Pandemic guidelines leave women and babies at risk

An international researcher and qualified midwife from the University of South Australia (UniSA) warns that guidelines discouraging women from attending face-to-face antenatal visits in recent months could result in a spike in stillbirths.

Associate Professor Jane Warland’s concern has emerged as a result of the fourfold increase in stillbirths in a large UK maternity hospital during the COVID-19 pandemic. Associate Professor Warland says the trend might also be replicated in Australia. She said alarming evidence from St George’s University Hospital in London, showing a spike in stillbirths this year, was not due to women or babies being infected with COVID-19.

“Rather, it is the indirect consequences of expectant mothers being told to stay away from hospitals for fear of contracting the virus or overloading the system. Many high-risk pregnancies were missed, resulting in four times as many stillbirths than usual,” Associate Professor Warland said.

She said that professional health organisations around the world quickly changed the guidelines for pregnant women when the pandemic hit, which may have led to unintended consequences.

“The normal recommendation is that women should see their caregiver at least seven times during their pregnancy. This ensures that any red flags — such as high blood pressure, reduced foetal movements and growth restriction — are all picked up during an examination.

“Instead, expectant mothers have been directed to 10-minute telehealth appointments via phone and Zoom. How can you check someone’s blood pressure or do a physical examination over the phone?”

Stillbirths are more common in first-time mothers, who are more vulnerable and less aware of potential abnormalities, which is why face-to-face care is particularly critical during their pregnancy, Associate Professor Warland said.

She added that home visits by midwives and caregivers could be a viable option to telehealth appointments until the pandemic is brought under control.

There is also sound evidence that women who sleep on their backs are more at risk of a stillbirth, most likely due to restrictions in the amount of blood reaching the placenta in that position.

A new program, including advice recommending that pregnant women sleep on their side from 28 weeks, was due to be rolled out earlier this year — but then COVID-19 hit, putting a temporary halt to its implementation.

Almost 3000 women responded to a recent survey commissioned by the Australian College of Midwives, asking women about their experiences of maternity care during COVID-19.

“The feedback has been telling,” Associate Professor Warland said.

“Women — first-time mums particularly — are voicing their concerns about not being seen, forgotten, ignored and scared that their baby might be at risk without regular health checks.

“These comments mean that women are not receiving the kind of care they are entitled to in a country which prides itself on a first-class health system.”

In Australia, six babies are stillborn every day, or 2200 each year — a rate that has seen little improvement in the past 20 years. This contrasts with New Zealand, Scotland, Finland, Denmark and the Netherlands, where stillbirth rates are 30% lower than they were 20 years ago.

“We need to understand that women are pregnant for a relatively short period of time,” Associate Professor Warland said.

“In normal circumstances they are highly vulnerable, but this pandemic has escalated that vulnerability and stress to new levels. We need to urgently look at the COVID antenatal care guidelines and find ways to support them that doesn’t put their life, or their unborn baby, at risk.”

Image credit: ©stock.adobe.com/au/Syda Productions