Happiness knew no bounds for Rajat (name changed) and his wife Shefali (name changed) when in June last year they came to know that they would be stepped into parenthood for the first time via IVF. Even though the pandemic was raging, they were on Cloud Nine.
“After spending lakhs at several IVF centres, we finally found our happiness. Pandemic and lockdown may not have been good for many. But for us, it was a blessed period,” says Rajat.
Before being blessed with a baby boy on March 2021, the couple had doubts regarding safety and precautions.
They had started visiting the centre called Seeds of Innocence in January, 2020, and Shefali succeeded in conceiving after about five months.
“Initially, it was difficult due to the lockdown but it gradually became easier after a few visits. The whole process happened during a pandemic. It was an emotional journey for us. The IVF centre gave us the happiness we were looking for. Pandemic wasn’t so bad for us,” says Rajat.
It was not as smooth for everyone. Vasudha Ranjan had a few miscarriages before she found she was pregnant in January, 2020. She and her husband were thrilled but in the next two months, things changed for them.
“It was not an easy journey for us. It was really bad. With lockdown being imposed, our clinic visits were restricted and I developed fear of stepping out. I had so many queries regarding pregnancy. Even during check-ups, my husband was not allowed inside clinics,” says Vasudha.
Reading reports of pregnant women catching Covid and newborn babies testing positive made the 35-year-old’s journey even more difficult. She would panic and feel breathless.
And due to fear of infection, she decided to manage domestic chores without any extra helping hand. To make matters worse, she and her husband caught Covid infection. The baby, fortunately, was safe.
“The only good part was my husband was always beside me. This wouldn’t have been possible during normal times. We got to spend a lot of time together. But the struggles were too many and it had been a difficult time as a first-time mother during the pandemic,” says Vasudha, who delivered a baby boy last September.
Planning in a pandemic
When Delhi was reeling under the second wave of the pandemic, Neha Sharma became mother to a baby girl for the second time, after a gap of nearly three-and-a-half years.
“We wanted that age gap between our two children. So when the work-from-home situation got stretched and it seemed that this is how it is going to be for a while, we decided to plan for the second child. Because it was a good opportunity to stay at home and take care of the newborn as well as my firstborn,” says Neha, who works at the Japanese Embassy.
Like everyone, the 32-year-old too had apprehensions over pregnancy during Covid period. Given that the situation had improved in the early months of this year, Neha was relieved but when cases started surging she started worrying.
“But surprisingly, my pregnancy journey was smooth at Ram Manohar Lohia hospital, which was also a dedicated Covid facility. They had created separate zones for Covid positive and non-Covid mothers. And the process was very convenient as there were limited mothers,” she stated.
Jigyasa Bhatia decided to plan for a baby this year after her gynaecologist recommended to conceive and suggested it is safe to have a child even in a pandemic situation.
“I was in frequent talks with my gynaecologist and she suggested having a baby at this time. Age is also a factor so I didn’t want to delay. My in-laws said it will be easier for both me and my husband to balance work and family during this time. I assume by the time I deliver, the situation may improve and we might have to go office,” said Jigyasa, who is 34.
Currently two months into pregnancy, Jigyasa got married in December, 2020.
“We are taking safety precautions. I got vaccinated with one shot before I had conceived and the second will be taken after 4-5 months. A bit relieved that I have taken at least one dose,” says Jigyasa, who works as an editor at Pearson Education.
However, many couples who had planned for parenthood last year or early this year have kept their plans on hold for the time being. Sukanya Ghosh Mitra, a graphic designer, said she doesn’t want added tension of infection along with pregnancy.
“I will have to be extra careful if stepping into pregnancy. There would be too many precautions. The situation is maybe better now but we never know how it is going to be after a few months. If cases doesn’t surge by early next year, then we can plan for a child,” she notes.
Flexibility in strategy
The pandemic has thrown a whole new set of challenges to gynaecologists across the country. Many pregnant women tested positive in the national capital.
GTB Hospital, a Delhi government-run facility that was turned into a dedicated Covid care centre, was attending to and admitting women who were testing positive.
“Last year, everybody was learning about it. Didn’t know in details about Covid during pregnancy or newborns testing positive. It was more of an observation phase and we were learning from other countries as some cases had already happened there,” recalls Dr Kiran Guleria, Director Professor, Department of Obstetrics & Gynaecology, GTB Hospital.
The strategy had to be flexible. Last year, the facility was admitting mild cases of pregnant positives. During the second wave of the pandemic, critical cases were given beds and mild ones were suggested to do home isolation.
