After the Covid-19 pandemic began, a May 2020 Unicef report predicted that an estimated 116 million babies would be born globally under its shadow, and five million in Pakistan alone.

Numbers from a UN population division report, updated in January every year, show an upward population growth trend of 2.10 percent since 2020, compared to the 2019 growth rate of 2.06 percent.

“Pakistan already has a very high birth rate and most couples have babies during the first year of marriage,” explains Dr Rahat Qureshi, a gynaecologist at a private institution. “One can easily analyse how our population grew during the first Covid wave. People were confined to their homes during lockdowns, fewer options and activities were available for them. There were many hurried weddings then too, with honeymoons spent in total lockdown.”

While governments called for an increase in social distancing, and SOPs to be followed, more births meant an overload of expecting mothers and a plethora of problems for doctors and patients alike.

Gynaecologists and new mothers were among those who were pushed to their limits through the three waves of the pandemic

“There were pregnant women everywhere,” says Mashaal Ali, a young mother who had a daughter in May 2020. “During lockdown, I would arrive at the hospital to see pregnant women queuing up at ultrasound clinics, in the doctors’ waiting area, and even in laboratories for various tests.”

Controlling physical contact in ob-gyn departments is challenging, as physical examinations are necessary, especially during labour, to ascertain both the mother and her baby’s health. This made following government SOPs and maintaining doctor and patient well-being quite demanding.

Dr Neelofur Babar, an obstetrician-gynaecologist (ob-gyn) at the Aga Khan Hospital for women in Karimabad, recalls the challenges she had in her practice. “It was a panic-stricken, uncertain time,” she says. “All health care providers had to wear personal protective equipment, such as an N95 mask, visor cap and gloves before contact with each patient.

“Exposure to a Covid-suspected or confirmed staff member or patient, meant we had to get a PCR [polymerase chain reaction] test done and remain isolated at home for 10 to 14 days. The hospital started teleclinics instead of physical appointments [to reduce exposure]. But when a doctor or staff member tested positive and had to stay at home, the remaining hospital staff had to do double duties.”

Hospitals made screening mandatory for suspected or confirmed Covid infection, so patients had to be screened 48 hours before entering the labour room. Since labour can begin without warning, the entire screening process became difficult for both mothers-to-be and doctors, resulting in many labour rooms being overbooked and unavailable.

“I had to wear a mask throughout labour,” Mashaal says. “Breathing through it was difficult, I felt weak and I thought I was going to die. Then, when I was admitted again for my baby’s jaundice, I was afraid that the hospital attendants tending to my baby would infect me or my baby fatally.”

Dr Qureshi maintains that, while Covid has a high morbidity rate for pregnant women — meaning the incidence of infection among pregnant women is high — the mortality rate seems to be low. “That was a good thing for our patients, but at the time we had little information on how the virus affected newborns,” she says. “Plus, we didn’t know how it would affect us doctors.”

Even worse, with the entry of attendants and visitors in hospitals restricted to control the spread of Covid-19, mothers-to-be had to go through labour and postpartum in complete isolation, without support.

“Neither my husband, nor my mother was allowed by the hospital to visit me and my baby,” recalls Mashaal. “I would be up all night, alone and crying.”

Dr Babar sympathises, sharing that, with higher births in 2020, there were also more cases of new mothers going through postpartum depression.

“All these new mothers had added worries,” she says. “Apart from knowing nothing about handling newborns, they had concerns about their babies’ health, their own well-being, lack of filial support as visitors were not allowed, and the uncertainty of not knowing if and when the situation would get better.”

It wasn’t just patients who were mentally drained.

“In the initial stages of Covid, there was a lot of apprehension, fear and reluctance to work amongst doctors,” Dr Qureshi says. “My family would tell me to stay home, lest I caught the virus from my patients and got sick, or worse, spread it amongst elderly family members. With more pregnant women coming in, I was scared too, initially. But of course, we couldn’t abandon our work, especially when we were needed the most.

“Some hospitals facilitated employees and their family members by providing accommodation and free medical support, which came as a big relief. I remember that patients and their attendants would sometimes be slack with Covid protocol and, when we reprimanded them, they would get offended. Also, everybody was confused, overworked and exhausted.”

Doctors in emergency fields such as ob-gyn have to work under immense pressure for long duty hours at odd times, and are more likely to face burnout, especially in a stressful time such as that of the pandemic.

To measure the pandemic burnout in ob-gyn doctors, a study was conducted from April 2020 to May 2021 at the Rawalpindi Medical University and allied hospitals. The results showed significant personal and work-related burnout, while only a few doctors experienced patient-related (associated with becoming emotionally involved in a patient’s problems) burnout.

Now in 2022, with a still consistently high influx of patients, Dr Qureshi does not see a complete removal of Covid regulations anytime soon. “I miss being able to see my patients’ faces while speaking to them, so I could have an idea whether they have understood my words or not,” she says.

Dr Babar agrees that there is still a while for the Covid situation to normalise. “As we sit at a metre’s distance, sometimes it is difficult to connect with a patient, with our faces half covered,” she says.

Dr Qureshi is more optimistic. “Two years on, we’re far better than where we were at the start of the pandemic,” she says. “Hospital staff are now fully vaccinated, and we find some solace in most of our patients being vaccinated too.”

She opens her drawer with a stack of files of patients scheduled to arrive that week. “Babies must be born, life must go on,” she says, pulling out some for the day. “We’ll just have to get used to it.”

The writer is a freelance contributor and can be reached at mehreennaveed2009@hotmail.com

Published in Dawn, EOS, May 8th, 2022