Advice and reassurance for welcoming a new baby in the COVID-19 era

Pregnancy and the addition of a new baby to the family come with many emotions – excitement, joy, love and feelings of great responsibility. In this time of increased uncertainty related to coronavirus outbreak, the anxiety around childbirth and caring for a newborn can be magnified.

Dr. Sarah Milton, obstetrician and gynecologist, and Dr. Tiffany Kimbrough, pediatrician and medical director of the mother/infant unit, offer some tips and encouragement for people welcoming a new bundle of joy.

How would you reassure new parents and parents-to-be during this uncertain time?

Dr. Milton: Being pregnant or being a new parent is a stressful time in the best of circumstances, so we acknowledge that this can incredibly stressful for our patients. I think the most important message to send is that we’re here for you and you’re not alone despite that fact that it can sometimes feel that way during social distancing.

We have a lot of systems in place to provide you with safe access to care, whether via telehealth or in-person. I’ve been at VCU Health for a long time and I’ve never been more proud to work here. I’m proud of our providers and I’m proud of our patients for the resilience everyone is showing through all of this.

Are pregnant people at increased risk for complications from COVID-19 as compared to the general population?

Dr. Milton: The good news is that based on the scientific evidence we have right now pregnant people are not at increased risk of getting sicker with COVID-19 than they would be if they were the same age and not pregnant. That doesn’t mean that they can’t get COVID-19 – they certainly can. They need to take the precautions experts are recommending for everyone, including frequent and thorough hand washing and social distancing. Unlike some other respiratory illnesses, like the flu, we’re seeing pregnant women get just as sick as their age-based counterparts, but not sicker.

How is VCU Health adjusting appointments and patient visits for pregnant people and newborns?

Dr. Milton: On the prenatal side, we’ve shifted about 80% of our visits to a remote format, either by phone or video – which is what the American College of Obstetrics and Gynecology recommends across the country, adding an element of safety to prenatal care right now. These are the appointments where there is not an affiliated piece of lab work or ultrasound.

I’ve found the video visits to be incredibly rewarding, to be able to visually connect with my patients and reassure them. I’ve been able to draw diagrams and show them pictures. I think it’s been well-received by patients as well. We miss being with our patients though!

Dr. Kimbrough: We typically see babies in the clinic setting 1-3 days after discharge from the newborn nursery. This quick follow-up helps us make sure that feeding is going well, and we conduct an assessment for jaundice which is a complication that can happen after delivery. That in-person visit also allows us to do any necessary bloodwork and help with breastfeeding if needed.

After that, we’re doing a combination of home visits and telehealth. A skilled nurse can go to the home and do additional assessments if needed. We’ve also really ramped up our telehealth visits. Through these telehealth visits we can see how feeds are going and help with latch. Our lactation team is also available via telehealth to provide support.

Moving forward, the in-person visits that are happening for babies are the ones where vaccines are due so we’re doing touchpoints on the typical schedule all the way to 15 months. We’re still here to support families beyond that. We're trying our best to address sick visits via telehealth and reserve in-person visits for well patients who need to come in for necessary services.

Can a pregnant person with COVID-19 pass the illness on to their fetus or newborn?

Dr. Kimbrough: In all the data so far, from China, Italy, New York and other areas that have been in the thick of the pandemic, we’re really not seeing infants born sick with COVID-19. The prevailing wisdom is that baby is not at increased risk of being born with COVID if mom is sick at time of delivery.

If someone is starting contractions, when should they plan on coming into the hospital?

Dr. Milton: We want people to know that the hospital is safe. We have screeners checking patients and visitors at the door and we’re working really hard to keep people with respiratory symptoms out of labor and delivery. We want you to come in for all of the usual reasons people would typically come to labor and delivery – contractions occurring every five minutes that are painful and taking your breath away, if baby isn’t moving normally despite really focusing on fetal movement, if water is broken or fluid is leaking, or if you’re experiencing heavy bleeding.

