For Morongwa Mohlala, a mother of two from Pretoria who works as a bank consultant, giving birth during the COVID-19 pandemic was not easy.
"It was really scary as I was worried that me or my baby was going to get the virus," she says. "However, what kept me calmed a little was the fact that it was still early days of the pandemic and very few cases were recorded in South Africa at the time. It was scary because I was alone as visitors were not allowed in the ward," Mohlala says.
"The problem that I had was that because it was lockdown, I couldn't buy clothes. I didn't have a receiving blanket because I'm old school so we don't believe in buying stuff before the baby is born. Luckily the hospital gave us bags that had most of the things I needed for the early days. We couldn't even get a birth certificate for my baby."
Mohlala says she became concerned when her baby was having breathing problems.
"I was worried, and thought maybe she has COVID-19 and I was scared to take her back to the hospital. Her skin also developed a very bad rash and I later discovered that it's eczema. Now we still have to go for immunisation. It is still daunting because we have to go to the clinics where there are crowds and I'm worried about getting infected," says Mohlala whose daughter, Lesedi, is now three months old.
Like many other expecting mothers, Mohlala's pregnancy and birth plans were impacted by COVID-19.
On Wednesday a new study, the National Income Dynamics Study - Coronavirus Rapid Mobile Survey (NIDS-CRAM), showed that antenatal and follow-up visits after birth dropped significantly during lockdown.
Of the 3 140 women surveyed, 16% reported that they last visited a health facility in April or earlier. "This represents a two-month gap in care, which is considered to be a risk for this group of women - but would admittedly vary substantially based on the individual's health," reads one of a series of papers published with the NIDS-CRAM data.
Just over half (58%) of these respondents reported attending a healthcare facility in June and 24% in May.
Fears of contracting COVID-19 is among the reasons for the drop in antenatal and post-natal visits of mothers like Mohlala. Some 40% of the surveyed mothers cited Coronavirus fears as the reason they did not keep up with antenatal visits.
"Missing these critical visits as found in our study, especially in the last trimester of pregnancy when blood pressure levels may be increasing and pre-eclampsia developing, can lead to longer term health impacts for both the mother and baby," the paper reads.
Also of concern is that about 11% of mothers living with HIV ran out of antiretroviral therapy and about 5% of mothers whose children needed care or vaccinations, did not seek such care.
Adapting to a new reality
To put mothers like Mohlala at ease and to keep them safe, hospitals like Mowbray Maternity Hospital had to adapt.
Sarah Willemse who has been a midwife at Mowbray Maternity Hospital for over 28 years, says the COVID-19 pandemic poses many challenges for the health care system and midwifery is no exception.
"Daily we must face the fear of the unknown. Limited physical contact creates a unique challenge in the care of a Person Under Investigation (PUI) or positive patient. We now have to adapt our specialty as physical contact forms the cornerstone of care," she says.
"Many changes had to be made to the maternity ward which include special isolation rooms and patient social distancing. Patients and health care workers are now required to wear masks at all times, which makes communicating very challenging. COVID PUI and positive patients require special equipment that cannot be used on other patients," says Willemse.
She says multiple measures and operating procedures are now in place to ensure the safety of staff and patients. "These carefully thought out plans include social distancing, staff personal protective equipment (mask, gowns, gloves, vizors), hand sanitiser at each patient's bed and main areas, limiting the amount of personnel in tea rooms and compulsory screening for staff and patients alike. "We are well prepared to ensure the safety of everyone stepping through the healing doors of Mowbray Maternity Hospital," says Willemse.
Expecting mom, Jodi Neuhauser and partner Justin Fife from Cape Town who had to change their plans for emigrating to the USA, say their biggest concern is not getting the virus but the impact it will have on the hospital experience. "If Justin tests positive that means he can't be in the hospital with me. I will have to be alone in a foreign country with my family million miles away. So, we have to be extra careful in everything that we do. Also, the fact that he is allowed in the labour ward and he has to leave about two hours after is a big concern," Neuhauser says.
