Regular prenatal doctor visits for checkups on the health of mother and fetus are essential during pregnancy. With regular monitoring, doctors can address problems as they arise. For example, tests for gestational diabetes are routine in the second trimester, so that the condition can be treated and the health of the mother and baby safeguarded. If left untreated, birth complications may occur when a baby grows too large to safely deliver without harm to either the child or mother. Likewise, regular visits monitor iron deficiencies, blood pressure, fetal heartbeat, position, and growth, all of which prevent illnesses, injuries, or death. Many problems can be resolved with advanced warning, avoiding costly and potentially dangerous emergency visits to the hospital. However, when Covid-19 hit last year, many women avoided medical facilities, and as a result, missed out on critical prenatal care. A recent medical review of how the worldwide health crises affected birthing mothers and their babies revealed some startling results. Here’s what investigators found.
Researchers Investigate the Worldwide Pandemic’s Effects on Childbirth
According to a Lancet Global Health Journal-published review’s findings, there was an increase in maternal and fetal mortality during the pandemic, as well as an increase in certain pregnancy complications, particularly in mid- and low-income countries. Reviewing six million global subjects contained in existing compiled studies of individual healthcare facilities, the report authors found the fatalities and complications could have been avoided in many cases, but for the hesitancy of pregnant women to see their doctors during the pandemic for fear of becoming infected. Pregnant women fearing Covid-19 skipped their prenatal visits or hospitals all together, some being left to labor and deliver on their own, ending in mother, child, or both dying, especially among lower income pregnant women.
Other factors that contributed to the negative outcomes were timing and severity of lockdown and restrictions in individual locations. India, for example, had more rigid lockdown restrictions earlier in the pandemic than other countries, leaving women with limited access to hospitals and clinics to obtain prenatal care or birth assistance. And globally, the pandemic has funneled most essential medical resources to treating Covid patients to the exclusion of other healthcare needs, including childbirth and pregnancy care. Thus, poorer countries that already struggled to provide adequate prenatal care fared even worse during the pandemic, showing a huge healthcare access differential between poorer and richer countries.
Other noted increases were the number of ectopic pregnancies handled via surgery. The condition, which occurs when a fertilized egg grows outside of the womb, is easily treated if caught early enough. In the absence of appropriate and timely treatment, however, it can be fatal if the fetus develops inside the fallopian tube, which eventually bursts and causes hemorrhaging. Other common pregnancy complications remained constant, such as premature birth, gestational diabetes, high blood pressure, and cesarean section deliveries. Interestingly though, even preterm births differed between low income and high-income countries, as higher income countries showed a decrease in preterm births, recording lower numbers of premature births, compared to lower income countries where preterm births did not decrease.
Finding out How COVID Affected Pregnancies and Births
The Lancet Global Health study reviewed previously compiled studies of pre- and post- pandemic pregnancy outcomes in two large medical databases, covering the 12 months from January to January of 2020 and 2021. Researchers used software that pulled the criteria they sought, while maintaining the privacy of individuals, as names and identification were redacted. Only non-Covid affected pregnancies were included in the analytical review. They reviewed an aggregate of 40 global studies of individual healthcare centers and found substantial differences between mortality rates and pregnancy complications in richer countries versus poorer countries regarding pregnancy care, access, attitudes, and outcomes.
The results, the researchers admit, may have been reflected differently if the study reviewed a wider range of types of facilities. However, using the methods and criteria stated, they found that while postpartum depression and fetal and maternal deaths due to still birth and ectopic pregnancies increased overall, low-income countries suffered higher numbers compared to higher income countries. Moreover, the pre-pandemic press toward decreasing the fetal and maternal mortality gap between poorer and richer nations all but died post-Covid, exposing the glaring differences in available healthcare resources throughout the world.
