As artillery shells fall, pregnant women give birth prematurely, are carried in and out of bomb shelters, or have babies in basements without even a midwife to help them. Tens of thousands more are displaced.
KYIV, Ukraine – Before the war, Alina Shynkar’s gynecologist advised her to avoid stress during her pregnancy, suggesting that she spend time “just watching cartoons and being silly”. It was simple enough advice, but not so easy to follow after air raid sirens blared, artillery barrages rattled windows and fierce street fighting broke out a few miles from her maternity ward.
Then keeping calm for her baby became Ms Shynkar’s quiet, personal battle during the war in Ukraine. She went to Maternity Hospital No. 5 in the capital, Kyiv, before the war started in late February to rest in bed due to risk of premature labor, only to see the hospital turn into a chaotic, panicked state weeks later.
“The girls were so stressed that they started giving birth” prematurely, she said. Doctors at his hospital moved frightened pregnant women, some of whom were already in labor, in and out of an air-raid shelter several times a day. Some were crying and others were bleeding.
“They were scared,” recalls Ms. Shynkar. “It was hard to see.”
The Russian assault on Ukraine has been a nightmare for pregnant women, especially in cities like Mariupol, Kharkiv and Chernihiv which have been bombarded almost constantly since the war began in late February.
In the besieged city of Mariupol in southern Ukraine last month, Russian artillery hit a maternity hospital, killing a pregnant woman and injuring several others, according to Ukrainian authorities.
Women in war zones across the country have been forced to give birth in cold, decrepit basements or in subway stations crowded with people cowering from the shelling, and without electricity, running water or midwives for help them.
And the recent reprieve as Russian forces withdrew won’t help that much in many places. By the end of March, Russian missiles, bombs and artillery had destroyed at least 23 hospitals and clinics.
Even pregnant women lucky enough to escape war-torn areas are deeply stressed, moving in and out of shelters during air raids or enduring arduous and perilous journeys to the relative safety of western Ukraine or to countries neighboring Europeans.
According to the United Nations Population Fund, the organization’s sexual and reproductive health agency, about 265,000 Ukrainian women were pregnant when the war broke out. About 80,000 births are expected in the next three months.
War poses both immediate and long-term risks to mothers, fathers and newborns. Among them are premature births, which can lead to a host of complications both immediately and later in life.
“Prematurity due to wartime conditions exposes the baby to death or complications for the rest of its life,” said Dr Jeanne Conry, president of the International Federation of Gynecology and Obstetrics. Although the data is not yet available, she said doctors in Ukraine are reporting an increase in the number of premature babies, who are more likely to have respiratory, neurological and digestive problems later on.
Dr Conry said a lack of access to drugs to prevent postpartum haemorrhage could lead to increased deaths of mothers. Babies are at risk, she said, because doctors might not have immediate access to the equipment needed to resuscitate them, and they have only moments to catch their first breath.
Evidence from World War II shows that starvation in pregnant women can lead to high blood pressure and diabetes in children later in life. Dr Andrew Weeks, professor of international maternal health at the University of Liverpool, said the war is making it more difficult to monitor babies during labour, increasing the risk of brain damage in children.
Dislocation and stress affect virtually all pregnant women in Ukraine. Doctors say pregnant refugees and their babies are at a higher risk of illness, death during childbirth and mental health problems that can continue after birth. According to doctors, displaced people have higher rates of premature births, low birth weight and stillbirths.
Some pregnant women in Ukraine have had high blood pressure and, in isolated cases, a stress-related inability to produce breast milk, which may be temporary, doctors said. Stress has also caused pre-eclampsia, a complication of high blood pressure that can be fatal.
When an air raid siren sounded on a recent day at the hospital, the staircase filled with women from the maternity ward clutching their bellies and dragging themselves to the shelter, a maze of low-ceilinged hallways and storage rooms. One room has been converted into a post-operative observation room and a makeshift neonatal site. Another, still cluttered with filing cabinets, has become a delivery room. The women rested on mats on the ground.
Dr. Yarushchuk directed the women to benches along the walls, where they sat silently in the darkened space, waiting a few minutes for the impending danger to pass.
Dr Yarushchuk said he made video calls to help women give birth in the basements of apartment buildings in the Kyiv suburb of Bucha, a few dozen kilometers away but at the time cut off from the capital by fighting.
“Our work has changed,” she says.
After Russian forces withdrew from Bucha last week, dozens of corpses were found strewn across the town – bloated and charred bodies of civilians, including children. Some, their hands tied, had been shot in the head.
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In Kyiv, another complication is a 9 p.m. to 6 a.m. curfew that leaves pregnant women entirely dependent on ambulances, which can operate at any time. Any trip by private car, under any circumstances, risks an accidental shooting at a checkpoint by nervous Ukrainian soldiers patrolling for groups of Russian saboteurs after curfew.
Yulia Sobchenko, 27, said she gave birth around midnight on March 20 and took an ambulance to hospital. But she was delayed by Ukrainian soldiers at checkpoints who, fearing the saboteurs, insisted on opening the door of the ambulance to check that it was indeed a woman in labor.
Her child was delivered at 2:55 a.m., and within two hours she was ushered into the basement due to an air raid alert.
“Me in my nightgown and with a rag between my legs and a little baby just after giving birth, and my husband with all our bags, had to go to the basement,” she said.
Her son, Mykhailo, was healthy and weighed 6 pounds 3 ounces at birth, she said, and “is a child of war.”
After birth, these families face other problems. New mothers who recently left No. 5 Maternity Hospital said they were unable to breastfeed, which Dr Yarushchuk attributed to stress.
Finding calm was the strategy of Ms Shynkar, who worked as an event organizer before the war. Her maternity hospital in Kyiv allowed women, their husbands and children to register three weeks before their due date to avoid being separated from the medical establishment by the shifting front lines of war. .
Speaking from her hospital room days before giving birth on March 25, she beamed a broad smile and appeared so calm she was almost unaware of the swirl of deadly violence just outside. She said she had never watched or read any war news.
“I try to focus on the baby,” she said. “Can I help fight the war? I want to, but I can’t, not now. But I can’t panic,” she said. “I can protect myself. That’s what I can do.
Ms Shynkar has given birth to a daughter, Adeline.
“It was a natural birth in a very nice and intimate setting,” she said of her hospital birth. “My husband was present at the birth and cut the umbilical cord. To be honest, I have no idea if there were air raid sirens because I was completely in the process.
It was a small personal victory in the midst of a much larger battle raging all around her.
For herself and for her country, she gave her baby the middle name Victoria.
Maria Varenikova contributed reporting from Kyiv, and Emma Bubola from London.