Nothing can ever truly prepare a parent for having their baby sent to the Neonatal Intensive Care Unit (NICU) after delivery. No amount of reading or planning can make it any easier. And when a global pandemic hits, all of that fear and stress is only compounded, making the NICU experience even more challenging.
“All the baby books tell you is that you’re going to go into labour, deliver a beautiful baby, and then go home to visitors and gifts. But when a baby is born sick or prematurely and has to come to the NICU, especially during a pandemic, the whole experience for the family suddenly changes,” Alison Drabble, patient care manager of the NICU at St. Joseph’s Health Centre, told HuffPost Canada.
COVID-19 has had a major impact on Canadian hospitals, affecting everything from visiting rules to the availability of life-saving equipment to the operation volunteer programs. And this is keenly felt by new parents who’ve found themselves with an infant in the NICU.
“Babies respond to touch. It’s in those early days after birth that they begin to attach to their caregivers. They’re wired that way.”
“Most moms get the chance to experience skin-to-skin, and see their baby within seconds of birth,” Taryn Gibb, a new mother from Whitby, Ont., wrote in an Instagram post on Thursday. “Most moms get to snuggle and bond with the child they’ve been growing for nine months. Not this mom.”
Immediately after Gibb’s son was born prematurely, he was “whisked away” to the NICU, where a team of nurses, physicians and neonatologists would begin taking care of him. Gibb didn’t get to see him for 24 hours after his birth.
New visitation rules at the NICU
Ordinarily, parents can visit the NICU and spend as much time as they want with their newborns. That time is important — research has found that skin-to-skin contact helps parents to bond to their babies, and stimulates growth and development in infants.
But in accordance with the Centers for Disease Control and Prevention’s recommendations about physical distancing, as well as pre-existing guidelines for navigating viral outbreaks, hospitals across Canada have had to adjust the rules in intensive care units.
In most cases, that means only one parent is allowed to be with their baby, while other visitors are barred completely. This lowers the risks of babies and hospital staff contracting COVID-19, but it also means that one parent misses out on those important first days, weeks or even months of bonding with their baby.
What physical distance means for bonding
Babies respond to touch.
It’s in those early days after birth that they begin to attach to their caregivers. They’re wired that way. Skin-to-skin contact calms and soothes. Eye-to-eye helps them to connect. They start trying to imitate facial expressions and gestures, and they revel in the musical quality of their parents’ voices.
This whole bonding period is one of the most crucial and pleasurable stages in infant care and development. It’s no wonder, then, that it can be distressing if that stage is disrupted, and one parent can’t visit their kid.
And for parents who are able to visit, it’s tough not having a support system to lean on. The sight of a newborn baby hooked up to a bunch of strange equipment can be jarring, never mind hearing doctors weighing odds of survival and advising on what to do in case of seizures, your infant’s heart rate dropping, or other medical complications. These are all potentially traumatizing things to experience alone.
In the postpartum period after childbirth, it’s important for mothers to have support. As they go through their own adjustment period, it’s advisable to get as much rest as possible, and the stress of being shuttled back and forth to the hospital, on their own, can be challenging.
“If you’ve just delivered a baby, the last thing you probably want to do is have to come to the hospital on your own,” Drabble said.
Some hospitals are allowing parents to alternate visits
In many Canadian NICUs, only one parent is allowed to be the designated visitor — and once they leave the hospital, they can’t return for another 24 hours.
This next-day rule still applies at both Sinai Health and St. Joseph’s. But they also allow parents to alternate.
“If one visits, then we allow the other to come in after,” Drabble said. “They just can’t come in together.”
There’s still a screening process that takes place before anyone is allowed to set foot in the NICU. All patients and visitors are checked for symptoms of COVID-19, and are asked a number of questions about their health, recent travel history and whether they’ve been in contact with someone who might be sick. If they pass, they’ll be asked to wear a mask and sanitize their hands before entering.
“If it’s a busy day, nurses can have up to three babies to cuddle at once.”
“We don’t like having to restrict parents,” said Shah. “We’d like for them to spend as much time with their baby as possible. We’re doing the best we can.”
Who is cuddling the babies?
Nurses are doing their best, too. They still try to make themselves available to visiting parents who might need help or guidance in the NICU, but it’s a challenge when everyone is trying to maintain social distance. And since all those valuable volunteer baby cuddling programs have been indefinitely suspended, nurses have been stepping in, as best they can..
“Cuddling babies is one of the greatest jobs we have, so there’s no shortage of people who want to pick a baby up,” Drabble said. “But if it’s a busy day, nurses can have up to three babies to cuddle at once.”
None of this is easy. There are no perfect solutions. But hospitals are doing everything they can to make things as safe and smooth as possible in the NICU and everywhere else.
Staying connected through video chats
Though both parents might not be able to be with their baby physically, that doesn’t make seeing them impossible. Many Canadian NICUs have been using video chat services to keep parents connected with their babies.
At St. Joseph’s, for example, the NICU is equipped with three recently donated iPads. “If a visiting parent wants to video chat with their partner, or make contact with any other family members who want to see the baby, they can do that now,” Drabble said. Virtual visits aren’t ideal, but Drabble said, “you can still bond with the baby that way.”
A 2017 study of 33 parents with premature babies found that bonding still occurred when webcams were used during prolonged isolation periods. A number of these parents reported that the technology allowed them to “feel that they were with their baby,” and even made them more responsive to what the baby would need if they were physically together — some mothers were able to produce breast milk, just by watching a webcam stream.
Dr. Prakesh Shah, pediatrician-in-chief and neonatologist at Sinai Health, says the hospital managed to arrange this beforehand, thankfully. Ten months ago, they implemented a program into NICUs called e-rounds, which is like FaceTime for healthcare workers.
It connects parents with hospital staff during medical rounds, so they can ask doctors questions and get answers immediately. They can also see and talk to their babies.
Other Canadian hospitals use similar remote check-in programs, such as FamilyLink and Smart NICU2Home. Parents can get information about their child’s bowel movements, weight, vital signs and breathing, all without setting foot in a hospital.
The only problem is access.
“We’re trying to fundraise and work things out so we can have an iPad for each baby, which would allow parents to be in contact more often,” Shah said. Parents are calling in more frequently to check on their babies, and there isn’t always enough technology to go around.
“We’d also like to have material on those iPads like music and soothing sounds and the parent’s voice, so that the baby can listen to it on a regular basis and know that somebody is around. We’re trying to reduce the stress on people.”
Born in a pandemic: ‘something to talk about’
St. Joseph’s has been entertaining the idea of a lighthearted way to commemorate this moment, for all the babies who arrived during this tough time. They want to create crib certificates that say “I WAS BORN DURING THE 2020 COVID-19 PANDEMIC,” as a testament to these little one’s resilience.
“Never in a million years did anyone think they’d be bringing a baby into a world that’s so upside down. Parents are going to have a hard time explaining it when their kid gets older,” Drabble said. “Maybe this will help. At least it’ll be something to talk about in the future.”