'It's not a death, it's murder': how India's second Covid wave has hit mothers and babies
The pandemic, on top of an already overstretched health system, has devastated maternity care
By Catherine Davison Delhi 28 May 2021 • 11:47am
At first, Chandan Vaishnav was not too worried about his wife, Lata, who had just tested positive for Covid-19. She was eight months pregnant and was, in theory, more vulnerable to the disease as India's second wave of the coronavirus has been hitting pregnant and post-partum women hard.
Still, Mr Vaishnav thought, this was Delhi, the capital, which has some of the best health facilities in the country. But the first hospital the couple went to refused to take her. So did the second. In the midst of a second wave that was overwhelming an already strained healthcare system, hospitals in Delhi werestruggling to procure enough oxygen and patients were scrambling for limited beds.
Over the space of two days, her condition gradually deteriorating, Lata was turned away from more than 20 hospitals; Mr Vaishnav estimates that he called another 50 to 60.
“I got the same reply – ‘we can’t take her. We don’t have enough beds.’”
With basic healthcare resources overstretched in the devastating second wave of Covid, obstetric care in India is being compromised even for patients who do not have the virus.
Chandan Vaishnav with with wife, Lata, during her pregnancy earlier this year Credit: Chandan Vaishnav.
Earlier this month, Save the Children warned that “India could be facing thousands of additional deaths for children under five and an increase in maternal deaths, as hospitals and clinics are directing virtually all their staff and medicines to coping with Covid-19 patients.”
At Safdarjung Hospital, which has one of the busiest maternity wards in the country, multiple doctors told the Telegraph that not only were there serious staff shortages, with many doctors and nurses diverted to a newly-formed Covid unit and others off sick with the virus themselves, but also a lack of oxygen, meaning they were able to admit fewer patients than usual.
Before coronavirus, the hospital would see an average of 75 births every day. Now, there are only 12 to 14, and they are unable to take referrals from other hospitals if the baby shows signs of foetal distress.
“There is a shortage of oxygen and no ICU beds, so for foetal indications [signs of foetal distress where a caesarean section is deemed to be the best course of action] we are referring patients to other hospitals,” one senior doctor, who wished to remain anonymous, said.
“We used to take every patient even if we were short on space, but now with Covid the risk-benefit ratio has changed.”
Najna Khatoon, with her baby, who was delivered by caesarean despite a lack of oxygen Credit: Catherine Davison
When Najna Khatoon arrived at the hospital in the early stages of labour, doctors quickly spotted signs of meconium in her amniotic fluid, a common complication that requires an emergency caesarean section.
Ms Khatoon was lucky; as a registered patient, the hospital agreed to admit her. “I was told that there was no oxygen and it would be difficult for the doctors to operate on me,” she says.
She could not afford private medical care as her husband had recently lost his job so, despite feeling “very scared”, she agreed to the procedure. Her daughter was delivered safely via caesarean section later that day. An official spokesperson for Safdarjung Hospital did not respond to requests for comment.
In the bed next to Ms Khatoon, Shama Isra is also recovering from an emergency caesarean section. Too scared to leave the house because of the virus, she didn’t attend any antenatal check-ups, so no-one noticed her high blood pressure until she was already in labour.
The the maternity ward of Safdarjung Hospital in Delhi Credit: Catherine Davison
“We had a lot of difficulties during these weeks,” the 34-year-old says. “People are frightened to go out. Be safe in your house, that is better.”
Kruti Dalal, a senior manager at child and maternal healthcare NGO ARMMAN, says that these delays can prove deadly.
“Often when women reach the hospital it’s too late,” says Ms Dalal. “They don’t identify danger signs early on, so not only is the woman’s and the child’s life in danger but it also adds to the pressure on the tertiary healthcare system.”
ARMMAN promotes the use of technology to address systemic gaps in the healthcare system such as lack of access to services, and provides information to women over the phone. Over the past year, with the help of 50 volunteer doctors, it has pointed 60,000 pregnant women towards services. In some cases volunteers coordinated directly with clinics to ensure women were admitted when beds were impossible to find.
