unable to access public health care resources, resulting in some patients foregoing any maternity care at all or seeking care later in their pregnancies. Each scenario has its own set of challenges.
Moreover, COVID didn’t only impact maternity but also women’s gynecological care with more public patients than ever before awaiting surgical procedures for fibroids and other reproductive health care issues.
“Maternal healthcare is a work in progress, but I have no doubt that we can do better, catch up with the backlog of cases and get to the point where we are administering even better service than our pre pandemic care.”
For Dr Goodman, the December newsletter helps readers from around the world better understand COVID’s impact on maternal health.
“We learned the importance of not excluding pregnant people from research, administration of new life saving medications, vaccinations, and appropriate intensive interventions. We relearned that the state of pregnancy increases vulnerability to infections and there are significantly more adverse outcomes.”
She added: “As always, pregnancy-related deaths around the world are a leading cause of premature mortality for women regardless of COVID or any particular pandemic. Health officials need to allocate more healthcare funds to women’s health and develop a durable infrastructure (dedicated hospital space, birthing centers, clinics, equipment, medications, training of healthcare providers) for the care of pregnant women.”