On Tuesday afternoon, Dr Aruna Karki, a consultant gynecologist at Kathmandu Model Hospital, received a phone call from a doctor at Nepalgunj Medical College asking her for advice on what to do for a Covid-19 infected 22-year-old woman in labour with oxygen saturation of 52 percent—critically low.

“I suggested that he perform a C-section without delay,” Karki told the Post. “If not the mother, the child could survive.”

Last week, a woman gave birth while waiting in a line for a polymerase chain reaction test. The woman had been rushed to the hospital after her labour started. Health workers, however, refused to attend to her, without knowing her infection status and placed her in line at the hospital for a test. The incident was reported to the Family Welfare Division of the Department of Health Services.

Authorities did not reveal the details—including where the incident happened— citing the sensitivity of the matter.

“What is concerning is that more maternal deaths are being recorded of late,” Dr Punya Poudel, chief of Safe Motherhood Programme at the Family Welfare Division, told the Post.

According to the division, 225 maternal deaths were recorded across the country in less than five weeks between March 24 and April 28–the period when the Covid-19 cases saw a gradual spike.

Normally, there are fewer than 100 maternal deaths throughout the country in a month, according to the Health Ministry.

With the new coronavirus infections continuing and the subsequent disruptions in health care services they are causing, the risk to lives of pregnant women and new mothers has increased.

“A lot of women are going to nearby health posts because of the Covid-19 pandemic,” said Dr BB Raut, a gynecologist at Lumbini Provincial Hospital in Bhairahawa. “As they are not well-equipped, pregnant women are at high risk. There could be deaths also.”

The Covid-19 pandemic, however, has drawn the attention of almost all agencies.

Poudel herself has been assigned to oversee two hospitals treating Covid-19 patients–Sinamangal-based Kathmandu Medical College and Duwakot-based isolation centers.

“We are terribly worried about maternal safety now as all agencies under the Ministry of Health and Population have been focussed in the management of Covid-19 cases,” said Poudel.

More maternal deaths also mean Nepal’s goal in reducing maternal mortality will not be achieved.

The country has already missed its own 2020 target to reduce maternal mortality to 125 per 100,000 births. It had reduced the maternal mortality rate from 539 per 100,000 in 1996 to 239 per 100,000 in 2016—for which the country even received the Millennium Development Goal award.

The health target under the UN’s Sustainable Development Goals is to reduce maternal mortality rate to 75 for every 100,000 births by 2030.

The ongoing prohibition enforced in most of the districts throughout the country —which has meant restrictions on public movement and all non-essential transport, and a drastic limitation on health care services as hospitals focus on Covid-19—only made things worse, say experts.

Maternal health experts feared that the ongoing pandemic would spell calamity on maternal health.

“All are vulnerable and are at risk of Covid-19 infections,” Karki told the Post. “But pregnant women and new mothers are more vulnerable and are at risk of getting severely ill and dying, as they have low immunity during pregnancy and after delivery of the baby.”

Last year too, during the first wave of the pandemic, maternal deaths had increased. Officials said that the institutional delivery rate, which was already low at around 59 percent, had declined further.

A complete halt to public transportation for four months during the lockdown from March 24 to July 21 had forced many women to give birth at home.

With the country grappling with a deadly second wave of the pandemic, most of the hospitals providing maternity services have been treating Covid-19 patients, which has discouraged pregnant women from seeking institutional delivery, fearing that the infection might transmit from the health facilities and health workers.

“Our maternity services are open,” Raut told the Post. “We used to provide maternity services for 60 every day during normal times but now just 15 to 20 come every day.”

Due to fear of transmission of the virus, health workers seek coronavirus test reports and it could take several hours to get the report, which means, even after reaching the health facilities, pregnant women will not be safe, doctors say.

“We are in a situation where women cannot come to hospitals to give birth. Even when health posts refer pregnant women to hospitals they are not coming due to fear of infections,” said Dr Deepanjali Gautam of Universal College of Medical Sciences Teaching Hospital, Bhairawha. “When they give birth at home they can die of complications during childbirth.”

Besides, as the infection has spread in the community levels, infection risks for pregnant women have also increased, according to Dr Poudel, chief of the safe motherhood programme.

“At present, not only the women residing in remote villages are at risk but those in big cities are also equally vulnerable to dying,” Dr Kiran Regmi, former health secretary, told the Post.

According to her, the number of reported maternal deaths may be even an undercount.

“There may have been more maternal deaths as reports of deaths come late,” surmised Regmi.

As the health facilities are overwhelmed with Covid-19 patients, chances of pregnant and postnatal women dying without getting intensive care and ventilator support has also increased.

“This is a very tough time for all and for pregnant and postpartum women and to their family it might be a nightmare,’ said Karki. “Besides, it will be too difficult to save them if the pregnant and postpartum women get serious from coronavirus infections.”

Several international studies have found that pregnant women infected with Covid-19 face higher risk of death than those who are not.

Asked what the government is doing about the growing number of maternal deaths during the pandemic Dr Jageshwar Gautam, spokesperson of the Health Ministry, said, “Is that the case? If so, we should all work to reduce maternal deaths. Concerned agencies under the Health Ministry should also take the issue seriously and work to reduce the deaths of pregnant women and new mothers.”

Sanju Paudel from Rupandehi contributed reporting.