By Dr Howard Manyonga, Head of The Birthing Team

Health systems are struggling to function optimally under the Covid-19 pandemic – and maternity care is no exception

Antenatal care, skilled delivery and postnatal care have a significant impact on the health of the mother, but health systems are struggling as midwives and nurses are being pulled into frontline work to combat the spread of the virus, limiting the support available for expectant mothers at the time of delivery.

Additionally many women are reconsidering whether to give birth at a hospital, a hotspot for potential infections amongst both patients and healthcare workers.

Dr Howard Manyonga, an obstetrician and Head of The Birthing Team, an affordable maternity programme, weighs in on the conversation…

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While our nurses and doctors are working on the frontlines to curb the spread of Covid-19 across the country, other health professionals continue to care for patients who are not infected with the virus. In the field of obstetrics and maternal care, we carry the weight of caring for two patients, mom and baby, at a time where the healthcare system is experiencing severe constraints.

Midwives have had to change how they work to further care for expectant mothers during the pandemic

Although the World Health Organisation (WHO) states that there is no evidence to suggest an increased risk of Covid-19 to pregnant women or mother-to-child transmissions, many women are reconsidering whether to give birth at a hospital, a hotspot for potential infections among both patients and healthcare workers.

Some hospital groups have come up with strict measures that are meant to limit the transmission of the virus

These include cutting down the length and frequency of in-person antenatal visits, restricting birth partners in the labour ward, adhering to a no-visitors policy and isolating the baby from the mother at birth.

“In the field of obstetrics and maternal care, we carry the weight of caring for two patients, mom and baby, at a time where the healthcare system is experiencing severe constraints”

Elective caesars unnecessarily consume significant Personal Protective Equipment

Another pitfall of local obstetrics is that the number of women giving birth by means of caesarean section is incredibly high, even before the pandemic, with South Africa having one of the highest rates globally. The procedure, if not medically indicated, unnecessarily consumes significant Personal Protective Equipment per procedure, which could be directed towards more frontline workers, and thus puts more healthcare workers at risk of transmission.

Covid-19 has added further pressure on an already weakened maternal care system, as we face a global shortage of midwives and nurses to provide quality care during pregnancy, delivery and after birth. Many health care workers are concerned that efforts to contain the virus will have unintended consequences on mothers and infants that will only become visible after the pandemic ends.

In terms of occupational preparedness, arming ourselves with knowledge is an important step

Working with our hospital partners, The Birthing Team,provides midwives with the training, facts and information to fully prepare themselves so that they can feel confident and comfortable in their daily tasks. As part of our support to our midwives and clinicians we have encouraged daily debriefs, highlighting the psychological strain of working in an environment of mass trauma. In addition to these debriefs we are continuously collating and disseminating information on best practice and embedding that into our teams.

Our midwives are using all available technology solutions to stay in touch with patients, including telephony and social media platforms. Since antenatal classes can no longer take place, many are volunteering their services and advice over Zoom calls and WhatsApp groups.

Telehealth has many advantages, including keeping patients safe from possible exposure to the virus and improving access to care during lockdown.

When combined with essential in-person services, tele-consultations ensure that our healthcare system is not placed under unnecessary strain

Going forward, we may see a pivot towards out of hospital services and the rise of community-based midwives to care for expectant mothers away from infection hotspots. The Birthing Team has built the foundation to enable rapid adaptation and scale up of a team-based care model. We can utilise community-based healthcare workers, including doulas and midwives, to exploit the possibilities arising from regulatory changes to the system. Additionally, we can enable the use of telehealth to drive affordable, value based maternity care.

About the author

Dr Howard Manyonga is an obstetrician and Head of The Birthing Team, an affordable maternity programme available at Netcare Parklane in Johannesburg, Netcare Femina in Pretoria, Netcare Pholoso in Polokwane and JMH City Hospital in Durban. Manyonga has extensive local and overseas experience in the public, non-profit and private health sectors, having previously headed Women’s Health at the WITS Reproductive Health and HIV Institute and was the COO of Marie Stopes South Africa.

About The Birthing Team

The Birthing Team, supported by healthcare management company PPO Serve, provides affordable private maternity care to women who are uninsured.

Their all-inclusive fee covers all necessary scans, tests, medication and consultations, including hospital costs for the delivery, based on their allocated care plan. They are currently operational at Netcare Park Lane in Johannesburg, Netcare Femina in Pretoria, Netcare Pholoso in Polokwane and JMH City Hospital in Durban, with more sites planned in 2020. Visit www.thebirthingteam.com for more information.