Voices from the Front Lines: Alicia Chenail-Friend and Gina Barber

We recently joined hospital staff for a few days to document the reality of treating COVID-19 patients in UK HealthCare clinical settings.

This edited interview is part of our ongoing series, “UK HealthCare: Voices from the Front Lines,” highlighting stories and perspectives from our frontline staff who have been caring for the sickest COVID-19 patients since March 2020.

Alicia Chenail-Friend, PA-C, is a physician assistant in the neonatal intensive care unit (NICU).

Gina Barber, APRN, is a nurse practitioner in the NICU. 

What’s your daily routine like here in the NICU?

ALICIA: We have a large patient population down here. On a daily basis, I have a set of patients that I'm covering and we make daily rounds, examine patients, do procedures.

A big part of our job is also going to deliveries. Any high-risk delivery, we attend so that we can be there if the baby needs any help with resuscitation.

GINA: And if they need any procedures or anything, (we do) whatever to help take care of them. The tinier babies need ventilation and stuff like that. So, we're kind of in charge of all that.

We typically take care of premature babies. All babies that are born at less than 35 weeks end up coming to the NICU automatically. And then, if there's a baby born at 35 weeks or later that is sick — born with a congenital problem, has trouble breathing, or some kind of birth event, needs anything besides normal newborn care — they end up coming to the NICU.

How has your work changed during the latest wave of COVID?

GINA: We've had quite a few more very sick moms in the ICU, and we've had deliveries early and then complications with deliveries and stuff related to how sick moms were from the COVID infection.

ALICIA: I think the other day, half of my assignment, the patients were born to COVID-positive mothers. And it was just kind of shocking how dramatically it's changed. I think once a week, or more than that, these moms are getting so sick so quickly that they are having to be …up in the ICU COVID towers and they're getting intubated and put on ECMO.

So, we are often getting called up to the adult ICU floor, which is a long way from the NICU, just to be there at bedside; if mom doesn't do well, they'll do a c-section and then we're there to be able to take the baby. Because often, these babies are being delivered early because mom is so sick and it's the best thing for both patients, mom and baby.

How hard is it when the mother can’t be with the baby after delivery because of COVID?

GINA: You're lucky if you have a COVID mom who is not super sick and she gets to keep the baby with her, and the baby does fine. But even some of those babies end up getting sick or needing a little bit of respiratory support and then they come here and (the mother) can't visit.

And, it's at least 10 days before they can visit. So, you're missing the first 10 days of your baby's life even if the baby tests negative. The husband or father or support person, if they're living with mom, is also exposed so they can't visit either. And that's your best-case scenario when you have a baby admitted to the NICU with a COVID-positive mom.

But, we've had quite a few babies who were actually dying and the parents can't come to the NICU. Babies dying is a really hard thing anyway, but to not be able to be with your baby, or to only be with them the last few minutes of life … It's easy for people not to think about when they're not in the situation or know someone in the situation, but it's heartbreaking.

ALICIA: If a baby is born to a COVID-positive mother, and needs to come to the NICU, we have to take the baby immediately. Mom doesn’t get to see the baby because we can't expose the baby to mom.

So essentially; the baby is delivered, we take the baby, we resuscitate the baby, and then the baby comes here to the NICU. We've had a lot of babies who are being born (premature) because their mom is sick. And sometimes, due to how premature they are or how sick they are, despite everything we've done, we've had some babies we were not able to save.

Do babies who test negative after being born to COVID-positive mothers still struggle?

GINA: We have several babies who, it just so happens, mom had COVID and the babies end up being negative. And their issues are related to being premature. Now, is that related to how sick mom is? Sometimes, yes. So inadvertently, yes, it's related to mom's COVID.

If you could talk to a pregnant woman who was hesitant about getting vaccinated or doesn't think COVID's a big deal, what would you tell her?

ALICIA: The sickest moms we are seeing are young, healthy otherwise, and they're pregnant. They contract COVID and are unvaccinated, and they are the sickest patients this hospital is seeing at times.

Unfortunately, it's not (rare). Every day we're seeing such significant impact on these babies and these families.

GINA: Obviously, when you're pregnant, you want to do what's best for your baby. I think there's a lot of fear, there's a ton of misinformation out there about the vaccines.

But, they've been around for a while now. There's enough data out there that says it's safe. It's recommended by all of the major organizations of physicians for maternity services for pregnant moms because they're at such higher risk for severe COVID disease.

It also is beneficial in that you're giving your baby those antibodies that your body's naturally building up. It's not a substance from the vaccine that you're passing on to your baby. You're building up natural immunity with the vaccine.

If you can protect your kids, that's an added bonus. But the biggest thing is, they need their mom.

ALICIA: Getting a vaccine is the best way to protect your baby, because your baby is not going to be able to get vaccinated until, at earliest, six months of life. If you're not vaccinated, you're at risk for getting (COVID) and then also giving it to your baby.

What's the one thing that you want the community to understand about COVID and what you see every day?

ALICIA: A lot of these moms who are the sickest don't have any other pre-existing conditions. The one risk factor is that they're pregnant, and they can be quite young.

It's just scary. A lot of the population under the age of 25 thinks that they're younger, so they're at much lower risk. But just being pregnant increases your risk so much that you can't think that it's not going to affect you, because we see it every day.

‘Devastating’ is really the only word. Because we've seen and talked to a lot of these moms after the fact, and you can just see the hurt. And then, they've wished they had gotten the vaccine.

GINA: The people who are taking care of you who are medical professionals, we got into this to help people. Trust your doctor. Trust people (whose) goal is that your health care is good and that you're well. You need to trust the people who are doing this and that see this all the time and know.