Barred neonatal visits hurt infants

Some nurses chose to ignore the no-visit rule, and now the health department has allowed mothers to feed their premature infants

Family members can now visit relatives in Gauteng hospitals for 15 minutes, according to a directive issued by the provincial health department on March 31. Previously the lack of physical contact and information on patients’ progress had caused anxiety for family members and patients, particularly mothers who had premature deliveries.

Restricting visits at hospitals was one of the measures put in place by the health department to curb the spread of Covid-19, but it took a severe toll on the mothers of premature babies, because they were barred from visiting the neonatal intensive care unit (NICU) wards.

Pinkie Filand, 38, is one of many mothers who had to rely on phone calls from hospital employees to get updates on the progress of her infant.

She was admitted to Edenvale Hospital’s NICU ward for shortness of breath and a lung infection. She went into early labour and, 10 days before lockdown, gave birth to a 24-week premature girl weighing just under a kilogramme.

“My husband was the only person who was allowed to see our baby when I was still in hospital because I was also getting treated for the infection. But after getting discharged, we both had to rely on the staff at the hospital to give us updates on how she was doing,” said Filand.

She had been told that her child would only be discharged once she weighed 1.75kg.

The baby was being fed donated breast milk and, according to the daily reports from staff members, they were pleased with the infant’s progress.

“It was not a very nice thing to experience because the last time I saw her was on the day I got discharged before the lockdown. With every phone call, we were worried that something could be wrong, but the nurses reassured us that she was doing well, so that helped a little,” Filand said.

Kangaroo method

Babies that are born prematurely and underweight are nurtured using the kangaroo care method, where they are placed on the chest of their mother or father for skin-to-skin contact.

Besides giving the parents and baby an opportunity to bond, the kangaroo method has been shown to be effective in reducing mortality, severe illness, infection and prolonged stays in hospitals.

Because Finland never had the opportunity to nurture her infant in this way, her fears of being unable to care for her baby were heightened.

The little girl was discharged after eight weeks in hospital.

“I cried when she got discharged because I [hadn’t been able to] see or touch her for almost two months. But I was [also] afraid because she was too small and I never got to bond with her after birth. The first few days of her being at home were hard because it was just my husband and I. No visitors were allowed since we were under lockdown,” she said.

Despite the lockdown restrictions being relaxed, healthcare workers have reported seeing similar levels of anxiety among new mothers as those experienced during the hard lockdown.

One nurse, who works in the NICU at a public hospital in Gauteng, said that healthcare workers found themselves faced with the dilemma of having to enforce preventative measures to reduce Covid-19 infections, while knowing the negative effect that these would have on mothers and their babies.

Bending the rules

According to the nurse, who didn’t want her name to be used because she is not authorised to speak to the media, the unit at her hospital sometimes cared for between 80 and 90 babies. Phoning each family became “unsustainable”, so the nurses decided to bend the rules.

“We know the medical effects of separating mothers from their babies and have seen how much families struggled to bond with their newborns after a prolonged separation, so we allowed the [mothers to visit their babies] at least once a week,” said the nurse.

Statistics show that, globally, about 15-million babies are born prematurely each year. In South Africa, about 84 000 births are preterm, with 10% of these cases not surviving because of complications.

“It was heartbreaking and difficult to explain to families that their babies, who were hospitalised, had died. As a nurse, I felt their pain more because they never got to understand what could have happened to their babies, since they couldn’t even see how they were progressing,” said the nurse.

“Another thing that we saw was that for those who finally got to take their babies home, they struggled to connect with their babies, while some were even afraid to hold them as they were too small and looked fragile.”

She added that during the month of December, she and her colleagues saw a rise in the number of preterm births because pregnant women were infected with Covid-19. The nurse said she hoped that the department would consider loosening the restrictions now that the country was under lockdown level 1.

Preemieconnect is a non-governmental organisation that offers support to families of premature babies but, because of the Covid-19 restrictions, it has not been able to offer optimal support.

This is one of the reasons the organisation is behind the zero separation campaign.

Tasmin Bota, the organisation’s founder, said Preemieconnect has called on the health department to allow mothers to nurture their babies, but a response to the request has not been forthcoming.

“I have been sending them all the information with regard to the zero separation campaign but we haven’t heard any feedback, so clearly there has been no effect of what we have been saying. Prematurity is not being taken as seriously as it should be [regarding] the effects that [separation] will have on the mothers and babies.”

Missed opportunities

As a mother who went through a premature birth herself, Bota said that the separation of mothers and babies resulted in missed opportunities for infants to thrive.

“Most preemies are discharged close to their due date. We got discharged a month before our due date because of how involved we were with the caring of our baby,” Bota said. “What I noticed with the parents that were not able to be there for their babies, [was that] the babies took longer to be discharged because they were not getting the extra attention and affection that the nurses do not have the time or the capacity to give,” she said.

It appears that communication regarding the department’s amendments made regarding mothers visiting their infants have been slow to reach nurses and families.

The department, in collaboration with specialists in maternal and neonatal health, came together and developed the algorithms for pregnant women and the neonates, according to health department spokesperson Popo Maja. These were sent to provincial coordinators to implement to cap the spread of Covid-19.

“Mothers are allowed to visit their preterm babies in NICU for feeding their neonates with the strict followup of IPC [infection prevention and control] regulations of screening first, using PPES [personal protective equipment] and masks and washing of hands,” said Maja.

“Visitation would be restricted to exceptional cases if either the mother or neonates are suspected of Covid infection, then regulations of isolation and quarantine apply.”

Mothers will still be allowed to visit their neonates should the country experience a third wave of Covid19 infections, said Maja.

‘It was heartbreaking to explain to families that their babies, who were hospitalised, had died’