We've all seen the adorable-yet-heartbreaking pics of grandparents meeting a new baby through the front window or standing at a distance on the porch, aching to cuddle that newborn. As many Canadian cities and provinces ease restrictions, and some households pair up to form "bubbles," is it safe for Grandma and Grandpa to hold their newest grandkid now? We spoke with Dr. Tali Bogler, a family medicine obstetrics provider at St. Michael’s Hospital in Toronto, to help us weigh all the risks and best practices.
Yes, as a doctor, I need to remind readers that everyone needs to make a decision that they feel most comfortable with, and the answers here do not replace medical advice from your healthcare provider. And our understanding of COVID-19 is evolving daily so the answers here are based on information available at the time of writing.
Ever since some provinces got the OK to build social circles or bubbles of up to 10 people, expecting families have begun exploring this option more. Prior to this announcement, new moms were struggling with the notion that they couldn’t rely on the grandparents for support, or could not introduce their newborn to loved ones. I would often hear my patients saying: “How are we going to manage?” or “This is not the pregnancy I imagined...” Many were grieving the loss of the pregnancy they envisioned, especially around introducing the newborn to loved ones—one of the most joyous moments in a growing family’s life. For grandparents especially, I can’t think of an occasion more painful to miss out on than holding and bonding with their newborn grandchild.
Another major challenge has been not having grandparents or relatives to call on to watch the older child when you’re going into labour, or to help with the toddler after the baby is born. This postpartum support is especially important to recover from the delivery and care for the newborn, particularly in the absence of reliable childcare during the pandemic.
But I think that ever since the expanded bubble announcement and loosened restrictions here in Ontario, these questions have transitioned to, “Should we be expanding our bubble, even if it’s allowed?" or, “How can we do this safely once the baby is born?”
It’s certainly not a bad idea, as this is one way to minimize the risk of COVID-19 transmission between all parties. However, rather than relying on this solution (which is not always practical), I encourage the family to ensure they are doing everything possible in the weeks and days leading up to the delivery to minimize their exposure to COVID-19: adequate physical distancing, proper hand hygiene, and wearing a mask in indoor settings. This way, if the baby comes earlier than expected (babies are notorious for arriving unannounced) or if the family needs support right away (e.g. due to a difficult delivery or postpartum recovery), all parties can feel more comfortable coming together.
I would add that if family members are coming from a different bubble (or were not able to minimize exposures to COVID-19 in the weeks prior) and are hoping to form a new bubble with the newborn baby and parents, it would be safest to quarantine for two weeks prior to coming together.
A COVID-19 test result is just a point in time. If done too early in the course of infection, this can lead to a false negative result and false reassurance. A negative COVID-19 result does not replace minimizing exposures in the weeks or days leading up to the meeting, or to stop using masks when coming together. If someone is worried about COVID-19 symptoms or had a potential exposure, I would encourage getting tested, but it's important to keep in mind that this does not replace isolating for 14 days prior to forming a new bubble.
I would say that it depends on the degree of exposure at work. For example, if the relative or grandparent is able to maintain proper physical distancing at work, wears a mask or additional Personal Protective Equipment (if necessary for their type of work), is careful about hand-washing, and is mindful about not touching their face, then the exposure might be quite minimal.
In general, I am less concerned about the newborn transmitting COVID-19 to the grandparents—especially given that the newborn is not running around socializing with others—and more concerned about the parents of the new baby transmitting COVID-19 to the grandparents, particularly if they were not able to minimize their exposures in the weeks and days prior to coming together.
Every family’s situation is unique, however, and when I speak about risk during COVID-19, I suggest thinking about the risk of contracting COVID-19 as well as the risk of developing serious outcomes in each family member. The current evidence would strongly suggest that the risk is greater for the older individual, especially for those with additional health conditions (such as obesity or heart disease).
The current data suggests that the risk to the newborn is quite minimal and that children have thankfully been spared from the severe effects of COVID-19. There are very few reports of severe illness from COVID-19 in children and these rare cases were more common in children with certain underlying medical conditions. I keep on reminding my expecting parents that there have been no paediatric deaths reported in Canada to date.
