‘Negative COVID-19 but positive pregnancy’: Best to delay new baby

Tuesday, 07/07/2020Dwi Oktarina, S.Si., M.P.H.

Life shield: A nurse puts a face shield on a newborn baby at RSIA Tambak Hospital in Central Jakarta on April 16. To slow the spread of COVID-19, medical workers are following strict health protocol. (JP/Seto Wardhana)

As more people stay home during this pandemic, concerns of rising numbers of pregnancies have emerged. West Java Governor Ridwan Kamil recently posted on his Instagram account a screenshot of an article relating to an increase in pregnancies in Cirebon regency, and urged men to “take it slow” with their wives. “Negative COVID-19 but positive pregnancy,” Ridwan posted.

Limited access to health services during this pandemic has led to worries that less people are receiving contraceptives. According to the National Population and Family Planning Board’s (BKKBN) latest figures, 28 million Indonesian couples receive contraception services. However, the board noticed a 20 to 30 percent decline in recipients from February to March, with variations among provinces.

Concerns of a baby boom and population increase are not the only reasons experts are advising couples to delay pregnancies. Head of BKKBN, Hasto Wardoyo, said pregnant mothers were vulnerable during the first trimester and tended to have health discomforts such as nausea. Their immune systems are also weaker than usual, and thus they are at increased risk of infection. We have yet to fully understand the effects of COVID-19 infection on fetuses, nor the effects of medication on the infected mother and fetus.   

Pregnant mothers also face more restrictions in prenatal check-ups during the pandemic. Well before the pandemic, Indonesia’s maternal mortality rate was already a major issue, with a high national rate of 305 per 100,000 live births.

Many factors related to the virus remain unknown. While researchers are still striving to discover a vaccine, a few cases of newborns being infected with the virus have been reported. In Wuhan, China, where the world’s first cases were found, a newborn became the youngest individual to be infected with the SARS-CoV-2 virus, reports in early February said, similar to another newborn in mid March in London. The mother in Wuhan had tested positive for COVID-19 before delivery.

Transmission of the virus to newborns is still a matter of speculation, as it is unknown if it occurs in the womb, or is transmitted during delivery or soon after birth as a result of close contact with the mother. A Canadian baby was tested several times following birth in mid May, and its nasopharyngeal swab, plasma and faeces were found to be positive. Yet, the baby was delivered through caesarean section, which means the newborn was protected from vaginal secretion and the amniotic membrane was unharmed. In addition, a sample from a nasopharyngeal swab was taken before the baby had skin contact with the mother. Doctors suggested transmission was likely to occur inside the womb, reports on May 16 said.

However, The Lancet journal recently published a study on nine pregnant women with COVID-19 suggesting that intrauterine transmission was highly unlikely. The samples of amniotic fluid, umbilical cord, breastmilk and the newborns’ throat swab had tested negative for the virus. 

In terms of nutrition, the pandemic may limit a mother’s choice of nutritious food, with many families facing increasingly lower incomes. Unmet nutritional needs during pregnancy may impair a newborn’s growth and development. This may lead to stunting, which is already a major national health problem.

The BKKBN has deployed field counselors to provide services to couples through home visits. It also plans to provide contraceptives to 1 million recipients in June. The program is aimed at increasing contraceptive use among those who have stopped using contraceptives during the pandemic.

Despite the government’s efforts, it is still missing the urgent need to target the many more people who are staying home. More educational campaigns are needed to advise couples to delay pregnancies through media such as television and radio. The latter medium would target audiences in more remote areas where television transmission is limited.  

Although the health system is overwhelmed in this time of pandemic, extra efforts can be made by empowering and strengthening midwives as counselors in educating couples to delay pregnancy. The National Midwives Association (IBI) lists more than 300,000 midwives in 34 provinces. It would surely be challenging, but small efforts in delaying pregnancies can help to lessen the burden on healthcare providers as well as on mothers and their families during the pandemic.

Volunteers from the nation’s village and subdistrict-based women’s and family welfare groups (PKK) can also be empowered. Volunteers across the country have been mobilized to distribute food assistance to eligible households in their community. They can also help raise awareness among mothers and young couples about maternal health and the importance of avoiding pregnancy during the pandemic by relaying the right information with pamphlets or posters while distributing food supplies.

Every woman has the right to be pregnant and bear a child and every child has the right to grow up healthily in the best possible environment. Still, in this time of uncertainty and limitations, it would be wise to delay pregnancy and wait until the pandemic has subsided. Decisions should be taken with caution, taking into account not only the mothers’ health, but also that of the baby, the wellbeing of the family and the capacity of the health system.

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