Worried about the volatile situation outside, this two-month pregnant woman began to suffer palpitations. Her worries were soon doubled when she witnessed mild spotting. Unable to get timely medical care due to stringent curfew, the light spotting turned into heavy bleeding only within few hours.
Followingthe killing of a militant commander in2016, the Kashmir Valley remained on boil for months together. Amid theagitation, the 25-year-old medico, who had received the “good news” onlysometime back, could not make it to hospital on time owing to the tightrestrictions on road.
“Thegovernment forces were not allowing vehicles to ply. My husband somehow triedto ferry me on a motorbike to the hospital, which, however, was stoppedmultiple times either by armed forces or angry mob on streets,” narrates DrAasiya (name changed), who currently serves as resident doctor in a privatehospital in Srinagar.
Meanwhile,the couple was also caught in stone pelting and tear gas shelling incidents,due to which they had no option but to go back. In the meantime, Aasiyadeveloped severe abdominal pain, which nobody on streets was willing to pay heedto, while the surrounding atmosphere kept on adding to her stress. As a result,Aasiya suffered miscarriage.
“Itwas my first pregnancy loss, so the trauma was bigger than what one couldreally think of,” shares Aasiya, who could not even undergo Dilation andCurettage (D&C), a procedure to remove tissue from inside the uterus, whichis usually necessary to perform after miscarriage—again due to restrictions.”So, I had to undergo whatever little treatment I could avail at home, due towhich my life was constantly at stake,” divulges Aasiya, adding that she couldnot overcome the mental trauma for months together.
Kashmirconflict has time and again taken a huge toll on expecting mothers in theValley, who otherwise are required to pay regular visits to maternity carecentres. The conflict situations often prevent them to take care of themselvesas well as their unborn babies, while the conflict-related stress poses aconstant threat to their pregnancy. Such situations many a time result inperinatal mortalities. The data of such casualties, however, is hard to bemaintained.
Fora pregnant woman, situation gets worse when curfew is declared around the timeof her due delivery date. “When a pregnant woman’s delivery date is near andshe comes to know that there shall be curfew the next day or so, she usuallypanics, which could be adverse for her maternal heath,” warns Dr Syed Naseer,leading gynaecologist and Associate Professor, SKIMS Medical College, Srinagar.
“Imaginethe psychological state of a woman who might deliver anytime but does not havea certainty of reaching the hospital safely,” he says, adding that the peoplearound her should constantly try to console and calm her so as to help bringher stress levels down.
InKashmir, the complicated cases, besides many other routine cases, inperipheries are usually referred to Srinagar for tertiary care especially inGovernment Lalla Ded Hospital—the apex maternity hospital of the Valley. Thedistrict hospitals are learnt to lack advanced facilities to handle such cases.However, due to frequent restrictions on roads, the patients usually fail tomake it to Srinagar, and instead land in district hospitals or localdispensaries that do not offer the kind of treatment and services they requireat the moment.
“Whenperiphery hospitals fail to provide proper medical facilities and care topatients, they refer them to tertiary care hospitals. However, many a time,patients are not able to reach the hospital on time due to frequent untowardincidents or restrictions on their way,” rues Dr Sana Sughra, a medico atRamzaan Hospital, Srinagar.
Consequently,the life of a patient as well as her baby is at risk. “In many cases, therehave been maternal as well as foetal deaths just because the patient was notable to avail timely treatment due to some conflict situation,” says Dr Sughra.”Even if a patient has been able to survive, she has not been able to overcomethe trauma she has had undergone.”
Manya time, she adds, intra-uterine foetal deaths occur due to high blood pressureof the mother. Besides, there are times when a pregnant woman witnessesabnormal bleeding—a situation known as threatened abortions. “Doctors prescribesuch patients certain costly injections or hormone supplements so as to help thebaby sustain. However, when people, especially those from humble background,are not able to make earning because of conflict situation, how can they affordsuch medicines?” she asks, adding that this way also there be a pregnancy loss.”We as doctors observe such cases on daily basis.”
Conflictaffects pregnant women in more than one way. Several women in Kashmir havesuffered miscarriages and spontaneous abortions as a result of constant stressand panic. When a woman conceives during stress, doctors say, there are chancesfor the foetus to be aborted “for it often doesn’t develop properly in thiscondition.”
Astudy by Doctors Without Borders, ‘Prevalence of PTSD in Conflict-hit Kashmir,published long back had attributed the high rate of miscarriages among women inthe Valley to Post Traumatic Stress Disorder (PTSD), an anxiety disorder causedby a shocking incident.
Manypregnant women in Kashmir have also suffered pre-term labour—delivery wellbefore the completion of the gestation period—due to severe stress. “Onceduring a conflict situation in the Valley, we found that 10 percent of thepatients admitted in our hospital had a pre-term labour, while many of them hadpre-mature leaking of amniotic fluid,” says Dr Naseer.
“Thenduring 2016 summer unrest, we had every third or fourth patient psychologicallypanicked and getting pre-term leaking, pre-term labours, hypertension episodesor premature contractions. So, definitely that side has increased,” he adds.
Besidespre-mature labour, experts say, stress and depression can also lead toincreased mortality rate among babies. “Besides, if a pregnant woman isstressed or suffering from depression, it can lead to low birth weight of thebaby,” says Dr Insha Rauf, Registrar, Institute of Mental Health andNeurosciences (IMHANS), Kashmir.
Subsequently,she adds, peripartum depression of a mother can lead to some other problems aswell in kids, like behavioural issues. “It can also disrupt the mother-childbond, for a mother is not able to look after her baby,” she says.
Researchsays such issues can have far reaching consequences so far as the psychologicalhealth of a child in later stages is concerned. As per a study titled ‘Exposureto postnatal depression predicts elevated cortisol in adolescent offspring’ byHaligan et. al., children exposed to peripartum depression have higher cortisol(hormone released during stress) levels than those of mothers not depressed andthis continues through adolescence. The maternal treatment of depression duringpregnancy is believed to help normalise the cortisol levels. Although thelong-term effects of elevated cortisol are unclear, these findings maypartially explain the mechanism for an increased vulnerability topsychopathology in children of antepartum depressed mothers.
Anotherstudy titled ‘Antenatal risk factors for postpartum depression a synthesis ofrecent literature’ by Robertson et. al. states that untreated antepartumdepression is one the strongest risk factors responsible for postpartumdepression, which has potentially devastating consequences, including suicideand infanticide. Lindahi, Pearson and Colpe (2005) found that suicides accountfor up to 20 percent of all postpartum deaths and also represent one of theleading causes of peripartum mortality. Such findings speak volumes about howthe conflict-related stress can affect an expecting mother as well as her baby.
Pregnancyis a natural process, which requires timely medical intervention at regularintervals. Let expecting mothers be treated as an exception while imposingrestrictions on roads. Let us not make their world stressful and instead tryour best to minimize the chances of any misfortune. Let no other Aasiya sufferfor having born in a conflict zone.
(DrRabia Noor is a media fellow with Nature India and Wellcome Trust/DBT IndiaAlliance. The story is a part of India Science Media Fellowship programme).