Unfortunately, this is not the case for grandparents, especially older grandparents, as nearly 97 per cent of all COVID-19 deaths in Canada have occurred in adults aged 60 years of age or older.
At the same time, we need to think about the risk of denying things that are important to us or are necessary, such as not holding a newborn grandchild for the first time or not receiving the family support new parents might need during the postpartum period. When I think about when I had my twin girls, it would have been extremely difficult—if not impossible—without the hands-on support from my parents.
Many of my patients are allowing their parents to hold the new grandchild in an outside setting, while wearing masks, with meticulous hand hygiene before and after the interaction. Nothing is without some element of risk, but as long as everyone is making an informed decision based on the current evidence that minimizes the most amount of risk, then I think this is the best we can do during these uncertain times. And at the end of the day, the decision is about risk tolerance. I often have to remind my patients that the grandparents in these scenarios also have the autonomy to make an informed decision.
There has been this understandable but unfounded fear that it is unsafe to visit the hospital during the COVID-19 pandemic. We need to squash this myth because it is simply not true, and frankly dangerous, for patients to avoid seeking medical attention in hospitals or medical clinics when necessary. I feel much safer going in and out of my hospital than I do grocery shopping. Hospitals have screeners at the front entrance, patients and providers are wearing Personal Protective Equipment (PPE) and there are all the necessary infection control precautions and protocols in place to reduce exposure to COVID-19. With all this in mind, the notion that new parents need to quarantine for two weeks after leaving the hospital simply because they were “inside a hospital” is not based on a ton of logic, especially when you compare it to other settings that we might interface with, which do not have as stringent infection control measures in place.
The same answer would apply to a home birth attended by midwives. Home births are not more or less safe from a COVID-19 exposure point of view, if the same infection control precautions are in place as they are in-hospital. Home births are “less safe” from a COVID-19 perspective if providers and family members present at the birth are not following the infection control measures and guidelines recommended by their local midwifery associations.
People often think that it is safer to drive instead of fly, however, the answer is not as simple as that. The evidence on this continues to evolve, but COVID-19 transmission on planes might be lower risk than what many people believe. (One example would be the first Canadian case of COVID-19, when the symptomatic individual who tested positive for COVID-19 was on a 15-hour international flight with 350 other passengers, and not one of the other passengers contracted COVID-19.) I’m not saying that the risk with flying is minimal, but current evidence is suggesting that it might not be as high as we had assumed.
The other thing to think about is how long the drive is. If the drive is four hours long, and requires very few stops, of course it makes sense to drive and is likely safer than flying during COVID-19. However, if the journey is longer and requires at least two days of driving, you need to quantify the number of stops along the way that would involve potential exposures (e.g. bathrooms, food breaks, rest and gas stations, and an overnight stay at a hotel). All of these exposures start to add up and the cumulative risk of acquiring COVID-19 while driving might be greater than flying.
If family members are driving to meet the newborn, I would recommend trying to physically distance at all these stops, wearing a mask and meticulous hand washing when leaving each location.
The answer to this question depends on your local, community transmission rates at the time: where there is a lower prevalence, there is lower risk. There are also infection control measures in place at all daycares and camps to make it as safe as possible (restricting the number of kids in close quarters/small space, not allowing certain activities that are known to be high risk for transmission, etc). As mentioned above, children might not be effective transmitters of COVID-19 as we previously thought. So, I’m less worried about older children in daycare in terms of risk to the newborn, and I’m a bit more worried about older children in daycare with grandparents in the home—particularly older grandparents and those with certain underlying medical conditions. It is also imperative that we start teaching children respiratory etiquette and how to wash their hands properly.
I keep on reminding all my patients that newborns have thankfully done really well in the context of COVID-19, and there are many other viruses, especially in the winter months, such as influenza and RSV, that can potentially have much greater consequences on the newborn. The concern with COVID-19 is really in terms of other vulnerable groups—specifically older individuals—and what we can do as a society to protect them. The same infection control measures that we were practising with newborns prior to COVID-19 still apply (like proper hand hygiene and not visiting the baby if you’re at all sick). I think that if we can stick to our basic principles on how to visit newborns safely, our little ones will be healthier, well after COVID-19.
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