Childbirth in the age of coronavirus: Parents in South Florida balance joy and fear
Jean Costume drove his pregnant wife Alena to the hospital, nudging the accelerator. It was time. Hallelujah and not yet, they thought. Alena rubbed her beach ball-sized belly to keep it from bursting. In between tandem deep breaths, they said an abbreviated prayer. They prayed for their doctors and nurses, for a safe delivery, for their 3-year-old son and his aunts at home.
A long exhale and one more plea: When they brought their baby daughter out of her insulated womb into a chaotic world infected with coronavirus, they prayed none of them would catch it.
Nurses in masks, face shields, gloves, gowns and booties at Memorial Hospital West whisked Alena by wheelchair to a COVID-19 testing room where both nostrils were swabbed so high “you might as well have tapped my brain,” she said. Hand-washing instructions and No Visitors signs were posted on the walls and blue social distancing tape was applied to the floor.
She waited an hour for the result. An interminable hour of trying not to think the worst because she knew expectant mothers who tested positive would be sent to an alternative maternity ward, as if marked with a scarlet plus sign. She tested negative, and moved to a labor and delivery room. She heard “Rocky” theme music playing over loud speakers; the triumphant song meant a COVID-19 patient was being discharged, alive.
“So surreal,” Alena said.
Six-pound, 6-ounce Remy emerged healthy at 6:51 p.m. on May 14, but it was not the childbirth experience her parents had planned. Life for the human race had changed radically since their baby was conceived nine months ago. Coronavirus compounded the stress of having a newborn and muted the joy. The threat of infection, as omnipresent as air, created trepidation about raising a child in the brave new world of a killer pandemic that has taken more than 2,200 lives in Florida and 352,000 across the globe, with no cure in sight and guarantees of wretched contagions to come.
Survivors adapt
Naiviv Perera Morales and husband Alex Alvarez Garcia got stranded in Miami when flights home to Uruguay were canceled. Then Naiviv went into labor five weeks prematurely, which she believes was triggered by coronavirus anxiety. They Googled local hospitals and wound up at the Jackson Memorial emergency room. Baby Alan was delivered by cesarean section April 19, weighed 3 pounds, 15 ounces and spent 11 days in the neonatal intensive care unit.
“We’re living in limbo,” Alex said.
They have embarked on their journey as a new family while quarantining at a cousin’s guest quarters in Miami Springs, surrounded by borrowed baby gear and a fog of pandemic uncertainty.
“How long will it last? The Black Plague lasted for years, and recurred in waves over centuries,” Alex said. “Nobody knows anything for sure. Darwin said the species that survives is the one that adapts. We’re adapting. The virus is strong, but nothing is stronger than family love.”
“The pandemic overshadowed his arrival”
Lane Casey was born March 26, about 16 hours after his parents, Shauna and Tyler, arrived at Mercy Hospital and had their temperatures confirmed as normal. A nurse told them not to worry, Mercy had admitted only eight COVID-19 patients.
Their widening eyes met over their masks. We’ll be out of here soon, they hoped.
Lane weighed a robust 8 pounds, 12 ounces despite arriving two weeks early. He spent 10 days in neonatal intensive care with reflux. Only Shauna was allowed to visit, only two hours per day, after scrubbing in twice and covering up with mask and gown, not ideal for bonding. But for the Caseys — parents of 5-year-old Connor and 3-year-old Lucy — the hardest part has been a sense of isolation. None of their relatives or friends was allowed to come to the hospital. Nor have they been able to share the wonder of meeting and holding Lane.
“It’s disappointing, and I don’t know when they will,” said Shauna, who lives in Miami Shores. “Lane’s birth felt kind of anti-climactic. The pandemic overshadowed his arrival. Everyone is stressed and it’s constantly in the back of your mind, so we couldn’t fully enjoy it.”
What does the future hold for Lane, Alan, Remy and all the babies of GenCoronavirus?
“Alan’s part of history,” Alex said. “What’s the first thing I’ll teach him as a father? How to wear a mask? Will he have birthday parties and pajama parties? Or only Zoom parties?”
Pregnancy for some may be postponed or shelved altogether because of coronavirus apprehension, Shauna said.
“Sometimes I feel sad for Lane because I’m not sure if he will know the childhood my other kids know, or the freedom of my childhood,” she said. “Will he know what it was like before coronavirus? Once we get a vaccine, will we always be worrying about a new pandemic?”
