14. 5. 2020

English Version | Waiting State

by Joana Moreira

 

The pandemic monopolized attention and muted moments in life marked by unity. Some leave without saying their much-deserved goodbyes. Others are born without the expected hugs. New mothers have never been more alone. Three of them tell Vogue how are they challenging history - and rewriting theirs.

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The new coronavirus stole us kisses, hugs, tenderness. Social distance has extended beyond the living, and there are many overwhelming reports on the profound loneliness of people who lose their loved ones and cannot say goodbye. To die in a pandemic time is to leave earth without the last touch. To be born in a pandemic time is to arrive on this earth not knowing when the first will be. The first smell, the first milk, the first touch of skin against skin. Security constraints mean that what were once happy times are now times of concern. The opinions of the General Health Directorate (DGS) and the World Health Organization (WHO) differ, leading to different attitudes between hospitals and health professionals. Graça Freitas, face of the DGS, said that “when the pregnancy comes to an end, a test must be made". But there’s a gap from duty to actually doing it. “Most of our cases of pregnant women with COVID-19 have no symptoms - 50% in our national database. Therefore, the test is justifiable, the screening, to all pregnant women who go into labor. And many hospitals have already adopted this procedure. Other hospitals, in addition to the pregnant woman, also intend to test her companion”, said Diogo Ayres de Campos, President-elect of the European Society of Perinatal Medicine, in an interview with SIC TV station. You only need to speak with health professionals to realize that the difference between health institutions, both public and private, from the north to the south of the country, is undeniable. 

“Not all Hospitals are operating in the same way,” says Paula Gonçalves, a nurse, to Vogue. “The reality is that pregnant women have not been included in the risk groups for COVID-19 infection. It has to do with the lack of scientific evidence”, she explains. Regarding the need to test, and despite the words of Graça Freitas, “the rules from DGS do not mention it. Within the pregnant population, there is no obligation to take the test”, explains Paula. Until now, the risk of infection among pregnant woman seems to be the same as that of the general population, and little is known about transmission to the fetus, but it looks like a low probability. There is also no evidence that the virus spreads through breast milk and the benefits of breastfeeding are believed to outweigh the potential risk of virus transmission. In the same way that there is no evidence that after delivery the mother with COVID-19 should be kept apart from the newborn. The impact of separation can be more damaging than the risk of infection. But this is a controversial issue, as DGS itself admits, but for WHO it is clearer: mothers with COVID-19 can and should make skin-to-skin contact with babies, breastfeed, share a room, give birth, all of it while maintaining the conditions of hygiene and cleanliness.

“I know of several cases in which the mother was not allowed to have skin-to-skin contact. Even with WHO and some other entities saying the opposite”, assures the nurse, who warns about the possible psychological impact on the future mother. “The benefits of skin-to-skin contact are clear, the connection, the mother's and baby's hormonal awakening, the first breast search and the first breastfeeding in the first seconds of life, all of this is highly recommended, it messes with physiological matters, and with the development of both the immediate postpartum recovery of the mother and the development of the baby”, she says. The psychological factor is now a real concern. “These are women and families who have been experiencing their pregnancy, which is an important time of life, very unique, which is not replicable because all pregnancies and births are different. Many of these women prepared for childbirth, managed their expectations before their partner, their family, had a very clear idea of ​​what they wanted, made their birth plan and, suddenly, everything they had envisioned ends up frustrated. Either because they became infected or because, as a matter of precaution, this dynamic was changed. It is a time when women are extremely sensitive, many women feel robbed of this very special moment. I think the psychological impact is very big.” Mental health is one of the points of the document with preventive measures for pregnant women in times of COVID-19 from the Center for the Study of Obstetric Medicine (NEMO) of the Portuguese Society of Internal Medicine (SPMI), issued on April 24th. "There must be special care for mental well-being and, if necessary, contact a psychological support line." 

But as long as there are no absolute certainties and tests are not guaranteed, the possibility of being infected is a constant concern. This is the case of Carolina Gonçalves. “In the last visit with my obstetrician, we spoke about this. She told me that there are already hospitals contacting all pregnant women at 39 weeks to carry out this test, but in the hospital where the birth will be, there is still no such indication. I am anxiously waiting for that measure to come out”. Carolina is 27 years old, an occupational therapist, and is pregnant for the first time. Because she has a job considered to be at risk for pregnancy, she has been at home since the 26 weeks. Today, on the way to 38, a lot has changed. “I consider myself a calm and optimistic person, but the current state of things has made me anxious. On the one hand, it is part of being a first-time mother and join this unknown adventure. It already develops a lot of adrenaline in us, [but] experiencing a pandemic is waking up and falling asleep anxiously, joining these two situations is even worse”, she admits.