Please don’t worry about coming into the hospital. We are here to evaluate you 24/7 and we’re prepared to keep you safe. If you have any question about whether you should come in or not, just call us (804-828-4409). We’re here for you!

If someone is healthy and plans to have a low-intervention natural birth, should they consider a home birth during COVID-19?

Dr. Milton: For years, the American College of Obstetrics and Gynecology has had a firm stance that having a hospital-based birth is the safer option for moms and babies. COVID hasn’t changed that. Most healthy moms are going to have an easy process having their babies, but unexpected things happen. If you’re in the hospital when those unexpected things happen, we can manage the situation quickly and safely.

Do parents need to be worried about being separated from their babies in the hospital setting?

Dr. Kimbrough: There are a few situations where we would discuss separation with a family – it really is shared decision-making between patients and health care providers. This involves talking about the risks and benefits of each side of the situation.

If a mom is COVID positive, we would discuss current recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics. Right now they’re following similar recommendations to other infectious diseases, like flu, where an abundance of caution is to separate mom and baby. Again, this involves discussion with the parents about what’s in their best interest and what their goals are.

If mom is so sick that she needs to be in the ICU setting, then we would more strongly recommend separation because she may be undergoing treatments that will put baby at increased risk for potentially breathing in some of those particles and contracting infection. We will discuss with the family and develop a plan that everyone feels safe with and that minimizes risk.

How is VCU Health deciding when it is safe for new parents and babies to go home?

Dr. Kimbrough: We have a lot of pathways in place to make sure the hospital is a safe place to be during the post-partum period. We want families to have support to get breastfeeding off to a good start and to make sure we’ve given enough time to see if baby has any issues that need to be addressed.

For right now, the earliest we’re discharging is 24 hours after delivery and then it’s case-by-case after that based on when mom and baby are ready. Again, this is done through shared decision-making with the family. We want to make sure they have good support and a follow-up plan and that everyone is safe.

Having a baby is exciting and we know everyone wants to come meet the newest addition. Who can come into the hospital and delivery room? Can families have visitors after their baby is born?

Dr. Milton: We have changed our visitation policy for the labor and delivery unit. During labor and birth there can be one healthy adult visitor. The same is true for ob/gyn outpatient visits leading up to the birth – one healthy adult visitor if absolutely necessary. It’s very much the best thing to limit the number of people in the health care system, so if you can come to your outpatient appointments on your own that would be preferred.

Dr. Kimbrough: The same is true in the mother/infant unit after baby is born – one healthy adult support person per day. Once leaving the hospital, two healthy adults can accompany baby to their newborn or well visit. We’re following screening precautions, so we’ll ask about any symptoms and conduct a temperature check to help keep everyone in the environment safe.

Up-to-date visitation policies can be found at vcuhealth.org/covid-19 and chrichmond.org/covid-19.

Once new parents go home with baby, what precautions should they take to limit exposure to COVID-19 for themselves and their newborn?

Dr. Kimbrough: There’s probably no one more aware of germs than new parents! They’re usually on high-alert for ensuring frequent handwashing and we recommend those same precautions. Before handling your infant, follow the CDC guidelines of thoroughly washing hands for 20 seconds or use an alcohol-based hand gel. It’s also important to think about high-touch surfaces in the home and frequently disinfect those as well. This includes light switches, door knobs, cell phones and tv remotes. Then, limit outings to essential trips outside the home such as grocery shopping (once a week or less), picking up medications and doctors’ appointments that you need to attend in person.

What should visits from family and friends look like at home?

Dr. Kimbrough: I’m a mom and I vividly remember everyone wanting to come meet baby, drop off food and lend a helping hand when my kids were born. Right now, it’s important to limit those in-person visits. You can still do phone calls and video chats – I’ve even seen on social media grandparents meeting new grandchildren through the window, making for some really sweet moments.