No transmission from sick moms to fetus
The parents knew about Angela Primachenko, the respiratory therapist in Washington state who was severely ill with COVID-19, on a ventilator and in a medically-induced coma when doctors induced labor and delivered baby Ava — named for “breath of life.”
A New York woman, Yanira Soriano, had her son delivered by c-section while she was on a ventilator and in a coma. Both moms and babies are fine now.
The expectant mothers also knew, even if they got sick, there is little evidence of transmission from mother to fetus.
“About a dozen of our maternity patients have tested positive for the virus but none of their babies,” said Dr. Michael Paidas, professor and chair of the department of obstetrics and gynecology and reproductive science at the University of Miami’s Miller School of Medicine. He has been on the front lines delivering babies at Jackson on a labor floor reconfigured with negative pressure rooms for patients who test positive.
“There has not been a definitive case of vertical maternal-fetal transmission,” he said. “We had one seriously sick patient in ICU, but she and the baby came out of it safely.”
A study in the Journal of the American Medical Association by a children’s hospital in Wuhan, China, where the virus originated, found that three of 33 infants born to mothers with COVID-19 tested positive for the virus. The doctors involved in the strictly controlled deliveries said the cases suggest intrauterine infection. Another study of 38 infected mothers in China found no transmission.
Paidas is leading a UM study of infected maternity patients and their newborns to collect more data from blood, urine and placenta samples.
Although much remains unknown about the novel coronavirus, Paidas has not seen any indication that the breast or breast milk can be a portal for the disease.
The greatest risk is likely postpartum, when the infant is in close contact with parents or caregivers who could be asymptomatic carriers.
“The big difference with COVID is it spreads so easily via respiratory droplets, just from breathing,” Paidas said. “When we see influenza in pregnancy, it pales in comparison to the magnitude of this disease.”
Hospitals’ policies prohibiting visitors and allowing only one partner in the delivery room, combined with extra precautions and doctors’ and nurses’ protective armor, have added tension to childbirth, Paidas said.
“I lost a faculty member to COVID,” he said. “The mental health aspect can’t be understated. We have a lot of anxious moms and care providers.
“We’re talking about estrangement, social distancing at the most personal, momentous time for patients. Back at home, cut off from family, they may be more prone to depression.
“I give credit to our patients and our team. They’ve risen to the occasion under unprecedented circumstances.”
A COVID-19 death in the family
Alena Costume never panicked during her pregnancy, except momentarily when the heartbreaking death toll from Italy and dire projections for the United States convinced her to reduce the number of guests at her baby shower in early March.
But when her uncle, Charles Peters, contracted the virus and died two weeks before Remy was born, Alena felt frightened and angry.
The family is still mystified as to how Peters, 71, got infected. His wife, a nurse in a home for the elderly, never caught it. The friends he played dominoes with never caught it. Peters had symptoms and tested positive at the hospital, but was sent home with medicine.
“He didn’t have a temperature and they said they were not admitting because they were full,” Alena said. “They did nothing about contact tracing, no instructions on how to alert others. He took a turn for the worse a couple days later and my aunt found him unresponsive in his recliner.”
A funeral was held May 23 for a limited gathering of 10 relatives. All 10, including Alena’s mother and aunt, will have to wait an extra two weeks in self-quarantine before they can see Remy.
“My family is in mourning at the same time they’re excited about the baby,” Alena said. “When it hits home, you realize it’s still spreading and anybody could be carrying it. We became even more cautious.”
When Jean comes home from work, he removes his clothes and takes a shower. Son Urih’s Saturday sleepovers with grandma ended. Instead of sending Urih back to preschool in June, they’ll wait until August or September.
As they left their Miami Gardens townhouse cocoon and drove to the hospital in Pembroke Pines on May 14, Alena’s uncle’s death and the insidiousness of COVID-19 weighed on their minds. They concentrated on good news. Jean, who had been barred from Alena’s obstetrician appointments for two months as the number of cases in Florida steadily approached 50,000, would be allowed to stay by Alena’s side in the delivery and recovery room — a practice some hospitals suspended.
The Costumes were on the verge of welcoming the baby girl Jean dreamed about.
“I knew how over-protective I’d be as a dad, so I prayed to God to give me a boy first so he can help me protect our little girl,” Jean said. “We named him after Alena, which means light. Urih means God’s light.
“We named her after me. My full name is Jean Remy. Remy means the Lord uplifts.”
Despite the global cascade of health and economic disasters caused by coronavirus, they hadn’t lost their faith. They hadn’t lost their jobs — Alena, 35, as project manager for campus wellness promotion at Barry University and Jean, 32, as a concierge in the hospitality business.
