Special Delivery

The coronavirus pandemic has complicated just about every aspect of life, and childbirth is no exception. And yet, early in the pandemic, there was almost no literature on how to handle deliveries when the mother has tested positive for, or shown symptoms of, COVID-19.

Recognizing this void, University at Buffalo pediatrician Praveen Chandrasekharan, together with colleagues from California, Italy and Spain, published a paper outlining the best approaches for delivering newborns in such cases. Filled with easy-to-follow infographics, the detailed yet flexible guidance has made an impact internationally.

Based on consultations with neonatologists from around the world, the authors of the paper developed three approaches for health care providers and parents to select from, based on the risks and benefits in each actual situation, as well as the personnel, space, caseloads and resources available.

Each approach offers guidance on specific aspects of care, such as COVID-19 testing of the infant, visitation policy, and discharge and follow-up plans.

Keeping the mother masked, ensuring there is proper personal protective equipment for health care workers and transporting the newborn in a covered isolette (enclosed crib) are elements of all three options.

Chandrasekharan stresses the importance of shared decision-making, advocating for parental involvement regarding concerns such as rooming-in (where mother and baby stay in the same room), skin-to-skin contact and breastfeeding.

“Both parents and physicians must have an understanding of the situation,” he says.

The paper also includes suggested protocols for caring for babies who develop COVID-19. Medical centers are encouraged to arrange for additional delivery rooms and personnel, and to conduct simulated COVID-19-related deliveries to understand logistics and equipment involved.

While best practices continue to evolve as the pandemic does, the options outlined in the article have been used to develop guidelines by institutions around the world. Their goal in publishing, said the authors, was to reduce the spread of COVID-19 while also reducing fears—including, adds Chandrasekharan, his own. “As a neonatologist and the father of a child who was born early, I wanted to make sure I knew enough of this condition before it hit us, and to make the best possible plans.”