The over burdened units

August 27, 2023

Public hospitals can provide the much needed support to lower- and middle-income women with regard to maternal and neonatal health

The over burdened units

The narrow stairway leading up to the neonatal ICU of Lahore’s Sir Ganga Ram Hospital (SGRH), packed with worry-ridden family members, indicates that hundreds of newborns suffer from health emergencies requiring ICU admissions.

The situation is not much different in other major public hospitals across Lahore. Every day, sick newborns, many born prematurely and some with congenital defects, are brought into these overburdened units, lacking adequate facilities to cater to the large number of patients requiring specialised care, including ventilator support, in severe cases.

In SGRH’s case, the distance between its maternity care wing, the MCH, and the neonatal ICU (NICU), adds to the problem.

The MCH, located a few hundred metres away, does not have an active neonatal nursery or a supporting unit for sickly babies.

“Unwell neonates requiring ICU admission have to be rushed to the one located in SGRH’s Children’s Hospital. The distance between theMCH and the NICU is of significance.

Time is of essence when it comes to saving a life,” says Sister Sanober Ramazan, staff in charge (morning), NICU, SGRH.

As people rush past one another outside the NICU, heat and humidity make it difficult to breathe, but there isn’t any other option for these families as they wait to hear from the doctors and staff.

Tears and sweat dripping from exhausted faces are a painful sight, for sure. “Yes, we see sick babies every day, and some do not survive. However, several factors are responsible for neonatal mortality,” says the staff.

“The SGRH has a fully equipped NICU, but the patient load is unimaginable,” says Ramazan. “We have staff, i.e., doctors and nurses, incubators and ventilators; but if a unit that has a capacity for a couple of hundreds is burdened with the care of thousands, it is bound to run into a few problems.”

The staff identifies a number of issues, but the most pressing is that “unhealthy mothers give birth to unhealthy children. If their (mothers’) health suffers, it can greatly impact the health of the unborn and newborn. We must fix maternal health to ensure neonatal safety and survival.”

Uzma, 24, who is pregnant with her third child, says that she had her two children in government hospitals. “At the time of my daughter’s birth, I had a C-section. I may need it this time, too.”

Currently, in the second trimester of her third pregnancy, the anaemic mother-to-be says the doctors have given her food supplements to help with her condition.

Uzma’s is not a singular case.Many women who have given multiple births with little gap between them may develop severe nutritional deficiencies that can affect fetal health and also increase chances of low birth weight in prematurely born babies, and even more serious health concerns.

“A three-year gap between pregnancies is imperative to maternal and neonatal health,” says Dr Iqra Arooj Cheema, DMS at Hawa Memorial Hospital, Wazirabad, a gynaecology and paediatrics hospital providing care to hundreds of residents of its nearby areas on a daily basis.

The over burdened units

“Ours is a 100-bed facility,”she says. “Every day, we have 7-8 spontaneous vaginal deliveries and more than 15 C-sections.

The sheer lack of maternal health awareness we see daily is concerning.”

The doctor explains that “on average, women lose between 380ml-400ml of blood during a C-section.

Even if they have a vaginal birth, there is still postpartum bleeding which lasts around 40-45 days. In some cases, women can develop postpartum haemorrhaging, and then there are dietary deficiencies; all these can lead to anaemia in new mothers.”

The anaemia, though treatable, becomes a health concern for the mother and the children when there is not enough gap between two pregnancies.

“Breastfeeding babies can help with the gap between pregnancies because the chances of a woman getting pregnant if breastfeeding are lower, but the most sensible solution is to use contraceptives, of which many varieties are available.”

Dr Cheema insists that a woman’s uterus needs to heal before the next pregnancy. If they have had a C-section, the scar must heal fully before the uterus is ready to take on a longtermpregnancy.

“There are seven layers of tissue that are incised in a C-section,” she adds. “A woman getting pregnant a year after her caesarian has little chance of carrying a baby fullterm.

She may give early birth because she developed scar tenderness and pain between 30 and 34 weeks of her pregnancy.”

Children born between 24 and34 weeks of pregnancy are premature; between 34 and 37 weeks they are called early births. They are normal if born between 37 and 42 weeks.

Most women who come to public hospitals for prenatal checkups and deliveries are from lower- and lowermiddle-

income families.

Many are undereducated and some are barely out of their teens. Many of these women come to the hospital towards the end of their pregnancies.

There are vaccinations and anomaly scans that they have not had, and most have nutritional deficiencies because they are not getting adequate food and nutritional supplements to have a healthy pregnancy and a healthy newborn who will not need an ICU admission.

Around the 20-24 week mark, it is stressed that pregnant mothers have an anomaly scan because around this time, most organs have developed and there is a heartbeat. This scan allows doctors to rule out any structural or chromosomal fetal defects. In case a life-threatening or quality-compromising defect is identified, the pregnancy can be legally terminated.

Dr Cheema says that pregnant women need a tetanus shot around the 28th week and a dexamethasone injection around the 34th week. “Dexamethasone helps in lung development.

In case of an early birth, can help ensure that lungs are fully developed so that the neonate does not suffer from breathing difficulties.

Premature babies without fully developed lungs have a much higher chance of mortality at birth.”

Neonatal health is acutely dependent on maternal health during and after pregnancy. For it, regular prenatal checkups, proper supplement and food intake and timely supportive medication and vaccinations are needed.

Public hospitals can provide the much needed support to lower- and middle-income mothers, but there is a need for proper awareness campaigns targeting women, so that they know how important it is for them to be healthy to have safe pregnancies and births.

The writer is a staff member

The over burdened units