Parnit Faber knew what was about to happen, as she labored with her third child, breathing heavily through a face mask.
But knowing didn't make the experience any easier.
After Faber gave birth to a boy, a nurse held up the infant for Faber to see, announced his weight -- and then carried him out of the room.
Her son Lucas was healthy. But Faber, of Darien, had tested positive for COVID-19 while giving birth at Advocate Good Samaritan Hospital in Downers Grove, so the baby was taken to neonatal intensive care as a precaution.
Faber didn't get to touch her child. It would be 12 days before she could hold him.
Faber was devastated, but she understood.
"It was just disheartening because what could I do?" said Faber, 39. "All I kept thinking was, I just want to make sure he's OK. I wanted him to be safe."
Chicago-area hospitals, and others across the country, are recommending that mothers with COVID-19 be separated from their newborns right after birth, in line with guidance from the American Academy of Pediatrics. They are often apart in the hospital for at least 24 hours, until the baby can go home with the parents -- including the mom, who's advised to keep her distance -- or other family members.
If it's not possible to put the baby in a separate room after birth or a mom wants to keep the baby in her room, the academy suggests making sure the newborn stays at least 6 feet from the mother. Many hospitals are recommending that women with COVID-19 pump breast milk to be fed to their babies by a healthy caregiver; according to the academy, no studies have detected the virus in breast milk.
"It's hard because in all these circumstances, we don't know what the right thing is, but right now, while there's so much uncertainty, we're being very conservative," said Dr. Emily Miller, a maternal fetal medicine physician at Northwestern Medicine Prentice Women's Hospital, where babies born to mothers with COVID-19 are being sent to specially designated nursery rooms.
Local hospitals often differ in how they handle other aspects of caring for women with COVID-19 and their babies -- differences that reflect how much remains unknown about the illness.
For example, NorthShore University HealthSystem, which has five hospitals in Illinois, is testing only those moms who are showing symptoms or have had known exposures, for COVID-19, while Prentice, Mount Sinai Hospital and Amita Health hospitals are testing all women about to deliver.
"The honest impression I have is there's not one perfect approach that makes the most sense for everyone, but for us, we've taken the approach we feel acknowledges the limitations of testing but simultaneously protects the health and well-being of babies," said Dr. Richard Silver, chairman of obstetrics and gynecology at NorthShore.
At both Prentice and Amita Health, which has 19 hospitals in Illinois, partners are generally not allowed in the delivery room if a woman tests positive. NorthShore hospitals and Mount Sinai are allowing partners if they wear personal protective equipment.
"This is all new territory for all of us," said Tracie Shelton, assistant chief nursing officer at Sinai Health System, which so far has had at least eight COVID-19-positive moms deliver at Mount Sinai, on the city's West Side.
The pediatrics academy recommends that babies born to COVID-19-positive moms be tested for the illness 24 hours after birth and then again at 48 hours after birth. If an infant tests positive but does not show symptoms, the academy recommends caregivers stay in frequent contact with health care providers for 14 days after birth -- through calls, telemedicine or office visits. Prentice, NorthShore, Sinai and Amita have not, so far, had any newborns test positive for COVID-19.
NorthShore says it has cared for nearly 30 pregnant women with COVID-19, though most were far from their due dates when they were diagnosed, Silver said. So far, the system's Evanston Hospital has had three COVID-19-positive moms give birth, he said. Amita has had 11 women with COVID-19 deliver babies. Prentice declined to give a number.
"The emotional toll this has had on pregnant moms and their families is not trivial," Silver said.
Advocate Good Samaritan Hospital, where Faber gave birth, is now testing all women about to deliver for COVID-19. But that wasn't the case when Faber delivered at the hospital in late March.
Before Lucas was born, Faber suspected she had COVID-19 but wasn't sure. A nurse at University of Illinois Hospital, she had developed a fever, chills and aches after caring for a man she believes may have had the illness.
It was so early in the pandemic that not all hospital patients were being tested for coronavirus. And Faber wasn't wearing a mask when she drew blood from the man's chest port or gave him a breathing treatment. Not until after Faber had cared for the man did she learn doctors wanted to test him for COVID-19.
The University of Illinois Hospital declined to comment on Faber's case, citing privacy issues. But Dr. Susan Bleasdale, the hospital's acting chief quality officer, said in a statement that the hospital has "always followed the latest scientific guidelines from local and national public health officials, which have changed rapidly over the last few months." The hospital began requiring all staff and patients to wear masks March 27, and began testing all patients for COVID-19 upon admission on April 16, she said.
Faber started feeling ill three days after she cared for the patient. She was then 39 weeks pregnant. She isolated herself in her bedroom at home, asking her husband to care for their daughters, ages 2 and 3, so she wouldn't spread her sickness.