Considering her partner works in a supermarket, Carolina opted for isolation by temporarily moving in with her parents. Without major changes to the health plan, doctor visits and exams, the most difficult thing was to readjust expectations. “I saw myself doing those things we always wanted to do: prepare the baby's room, which is now half-way done, do a photo shoot, which we had to cancel, the famous baby shower was also suspended... And to live the last days as a couple, strolling, dining out, preparing the house, the latter reason being the most difficult to manage”, she confesses. For now, contact with the baby's father remains at a distance. “It hasn't been easy for him [...]. He takes extra care at work with the hope that he won't get contaminated”. Hope (and caution) is all that is left for her to fight fear. “My biggest fear is that we get contaminated right now. After so much protection, some carelessness can ruin everything, or not, because every day we hear stories of people who can’t think of how they got infected. My fear is that, at the time of delivery, I will have some symptom and that the baby will be taken away, that they don’t let the father see her and or me breastfeed her”, she acknowledges.

Laureen Gouveia de Melo's story is different. The 26-year-old photographer, living in Paris, has a gynecological disease and that is why she defines her future baby as “a little miracle of nature”. Given the circumstances, she had been at home since December, and visits to the streets were scarce even before any mandatory isolation was issued. However, her husband continued to work. Until Laureen felt the first symptoms. “We called Saúde 24 and they advised me to stay at home because the symptoms were not alarming, it was cough, headaches, diarrhea, moderate difficulty in breathing and muscle pain... At that time, France was at the peak of the epidemic and only people with more breathing difficulties were admitted to hospitals for lack of beds,” she explains to Vogue. The days passed and the symptoms got worse. “It was being very hard for me. The pulmonologist sent me to take the test on March 30,” she recalls. The result was expected: positive for COVID-19. “The concern for the baby has started to set in, even if everyone tries to reassure us that he is protected. Basically, are we really sure?”, she asks. "There are many questions and fewer answers."

Today, more than a month later, and at 28 weeks pregnant, the symptoms have practically disappeared. But nothing is certain. Laureen knows that a new test is not scheduled, and so she hopes to be able to do a promised serological test, to assess immunity to the virus. For now, and because she has a risky pregnancy, she continues to visit her doctor, but with increased protection. “I have to have a mask, gloves, let everyone know that I am infected with COVID-19 before I arrive and the [baby's] father can never accompany me”, she says. The childbirth preparation classes, however, were canceled. “I risk not having taken any classes before having the baby. It’s a source of additional anxiety”, she does not hide. “We had imagined a magical moment that we would share together, the baby's father and me. In fact, we had booked a single room in the maternity ward so that he could stay with us day and night and thus start our family life as a trio. But with all this, everything has changed.” Laureen knows that "the delivery will not take place in the same way as a 'normal' delivery, but nothing is written and everything is seen on a case-by-case basis."

Inês (fictitious name) prefers to remain anonymous when she tells Vogue her story. She is a health professional, and has now  a baby in her arms, but what has happened recently is something she will not forget. At the age of 33 and at 39 weeks of her first pregnancy, she discovered she had COVID-19. “I did the test on a Friday, only to be admitted on a Sunday”. She had been at home in isolation for a long time and completely asymptomatic. “I was surprised. The only trips I made were appointments at the hospital and once or twice I had to go food shopping. It was almost impossible to have contracted it from contact with people. Only if it were through surfaces, in the hospital or supermarkets”. Inês decided to go home, try to do the isolation with the baby in her belly, “limiting the maximum number of days that I would have to be in isolation from her later”. Still, she didn't want to leave the hospital without her husband being tested. “Our idea was if it was really negative he would be able to come home with the baby in his care”, she explains. The companion test was negative and a scrupulous action plan followed. “When we got home, we cleaned everything up and basically divided our house in two, so as not to share spaces. Each one in their own room, with their own bathroom, in the living room as well, we created an area for each one of us, and in the kitchen we had different utensils, without sharing. This kept going on until delivery and then in the postpartum for two more days, because although the father was negative, he ended up being in contact with me, and as much as I tried to isolate myself, I was afraid that I could have infected him”, she tells Vogue. 

The delivery would only happen almost ten days later. “As soon as I got into the emergency room, I did the screening again, but the result only came later, which means I did the cesarean section assuming I was COVID-19 positive. Only that night I knew it was negative. That's why the procedures [at delivery] were to let me see the baby's exit from the belly, to cut the cord, and that was basically it”, she says, with a sigh. "That was the most difficult thing to manage, because in the end I was in a place with only positive COVID pregnant women when I knew I was negative and then there was also anxiety and difficulty in managing things at that moment". Because it’s her job, Inês knows that “false negatives are much more common than positive ones, but these also exist”. The first time she touched her daughter, it had been 48 hours after giving birth. "I was responsible for having an early hospital discharge because both of us were negative after 48 hours". She went home with the baby, "with no need to distance herself from her, just washing her hands and all that stuff." However, the result of the father's test took four days and there was a possibility that he was infected. So "we cleaned everything up again, and he ended up going to the room where I was, which was supposed to be the 'COVID room' and I went back to our room, supposedly the clean room, to receive the baby," she explains. “I confess that it is a difficult thing to manage. It is difficult to be with a newborn and constantly having to remember all the logistics of disinfection and non-contact and isolation and all that,” she says. Today the three of them: mother, father and baby are at home. Negative, happy and, above all, together.