Possible Factors that Influence How Pregnancy, Labor, & Delivery goes during COVID
Even considering only the United States, the pandemic has affected lower income families to a greater extent than higher income families, since healthcare access is more difficult without insurance, too costly for most to obtain privately, or hard to maintain due to job losses during the pandemic. As such, pregnancy outcomes are likely aligned with much of what the Lancet study analysis concludes. Since some have been discouraging patients from heading to doctors’ offices and hospitals, scheduling only teleconferenced visits (if patients have access to technology) for non-life-threatening visits and referring patients to hospitals only in emergencies, many women have presumably been caring for themselves during pregnancy and even labor and delivery. In addition, restricted access to clinics for contraception has not helped with pregnancy prevention in the first place.
With the combined threat of catching the virus and the discouragement for in-office visits with healthcare providers, more women have most likely been left with less or no guidance on the progress of their pregnancy or the health of themselves or their babies. For example, prenatal care includes scans and testing of the fetus and the mother in the first, second, and third trimesters, with different tests for different stages. At first, the fetal heartbeat is recorded and an ultrasound may be ordered to identify the fetus’s development and position in the womb. The mother is likewise advised about prenatal vitamins and diet, what signs of trouble to look for, and how to maintain a safe pregnancy. Later, the mother’s sugar levels are measured and monitored, in an effort to diagnose and treat gestational diabetes as soon as possible. Her heart rate and blood pressure are tracked as well to look for signs of how the pregnancy is affecting the mother, and whether preeclampsia or eclampsia is developing. High blood pressure, otherwise known as pregnancy hypertension, and elevated protein in the urine are key indicators of potential preeclampsia. These are conditions that can injure, even kill, both mother and baby, if untreated.
At some point, genetic counseling is provided and testing considered, especially for older mothers or those with family history of genetic defects that could be passed down to the baby. Down Syndrome or other genetic conditions affecting the baby can be detected with certain tests, such as amniocentesis. These prenatal tests and monitoring can alleviate fears and further problems from developing and avoid fetal and maternal death or injury in some cases. For example, if caught early, gestational diabetes can be managed and the mother’s blood sugar and baby’s weight correspondingly controlled. Unnoticed or unmonitored diabetes can lead to a baby too large to birth naturally and a mother whose blood glucose levels are dangerously abnormal. A woman who goes into labor outside a hospital can end up dying, as well as her baby, when the baby is too big to deliver. Other conditions that can be fatal if not diagnosed and treated early in pregnancy include maternal infections, abnormal positioning of the fetus in the womb prior to labor, and excessive bleeding.
Your obstetrician or gynecologist may encourage teleconferenced visits during the pandemic, but the American College of Obstetricians and Gynecologists recommends that high risk patients, those with known histories of diabetes, high blood pressure, multiple births, prematurity, and anemia, for example, should have in-office visits for testing. Older women over 35 and pregnant should also receive testing at a health facility, per the ACOG guidelines.
Getting Legal Help when Bad Outcomes are Preventable
If your doctor did not take the appropriate tests or scans and you or your baby suffered preventable injuries as a result, be sure to consult with a medical malpractice attorney to evaluate whether your physician is responsible for the complications or harm caused. You have the right to be compensated for the losses caused by a medical professional’s negligence, whether they failed to conduct routine prenatal testing, screen for genetic abnormalities, diagnose a high-risk pregnancy condition, or take immediate and proper action pre-labor or during labor and delivery. A singular mistake could cost you or your newborn the rest of your lives.
For this reason, a pregnancy or birth injury lawsuit can be used to compensate you and your loved ones for economic losses, such as lost income and medical costs in the near and long-term, as well as your emotional and physical suffering. Contact us today to speak with an experienced attorney about what happened in your case and learn more about how we can help you on the road to recovery. Our convenient New Jersey offices can be reached at 866-708-8617 or feel free so send us a message requesting your free initial consultation.
- Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis, The Lancet Global Health
- ACOG Novel Coronavirus 2019 (COVID-19) Practice Advisory
- More pregnant women died and stillbirths increased steeply during the pandemic, studies show. The New York Times