The Postpartum Recovery Gap

Kuala Lumpur, Sept 15: A study conducted by the pre and postnatal care app MUTU System revealed that almost all respondents or 89.1 per cent felt unprepared for their postpartum recovery journeys, typically taking around 6-8 weeks.
Dr Janani Sivanathan (pictured above), a maternal-fetal medicine specialist and an obstetrician and gynaecologist from Sunway Medical Centre (SMC) explains that generally, preparation for delivery is more often than not given priority over arrangements for recovery.
This is because people perceive that there is a higher risk for complications to arise before birth as such, once the baby is delivered, there is a sigh of relief that the duty of care is done.
Today, the COVID-19 pandemic has further made the pregnancy journey a particularly stressful time for expectant mothers as more worrying issues from vaccination concerns to additional precautions for mother and child to prevent infection risks.
On top of that, the current pandemic has resulted in mothers having difficulty accessing primary care and extended postpartum social support networks, especially if they are living in an area under the Enhanced Movement Control Order (EMCO).

Giving Birth, But Tested Positive: Knowing What to Expect Helps You Better Able to Recover

In 2019, the maternal mortality ratio in Malaysia was at 21 maternal deaths per one hundred thousand live births.
Postpartum care is as much about being emotionally prepared for what’s coming and knowing simple strategies to help the recovery period, especially with the increased risk for infections during a pandemic.
Data from Centres for Disease Control and Prevention (CDC) suggests that pregnant and recently pregnant patients with COVID-19 have a higher risk of severe illnesses compared with non-pregnant ones.
Although the absolute risk for expectant mothers experiencing severe COVID-19 symptoms is low, these data indicate an increased risk of ICU admission.
Dr Janani recalled having a patient who presented with preterm labour at 29 weeks after being confirmed positive with COVID-19 and required careful monitoring after delivery.
“During the delivery process, I had multiple concerns regarding the mother and child’s health. The mother’s blood investigations showed that she was at risk of progression to multiorgan failure due to severe sepsis, which could lead to morbidity and mortality.
“Premature babies also have a higher risk of contracting COVID and underlying sepsis,” Dr Janani said.
With COVID-19 potentially affecting the mother’s health post-delivery, Hu Kee Yie, a physician from Sunway Traditional Complementary Medicine (TCM) Centre said that pregnant and postnatal mothers are highly encouraged to register and complete their vaccination as earlier as possible, as it can protect them from severe illnesses.
Dr Janani added that vaccinations can be life-saving as it reduces the risk of contracting severe illnesses.
“Many studies have shown its safety profile in pregnancy and breastfeeding. Therefore, it is safe for expectant mothers to be vaccinated at any time during the pregnancy, but preferably after 12 weeks of gestation,” Dr Janani added.

Mother and Child’s Health Remains the Priority

Apart from getting vaccinated, pregnant mothers are encouraged to take all available precautions to avoid exposure to COVID-19 and optimise their health.
These include attending scheduled antenatal and postnatal appointments, maintaining a healthy diet and consuming multivitamin supplements of folic acid and Vitamin C and D.
They should also follow routine hygiene practices, including washing hands often, if not fully vaccinated, wearing a mask, maintaining physical distance, and have limited contact with other individuals.
“When a COVID-19 positive patient has delivered her baby, there is a need to focus on her COVID recovery by doing teleconsultations and arranging for herbal medications to be delivered every 3-5 days. Only after she is fully recovered from COVID-19 can we then proceed with providing herbal nourishment for her confinement,” Hu said.
All in all, the postpartum period pre and during pandemic represents a critical window of opportunity to improve maternal health, and help from a professional or family caregiver would ideally benefit the mother’s postpartum recovery, Dr Janani said.
Some suggestions for COVID-19 positive mothers during the postpartum recovery period include hydration, adequate rest and ambulation, keeping a check via the oximeter, attend prenatal and postpartum care either physically or via teleconsultations.
If the mother develops a high-grade fever, persistent cough, chest pain, vaginal bleeding or leaking, or reduced fetal movements, seek medical help immediately.
Mothers with underlying medical illnesses such as diabetes, hypertension, or kidney disease are encouraged to be hospitalised for close monitoring.

A COVID-Safe Hospital

The care of pregnant mothers required a unique and coordinated response due to the nature of the disease.
Most of the hospitals in the country has become ‘COVID hospitals’. The demand for hospital beds and space increased rapidly, subsequently adding on the considerable impact on the functionality of the postnatal service.
To address the potential infection risks during the pandemic, Sunway Medical Centre has developed multiple Standard Operating Procedures (SOPs) for the safety of both mothers and their newborns during prenatal, labour and delivery, as well as the postpartum periods.
As a COVID safe hospital, some of the safety measures taken include negative pressure rooms, cabins and isopods to keep the suspected or confirmed COVID-19 positive patients. Clean, indoor air with UV-equipped air vents and air handling units (AHU), vaccination programme that includes vaccinated staff and consultants and compulsory testing upon admission as well as regular sanitisation.

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