Nearly 700 coronavirus-positive women gave birth at a single India hospital

Mumbai: After four miscarriages and years of heartbreak, Nahid Khan was just weeks from giving birth in April when she received shattering news: She had tested positive for the novel coronavirus.

Khan and her husband scrambled to find a place for the 29-year-old to deliver. The pandemic was surging through Mumbai in a devastating wave, overwhelming hospitals and closing smaller maternity clinics as their staffs became infected.

The couple ultimately found a bed at BYL Nair Charitable Hospital, a 99-year-old government-run institution in the heart of India's financial capital. Just three days earlier, the hospital had performed its first delivery of a coronavirus-positive mother.

Khan would become one of nearly 700 such deliveries in the months that followed. Pregnant women from all over greater Mumbai, home to at least 18 million people, converged on Nair. Its doctors believe the hospital has treated the largest number of pregnant women with COVID-19 in India - and possibly in the world.

Data collected

Now the hospital's experience is playing a key role in the global search to understand exactly how the coronavirus affects pregnant women and newborns. Researchers in India are using the data collected at Nair to help establish whether the virus is linked to higher rates of miscarriage, premature birth or maternal mortality.

Khan delivered a healthy baby girl - who tested negative for the coronavirus - after an emergency Caesarean section. She remembers the pain after the surgery and the anxiety about the virus, but also the comfort from "talking to other women who were going through a similar experience."

Initial studies in the United Kingdom and Korea have found that coronavirus-positive mothers generally have good outcomes and do not transmit the virus to their babies. Other research has linked coronavirus-positive mothers to higher rates of premature births and maternal morbidity.

But studies based on large-scale data remain scarce, especially in places like India, which is adding more coronavirus cases per day than any other country on Earth. India has recorded more than 7 million cases, second only to the United States.

In recent decades, India has made significant progress in reducing maternal mortality and increasing the proportion of women who give birth in hospitals or clinics, rather than at home. It is aiming to cut maternal mortality by half from current levels by 2030.

About 4,000 deliveries take place every year at Nair, a collection of more than 10 buildings in south Mumbai. But when the pandemic hit, "everything was new to us," said Niraj Mahajan, the gynecologist who oversaw care for coronavirus-positive mothers.

The day the first such patient arrived, Mahajan recalled, the hospital was already treating 100 infection-free pregnant women - and the challenge was to keep them that way.

Makeshift labour room

The hospital created a separate, makeshift labour room in an empty ward, shifting equipment trays and oxygen cylinders for doctors to use. The next day, on April 14, Shayla Srivastava, a 25-year-old gynaecology resident, was on duty to conduct the first delivery.

Because there were no powerful overhead lights in the improvised setting, Srivastava turned on the flashlight on her mobile phone and asked the nurse to hold it as she conducted an episiotomy - a small surgical incision near the vaginal opening to prevent tears. Then her face shield fogged up so much she couldn't see, so she removed it.

For Hina Patel, 20, the woman giving birth, "those were the scariest few hours of my life," she said. "I couldn't stop thinking [about] what the virus would do to me and my baby."

Srivastava was less worried about being infected herself than ensuring a safe delivery. The moment Patel's baby girl arrived and emitted her first cry, Srivastava felt ecstatic. "I just said, 'Thank god.' " Earlier this month, Srivastava contracted the virus but has since recovered.

COVID-19 facility

The makeshift ward functioned for three more weeks, and over 40 women delivered there. (Doctors got headlamps on the second day, obviating the need for mobile phone flashlights).

In April, the entire hospital was declared a COVID-19 facility, the first medical college in India to receive the designation. With the hospital now serving only coronavirus patients, the maternity care moved back to the main gynaecology department, which has 120 beds. While some other hospitals in Mumbai continued to treat coronavirus-positive mothers, Nair became the focal point for such cases.

Most of the women who were referred to Nair had attempted to get admission at an average of four hospitals before arriving, Mahajan said. In one case, a woman was turned away from nine other hospitals. Some traveled more than 20 miles from far-off suburbs and towns on Mumbai's periphery.

Eight pregnant women with covid-19 died at Nair, together with their foetuses. Seven of the women were in their third trimester. "They reached the hospital very late and went into acute respiratory distress while undergoing treatments," said Ganesh Shinde, head of the gynecology department. Shinde said the hospital did not see an increased incidence of miscarriages or stillbirths among its pregnant patients with covid-19.

The babies of such mothers fared well, with only one warning sign: The infants of coronavirus-positive women were somewhat more likely to spend time in the newborn intensive care unit. But the rates of premature birth and the number of babies who died in the intensive care unit were similar for infants of infected and noninfected mothers. More than 41 babies, less than 10% of the total, also tested positive for the virus a few days after they were born, but doctors say they don't know whether it was transmitted in utero or from contact with their mothers after the births.

All-India registry

The hospital is now part of an all-India registry called "PregCovid" through which researchers will study the impact of the coronavirus on the health of pregnant women and babies. It has collated data from more than 1,100 pregnant women from 19 hospitals across the country. (More than half of the data comes from Nair.)

Ultimately, Shinde said, the hospital's experience was a hopeful one. It decided not to separate mothers and infants, unless either one was showing significant symptoms. It introduced extra distance between hospital beds and placed barriers, curtains and partitions to help limit exposure to the virus. Fewer than 10 of the department's health-care personnel tested positive, and all of them recovered.

As the pandemic has dragged on, hospitals in Mumbai have adjusted to the new reality and resumed their emergency work, including childbirth. Nair continues to receive up to 30 coronavirus-positive mothers each week, Shinde said.

Nasir Patel, whose wife, Hina, was the first mother with covid-19 to deliver at the hospital, remembers how he broke down in tears of sheer relief when the nurse showed him his baby girl for the first time.

"I was gripped by fear of the infection; I simply could not stop the trail of negative thoughts," he said. "I calmed down the moment I saw my baby moving her little hands and feet."