Let me start off by saying how much we as Doulas so greatly appreciate the efforts that hospitals, clinics, and providers have made to have the benefits of Doulas being a part of the birth team- recognized. Truly, we are so glad to be seen and valued by you. Moms and babies need everyone to prioritize their desires and care- together. This is not meant to step on toes or fracture such beneficial relationships. But, there is a huge problem that is happening all over the country right now, and it needs to be brought to light. Brand new mothers are being told that they cannot bring their newborns to their two and six-week postpartum checkups. I'll say it again.
Brand new mothers...are being told...they cannot bring their newborn baby (that was just inside of them, around the same care providers and delivered at the same location), to their postpartum checkups. Asking mothers to leave their newborns at home for their appointments, is asking mothers to not seek care.
As a mother, my heart sinks at the thought of this. As someone who has suffered from Postpartum Depression and anxiety, I empathize with those who are too afraid to leave their newborns to seek care. BUT, as a professional Doula and Lactation worker, I have some serious concerns, supported by evidence, and the feelings of those who have had babies during Covid-19 that should be considered when creating policies like this. Postpartum Depression and Anxiety rates already are about 1 in 6 (with rates increasing during Covid-19).
Not only do some babies struggle with breastfeeding at six weeks, and being at the breast for every feeding is beneficial for mom and baby, some babies struggle to take a bottle and could have a very difficult time away from mom. Separating mothers and babies is not the answer.
"Asking mothers to leave their newborns at home for their appointments, is asking mothers to not seek care."
1) Let's start by talking about the level of concern with separating newborns from their mothers.
Newborn babies are born developmentally immature compared to other mammals that can walk, crawl, etc. More and more maternal health care workers and advocates are recognizing the importance of the "fourth trimester" (the first 12 weeks of development and bond initiation between mother and baby). There is so much evidence that supports and displays the benefits of creating an initial attachment and bond. I could probably cite a hundred sources, but here are just a few.
"Infancy is a crucial time for brain development. It is vital that babies and their parents are supported during this time to promote attachment. Without a good initial bond, children are less likely to grow up to become happy, independent, and resilient adults." (Winston, R, 2016, NIH)
"At this point, it appears that COVID-19 in infants and children represents a much lower threat to survival and health than other infections that breastfeeding is protective against. The benefits of breastfeeding and nurturing mother-infant interaction to prevent infection and promote health and development are especially important when health and other community services are themselves disrupted or limited." (World Health Organization, 2020)
So clearly, there is evidence that supports healthy initial bond between mother and baby. Now am I saying that babies and mothers are doomed if they cannot be together? No. NICU babies are separated from their mothers and are very capable of growing up with strong attachments. This, however, is a medically necessary separation with parents able to assist the nursing teams with their infant's care and give skin-on-skin contact and breastmilk in many instances.
2) What happens at a Postpartum Check-up? What is the actual risk of transmission?
Postpartum check-ups usually happen at 6 weeks postpartum (if a mother has a cesarean, she can expect a two-week incision check appointment). During those six weeks, the infant has likely already seen a care provider three times. Meanwhile, the woman whose body went through a physical and hormonal marathon, has been without physical eyes on her health. These checkups can be of high stress for many new parents because this is the first time they are getting the chance to talk about their birth, their transition to motherhood, and quite possibly, their postpartum mood disorders.
Parents wanting to breastfeed, but who are struggling, can often get in-person guidance and reassurance from their trusted care providers at the same time as their postpartum check-up, which actually decreases exposure for mom and baby because it removes the need to see another new person for breastfeeding support.
For new parents with anxiety and thought patterns about their newborn that are outside the scope of "normal", having to leave their newborn at home could be the deciding factor between voicing depression or anxiety symptoms and asking for help, or continuing to struggle alone with anxious thoughts, and treatable depression symptoms at home.
So what's the actual risk (Let's remember that based on reported cases for the U.S in August, just 0.17% of the population contributes to new cases each week on average)?
Well, there are several variables when determining that, but let's consider a few things that reduce the possibility of infants getting Covid-19.
1) If babies are carried into the clinic in their car seats, a breathable cloth car seat cover could act a "mask"
2) Breastfed babies receive catered nutrients and antibodies based on the mother's environment (the clinic for example).
3) We know that hand-washing and cleaning surfaces can drastically reduce transmission (assuming the person in contact with the mom even has Covid-19).
4) Using screening questions based on household member's symptoms and possible travel to determine whether an appointment should be rescheduled, or virtual alternatives are offered is a standard tool used in many clinics.
"For parents with anxiety and thought patterns that are outside the scope of normal, having to leave their newborn could be the deciding factor between voicing depression + anxiety symptoms and asking for help, or continuing to struggle alone with anxious thoughts, and treatable depression symptoms at home."
3) Arranging Childcare Just Leads To More Exposure
If moms are not allowed to bring their newborns to their postpartum appointments, what are they supposed to do? What about the single mothers? What about the mothers of deployed spouses with no other family nearby? What about those who have abusive partners and feel that it is not worth the risk of the baby's safety to leave them, so they decide to skip their appointment altogether?
If these new mothers choose to go to their appointment and arrange for childcare, the chances of introducing someone new into the home are high. Not only does this mean increased exposure for the family, but an increased risk of exposure for the person caring for the baby/children. Mind you, over 95% of births happen in hospitals...with sick patients.
4) What Do The Mothers Want?: Leaving Their Newborn Should Be a Choice
We reached out to our clients who have had their babies since COVID restrictions started. Here are some of their experiences...
"I use a midwife. So, my 6-week appointment was over the phone. I was totally fine with that. It was a great conversation. In fact, next baby, I will probably tell them I don’t need a 6-week appt. I’m a nurse, I know when something is wrong. But, if I couldn’t have brought my baby to my appointment, I would not have gone, no questions asked."
"I've never been able to bring my newborn to my postpartum appointments. Thankfully, I had my husband working from home and I arranged my appointments around nap time. It felt weird. And I forgot- I almost missed my appointments."
I only went in because my work required it."
"I ended up in the hospital due to excessive bleeding and fever and even though I was breastfeeding and staying in L&D [she] still wasn’t allowed to be there. It totally broke my heart to spend the night away from her when she was only 10 days old."
"I understand them being careful with COVID but I literally stayed one room over from where we had been with her 10 days before. I still don’t understand why she couldn’t be with me."
"We struggled with jaundice and poor weight gain at first and were at the clinic almost every day. While [the clinic's] pediatrics’ official policy is both parents can come up until the 2-month well visit, at one appointment, we were told by the person at the door that only one of us was allowed in. I was still a wreck both physically and emotionally and really could have used my husband’s help and support."
"Nobody even told me that I couldn't bring her. I didn't find out until I got there. I was crushed. My midwife was able to squeeze me in under the radar, but if she weren't so amazing, I don't even know what I would have done. I can't imagine leaving my two-week-old nursing newborn. I already struggle with milk supply"
These experiences are not reflective of mothers feeling comfortable being away from their newborns. Now, this is a small sample of parents during COVID. And if parents want to choose to leave their newborns at home for their postpartum appointments, I think their desires are valid. BUT, the risk of mothers who need care being made to feel like they have to choose does not seem conducive to healthy mothers, and healthy babies.
As stated initially, I am sure this is going to step on the toes of people I deeply value in my life as friends and professionals. But it is my job to stand with our clients and support them. Right now they feel confused and betrayed by those who are supposed to support and provide care for them. Separating newborns from their mothers is not sustainable, and it is NOT evidence-based. It's time to rethink these policies.
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