A Newborn Doc at the frontline
By: Dani Dumitriu
Tags: Newborn, New York, Covid 19, Maternal, Frontline

Melissa DeRosa, secretary to the Governor of New York, launched a COVID-19 maternity task force on April 20. An important mission of the task force is to spearhead birthing centers as safe alternatives for low risk women laboring during this pandemic. As a pediatrician working on the frontline in a newborn nursery, I responded to the Governor’s tweet, volunteering to be on this task force. I did not receive a response. I called the two numbers I could find. One went to a voicemail that said the inbox was full and hung up on me. The other said they were experiencing calls that were longer than usual and therefore I should call back later and also hung up on me.

Looking at the publicly released list of task force members, there is no representation from a general pediatrician. Rightfully, obstetrics and neonatology are represented. But these are two pillars in a three-pillar medical team. Most women who give birth, and especially those considered “low risk” and appropriate for transfer to a birthing center, deliver healthy newborns. And that’s what I am an expert in.

But I would be remiss not to mention that my expertise extends beyond the professional realm. Seven years ago, I gave birth to my third child in my own home, here, in New York City, the epicenter of the current pandemic. I understand the complexities of outside-of-the-hospital birth just as well as I understand the complexities of hospital birth, the complexities of hospital birth during a pandemic, and the complexities of hospital-birth in a hospital at the epicenter of the pandemic. And I feel strongly that a general pediatrician, especially one specifically focused on newborn care, should be at the table during the decision making process of this incredibly important topic.

Here is why:

Before March 13, 2020, I was mostly a scientist. Yes, I had a medical degree. Yes, I had an active medical license. Yes, I was a board certified pediatrician. And yes, my Columbia appointment came with 20% effort carrying for newborns in the nursery at the NewYork-Presbyterian Morgan Stanley Children’s Hospital (MSCH). But before that day, I was mostly considering myself a scientist, deeply committed to my NIH-funded studies of rodent models of stress and resilience. I used to joke that I was 120% scientist — and physician for whatever time there was left after that.

But that all changed on March 13, 2020, when our hospital diagnosed the first woman in labor with COVID-19 and I, as one of six core attendings in the nursery, would soon be carrying for babies born to these moms. The flurry of activity was overwhelming for many. There were so many questions. So many unknowns. Whole policies and procedures changed. Some of our attendings fell into the category of high risk. Who would care for these infants? And how?

In the midst of this, for reasons that I am still psychoanalyzing in myself, I stepped up and volunteered to be the nursery’s “COVID attending”, which I was for most of the first month of the pandemic that overtook our hospital, healthcare system, and way of life. For the past month, I have been 120% doctor and honored to be able to use my expertise at the frontline. There are a lot of experiences to share about that month.

Here is one:

When I walked into the nursery on that day, one of the babies of a COVID-19 positive mom that had been admitted overnight was inside our newly designated “PUI area”. (Babies born to COVID-19 positive moms are considered “persons under investigation” or PUIs for the first 14 days of life.) I asked the nurse how this baby’s poor mom was doing. Generally, babies in this area have very sick moms that cannot care for their infants in their private room, which is where babies normally are admitted to. The nurse looked at me confused and said “Fine”, curious to why I was asking this. When I finally opened the chart, I saw that the mom was indeed medically stable. She could have had the baby in the room.

I called the mom on her cell phone — one of our many new and strange standard practices now. (These calls are meant to reduce healthcare exposure. We first speak to moms on the phone, addressing any issues or concerns, going over how to care for the infants, etc, then we visit the rooms for the physical exams of the babies.) The mom was panic-stricken. For almost 10 minutes I just let her talk. She was so scared of giving COVID-19 to her baby that she didn’t want to have her baby anywhere near her. She didn’t want to breastfeed because she feared this would transmit the virus. She detailed to me how she had found a friend who would take the baby from the hospital and care for them in their home, far away from mom, for the first 14 days. Then she jumped into a flurry of concerns that 14 days might not be long enough.

When I was finally able to talk, I spoke calmly but confidently. At that moment in time, we had had over 50 PUI babies admitted, most of whom I had personally cared for. I could reassure her that none of our babies had gotten sick despite rooming in with their moms, direct breastfeeding, and going home with their moms. We take precautions of course. Masking, hand washing, breast hygiene, baby’s isolette six feet away from mom. But baby can be with mom! We also now know these babies are doing well when they come back for their first well child visit at our new COVID Newborn Follow-up Clinic. Overall — I could tell this mom with confidence — we are seeing really good outcomes in babies.

As a pediatrician, and in particular a newborn doc, I am still baffled by this. We are always worried about bugs near babies! I told this mom that while still speculative, we think that a breastfeeding COVID-19 positive mom might indeed protect her baby from catching the virus from others. We think this because we know for many other diseases, maternal antibodies transfer to the breastmilk and then to baby, conferring protection against a slew of terrifying germs.

I spent 36 min on the phone with this mom. One hour later, the baby was in mom’s room, breastfeeding.

I can’t relay the magnitude of that in words.

And that’s why I think a general pediatrician belongs at the decision making table.