Maternity and Neonatal Care. Review on Aster Medcity - Kochi

This is going to be a long review and will touch on all aspects of care me and my wife experienced at Aster Medcity, Kochi, with respect to maternity health services, and neonatology.

I am currently doing my residency at Aster. I chose Aster for the maternity care services because it is a quaternary care center capable of tackling any kind of complications associated with labor. The fact that I knew most of the doctors and staff really helped smoothen the experience.

My wife(Dr Aiswarya – Aishu for short) was under the follow up of Dr Zareena right from the start. An excellent doctor and human, hands down. She was very clear with the instructions, care, and friendly. I used to take my wife for the appointments during my duty off days, and Dr Zareena used to schedule the appointments of the days I requested so that I can pay full attention. This is our first pregnancy experience. Aishu had plenty of concerns and doubts – all cleared perfectly well by Dr Zareena. The coordinators, staff at the Obs department OP were friendly and approachable.

Delivery was planned on Feb 3, but wifey had an early sign of labor(‘show’ – the mucus plug covering the cervix came away) on Jan 23. She messaged the picture to Dr Zareena, and she advised to come to the emergency department as soon as possible.

We were received in the ED by Dr Janaki, my friend – she congratulated me, and her cool and happy nature helped me be calm in the situation. My wife was consulted by the duty doc from obstetrics, who confirmed that she is in early labour, and required admission. Covid test was done as per protocol which turned positive. This changed a LOT of things. Covid wards were full. Dr Johnson – head of the ED department – took the matter into his own hands. Aishu was shifted into a covid isolation room. This room was almost similar to the single rooms where patients are usually admitted. It had an attached toilet too. The room provided the privacy and peace of mind, so that Aishu could prepare for child birth in peace. In case the labour progressed, the ED team were very much ready to conduct the delivery there, and all communications between ED – Obstetrics – anaesthesia – were crisp and clear. Anaesthesia is in the picture because wifey was very particular about epidural analgesia during the time of labour. It has an advantage that pain is significantly reduced, and if at all there be need of caesarian section, meds can be topped up via the epidural line. We were updated timely on all these communications, and Aishu was quite comfortable there.

The gynaec on call duty doctor secured an OT where the delivery can take place, in compliance with covid precautions. The progression of labor was pretty fast for Aishu despite being a primi. Dr Zareena came from her home at night to conduct the delivery. Dr Nithin, my friend from the anaesthesia department, updated Aishu on all aspects of epidural analgesia. Aishu was comfortable once the epidural analgesics worked their magic, HUGE thanks to Dr Nithin for taking away the pain!.

I was able to be with Aishu throughout the labour. The nursing staff who assisted the labour was so helpful. The Obstetric team of docs headed by Dr Zareena, and the nursing staff together helped Aishu cross the hurdle of labor, and a baby girl – 37 weeks gestational age was born on 23rd Jan at 11:04 pm without much labor associated complications. The neonatologist(Dr Joice) examined the kid as soon as she was born, and told me that the baby is fine and healthy.

Now was the hard part – Baby had to be separated from the mother in view of Aishu being covid positive. This is the hospital protocol at Aster – and I sincerely feel it difficult to digest. Aishu was initially transferred to the covid ICU because no covid isolation single rooms were available. And naturally baby cannot be taken to the covid ICU for feeding because there were plenty of other patients in the ICU, with other infections in addition to covid. So baby was taken to a single room, accompanied by a nurse specialized in neonatology care. Special mention to the nurse Ruth, who was a class apart when it came to neonatology care. We were advised to start the baby on expressed breast milk, but without the baby near Aishu found it really hard to produce milk. There was no choice but to start the baby on formula feeds.

So now the wait began to reunite baby and mother. Aishu was well taken care of by the nurses Della and Gowri in the Covid ICU, thanks a ton to them! My mother-in-law and the neonatology nurse took care of the baby, while I gave company to Aishu. A covid positive isolation single room was available the next day evening, and Aishu was transferred to the room.

Me and my family were fully willing to take the baby to the covid positive isolation room, so that the mother can start feeding as soon as possible. The baby may get covid from Aishu, but this was a risk we were fully willing to take. It was a hard time for Aishu – I tried my best to console her, but this was beyond me. I would suggest Aster to appoint a psychologist/maternity counseller to counsel the mothers separated from their newborns, in this era of covid. More such cases will come for sure. The mothers are filled with loads of doubts, uncertainties, anxiety, and irritability in such situations. Dr Zareena came for morning rounds every day, and tried to console Aishu as much as possible.

We waited for the neonatology rounds the next day on 24th Jan. The neonatologist on call had seen the baby right after birth(early morning 24th Jan – 12 am), but we were wondering why the neonatology team did not come for rounds even by evening. Anyway, I called my friend Dr Shilmiya(Paediatrician on call), she had a look at the baby on 24th evening, and said there is nothing to worry.

I thought that the nurse specialized in neonatal care will be there beside the baby till discharge. That was not the case. The protocol in Aster was that the baby will be tested for covid, and if the test is negative, the neonatology sister will leave the scene, handing over the care to the nurses in the ward. This protocol was not clearly communicated to me, my wife of the bystander of the baby(Mother-in-law). So when I got the call at 1:30 am in the morning of 25th, that the neonatology nurse is leaving, I was confused. My mother-in-law, who was already cranky because her daughter could not be beside her grand-daughter, became a lot crankier, giving a hard time to the ward nurses! The ward nurses called me and told there is nothing to be afraid of, and that the baby will be well taken care of. I had a talk with the ward nurses in the morning. I could understand that they were irritated by my mother-in-law. I also asked the nurse why the neonatology team did not come for rounds the previous day, the answer of which was ‘the covid test of baby was not done, maybe that’s why’. Anyway, I told them to be cool, that mother-in-law is cranky because of the protocol that separated mother from baby, and also because the neonatology team did not come for morning rounds on 24th morning.

