A pandemic pregnancy: from the outbreak of the sanitary crisis until today
Stories of giving birth in the midst of unprecedented times
It was April 6th, 2020 in the city of Barcelona. Alicia was getting ready to go to the Sagrada Familia Hospital to give birth to her second child, Aleix, in induced labour. When she got there, she tested positive for coronavirus via a blood serological analysis. She thought the test was merely a formality, after all, Spain had been in lockdown since the state of alarm of the 13th of March which had made her stay home with no contact with the outer world, — until it was a life-changing event.
The 35-year-old was told she couldn’t deliver her baby at that hospital and that she should try her luck at a public centre. The first one she went to wouldn’t even let her in the waiting room because of her positive test. “They even refused to monitor my baby to check if he was ok”, she said. Finally, Vall d’Hebron Hospital opened its doors to her, but that wasn’t the end of a traumatic experience… They made her wait in an isolated box from 11 am until 8 pm with no visits allowed and no food, as she was supposed to have induced labour.
A bold nurse did enter the room she was staying at, protected from head to toes with a PPE (Personal Protective Equipment) following the very first recommendations doctors all over the world were receiving from the World Health Organization. “Because of the way she was shielded, she could not see much. I had bruises all over my arm from all the times the nurse had to poke me to find the vein to insert the IV”.
Alicia got tested again, and this time it was negative. With the new results, she managed to leave the public hospital, call the doctor she had originally prepared the giving birth with and delivered her baby boy on the 8th of April, amid a pandemic in an empty wing of a private hospital. “It seemed apocalyptical”, she said. “The pandemic had changed everything in maternity hospitals. At that time, there was no knowledge of anything. It was all still very recent. I was afraid of what could happen to the baby physically if I had been infected with the virus while pregnant. I was totally frightened by the unknown”, states Alicia remembering the events that took place more than a year ago. Thankfully, Aleix is now a healthy and strong 1-year-old boy, but the reality that numerous mothers lived during the outbreak of the pandemic would terrify many.
The uneasiness and tension these lines might produce to the reader are not without reason. The reality of the first wave of the pandemic in Spain was an absolute crisis. “At the beginning, everything was a total novelty and unprecedented. I remember being on duty all day long, connected 24 hours, including Saturdays and Sundays, because the Coronavirus was the great unknown”, said Doctor Lola Gómez Roig, a renowned gynaecologist specialized in high-risk pregnancies and head of the Obstetrics and Gynecology Service at the Hospital Sant Joan de Déu and at the Clínica Corachán in Barcelona. March and April were the darkest months of the pandemic, the first time citizens were ordered to lock themselves indoors. In those days, the streets emptied and the dead were counted by the hundreds. At that time, the vaccine was not even on the horizon, let alone any studies on the effects of the virus on pregnant women. In Dr Gómezs’ 26 years of experience in the field, helping to deliver more than seven thousand babies, she had never seen anything like what the pandemic caused in maternity hospitals before.
Nurse and maternity coordinator, Erika Sánchez, corroborates these extreme times: “At first, this was crazy. Health workers, sometimes had to adapt to new measures five different times within the same day”. Little information was available on the effects of Coronavirus on pregnancy, but the urgency to adapt to the new situation created by the pandemic led to a number of fast decisions taken by doctors in charge to best prepare their professionals to help new moms. Patients like Alicia were not the only ones who perceived the chaos that COVID brought. Health workers were overwhelmed, under a lot of stress and working with fear in a state of alarm that engulfed the whole country. And they were falling too. The situation threw hospitals into turmoil, given that its professionals — anesthesiologists, midwives, etc. — were getting infected with the virus. “Therefore, after the outbreak, I, as the head of department, felt that it was essential that no more of my professionals fell so as not to be left without personnel on duty for the women who came to give birth”, explains Dr Gómez Roig.
In Sant Joan de Déu, they were delivering 20 babies a day at the peak of the pandemic, which made them become a reference hospital for the whole country. A temporary joint protocol was drawn up with the professionals in the sector, hand in hand with specialists in infections, so that everyone would follow the same standards and caution actions. They minimized the number of face-to-face visits to only those that were mandatory, regulated bringing companions to medical visits, all with the common objective of minimizing the risk of exposure of women and professionals. “Based on the experience of dealing with the pandemic for over a year now, we have been learning more and more every day and decided to set up a “clean area” and another one specifically for women with COVID to deliver. Today, future mothers who are positive can give birth in a prepared area where both, the baby and her, will be safe; and if they do not have COVID, the delivery is the same, only with everyone wearing a mask”, explains Dr Gómez Roig.
In addition, the specialist gynaecologist publishes the information resulting from her research in national and international journals. Through these, they have detected that pregnant women do not appear to be more susceptible to infection or to serious complications compared to non-pregnant women and most COVID-19 infected pregnant women will have mild or asymptomatic disease; but the existing data are still limited, and sizable series are scarce. The only ones at risk or more vulnerable are elderly, obese, hypertensive and diabetic mothers. On the other hand, based on the available scientific studies, there is currently no clear evidence of vertical transmission — one from mother to newborn during pregnancy, at the time of delivery, or through breastfeeding.
But, since all this new evidence found came at a slow pace, the pandemic made pregnant women very anxious and more of them grew hesitant feelings on the idea of deciding to have a baby. We know now, from the results of the National Institute of Statistics, that in 2021 the number of babies born in December and January in Spain — conceived during confinement — fell by 23% compared to the previous year. The stress of pandemic fear and confinement worked against couples, and COVID brought economic instability and uncertainty; none of which are favourable for bringing a newborn to the world… The pandemic has plummeted Spains’ birth rate.
How can we go back to normal and hope that women return to having a peaceful pregnancy? Some believe the answer is in the lines of giving a voice to the doctors who are taking the time to investigate their specific case and putting them in the spotlight of scientific research. “The message we give is that pregnant women should not worry about COVID but, obviously, like the rest of the population, follow the measures to avoid becoming infected”, says Dr Gómez Roig. With the controls that are now sufficient to be able to have a good and under control pregnancy, professionals want to encourage women to not stop getting pregnant because of the anxiety these times have brought. “Enjoying motherhood is possible in the midst of these singular times. Giving birth with a mask does not stop the act of creating life from being beautiful”.
Women like Carla had their first baby in 2021, one year after the outbreak of the health crisis. Carla had the virus before her pregnancy, so she already had antibodies. Maybe that was one of the reasons why she could be less distressed, that and the fact that hospitals are now much more prepared. “I gave birth a year after the state of alarm was declared, when we already knew much more. At the time of delivery, my husband was able to come in with me, both of us always with our masks. But I didn’t even realize I was wearing it. I was thinking about something much more important: the eagerness of holding my daughter in my arms” says the 30-year-old new mom.
Being able to take a step back and see how much progress has been made, allowed women like Carla to portray giving birth in a pandemic in a much more positive light, even finding the good aspects about it: “Nowadays, 48 hours after labour, no one is allowed in to visit you. I’m grateful for that, since after childbirth you are not in a perfect physical condition. New moms are very tired and weak, and now we get to spend more alone time with our new little family before going back out there. It’s a good change that COVID has brought to maternity”, says Carla. Moreover, the virus has made everyone be more careful around babies and there are fewer lung infections in newborns. “Today, no one would even think of touching my baby without my permission or without previously having washed their hands”.
Health workers in the nativity sector are an example of how we can never despair in front of unparalleled times. They are true heroes. Thanks to their hard work, 24 hours a day, 7 days a week, today mothers no longer have to be afraid or suffer from scrutiny when arriving at a hospital to give birth during a pandemic.
