Newborns, Visitors and COVID-19: When can I hold your baby?

June 8, 2020

A post from our blog, Happy. Healthy. Southie.

By: Jocelyn Guggenheim, NP

In the nearly 2 decades I have spent working with new parents, I can’t remember a time when the question about who should be allowed around a newborn was so complicated.

We have always wanted to keep new babies and new parents healthy, fed, and supported (no small feat) but the evolving COVID-19 pandemic has made doing that nearly impossible. Everyone wants to know what is safe. And while these decisions will look slightly different for every family, I thought it would be helpful to outline some basic principles that I discuss with my primary care patients and new mothers who attend my weekly (Zoom) support group to help them make a plan that works for them.

This basic decision framework is more robustly outlined in this article, written by Brown University economist Emily Oster, who has made a career of helping parents navigate complicated questions with limited scientific evidence.

First, decide what you’re deciding:

“Should we have visitors” is different than “can my mother drop off food”. Most of my families want to know when it is safe for grandparents, aunts and uncles, and friends, to hold their newborns.

Next, decide what benefits your decision could bring:

The most common one: “when can my mother hold my baby” may bring a varying amount of benefit, depending on a host of factors related to you, your mother, and your baby.

For some parents this may mean a daily nap, shower, or meal that they would not otherwise get. For others this may simply produce a 15-minute cuddle, a photograph (and likely a very happy grandparent) but then after the moment passes there will be no lasting benefit.

I have always encouraged new parents to really think about what type of help is actually helpful, now more than ever.

After you decide the benefit, determine the risk (to all parties):

There is the risk to the baby, the risk to the parents, the risk to the visitor, and the risk to society.

For babies we are not totally sure what the potential risks are. Children seem relatively unaffected by this virus so far, but we have very little information relative to all other viruses, and we know that even a common cold can be deadly for newborns. Rarely some children are having a severe reaction weeks after infection (known as MIS-C).

Parents may be in the healthy young adult age range, limiting the chances of severe consequences from COVID-19. But any parent knows that caring for a child when you are even a little unwell is challenging, to say the least. We need to ensure parents are as healthy as possible so they can be there for the new family member.

The risk to grandparents will differ depending on the health status of the grandparent, but many will automatically be in the high risk category by age alone (65 years and older).

Then there is the underlying risk to society. Our collective goal to stop new infections so this virus does not overwhelm our healthcare system or injure high risk people who cannot afford to stay home, will be helped with every prevented infection.

Finally, not every visit carries the same amount of risk. Outdoor socially distanced visits (6-10 feet apart), where all adults wear masks and no one even a little bit sick attends, are low risk. Indoor events with food and touching (let me bring you dinner and let’s eat together while I hold your baby) carry a very high risk of transmission. We know this virus is contagious up to 48 hours before anyone develops symptoms, and activities like talking, singing, and sharing food indoors increase transmission rate significantly.

The underlying challenge of all of these conversations is the pressure new parents feel to say yes when people outside the immediate family ask to be brought in. It has always been the crux of this conversation. Frankly, if a parent knows they need help to survive (see the example of a grandparent who is trusted and readily available to provide a meal, a clean house, and a desired break), they usually don’t ask me if that is acceptable. They have already decided that they need it and have likely taken steps to socially bubble with that person so risk is reduced as much as possible.

These situations are particularly difficult when the new parents see the people who are asking to be brought offering a less clear benefit. The struggle to say no to these requests seems like a rejection that isn’t their intention to inflict. Why is it hard for new parents to say no?

They feel guilty about saying no to someone they love

They feel sad that they don’t feel the interaction would be worth the risk

They know their already heightened anxiety would be brought to an unbearable level after the potential exposure

They worry about damaging the relationship and all the short and long-term consequences of this

I could go on and on

We know that the rate of postpartum anxiety is as high as 1 in 5 for women and 1 in 10 for men.

These are families who have likely gone into a hospital during a pandemic. They have labored, sometimes alone, wearing a mask while their delivery team wore what looked like hazmat suits. They were tested for COVID-19 and treated like they could have been infected, even if their test was negative.

If they had partners with them their partner wasn’t allowed to come and go from the room. They haven’t been able to hire help, to get in-person lactation support, or to attend in-person support groups. They have seen what it took to slow the spread of this disease and they don’t want to open their family up to risk if they can avoid it. Cocooning is already a natural instinct after the birth of a baby, but now it feels like an imperative.

So, if you’re a new parent who is not sure what to do, reach out to medical professionals, counselors, or friends who can help you can think straight when you’re tired, and worried, and overwhelmed. Also, know you are not alone, these are universal issues for new parents during COVID-19.

If you’re asking to visit and are told to wait, please respect that this decision didn’t come easily and saying no is as challenging as saying yes.

And if you’re thinking about asking to visit a new family I would advise you just not to ask. They will tell you when they are ready for you. Food dropped on the doorstep with a text that you already left is the nicest gift for parents who haven’t asked you for more.

For more supportive advice from SBCHC’s health experts, visit our Happy. Healthy. Southie. blog.

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