I felt that communication aspect of the neonatology team needs to improve. If it was communicated that the neonatology nurse will accompany the baby only till the kid is covid negative, we could have prepared beforehand with respect to feeding and taking care of the baby. The neonatology nursing staff were excellent, but it’s the communication from the higher ups that left us blank. The neonatology nurse said that her higher authority told her to take care of another baby, as our baby is covid negative. If we were kept in the correct loop of communication, things would have been smooth. I also feel that the neonatology team should have come for routine rounds on 24th morning, with adequate precautions for covid. Being a hospital with top-of-the-line care, this is what I would expect.

Aishu was cranky as hell by this time. She had concerns because she could not express breastmilk well, and no one came to advise her regarding the same. She had earlier worked in a small gynaec based hospital, and had a good idea how the mother is taken care by the nurses. Despite being such a small hospital, the nurses there had a huge role in alleviating the anxiety of the mother, because they were experts in the field. True that doctors take rounds, but it is the nurses that spend most of the time with the patients. She craved for that type of care. Too bad she was stuck in the covid isolation ward.

On 25th Jan morning I met Dr George Paul, head of the department of neonatology. I requested that the baby be transferred near the mother, and he replied that I sign a consent for the same. But he also said that if at all the baby needs phototherapy the next day, it can create logistical issues, as it is difficult to transfer the kid from covid positive side to the phototherapy unit. So I decided not to transfer the kid to the side of mother.

Now as far as I am concerned, there are pure logistical issues. Aster being a huge hospital should have no trouble shifting a baby from covid positive side to phototherapy unit. It is something to be solved, there will be no shortage of covid positive mothers in the future! These are people who have lived their past 9 months thinking of nothing but the baby, and it is not at all a good idea to separate the mother and child.

I am from the Pulmonology department, and I remembered the importance of communication stressed by my consultants Dr Praveen Valsalan and Dr Elizabeth Sunila. I can proudly say that when it comes to communication, they leave no stone unturned. And all patients get the rounds, and same quality of care, no matter their covid status.

Since the baby was covid negative, the neonatology team including Dr George Paul and the lactation specialist came to see the baby on 25th morning. He is such a gentle person, said there is nothing to worry, and that the baby may be planned for discharge the next day after reviewing the blood reports. I requested the lactation specialist to visit Aishu and alleviate her concerns regarding breast feeding, but it seems the protocol at Aster does not allow them to go to covid positive areas. Now that made me really irritated.

I learned the technique of feeding from my mother-in-law and decided to look after the baby that day. Luckily the lactation consultant(Mrs Elsy) came to me and taught the technique of proper formula feeding and mixing, how to burp, how to clean up, how to swaddle, and just about the basics of neonatal care from the perspective of a parent. She also took the phone number of Aishu, to advise her on lactation via phone.

This gave me the confidence to look after the baby on 25th night. The role of the ward nurses here is not much – they clean up the baby at 5 am and change the diapers – and take blood samples if needed – that’s about it. I wish they were more involving – but that’s impossible because they are already stressed as it is – because in ward, the nurse-to-patient ratio is 1:5 to 1:6. This explained why the ICU nurses are way better when it comes to communication and care compared to ward nurses. Aster really needs to sort out its nurse-to-patient ratio in wards if patient care needs to be better. I also would suggest nurses who are experts in the field of maternal and neonatal care to be posted in such wards –and more involving rather than being mechanical - I sincerely don’t want my wife saying that a small gynaec hospital gives more mental support when it comes to maternity care than my Aster!

Aishu called the lactation specialist via phone after getting discharged on 26th. Mrs Elsy helped a lot in alleviation of Aishu’s concerns.

Another area that needs improvement is food. The patient food comes as advised by the dietician. But what use is if the food is not palatable? True one does not come to hospital expecting food like that in resorts, but there is huge room for improvement. I haven’t heard a single patient telling good about the hospital food. Now one may argue that healthy food and taste does not hand in hand – I can argue that my mother makes food that’s both healthy and super tasty! It’s just about putting one’s heart into cooking sincerely. I am sure patients will highly recommend Aster if the food section is sorted out. Luckily there are plenty of food stores in Aster including Paragon, of which my wife is a huge fan of. I got food for her from Paragon and Starberries, which she enjoyed a lot.

Another thing to point out, the food section never takes the calls. We were given the extension number to call for ordering food from the hospital pantry, but they never respond to calls. Someone needs to look into it.

I will be giving points out of 10 separately for each department.

Obs and Gynaec – 10/10

Emergency Dept – 10/10

Anaesthesia – 10/10

Covid ICU nursing team – 10/10

Neonatal nursing staff – 10/10

Neonatology team – excellent team – but bound by protocols w.r.t covid

Ward nurses – excellent staff, but bound by patient load!

Maternal counselling post child-birth – especially when covid positive – disappointed. This area needs huge improvement. Someone needs to be appointed to check on the mental health of the mother after delivery, especially when separated from the baby. Something as small as a call from the baby’s doc to the mother in this special situation of separation, can go a long way. If there are strict protocols that separate mother and child, there should be stricter protocols to ascertain mental health of the mother and care of baby.

Hospital food – 6.5/10

The above review is written, with best intentions, with the sincere wish that Aster Medcity is second to none when it comes to patient care – all aspects of it – be it doctors, nurses, food, protocols, etc. Aster sure has everything one can ask for, but these can be put into better use with change in some aspects, some of which I have mentioned above.

HUGE thanks to the whole team at Aster Medcity for being a stepping stone in this new journey!