We do encourage families to use their support systems, but to do so in a socially distant way. People can still drop off meals to the home and leave them on your porch, or maybe run an errand to help out. There will lots of time when this is all over for in-person visits and grandparents spoiling the new babies.

Should someone breastfeed if they have COVID-19?

Dr. Kimbrough: In the event that mom and baby are separated in the hospital, we are encouraging moms to start pumping, following very strict hand hygiene first and then cleaning pump parts after every pump session.

We absolutely want families to continue breastfeeding if the COVID symptoms happen after the hospital stay. Some ways parents can help keep themselves and baby healthy include wearing a mask while breastfeeding if you do have symptoms, doing breast cleansing and hand hygiene before nursing, changing clothes in case there are any droplet particles on them, and again doing hand hygiene after nursing.

There has been no detection of the virus in breastmilk through multiple studies, so breastfeeding is safe to start or continue. It’s also helpful for your baby to get antibodies, potentially to COVID but to other infections that may be in the environment.

Do you have any recommendations for parents who are sheltering in place at home to help make their lives a little easier right now with a brand new baby?

Dr. Milton: My advice here comes as a mom of two rather than as a physician. I think we’re so fortune to have things like FaceTime, video calls and ways to get creative with family and friends. Set up a routine that includes daily connection to your support system. The post-partum period can be pretty isolating and there are some really good resources available for new moms who are struggling emotionally. We can help manage this with telehealth visits as well, so please reach out to us if you need help. We’re here for you.

Dr. Kimbrough: As a new parent, I probably sent my husband out every day to buy something the baby needed. Even though we’re recommending limiting your trips out, you can use ordering and home delivery systems for your groceries and those necessary baby items. Or, your support system may be willing to drop things off for you if they’re already running an errand. You don’t have to be completely cut off. There are avenues to get what you need while you’re adjusting to new parenthood.

Are there lactation resources available during this time for parents who may need breastfeeding support?

Dr. Kimbrough: Yes! Telehealth visits are available Monday-Friday with our lactation team.

How does COVID-19 present in an infant? What symptoms should parents look for?

Dr. Kimbrough: The most-reported symptoms for all age groups are fever, cough and shortness of breath. The interesting thing about kids – they’re not little adults, they’re different – is that they have this classic triad much less than adults so it can make it a little tricky. Kids can have more fatigue and gastrointestinal symptoms like vomiting, diarrhea or loss of appetite.

We don’t expect for families to be able to know for sure. We’re here to support you, whether through a virtual visit or phone call, so if you have concerns please reach out early and often (804-828-2467). Keep us updated with any changes in symptoms so we can help. The rates of complication for children are much less than for adults, but they’re not zero so we do want to hear if children have symptoms and if those symptoms are changing over time.

What is the best way for new parents to protect themselves and their babies against COVID?

Dr. Kimbrough: Handwashing, handwashing, handwashing! Twenty seconds is a long time to be lathering up, so figure out a method to make sure you’re washing for the appropriate length of time – whether singing the happy birthday song twice or whatever your favorite tune is. You’d be surprised how many times you touch your face throughout the day so try to be aware of that and limit face touching as much as possible. Then, follow those strict social distancing parameters. We’re all social creatures and we crave connection, but for right now it’s important to limit in-person contacts to only what’s truly necessary.

Where can I get my car seat checked to make sure it’s installed properly?

For the health and safety of our community, CHoR and other certified child passenger safety seat resources are not currently providing safety seat checks. View tips, videos, demonstrations and expert advice on the Safe Kids ultimate car seat guide website. Have older kids, too? Plug in your child’s height and weight on the site to get guidance on the best type of seat for them.

Watch the interview with Drs. Kimbrough and Milton:

Congratulations on this exciting time! We’re here to support you on this journey.

Learn more about pregnancy resources as well as caring for your new baby through help with breastfeeding and pediatric medical care.