Timely, Evidence-Based Information Key to Keeping Midwives and Mothers Safe in Indonesia
By Atas Habsjah, Pita Putih Indonesia/WRA Indonesia, 06/09/2020
Since the COVID19 outbreak began, more pregnant women are visiting Leoni’s* maternity clinic than ever before. A midwife in Jakarta, Indonesia for 40 years, Leoni worries about protecting herself, especially when critical situations arise.
Following the announcement of first positive COVID19 case on March 2, 2020, the Indonesian Midwives Association issued guidelines to protect their members and uphold their commitment to making pregnancy and childbirth safer during the COVID19 pandemic. The association shared a questionnaire to detect potentially infected patients, providing interim guidance to reduce the risk of midwives becoming infected by COVID-19 from exposure during immediate clinical care interactions.
Every day, Leoni receives informational flyers from the association on protection measures for health workers against COVID-19. Guidance from the WHO and UNFPA-Jakarta was condensed and translated to local languages then put into flyers, so midwives were able to understand the information easily. The flyers keep her up to date with the latest developments in the spread of the virus, while sharing best practices from midwives in Indonesia and other countries.
A pregnant woman named Annisa* noticed the protocols at her gynaecologist clinic suddenly changed. New prevention measures were enacted, impacting Annisa’s delivery and birth plan. When Annisa was ready to deliver, she was required to take a COVID19 swab test before she entered the labour room. Additionally, her husband was not allowed to accompany her during delivery, due to a shortage of personal protective equipment, which was only to be used by medical personnel. Finally, the new protocols required Annisa to give birth by a caesarean section – a violation of her rights to respectful maternity care.
At Leoni’s maternity clinic, she relies on the support of two young assistants to screen patients for COVID19 with the association questionnaire. Leoni, who is over 60 years old, is at higher risk for contracting COVID19. As more pregnant women arrived at her clinic, Leoni noted more women came with urgent, high-risk conditions, with some women bleeding and others already in labour. When these critical situations arise, Leoni forgoes the questionnaire, and quickly dons PPE before examining women like Bianca*.
Thirty-six weeks into her pregnancy, Bianca, 24-years old, rushed to the nearest maternity clinic when her water broke. The clinic denied her care as she did not have a national identity card or insurance to cover the cost of care. Bianca was in critical condition when she reached a second maternity clinic. The midwives acted swiftly, donning personal protective equipment (PPE) to protect themselves against COVID19 while Bianca delivered.
Issuing healthcare guidance based on the latest evidence is crucial to ensuring midwives, mothers and their babies are safe and protected. The Global Respectful Maternity Care Council, convened by White Ribbon Alliance, launched the Safer Together campaign which, among other vital actions, calls upon governments and healthcare decision makers to promote evidence-based information and ensure health workers follow the latest evidence. Join the campaign, and help everyone stay safer, together.
*names have been changed to protect privacy