Her 2-year-old, Alana, would come to the bedroom door and call "Mommy," not understanding why her mother wouldn't come out.
Then she'd hear Alana's sister, Brynn, explaining: "Mommy's sick."
Faber also missed most of Alana's 2nd birthday, which occurred during her self-imposed isolation.
"I came out real quick in my mask and said, 'Happy birthday,' " Faber said. "It was tough."
During that time, Faber was tested for COVID-19 but didn't receive the results quickly. Her doctor had planned to induce labor on March 21, given her risk factors, which included advanced maternal age and gestational diabetes. But she and her doctor decided to push back the date a couple days in hopes of getting the test results.
By March 23, there was still no answer, and Faber and her doctor decided it was time to move ahead with the induction. Faber had started to feel better, but when she arrived at Good Samaritan she received another COVID-19 test, in hopes of more rapid results. The nurses caring for her donned full personal protective equipment in case she had the illness.
In midafternoon, the results of her first test finally came back: negative. Faber was elated, and the nurses caring for her removed their layers of protective equipment.
Faber's husband, Aaron, remembers being surprised at the negative result, given how sick his wife had been.
Parnit's labor continued to progress normally. And then, about 10:30 p.m., the second test result came back. It was positive.
"My OB walked in, and she was gowned up, in the full gear," Parnit said. "I looked at her and I was like, 'What happened?' and she said, 'Your test here came back positive,' and I was just shocked."
As a nurse herself, Parnit felt terrible for the nurses who had cared for her without protective equipment. She also knew the result meant that she wouldn't be able to hold her baby once he was born. She and her doctor, Colleen Skay, had discussed earlier that week what would happen if Faber were positive for COVID-19.
Parnit wanted to do the right thing for Lucas, but she missed "the bonding with the baby and being with the baby. That was really hard for my husband and myself."
She cried as Lucas was carried out of her room.
"It's heartbreaking to think about a mom not being able to spend the time she deserves with her newborn," Skay said. "We all know how very valuable that experience is for a mom and baby."
Doctors decided to keep Lucas in the NICU for about two days, just to be safe. Every day, Parnit would use FaceTime to talk with the neonatal nurses and get glimpses of her son.
"I would just cry every time, and the nurses were like, 'Oh, he's doing great,' " Parnit said.
"It was just so hard, because I missed my son," she said.
Lucas wasn't tested for COVID-19, but he never developed any symptoms and seemed healthy.
When Lucas was discharged from the hospital, the Fabers made the difficult decision to send him home with Aaron's brother and his family. Many Illinois hospital systems continue to recommend that babies born to moms with COVID-19 be released into the care of a relative -- or, if they go home with their parents, remain mostly separated from their mothers -- for a time.
In these situations, the American Academy of Pediatrics recommends that the mother stay 6 feet away from the child. If that is not possible, the academy recommends moms wear masks and make sure their hands are clean when caring for the infant. Those precautions should be taken until the mom has been free of fever for three days and at least seven days have passed since her symptoms first appeared, or she's tested negative for COVID-19 twice.
"That was just like the worst day for us," Parnit said of the day Lucas was discharged but couldn't go home. "For the safety of the baby, we can't have him come home and expose him."
The day after Lucas was discharged, Parnit started feeling worse again. Her oxygen levels dropped and she found herself gasping for air. She had developed pneumonia. Still in the hospital, Parnit was put on oxygen and sent to the COVID-19 unit.
"All I could think was, 'I have to push through this. I have to be strong. My kids needs me. My family needs me. I can't let this virus get me,' " Parnit said.
The worst of the illness soon passed. After about a day and a half, Parnit no longer needed oxygen and was discharged from the hospital. She went back into self-isolation in her bedroom.
Five days passed before it was deemed safe for Lucas to come home.
Aaron Faber hadn't been tested for COVID-19, but he seemed healthy, other than one day, about a week before Lucas was born, when he ran a fever. Their two young children also had felt ill for about a day, weeks earlier, but had been fine since. Given the lack of widespread testing at the time, no one else in the family was tested for COVID-19.
Aaron finally carried Lucas across the threshold of the family's home when the boy was 9 days old. But Parnit still kept her distance, scared of harming him.
Her husband, wearing a mask, cared for Lucas. She could occasionally hear Lucas crying from her bedroom.
"I just kept telling myself: This is for him. This is for his safety," she said. "I couldn't live with myself if something happened to him."
Three days later, she was able to, at last, hold her baby.
He was 12 days old.
"It was just the best feeling in the world to hold him, to just finally be with him," she said. "I just didn't want to let him go."
So far, everyone in the family has remained healthy. Lucas is now 7 weeks old, gaining weight and sleeping well. Parnit doesn't have to go back to work until July.
Still, Parnit can't help but feel a lingering anxiety every time she coughs.
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