For most children, life begins in a delivery room at the hands of an obstetrician-gynecologist (OB-GYN), a medical doctor who specializes in female reproductive health. The delicate hands of these doctors tend to the mother with utmost care, ensuring that both the mother and the baby are safe and healthy.
Now, amid a pandemic, it is hard to imagine raising a child where the threat of the virus and its impact on everyone’s livelihoods loom over our heads. Hospitals, among other institutions, are caught in the crossfire of the pandemic’s drastic effects, altering many standard protocols within the pristine white walls. Medical personnel are forced to be swiss army knives, fighting a new strain of coronavirus while battling the usual diseases and other health issues simultaneously.
For OB-GYNs, long hours in the labor room are now accompanied by more barriers such as protective—yet restrictive—gear and COVID-19 positive mothers. With the emotional effects of the pandemic and the overwhelming surge of patients, these doctors are tasked with coping with these changes and dangers to preserve lives—of both parent and child.
In a pandemic, it wouldn’t be amiss to assume that the standard procedures set for delivering babies would change. Dr. Belinda Pañares, chair of the Department of Obstetrics and Gynecology at Chong Hua Hospital-Fuente in Cebu City, affirms that the first step in handling a soon-to-be-mother is to have their swabs taken for analysis through the RT-PCR test or the real-time reverse transcription polymerase chain reaction test. “As early as 37 to 38 weeks [of pregnancy], our patients [undergo] RT-PCR so when they go into labor, we already know the status of the mother, [and] we can prepare,” she conveys.
Patients who test negative for the coronavirus are then transferred into service labor beds, to keep them in areas where there is little chance of transmission of the disease. However, patients who test positive are placed into two rooms, known as “yellow rooms”, a term referring to infectious areas.
“In pre-COVID times, these [were] used for patients who wanted to have two significant others [with them] while they were in labor, and they [would] deliver there also,” Be. Pañares recalls. But with the pandemic, the mother delivers alone with the help of the assigned OB-GYN to protect herself and the baby from possible infection.
Dr. Belle Marie Pañares, an OB-GYN working at public and private hospitals in Cebu, paints a different scene after the delivery of a baby. If the patient is diagnosed with COVID-19, the newborn is immediately placed under isolation for 25 hours and undergoes the RT-PCR test.
The next challenge is the newborn’s sustenance through breastfeeding. B.M. Pañares mentions that studies have indicated that the virus cannot be transmitted through breast milk—a small win perhaps for the infant’s nutrition. “The mother is encouraged to pump the milk so that the baby will be bottle-fed,” she asserts, adding that while the mother is self-isolating, the child is usually cared for by their next healthy relative.
The duty of an OB-GYN has always been a difficult one to master, even more so now due to the safety measures placed upon health workers in the current scene.
As a medical worker over the age of 60, Be. Pañares can’t help but be concerned for her own health. “At my [age and] status now, [the] fear of the infection is uppermost in my mind,” she divulges. Although there are procedures that are set in place to help against contracting the virus, the lengthy hours spent in the hospital and the amount of people they encounter daily are plenty enough exposure points to keep the worries surfacing.
An obligatory step made toward their protection against the virus is the donning of personal protective equipment (PPE). All medical personnel situated in the labor room must wear Level 4 PPE—“a full hazmat bodysuit with goggles, a face shield, an N95 mask, booties, and gloves”—at all times, explains B.M. Pañares.
“You cannot drink water, you cannot pee, you cannot scratch your eyes if they’re itchy. Then after the procedure, when you doff your PPE, oftentimes you are already soaked in sweat,” she recounts an instance when she was on labor watch for a patient, donning full PPE gear for 10 hours straight.
Likewise acknowledging the added burden of using PPEs, Be. Pañares nevertheless points out that, as a frontliner, her primary concern is to avoid contracting the virus. If proper PPE usage is observed and with medical staff being meticulous in their actions, the chances of the medical team acquiring the virus would be minimized, she reiterates.
The true cost
“Pre-COVID times, [the] labor room [was] a bustling area.” The days when Be. Pañares would stand in a busy yet lively delivery room seem like decades ago, with the danger of the virus painting the hospital a bleary color. The private hospital she runs has experienced a drastic decline in deliveries, going from “eight to 10 [expectant mothers a day]” to admitting two to four only. Different factors such as fear could explain the drop, but B.M Pañares suspects that the higher cost of delivery is the main culprit.
Due to necessary precautions such as PPEs and the RT-PCR tests, the cost of delivery in the private hospital, having started at P50,000, has incrementally risen to P150,000. “The cost is [doubled] because the hospital has taken extra measures to provide safety to not only our OB patients, but also [to] all the patients who are admitted in the hospital,” B.M. Pañares explains. The patient would also have to pay for the hazmat suits donned by the medical team, which cost P2,600 each.
If the mother is COVID-19-positive, around seven medical personnel will handle the baby—that means seven hazmat suits the patient has to pay for. B.M. Pañares discloses, “The hazmat suit is [changed] per shift; the shifting of the nurses is [every] eight hours,” compounding the financial burden further as patients extend their stay in the hospital.
During delivery, the mother will encounter more staff members, all of whom are required to wear hazmat suits, resulting in an outstanding bill that is heavier than a swollen belly. B.M. Pañares believes that mothers are more inclined to choose more affordable options such as government district hospitals, provincial government hospitals, or even a lying-in clinic.
“[The higher costs are] the problem nowadays because not all can afford [to give birth],” Be. Pañares expresses, “[but] the hospital cannot turn them away, especially when it’s already an emergency.” Thus, the hospital will have to shoulder the costs and issue promissory notes, which she describes as a corporate social responsibility.
Their duty, our responsibility
Although the current times are very stressful, medical professionals continue to carry out their duties and obligations in service to the people. While there is no question to their ability, their safety and wellness of all health workers must also be ascertained. There is no overestimating the sacrifices that have been made by the medical community to protect those around them—most especially in the current pandemic.