Infant Journal
for neonatal and paediatric healthcare professionals

COVID-19: reflections on childbirth and neonatal care in Italy

In Italy, the spread of the SARS-CoV-2 infection has hit with an uneven distribution and, fortunately, in the neonatal setting the virus affects fewer patients and with less severity. Nevertheless, the moment of childbirth has turned into a more complex event for healthcare professionals as we have to work with visors, masks and gowns. The continuously increasing number of COVID-19 cases has also given rise to the need for specific protocols to protect pregnant women and newborn babies.

Felicia Filomena Varsalone
Neonatal Doctor, Neonatology, Bolognini Hospital, Seriate, Bergamo, Italy.
felicia.varsalone@asst-bergamoest.it

I work in Seriate in the Province of Bergamo in the Italian region of Lombardy where, at the time of writing, there have been approximately 600 births since the beginning of the COVID-19 pandemic. In Italy, the spread of the SARS-CoV-2 infection has hit with an uneven distribution and, fortunately, in the neonatal setting the virus affects fewer patients and with less severity. Nevertheless, the moment of childbirth has turned into a more complex event for healthcare professionals as we have to work with visors, masks and gowns. The continuously increasing number of COVID-19 cases has also given rise to the need for specific protocols to protect pregnant women and newborn babies.

Precise and distinct pathways have been put in place for women giving birth depending on whether they are COVID-positive or COVID-free. In Lombardy, a network of six hubs for pregnant COVID-positive patients has been designed.

Our working practice has changed, marked by constantly updated rigid protocols. We have learnt the repetitive and exhausting process of donning and doffing personal protective equipment (PPE) in a rapid and controlled response to an emergency.

The moment of birth

For parents, childbirth is a time of bewilderment and the curiosity of facing something new, something that they may have never imagined before. Emotions mix with fear when they cuddle their baby for the first time. Now, in the time of COVID-19, the mother faces the pain of childbirth with the discomfort of wearing a mask on her face. The father, while present at the moment of birth, is only allowed a quick cuddle and then immediately leaves, only to return at the time of discharge.

The identities of the doctors and nurses are hidden behind masks, glasses, gowns and gloves. The only visible part of their face is the eyes and it is with these that we embrace each other. The empathy and every encouraging word to the parents must overcome these barriers, where feelings are perceived only through a glance.

Babies born to asymptomatic COVID-positive mothers can room-in (mother and baby stay in the same room without any other patients in that room) but the infant is kept in a cot two metres away from the mother’s bed. Breastfeeding is allowed, while taking precautions to avoid transmitting the virus to the infant by the use of PPE. In our unit, five COVID-positive mothers have given birth and we have not recorded vertical transmission of the virus.

The NICU is closed to parents but we send photos and videos to try and help keep them virtually close to their infant.

Admission to the neonatal unit

It’s a day like any other, as busy as ever. Suddenly the phone rings and I am asked to attend the preterm delivery of a COVID-positive woman. I stand at the door of the delivery room momentarily feeling lost. I have to resist my instinct to rush inside; first I must put on my armour to protect myself from the insidious and invisible enemy – mask, hat, gown, double gloves.

I enter the delivery room where I find frightened, tired and unrecognisable faces whose voices are muffled through the masks that they wear.

There it is… the first cry. The midwife hands the baby to me and reality is distorted. The euphoria, emotions and the intensity of the moment is toned down by the parents’ tears. Their cuddles are transmitted through loving looks aiming to seal the first bond with their new baby, the bond that will last forever. Instead the parents must let go of their baby; they must entrust his care to us in order to be able to hold him again only at the time of discharge, which may be weeks, sometimes months.

New admissions to the neonatal intensive care unit (NICU) are considered COVID-positive. We have closed the doors of the NICU, forbidding parents from entering. Any assistance given to the infants takes place with great caution. Invasive procedures, such as intubation, can only occur with the appropriate PPE.

At this time, those present on the unit are just the staff and our little patients who, unaware of the latest events, seek to cling on to life alone. Segregated and imprisoned in its incubator, the baby has us doctors and nurses to take care of him but the presence of his parents next to the incubator, their gaze and their touch, is missing. I wonder what will be the effect of this enormous absence on a premature infant.

Andrà tutto bene – everything will be alright

COVID-19 has moved parents away from the neonatal unit, forcing them to imagine their child almost as if it were a dream. They can only experience the thrill of their new arrival with nervous anticipation of the result of a virus test on top of precarious prematurity. For neonatal staff there is the need to protect the life of this new infant but we must not forget its parents. Once a day there is telephone contact between the doctors and parents and to try to reduce the huge void we have found virtual ways to keep parents and infants together. We regularly send and receive photos, videos of their little ones, a virtual cuddle, a kiss from a distance – ways to stay close even if miles apart.

As healthcare professionals we all face our daily work, alternating between the joy of a negative COVID-19 swab in a newborn infant and the sadness of many deaths in adult intensive care units. We continue to fight for our babies until the great moment of their discharge arrives and they can be reunited with their parents. After hospital discharge, the neonatal clinical follow-up appointments, including repeat testing for COVID-19, are scheduled on days 7, 20 and 30.

We share in the hope that everything can return to normal soon while knowing that nothing will be the same as before – the coronavirus has highlighted what is indispensable, what is useful, what is not necessary. Today in the time of COVID-19, the world regards us as heroes, but we are not the real heroes. The real heroes are the little infant warriors who have landed prematurely in our open hands and the families who have had the joy of bringing their baby into this world dampened by the spread of the coronavirus.

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