March 2020 was an anxious month. Amid global uncertainty about the SARS-CoV-2 virus, maternity units across the world were preparing to care for pregnant women with COVID-19.
There were many unknowns. At that point in time, only limited data on coronavirus and pregnancy were available, mostly based on experiences in China. Pregnant women did not appear to be at increased risk of acquiring COVID-19, but high caesarean section rates were being reported.1
While the causes behind this trend were unclear, it set alarm bells ringing. In resource-limited settings, caesarean section carries an increased risk of maternal morbidity and mortality. Would the pandemic force a large number of women into operative delivery?
There was a clear need for answers to many important questions regarding COVID-19 in pregnancy. Was it safe to have a vaginal birth? What about postpartum management? Could women breastfeed? Should maternity services be reduced? What approach would be best for the population at large?
A small number of international obstetric and gynaecology (O&G) organisations had begun to distil the available evidence and publish guidelines on these topics. The Royal College of Obstetricians and Gynaecologists (RCOG) in the United Kingdom led this charge, publishing their first guidance on 9 March 2020.2 At this point, the World Health Organization (WHO) and United Nations Population Fund (UNFPA) were yet to provide pregnancy-specific advice.
Although the RCOG guidelines were extremely valuable, they were not written with resource-limited environments in mind. It was clear that guidance for low- and middle-income countries would also be required.