Although the NGO’s outreach used to be predominantly in rural areas with sparse healthcare facilities, since the pandemic more women from large cities such as Delhi have got in touch.
In April, there was an increase in calls by almost 50 per cent compared to the previous month, with a substantial number of those coming from cities such as Mumbai and Pune.
“Outpatient departments were either completely shut or they were diverted for Covid-19 patients, so women’s access to even the regular antenatal and infancy care was severely restricted,” Ms Dalal explains. “Definitely they could not reach out in case of emergencies.”
“This past year more than anything has emphasised the need for technology and the need to leverage what we have,” she adds, in order to “reach every woman and child that we possibly can”.
Whilst teleconsultations may help to plug the gaps in preventive healthcare, without essential resources such as oxygen and ICU beds, pregnant women who do require hospital care will continue to be put at risk.
Although the crisis in Delhi is slowly subsiding, with the government having scaled up oxygen procurement and opened several new critical care centres, obstetricians are calling for more emphasis to be placed on maintaining critical care access for pregnant and postpartum women before an anticipated third wave hits India later this year.
For Chandan Vaishnav however, those changes will come too late. After two days of searching, Lata was finally admitted to a hospital in the neighbouring state of Haryana. By that point however, her oxygen saturation levels had dipped dangerously low. Both mother and baby died on April 28.
“We were searching from hospital to hospital. I was continually on the phone, looking for admissions. She was looking at me, and I could not do anything,” Mr Vaishnav says. He blames his wife’s death on the government’s lack of preparedness.
“If the government would have taken the appropriate actions during the first lockdown, if I could have got her admitted two days prior - she could have been saved,” he says. “It’s not a death - it is a murder. It’s a murder of my baby, and my wife.”
On the other end of the phone line, his voice cracks. “I tried. I tried. And ultimately we lost her.”
Protect yourself and your family by learning more about Global Health Security
The pandemic, on top of an already overstretched health system, has devastated maternity care
By Catherine Davison Delhi 28 May 2021 • 11:47am
At first, Chandan Vaishnav was not too worried about his wife, Lata, who had just tested positive for Covid-19. She was eight months pregnant and was, in theory, more vulnerable to the disease as India's second wave of the coronavirus has been hitting pregnant and post-partum women hard.
Still, Mr Vaishnav thought, this was Delhi, the capital, which has some of the best health facilities in the country. But the first hospital the couple went to refused to take her. So did the second. In the midst of a second wave that was overwhelming an already strained healthcare system, hospitals in Delhi werestruggling to procure enough oxygen and patients were scrambling for limited beds.
Over the space of two days, her condition gradually deteriorating, Lata was turned away from more than 20 hospitals; Mr Vaishnav estimates that he called another 50 to 60.
“I got the same reply – ‘we can’t take her. We don’t have enough beds.’”
With basic healthcare resources overstretched in the devastating second wave of Covid, obstetric care in India is being compromised even for patients who do not have the virus.
Chandan Vaishnav with with wife, Lata, during her pregnancy earlier this year Credit: Chandan Vaishnav.
Earlier this month, Save the Children warned that “India could be facing thousands of additional deaths for children under five and an increase in maternal deaths, as hospitals and clinics are directing virtually all their staff and medicines to coping with Covid-19 patients.”
At Safdarjung Hospital, which has one of the busiest maternity wards in the country, multiple doctors told the Telegraph that not only were there serious staff shortages, with many doctors and nurses diverted to a newly-formed Covid unit and others off sick with the virus themselves, but also a lack of oxygen, meaning they were able to admit fewer patients than usual.
Before coronavirus, the hospital would see an average of 75 births every day. Now, there are only 12 to 14, and they are unable to take referrals from other hospitals if the baby shows signs of foetal distress.
