Delivery room dread

AS news broke about the death of Jodian Fearon — the mother who developed complications in delivery last month after being denied access to health care at several Corporate Area hospitals —waves of anxiety ricocheted through the abdomens of pregnant women who are expecting to give birth soon.

While the circumstances surrounding Fearon’s death are still under investigation, expectant mothers who were already queasy over the unknown risks that COVID-19 can pose to developing foetuses, shifted their worry to whether they will be able to deliver safely when the time comes.

Shyann, a 28-year-old teacher who is carrying twins, shared with All Woman that she tries not to think about delivery because it makes her uneasy.

“Honestly, I’m terrified,“ she expressed. “This is my first pregnancy and I’m healthy. So far everything is going well, but my doctor said carrying multiples means I’m high risk and I might need to do a Caesarean section. I wanted to deliver privately but things are slowing down financially and seeing what happened with Jodian Fearon, I’m considering just going to a public hospital instead and saving the money for the babies.”

Another expectant mother, Shelly-Ann, is in higher spirits, but she is also harbouring doubts.

“I’m happy that so far the virus doesn’t really seem to affect children and babies as badly as older people, because I feel like by the time I reach nine months in July everybody will have it. I’m just trying my best not to catch it and hope that when I go to deliver they don’t think my asthma is COVID-19 related,” she said.

A third mother in her 30s, who asked that her name be withheld, said that she tries not to consume too much news about COVID-19.

“I just try my best to not follow up what’s happening in the world right now, because it’s not like I can stop the baby from coming. I’m due in June and I can’t do anything more than read my Bible and trust my doctor.”

While these women’s doctors try their best to soothe them individually, Jamaica’s Chief Medical Officer Dr Jacquiline Bisasor-McKenzie reassured All Woman that the public health system remains committed to its responsibility to expectant mothers during COVID-19.

“The fact is that once the patient comes in to deliver, we are not going to turn the patient away. She is going to be dealt with. We have a responsibility to manage the patient,” she said.

“At all our hospitals we have put in the COVID wards, but if a pregnant patient comes in who needs to be delivered and there is a history of fever and respiratory illness, then she would be treated as a suspected case of COVID, and she would need to be isolated on the labour ward and all the necessary precautions taken to deliver the patient safely, while limiting exposure to the staff and other patients,” she explained.

She pointed out that facilitating on-ward isolation is not abnormal, because of how delivery rooms are set up.

“Most hospitals will have a labour room that they can put a patient in, or they have, on the labour wards, areas where they can section off the patient,” she noted. “If the patient becomes critically ill and requires ventilatory support, then that patient will be transferred to a hospital that has ventilatory support.”

The CMO pointed out that at least one hospital under each regional authority now has the capacity to provide this kind of support.

“If the patient is severely ill, then we want to have them in one of our Type A hospitals [University Hospital of the West Indies, Kingston Public Hospital, and Cornwall Regional Hospital], that would have all the additional support of staff and other capacities to fully manage the patient.”

Hoping to make it out safely

But the fears are not limited to COVID-19, as Jamaican women have long dreaded the delivery room, hoping that they, and their babies, make it out safely. In recognising that too many Jamaican women were dying in childbirth each year, the three-year Maternal, Neonatal and Infant Health (MNIH) project was launched in 2018.

“We have 79 deaths per 100,000 live births, and it really should be lower. It is a really critical issue, and infant health issues are being addressed as well. When mothers die, it has a lot of ripple effects on the family. Moreover, those deaths are preventable,” explained Linnette Vassell, advocacy specialist in the MNIH project.

Professor Affette McCaw-Binns recently presented her findings on the maternal mortality trends in Jamaica between 1998 and 2018, at a national mortality review meeting.

The summary of her findings, provided by the Women’s Resource and Outreach Centre (WROC), showed that, “There has been no significant change in the maternal mortality rate in 21 years; however, deaths indirectly related to pregnancy and late deaths have doubled. Improvements have been seen in the southern region for maternal deaths, but not late maternal deaths, while rates have been trending up in the south-east and western regions.”

The study also found that the previously downward trend in the north-east region was reversed in 2016-2018, and needs to be monitored.

The leading direct causes of maternal deaths are hypertension, pre-eclampsia, haemorrhage, abortive outcomes and infection. The main conditions that contribute indirectly to maternal deaths are circulatory diseases (for example strokes, heart attack), HIV/AIDS, sickle cell disease, and diabetes. These are also risk factors to late maternal death (more than six weeks after birth).

The MNIH project falls under the Programme for the Reduction of Maternal and Child Mortality (PROMAC), which was developed and implemented by the Department of Community Health & Psychiatry at The University of the West Indies with funding from the European Union. The department carries out the project in partnership with WROC and other civil society organisations. The aim of PROMAC is to reduce maternal and infant mortality in Jamaica, which remain high, and which Jamaica failed to achieve under the millennium development goals, which were succeeded by the sustainable development goals in 2016.

According to project lead Professor Wendel Abel, since the MNIH project was launched, it has collected baseline data on MNIH and patient rights; executed capacity-building workshops; built partnerships with key and non-health players; developed an advocacy plan of action; analysed the policy and legislative environment related to human rights and MNIH; developed training manuals; launched a public education campaign; and increased collaboration in patients’ rights advocacy to monitor, affirm rights, lodge complaints and mediate MNIH issues.