They hadn’t lost their default attitude of gratitude. Jean, who was born in Haiti and remembers crying for food, and who grew up in North Miami grieving the friends who got in trouble and went to jail, is confident his kids will prosper — no matter how many pandemics strike.
They hadn’t lost their sense of humor. While Alena awaited test results, Jean slipped out and brought back Chick-fil-A, the same meal they’d eaten after every doctor’s appointment.
Five hours of labor later, Alena’s extreme pain gave her the shakes.
“Then I threw up,” she said. “It was more intense than with Urih. I was ready to say call it, cut me open, I don’t have the strength to push anymore.”
With the couple’s chosen contemporary Christian music playing in the background, a masked Jean and masked and face-shielded nurse helped Alena catch her breath between contractions.
“I started screaming: ‘She is coming!’ Like if your child scored the winning shot in the championship game,” Alena said. “‘She is coming!’ They could hear me from outside the room, that’s how loud I was.”
Remy was born, her unusually long fingers balled into fists. She was placed skin to skin on her mom’s chest. Nobody was thinking about coronavirus.
Remy cuddled with her parents for 10 hours before she was transferred to neonatal intensive care for phototherapy treatment of jaundice. Elevated bilirubin levels in her blood, which can cause brain damage, prompted a discussion about moving her to Joe DiMaggio Children’s Hospital for a transfusion.
“Here we go again,” Alena said. “Urih was in NICU for nine days with a collapsed lung.”
But Remy improved. After four days under the lights, she lost her yellow tint. She was discharged.
“I was overcome with joy. Relieved,” Alena said. “Finally we get to take her home. She’s healthy.”
Said Jean: “We walked out, and the only reminder that the virus was present was our masks.”
Parents are stranded in Miami, the baby comes early
The birth of pandemic baby Alan Alvarez reflected the upheaval of the society he entered abruptly.
His parents, Alex and Naiviv, met at a park in their hometown of Havana. He, an engineer who loves solving math problems and playing word games, figured out the origin of her name. It’s her mother’s name, Vivian, in reverse.
“He’s a genius,” Naiviv said.
Eight years later, after he’d relocated to Uruguay, they married and she joined him in Montevideo.
The due date for their first child was May 29, so they decided to take a vacation to Las Vegas and Miami in late February. Inside crowded Vegas casinos and nightclubs, they found themselves growing unnerved as headlines about a hyper contagious virus devastating Europe and jumping to the U.S. dominated the news.
Once they got to Miami, travel was disrupted and lockdown orders took effect. Alex did the math on community spread rates. They feared contracting the virus on a long flight.
“We thought we had enough time to return to Uruguay after the initial 30-day shutdown ended,” she said. “But it got worse. We got scared.”
They stayed put with Alex’s aunt, watching TV and the grim updates of tallies, graphs and models. They searched “childbirth in Miami” on the internet, found favorable reviews and settled on Jackson as their backup plan.
When Naiviv’s water broke unexpectedly on April 18, they rushed to Jackson.
“It was a weird scene,” Alex said. Had he been dropped on a sci-fi movie set? Or in Chernobyl? Doctors and nurses wore in scuba masks, hooded spacesuits with exhaust valves, hazmat coveralls, window-sized face shields. “We couldn’t see anybody’s actual face. They treated us like we had a toxic terminal disease while trying to be kind.”
Both tested negative and spent the next 15 hours together in a labor and delivery room. Masked nurses came and went.
“They were very encouraging, all night,” Alex said. “’Hey, mommy, what can we bring you to eat? Hey, daddy, don’t worry, it’s going to be OK.’”
When Alan’s heart rate plummeted, two doctors decided to do a c-section. Alex was ushered into the operating room, garbed like a surgeon. Alex had predicted Alan would be born at 8 p.m. because their wedding date was Aug. 8, 2016, they met in 2008, “and everything in our lives is eights,” he explained.
At 8:09 p.m., one doctor lifted the screaming newborn and said, “You have a beautiful baby boy.”
“Well, he was not so handsome because he was tiny,” Alex said. The doctor asked for his cellphone and snapped a photo. Alan was swept away to the NICU.
Not until three days later could Naiviv hold her son, as delicate as a china doll.
“A nurse named Patience allowed her to hold Alan, at last,” Alex said.
The new parents felt utterly alone, separated from their families and stuck in a foreign country. But the Jackson nurses cheered them up and served them a special steak and shrimp dinner, and a cake with a rose on top, and the image of a flickering birthday candle on a tablet screen.