“In the first wave we noticed that the impact of the virus was minimal on pregnant women. It was almost the same in non-pregnant woman. Very few serious or complex cases were observed. However, in the second wave, there were the most severe and complex patients brought in who needed ICU admission. There was greater need for oxygen therapy and higher maternal and neonatal mortality. We saw stillbirths and pre-term deliveries. In many cases, baby died in the womb. Women came with lungs and liver complications owing to the infection,” Dr Kiran adds.
Even couples who were planning for a baby through IVF had to face uncertain situations because of the two lockdowns.
According to city-based IVF experts, many who were undergoing the cycle had to stop abruptly and most of the clinics saw low turnouts because of Covid fear.
“There were many who had planned for baby last year or this year. They put their plan on hold. For those who were visiting clinics, their turnout became zero. The complexities for pregnant women were not understood on time. There is an increase in pre-natal stress, social interaction is down, most are living isolated lives. And there is always the risk of contracting infection,” says Dr Ruchi Malhotra, senior IVF consultant at Fertile Solutions IVF Centre.
She added there have been very few cases of planned pregnancy via IVF in this phase and many didn’t want to conceive.
The pandemic has made times difficult for IVF centres as well. Dr Gauri Agarwal, IVF & Infertility Specialist and Founder, Seeds of Innocence, says that during the first lockdown, these clinics were shut.
By mid of 2020, the situation improved and around 25 per cent of the clients started returning to the centres.
“During the second wave only 10 per cent came for their IVF cycle. Some got eggs preserved because of the age factor, so that they can conceive later. For many, financial constraints became a major factor to step out of the IVF process. In areas like Ghaziabad, we have to offer services at a lesser price. Or else, people won’t avail it because of high costs. As far as the industry is concerned, it is still recovering,” she states.
“The situation was difficult last year, but it is better now. There has been premature birth and death in womb of women who had tested positive. However, we cannot speak on pregnant women who succumbed to the virus during the second wave, it is up to the ICMR,” says Dr Nirja Bhatla, acting HOD, department of obstetrics and gynaecology, AIIMS.
Covid puts birth plans on hold
Many couples who had planned for parenthood last year or early this year have kept their plans on hold. Women were extra careful and took more precautions before deciding on pregnancy.
Pregnant women in India announced eligible for vaccination against Covid-19. Health ministry approval based on recommendations of National Technical Advisory Group on Immunization.
How and where
Pregnant women can be inoculated with vaccines available in the country any time during pregnancy at the nearest government or private vaccination centre after registration on CoWin or by walk-in registration.
25% Clients started returning to IVF centres as the situation improved by mid of 2020. During the first lockdown, the clinics were shut.
10% Patients came to the centres for getting their IVF cycle. Some got eggs preserved because of the age factor, so they can conceive later.
On vertical transmission (from mother to baby antenatally or intrapartum), emerging evidence suggests this is probable, although the proportion of pregnancies affected and the significance to the neonate has yet to be determined.
The country’s first documented case of vertical transmission of Covid-19 from mother to child, leading to severe disease in the infant, was reported by Pune’s BJ Medical College and Sassoon General Hospital in 2020.
According to BJMC researchers, this is the first proven case of transplacental transmission of SARS-COV-2 from a pregnant woman to the foetus.
WHO on Covid-19 and pregnancy
Are pregnant women at higher risk of Covid-19?
They do not seem to be at higher risk of getting SARS-CoV-2.
However, studies have shown an increased risk of developing severe disease if they are infected, compared with non-pregnant women of a similar age. Covid-19 during pregnancy has also been associated with an increased likelihood of preterm birth.
Can I touch and hold my newborn if I have Covid-19?
Yes. Close contact and early, exclusive breastfeeding helps a baby thrive. You should be supported to:
Breastfeed safely, with good respiratory hygiene.
Hold your newborn skin-to-skin.
Share room with your baby.
Wash your hands before and after touching your baby. Keep all surfaces clean.
Mothers with symptoms of Covid are advised to wear a medical mask, during any contact with the baby.
Who are at greater risk?
Pregnant women who are older, overweight, or have pre-existing medical conditions such as hypertension (high blood pressure) and diabetes are at particular risk of serious outcomes of Covid-19.
Do pregnant women with suspected or confirmed Covid-19 have to give birth by caesarean section?
No. WHO advice is that caesarean sections should only be performed when medically justified. The mode of birth should be individualized and based on a woman’s preferences alongside obstetric indications.