‘We have to make our own sanitiser’: Midwives fear coronavirus will mirror Ebola with surge in maternal deaths

“Some give birth at home because of coronavirus,” Deddeh Mulbah tells The Independent. “At the end of delivery, they have to cut the coil with a razor blade and tie it with rope. After one or two days, the baby gets sick and then they rush back to the hospital.”

The 29-year-old midwife, who is from Liberia, voiced fears the coronavirus crisis will wreak havoc in the West African country in the same way the Ebola outbreak did.

Ebola led to high rates of maternal deaths in Liberia in the middle and aftermath of the epidemic, due to women avoiding healthcare services and resorting to dangerous home births instead.

Campaigners have now raised concerns the coronavirus pandemic will lead to pregnant women and newborn babies needlessly dying from preventable causes during childbirth.

Ms Mulbah, who is from Kakata, said pregnant women in Liberia are highly anxious about the coronavirus emergency and scared to access healthcare services.

“We see people who are concerned in the community where we live,” she adds. “Some will come to me and say, ‘I don’t want to come to the hospital because of the virus. I don’t want to get it’. We say: ‘You have to come to the hospital even though coronavirus is in Liberia, and it will be a problem if you don’t come’. You can see the fear in some of their faces.”

She said healthcare staff are battling against a shortage of personal protective equipment (PPE) and being forced to make their own hand sanitiser from scratch.

“In this crisis, it is not easy,” Ms Mullbah adds. “The masks are not easy to get. There are no gloves. No sanitiser. We have to make our own sanitiser. We just buy the alcohol ourself and mix it with Dettol to make sanitiser for our own safety. But now the sanitiser is finished.”

The mother-of-one, whose child is almost two-years-old, noted being a midwife was a gruelling job before the coronavirus emergency.

“You come to work from 6am,” Ms Mullbah says. “You don’t have time to eat or drink. When you are feeling tired, you go home. But there is no rest because you have to care for your family. And the next day you are coming to work. The stress causes tension. Today when I leave here and go home, I will have a sharp headache.”

Ms Mullbah, who says she became a midwife to save lives, explained there is a shortage of healthcare workers in Liberia due to training being inaccessible.

“You leave your home to come and work somewhere for no salary so it not easy,” she adds. “My first concern is the mother and how she will be cared for. You don’t know whether they are infected with coronavirus, so you feel afraid to interact with them. But it’s important you speak to them like a human being, otherwise they will try to deliver at home. Ebola affected the country by killing many health workers. So people got scared when coronavirus came and remembered how additional people died during Ebola from other causes and said we also have to be careful now. Health workers are afraid too.”

Plan International UK, a global children’s charity, argued the coronavirus crisis will cause a surge in maternal deaths due to healthcare systems being swamped with emergency efforts to tackle the Covid-19 crisis and pregnant women not seeking maternity care due to fears of contracting the virus.

Rose Caldwell, its chief executive, told The Independent: “We’re deeply concerned about the impact of coronavirus on children and families in some of the world’s most fragile communities. In developing countries like Liberia and Senegal, health systems are already weak and can quickly become overwhelmed when a crisis like this hits.

“The Ebola crisis in 2014 put huge pressure on healthcare workers in some of the most affected countries, such as Liberia, and this posed a serious threat to pregnant women and girls giving birth at this time, leading to a rise in maternal deaths. We know that many of these healthcare systems still haven’t fully recovered from the devastation caused by the Ebola outbreak and won’t be in a position to cope with another pandemic.”

A study by the Liverpool School of Tropical Medicine previously found maternal and newborn deaths in Sierra Leone rocketed after the Ebola outbreak due to concerns around getting the virus and not trusting healthcare workers putting women off going to services to give birth.

Researchers discovered deaths of women during or just after childbirth rose by almost a third while deaths of newborns increased by a quarter between May 2014 and April 2015 in comparison to the year before. While the number of women giving birth at healthcare services plummeted by 11 per cent, despite the fact the majority of services were up and running.

Ebola is significantly less contagious than coronavirus but far more deadly — killing up to 50 per cent of people who became infected with it and claiming 11,325 lives.

Reflecting on the coronavirus crisis, Ms Caldwell added: “What we’re already hearing from our teams across the world is that expectant mothers don’t want to visit health clinics because they’re afraid of contracting coronavirus while they are there, and are instead choosing to stay at home to give birth. This is particularly worrying with pregnant women in developing countries because, in many circumstances, it puts the mother and baby at risk.”

Plan International UK, which has launched an emergency appeal urging Britons to support its work to help those hit by the Covid-19 emergency around the world, argues the impact of the “worst health crisis of a generation” could be catastrophic for girls in the poorest communities across the globe.

Mame Badji, a midwife in Senegal, said she is working longer hours than ever due to services being “overwhelmed” in the wake of the coronavirus outbreak.

“Unlike other health centres, which people have deserted because they are afraid of contracting coronavirus, the visiting rate to maternity centres has increased,” she adds. “Because it has increased, our days are longer as we are seeing more pregnant women. We have to make sure we see and attend to all the pregnant women who come, no matter how many, because often the woman has travelled a good distance to the hospital and it’s unfair to ask them to return the next day. We make sure we extend our working day and we see all the patients who come in. The pregnant women are very stressed about coronavirus, as well as the health workers.”

Ms Badji, who is from Kebemer, said she is anxious for the safety of pregnant women and their babies in case they become unwell while in hospital — adding that pregnant women become very worried about Covid-19 when they hear that people in their communities have contracted the virus.

“I’m always afraid a woman can come and be very healthy and then get contaminated while she is in the hospital with her newborn baby,” she adds. “As a midwife, I’m scared that I will get contaminated with coronavirus and I’ll spread the virus to my whole family. I’m very anxious about this. My husband has also been stuck in a different area of Liberia for about a month now because of government rules restricting travel, and I’m scared about what condition he is in, because I can’t see him.”

Ms Badji, who said she had dreamed of being a midwife since she was a child, provides fellow midwives with extra support when they are delivering women who have high-risk pregnancies.

An estimated 2.8 million pregnant women and newborns die every year — with one dying every 11 seconds due to factors which were generally preventable — prior to the Covid-19 crisis.