Under what circumstances would you consider never holding your newborn baby, depriving yourselves of that golden hour of brain development and optimal attachment?  What would the circumstances need to be for you to choose that separation and all of the grief and consequences for two weeks? That is exactly the choice many American birthing parents who are ill with COVID-19 are facing. 

While the World Health Organization (WHO) recommends keeping the birthing parent and their baby together and actively breastfeeding (while using precautions), the US Center for Disease Control (CDC) recommends treating the newborn as a person who may have the illness with isolation from their parents for two weeks. Currently they may receive breastmilk through an alternate feeding method. Any caregivers must be gowned, gloved, and masked, and not have the illness. I checked extensively through social media and private email platforms of perinatal organizations, and found that hospital guidelines are mixed. Some don’t have room to isolate an infant for two weeks and are defaulting to the WHO guidelines. So if you are birthing in a small hospital and are ill, you are likely to keep your baby.

However, many larger hospitals in the USA are prepared to follow the CDC recommendations and have written two weeks of newborn separation into their guidelines.

Just like an adult’s, newborn’s brains are affected permanently by separation and loss; it’s something that has been studied scientifically for over fifty years. However recovery and repair are also possible. Infants are incredibly fragile and incredibly resilient.  As parents and counselors to parents, we want to protect children as much as possible. When bad things happen we are willing to do what is needed to ameliorate their effects. 

The problem now is that parents may have the decision made for them, may be pressured into separation, or may make the choice without fully understanding the consequences. Lastly, they may not understand the lasting effects on the newborn’s brain and developing mind (psyche) and not act to repair those consequences. 

Are Medical Professionals Making The Decision or Are Parents?

In discussions with certified nurse-midwives, they see their role as guiding parents into the right decision for them.  In many instances their position was this: “There is so much we don’t know about the disease, and the parents will be bearing the consequences of any decision. So they should be the ones making the decision.” 

Other perinatal professions and hospital administrators do not see it that way, but instead take on the mantle of authority. The American College of Obstetrics and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) state the newborn should be treated following the CDC guidelines. However, this is a healthy baby and the obstetric and maternal fetal medicine areas of expertise end once the umbilical cord is cut. Pediatricians are the medical experts but so far the American Academy of Pediatrics (AAP) has stayed silent on this particular issue, deferring to the CDC guidelines on it’s web pages and blog.[i] If physicians who are used to an autocratic decision making style impose their beliefs on their patient and separate the newborn without a lengthy discussion with parents, that is not good medical care. They do not have to live with the outcomes of this decision, and the consequences of two weeks of separation at this developmental stage are lifelong.   

Is it medically ethical for physicians to make this decision for a family?

Anytime a decision may have a negative outcome for a person or group, or it goes beyond legality or efficiency, then ethics are involved. Ethical choices involve human rights, what is just, what is virtuous, as well as what is for the common good. In this way, it is definitely an ethical dilemma and one that ought to be made by the parents, not the health care provider.

I am concerned about parents who are not being given the choice as well as those who do not understand all of their options – people who are regularly marginalized and seen as not capable of making “good choices” by those are in authority.  This is most often along the lines of Medicaid status, perceived race, ethnicity, income, education, or citizenship.  Parents who are well resourced, and similar in ethnicity and background to the health care provider are more likely to have more leeway in making their own decisions. They are also more likely to have a contrary decision respected by authority. Stories are already circulating from major American cities that Black birthing people are receiving worse care and treatment than usual. Both ACNM and AAP have spoken out on their concerns that professional members do not show bias in their care during the pandemic. Even the NAACP has written a special paper on the equity implications of the coronavirus epidemic in the U.S. 

 Isolation of the newborn without adequate understanding of their options, including the fact that the rest of the world isn’t doing this, needs to be part of the family’s decision making.  All choices, including isolation or keeping the family together deserve respect and support. Parents should also be allowed to change their minds. 

 

Read more about the infection risks, infant mental health risks, whether this is a medical or human rights decision, why the US guidelines differ from the rest of the world, and what you can say to help parents and infants...