“There is a shortage of oxygen and no ICU beds, so for foetal indications [signs of foetal distress where a caesarean section is deemed to be the best course of action] we are referring patients to other hospitals,” one senior doctor, who wished to remain anonymous, said.
“We used to take every patient even if we were short on space, but now with Covid the risk-benefit ratio has changed.”
Najna Khatoon, with her baby, who was delivered by caesarean despite a lack of oxygen Credit: Catherine Davison
When Najna Khatoon arrived at the hospital in the early stages of labour, doctors quickly spotted signs of meconium in her amniotic fluid, a common complication that requires an emergency caesarean section.
Ms Khatoon was lucky; as a registered patient, the hospital agreed to admit her. “I was told that there was no oxygen and it would be difficult for the doctors to operate on me,” she says.
She could not afford private medical care as her husband had recently lost his job so, despite feeling “very scared”, she agreed to the procedure. Her daughter was delivered safely via caesarean section later that day. An official spokesperson for Safdarjung Hospital did not respond to requests for comment.
In the bed next to Ms Khatoon, Shama Isra is also recovering from an emergency caesarean section. Too scared to leave the house because of the virus, she didn’t attend any antenatal check-ups, so no-one noticed her high blood pressure until she was already in labour.
The the maternity ward of Safdarjung Hospital in Delhi Credit: Catherine Davison
“We had a lot of difficulties during these weeks,” the 34-year-old says. “People are frightened to go out. Be safe in your house, that is better.”
Kruti Dalal, a senior manager at child and maternal healthcare NGO ARMMAN, says that these delays can prove deadly.
“Often when women reach the hospital it’s too late,” says Ms Dalal. “They don’t identify danger signs early on, so not only is the woman’s and the child’s life in danger but it also adds to the pressure on the tertiary healthcare system.”
ARMMAN promotes the use of technology to address systemic gaps in the healthcare system such as lack of access to services, and provides information to women over the phone. Over the past year, with the help of 50 volunteer doctors, it has pointed 60,000 pregnant women towards services. In some cases volunteers coordinated directly with clinics to ensure women were admitted when beds were impossible to find.
Although the NGO’s outreach used to be predominantly in rural areas with sparse healthcare facilities, since the pandemic more women from large cities such as Delhi have got in touch.
In April, there was an increase in calls by almost 50 per cent compared to the previous month, with a substantial number of those coming from cities such as Mumbai and Pune.
“Outpatient departments were either completely shut or they were diverted for Covid-19 patients, so women’s access to even the regular antenatal and infancy care was severely restricted,” Ms Dalal explains. “Definitely they could not reach out in case of emergencies.”
“This past year more than anything has emphasised the need for technology and the need to leverage what we have,” she adds, in order to “reach every woman and child that we possibly can”.
Whilst teleconsultations may help to plug the gaps in preventive healthcare, without essential resources such as oxygen and ICU beds, pregnant women who do require hospital care will continue to be put at risk.
Although the crisis in Delhi is slowly subsiding, with the government having scaled up oxygen procurement and opened several new critical care centres, obstetricians are calling for more emphasis to be placed on maintaining critical care access for pregnant and postpartum women before an anticipated third wave hits India later this year.
For Chandan Vaishnav however, those changes will come too late. After two days of searching, Lata was finally admitted to a hospital in the neighbouring state of Haryana. By that point however, her oxygen saturation levels had dipped dangerously low. Both mother and baby died on April 28.
“We were searching from hospital to hospital. I was continually on the phone, looking for admissions. She was looking at me, and I could not do anything,” Mr Vaishnav says. He blames his wife’s death on the government’s lack of preparedness.
“If the government would have taken the appropriate actions during the first lockdown, if I could have got her admitted two days prior - she could have been saved,” he says. “It’s not a death - it is a murder. It’s a murder of my baby, and my wife.”
On the other end of the phone line, his voice cracks. “I tried. I tried. And ultimately we lost her.”
Protect yourself and your family by learning more about Global Health Security