"I was thinking that we are about to bring a baby to the world who doesn't know a world without a mask. Faces will be hidden in a mask all the time," she says.
Fife tells Spotlight his partner has been absolutely amazing with preparing for the baby. "We have to attend online antenatal and hypno-natal classes. I want to be involved so I have also been doing some reading," he says.
Thinking out of the box
Tracey Aitken, founder of The Zoe Project, an organisation that provides maternal healthcare programs supporting vulnerable women, girls and babies in the Western Cape, says it is time to readjust the way of thinking, be flexible in the way of thinking and go back to basics.
"The pandemic is still going to be with us for a very long time. It is time to start thinking out of the box. Instead of expecting mothers worrying that they will be alone in the labour ward they should start thinking what music will I need to calm me down in that ward, let me practise my breathing technique and remember to pack my favourite blanket to make the experience better. Moms must make good use of what they learnt at antenatal classes and be prepared to do this alone," she says.
"Covid is not the best scenario. It is a stressful time for everyone. But instead of concentrating on stressful feelings and dads worrying that they won't be allowed in the labour ward, how about you start reading on how to welcome the baby? Read about how to kangaroo at home. Remember fathers are only allowed in the labour ward during birth and an hour after that for some. If you miss that, you have to come up with a plan on how to bond with this child. Now is the time expecting parents need to communicate even better," says Aitken, adding that dads must now always remember to keep their phones on and know what maternity pads are because now they have to step up even more."
Karen Wilmot, a virtual (online) midwife, says she has seen an increase in the number of expecting mothers wanting her help and she has supported most of her clients 24/7.
"The demand had definitely increased because of the pandemic. It is not just about the fear of being pregnant in the pandemic but also what kind of support is there when the mother gets to the hospital. I think everybody is in fear and decisions are made based on fear," she says.
Learning new ways to support mothers
With limited number of people wanted in the hospital, most mothers who had planned to have birth doulas by their side, now have to do this alone or with only their partners if they are lucky to make it inside. A doula is trained to support expecting mothers emotionally and physically throughout their pregnancy and is not a medical professional.
Aitken says her doulas have become over-the-phone doulas. "The pandemic is felt most by a mother who knows about a doula and now she can't be helped by one. The pandemic has ripped the services of doulas away. We need doulas in every maternity ward. Counselling is needed. A grief doula is needed but mothers that lose their babies now have to do this all alone with no help. With social distancing it is not easy. You know for me it's always about let me give that mommy a huge hug, let me love you and let me make it right now but the pandemic doesn't allow that," she says.
Wilmot agrees. "Doulas have been so great at supporting the moms and they have a deep understanding of the hospital system. They understand the birthing environment and they have also become advocates. They understand all things that happen at the hospital. They know how things work and they can manage and understand procedures but with the pandemic they are not allowed in hospitals and new moms have to do this alone with little or no understanding of the hospital system and it has left most moms frustrated but it is what it is. We have to learn new ways to support these mothers," she says.
In an effort to put expecting mothers and new moms at ease, the Perinatal Mental Health Project together with other organisations and experts have teamed up to offer support to mothers through the Messages for Mothers Alliance.
One of the messages to mothers is very timely given the NIDS-CRAM findings released this week: "Pregnant women should continue attending their planned antenatal visits," and "Wear a cloth mask. When you arrive at the facility, you will be asked questions about COVID-19, have your temperature checked and asked to use hand sanitiser."
Willemse says such reassurance is key to prevent panic and spread of misinformation.
"Any patients who are identified with symptoms at the various screening points are immediately removed from the general population and seen separately," she explains. Positive patients are then given special follow-up dates and are seen in different areas to the non-COVID population.
"We are trying to space out appointments a little more than we would normally do. For example, if a patient would normally be asked to return in two weeks, they may now be asked to come back in three or four weeks, if it is safe to do so. In this way, we try to prevent over-crowding," says Willemse. "Patients are sent an SMS prior to outpatient appointments to remind them that partners are not allowed inside the hospital during outpatient visits. Partners either wait outside or in the provided tent with shelter."