“We gained a family at Jackson,” Alex said. “They gave us the family warmth we were missing. Patients are dying of the virus, caregivers are dying, but their spirit was amazing.”
The parents returned to their temporary home — a small apartment at the back of a house, containing their suitcases packed with vacation clothes — and Alan remained in the hospital for another eight days.
“You notice he was born on the 19th in the year of COVID-19,” Alex said, while Naiviv showed off their nearly 6-pound boy from a distance. Alan grinned. He is named after Alan Turing, the late British mathematician, father of computer science and Alex’s idol.
Isolation from family and friends
Two-month-old Lane Casey was born soon after schools emptied, businesses closed and everyone was warned to stay home. A scramble for masks, hand sanitizer and toilet paper consumed frantic Americans. Miami Mayor Francis Suarez, scheduled to announce a state of emergency, tested positive for COVID-19. It seems so long ago. Deaths from the virus in the U.S. have now exceeded a somber milestone: 100,000.
When Shauna Casey went into labor two weeks prior to her April 10 due date, Mercy Hospital in Coconut Grove was preparing for a possible surge in patients afflicted with the virus. Italian and Spanish hospitals were overwhelmed, and the predictions of bed shortages in New York City were staggering. Some expectant moms considered giving birth at home, with a midwife, but Shauna preferred the security of a hospital setting.
“I just wanted Lane to come because I didn’t know how much worse it would get and I didn’t want to deliver alone,” Shauna said.
Once Lane was delivered, neither Shauna nor husband Tyler was allowed to leave their room.
“It was like we were kind of in jail for four days,” Shauna said.
When Lane was moved to the NICU, only Shauna was permitted to visit, for a shrinking window of time.
“Every day, it was something different with more intensive precautions,” she said. “By the end of Lane’s stay, the hospital staff was in full PPE with double gowns. All the visiting moms in the NICU got nervous so they moved the beds farther apart and cut our hours.”
Since Lane came home, the Caseys have missed seeing friends and family. Zoom chats are no substitute for hugging, touching, cradling. You can’t rock a baby online.
“You already feel isolated as a new mom,” Shauna said. “I have two other kids to keep me distracted. If Lane was my first, I’d really struggle, and I feel bad for the moms feeling lonely during this restricted life we’re living.”
Homecoming
Remy’s May 19 homecoming was like a jubilant victory for the Costume family. Love conquers all.
“My sister baby!” Urih cried, bouncing around on the sofa as Alena sat down with sleeping Remy in her arms.
“Gentle, remember,” Alena said. Urih smushed a toy lamb on Remy’s face to kiss her and patted her head with its paw.
“You’ve heard your brother’s voice,” Jean said. “He’s been very entertaining for nine months.”
When Jean changed Remy’s tiny diaper, Urih noticed the umbilical cord stump and let out a loud “Ewwww!”
“It’s going to be an adjustment with two,” Alena said. “A completely different situation.”
Unlike Urih, who was a colicky infant, Remy is mellow. The perfect disposition for neurotic pandemic times. She didn’t fuss when Jean picked her up and whirled her around the room.
“I gave you your first dance,” he said.
The first dinner for the new family of four was Peruvian takeout from La Granja.
Urih said grace: “Thank the Lord, amen.”
“Cheers,” said Jean, clinking glasses. “We’re all home.”
And home will be their nest and bunker until it’s safe to reenter the altered world their children will inherit.
“No, we don’t want to raise our kids in a bubble because it creates fear. That’s not how we were raised,” said Alena, who spent summers on her grandmother’s farm in Mandeville, Jamaica, milking cows, killing chickens, picking vegetables and playing imaginary games on mountain slopes. “How do you live in a world out of your control? It’s like a roller coaster. You can cry, but you’re still on the ride so you might as well enjoy it.”
They choose optimism over the alternative, rooted in the faith they’ve built with fellow congregants at Miami Vous Church, which has been live-streaming services and offering a daily noon prayer on Instagram.
“Panic and paranoia don’t help the situation. Mankind has been through much worse, and our super power is to adapt,” Jean said. “It’s like Remy came along to put our focus on her instead of coronavirus misery.”
Remy’s timing, and that of her parents, could be interpreted as bad. Or maybe 2020 babies will grow up to be not only master hand washers but life savers.
Vous Church members gave Remy a onesie printed with the nickname WORLD CHANGER.
“We’ve lost so many during this crisis, yet so many are being born,” Alena said. “Children remind us that the promise of the future is real.”
This story was originally published May 28, 2020 at 7:10 AM.
