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In light of the pandemic, every conversation revolves around COVID-19 and its impact on our lives. While all of us are worried and extremely cautious, for pregnant women and their loved ones, it has become an exceptionally hard time to deal with their prenatal care.
Take my friend Tasnim*, for example. She has been trying to have a baby for years. Finally, when she did conceive, her joy was quickly replaced with anxiety. Pregnancy is a time that warrants a lot of care and precautions. Expecting mothers gear up to deal with a lot during this time – gestational diabetes maybe, or even high blood pressure. But a pandemic is not something that anyone was warned about.
With COVID-19 taking over our lives, Tasnim now has to rethink about every decision she makes. With hospitals stretched to their limits, a lot of the medical support that she’d have received is now being redirected to deal with COVID-19. She also has to think about the increased vulnerability faced by her and her unborn baby owing to the hormonal and immunological changes in her body.
Factoring in the chance of contact with the infection, she is taking a hard look at every aspect of her prenatal care – the location and safety of the hospital, what appointments are absolutely necessary, what visits she can replace with video consultations, and even about the safety of her delivery.
How COVID-19 threatens expecting mothers and babies
As a woman over 35, Tasnim has to be especially worried about ensuring her safety, as older women, and those who are overweight face higher risks. Those with pre-existing conditions like diabetes or high blood pressure are also more susceptible to severe cases of COVID-19.
Pregnancy is a unique immunological condition that focuses on the development of the fetus and tries to protect the body from pathogenic infections.
As COVID-19 related information continues to change rapidly, medical researchers across the world are involved in studies that can help better understand its effect on maternal and newborn health.
“According to a study published in the NCBI, pregnancy makes it easier for women to breathe in infectious droplets.”
This is the main reason why pregnant women have been classified as being in the moderate risk category.
Just like most expectant mothers, Tasnim’s biggest concern was about her unborn baby and the only nugget of information that gave her peace was that there is no proof for the transmission of COVID-19 from mother to child, through breastmilk or otherwise.
But she still has to continue being aware. If her body goes through infections or other severe complications like gestational diabetes, it could have a negative effect on the growth of her child, even in the long term.
Leveraging digital solutions to replace physical appointments
As Tasnim gears up for her first prenatal visit, she is filled with excitement and a little dread. While she gets to learn more about her health and her baby’s health, she is also worried about potential infections or complications she may face.
One of these is gestational diabetes. She has a number of friends who faced diabetes during their pregnancy. Since Indian women have the highest case of gestational diabetes in the world, she knew her chances were pretty high.
Almost 6 million births in India are affected by hyperglycaemia in pregnancy, of which 90% are due to gestational diabetes.
Gestational diabetes often has a long-standing effect on the health of the mother and child, such as excessive birth weight, preterm birth, and higher chances of having complicated deliveries. During an already sensitive time, complicated deliveries are truly worrisome.
But consistent self-monitoring has proven to be helpful when dealing with gestational diabetes.
Sure enough, Tasnim’s doctor brought up the subject right during the first visit and suggested getting devices like a glucometer, a fetal heart rate monitor, and a blood pressure monitor for herself.
Prenatal appointments are usually scheduled once every month in the first trimester, every two weeks in the second trimester and weekly in the third trimester. But most doctors, including Tasnim’s, are trying to cut down on the number of appointments during this time.
The usual tests during these visits include checking blood pressure, weight, checking the baby’s heartbeat and checking for swelling in the mother’s hands, feet or face. Urine samples are also tested to understand the amount of protein to screen for preeclampsia. Other tests like pap smears, pelvic exams, blood tests or nonstress tests are only assigned if the mother has risk factors for other complications.
In light of the current pandemic, doctors are also suggesting getting digital devices like fetal heart rate monitors, blood glucose meters, and blood pressure monitors in order to reduce the number of prenatal appointments.
If the pregnant mother is equipped with the necessary devices and gets her urine tested at a separate lab, their exposure to the hospital environment can be reduced. This is done in order to reduce the anxiety and worry of venturing out and to opt for in-person appointments, only when needed.
Vital readings from these devices and video consultations for constant engagement can replace a number of these appointments while ensuring long term safety.
Why doctor-patient face time matters
While having fewer visits to the outside environment was a relief for Tasnim, she was also worried about the 1-on-1 consultation that she was missing out on. A large part of a healthy pregnancy and delivery involves having a trusting relationship with your Ob-Gyn. They are the people who will see you through each of your prenatal appointments and your delivery in order to coach you through the most important physical experiences of your life.
Most prenatal visits will also include checking in with your doctor on how you are feeling – physically and emotionally. The doctor can also help in answering any questions you may have, offer tips on self-care, and prepare you for postnatal care. They will also guide you on what to expect as your pregnancy progresses and any red flags to watch out for.
But thanks to digital health, Tasnim doesn’t have to give up on any of these support as video consultations worked just as well for these purposes. Sitting down with her doctor, even over a video call, with her arsenal of questions and her doctor’s responses reassures her of having a healthy pregnancy.
Seeing her doctor regularly and having a good enough relationship to ask any questions, make it easier for Tasnim to have all the information she needs. The complete transparency ensures that she feels comfortable asking even the silliest of questions, which may sometimes be indicators of bigger problems.
While video consultations cannot take the place of in-person care, it can augment her consultation experience. When paired with her occasional hospital visits, it can provide her with an experience that is considerably comfortable, for the current times.
There has been a significant rise in the number of pregnant mothers experiencing cases of anxiety and panic since COVID-19 began. While perinatal depression has always been a concern, right now it is becoming even more of a pressing matter. While a lot of women still continue to go undiagnosed or don’t reach out for help, video consultation makes it possible for them to get the support they need.
A study on the effectiveness of telemedicine interventions on maternal depression showed that pregnant women who underwent cognitive behavioural therapy found overall improvement.
The year that pre-natal care changed
Tasnim, like most expectant mothers, takes her doctor’s word as gospel. But when her doctor relies on her description of a symptom, there are chances for misdiagnosis.
Research suggests that only 56% of women are good at self-diagnosing vaginal infections.
So most doctors recommend additional tests to confirm this case. But during the current times, the doctors may end up writing prescriptions right away, and wait to see if that works.
Even if the patient expects her doctor to give her a miracle remedy to her problems right away, this may not be the case. If the doctor’s suggested medicine doesn’t work, she may have to go in for lab tests, then go over that with her doctor again, leading to a more tedious task. But at the end of the day, video consultations make it possible for Tasnim, and other expectant mothers to have the physical and emotional support that she needs from her Ob-Gyn.
When the industry is trying to make the most of a worse situation, video consultation can help deliver quality healthcare and prenatal care, in particular. Even when essential resources are being redirected to address COVID-19, the increased flexibility of video consultation makes it possible for doctors to keep up with their patients at their pace.
The increased need for self-monitoring and awareness has made Tasnim more involved in her pregnancy than she expected. She is now empowered to detect potential red flags and understands the importance of keeping up with her prenatal care.
With a lot of expectant mothers, doctor visits were a passive experience where they underwent check-up and answered routine questions. But the current situation has made them all become more self-sufficient and knowledgeable about their healthcare and pregnancy. Routine self-monitoring can help them form better healthcare habits that can provide positive outcomes in the long run.
As we all learn to live with the pandemic, expecting mothers like Tasnim are also learning how to take charge of their reproductive health. They are trusting in their doctors, the healthcare system, credible information, and making the most of available digital health solutions to keep ensure a healthy, happy, and most of all, safe pregnancy.
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