Key Points
Most hospitals have limited visitation to prevent spread of COVID-19 and these rules often apply to parents with babies in the Neonatal Intensive Care Unit (NICU).
There are no published NICU-specific clinical recommendations or guidance for how hospitals should address healthy, asymptomatic parents related to parenting in the NICU and COVID-19.
As a result hospitals have independently adopted and continue to enforce a disjointed variety of parent visitation policies including NICU Bans and Restricted Visitation that limit Parents from entering the NICU to parent their medically fragile newborns and fully participate in their care.
Human Rights Violations during COVID-19 are rampant and largely unchecked across the entire spectrum of childbearing in pregnancy, birth, and postpartum.
In the NICU setting it is unethical to withhold Parents, an evidence-based intervention with well documented benefits for both newborns and their parents. Further, separating medically vulnerable newborns and parents for days, weeks, or months is a human rights violation.
We are calling on public health and human rights organizations to develop pandemic response guidelines for healthy, asymptomatic parents in the NICU.
We've been following what's happening in hospitals around the country for families birthing healthy term babies and those with babies admitted to Neonatal Intensive Care Units (NICU). Most hospitals have limited visitation to prevent spread of COVID-19 and these restrictions often apply to parents with babies in the NICU. Without NICU-specific clinical recommendations or guidance for healthy, asymptomatic parents with regard to parenting in the NICU during the COVID-19 pandemic, hospitals have independently adopted and continue to enforce an arbitrary and nuanced variety of parent visitation policies, a sample of which can be read here. Based on what is known about how COVID-19 is spread, this level of observed variation in policy across NICUs describes a system that is disjointed, unprepared, and in need of universal guidance to facilitate equitable rules based on the best available evidence.
Human Rights violations during the COVID-19 crisis are rampant and largely unchecked across the entire spectrum of childbearing in pregnancy, birth, and postpartum. Banning support people, partners, and parents from birth and postpartum units, and NICUs results in the same human rights violations and leaves our most vulnerable without a voice and without informed decision making, which can negatively impact care as well as short and long term health outcomes. Hospital Visitor Bans during COVID-19 are currently being investigated in several US States. In the case of NICU visitation these rules also ignore the latest evidence that recognizes a parent’s relationship with their baby and their advocacy role in the NICU as essential to optimal infant health and wellbeing, in addition to offering a protective effect on parental mental health outcomes.
We know that COVID-19 has exacerbated pre-existing racial and health inequities already present in the United States. Racial and ethnic disparities exist in preterm- and low birth weight birth, which are the leading causes of infant mortality among Black infants. Preterm birth rates among Black women are 49% higher than the rate for all other women. Rule changes that ban parents or restrict parenting in the NICU disproportionately impacts families in communities already at higher risk for poor outcomes because of racial, social, and maternal-child healthcare bias.
Unethical rules that ban parents from the NICU, and rules that make parenting in the NICU more difficult by restricting parent access to the NICU are harmful and complicated by ever-changing data, lack of consistent national and international policy, varied interpretations of professional guidelines, and poor communication between hospitals and parents who have no way to know what new rules their chosen L&D unit or NICU will hand down, and who are often not made aware that they have options or what those alternatives may be—like transferring their baby’s care to a nearby hospital with more family centered rules in place.
A Call to Action
We are concerned that as states continue to reopen, communities will experience subsequent waves of infection that may create conditions similar to those that initially compelled hospitals to react with extreme and unethical policy changes. NICU Families have very little clinical guidance to rely on that speaks to the unique needs of families with babies born preterm, critically ill, in need of palliative care or with a terminal diagnosis in the NICU during COVID-19. Without this guidance families are at the mercy of the policies at their given hospital, and they are suffering as a result.
NICU families need less trauma and more connection.
It is a human right that parents and their hospitalized newborns remain together whenever possible and for as long as they are able.
We know that for Parents navigating the burden of separation, transportation and travel, pumping, parenting a new baby in the NICU while often caring for older siblings at home, managing financial obligations, maintaining work and family responsibilities and relationships, all while trying to take care of self and physically heal from a recent birth, make any time spent at their baby’s bedside a herculean feat.
It is the responsibility of every Institution (Hospitals and their NICUs) to do everything within their power to protect the mother/baby dyad, and to make it easier—not harder—for families in crisis.
We are calling on public health and human rights organizations like the Centers for Disease Control (CDC), the World Health Organization (WHO), professional Associations like the Academy of Pediatrics (AAP) and the National Association of Neonatal Nurses (NAAN) to take a stand that parents are not visitors in the NICU and develop pandemic response guidelines for healthy, asymptomatic parents in the NICU. Decision makers must begin with the belief that the mother/baby dyad is critical to the success of human milk feeding, attachment, maternal mental health, and infant growth and development, and then do whatever it takes to center families first in the context of a pandemic.
Update: in January 2021 a position statement was released by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), the National Association of Neonatal Nurses (NANN), and the National Perinatal Association (NPA) stating that NICU parents are "essential caregivers" and when following the local health directive measures they should be provided unrestricted access to their hospitalized infant.