The public health demands of the COVID-19 pandemic imposed extraordinary constraints on family and social life and curtailed individual freedoms in various ways. As the threat of COVID-19 begins to subside across the country, institutions must weigh the costs and benefits of COVID-era policies and determine the way forward in a post-COVID world. The findings of this study raise important questions about these restrictions and the implementation of FCC in postpartum settings following the pandemic.
The foundational principles for family-centered postpartum and newborn care include: 1) parents have access to the infant and are able to participate in all aspects of newborn care, 2) patient and family autonomy and authority are respected (above and beyond the convenience of healthcare providers), 3) patients have access to family and social support to the extent desired, and 4) healthcare providers give individually tailored education designed to empower parents during their transition into the parenting role (Public Health Agency of Canada, 2019; Curley, Hunsberger, & Harris, 2013; Zwelling & Phillips, 2001). Policies and practices which have limited parents’ access to their infant and their participation in newborn care run counter to FCC. This includes social distancing measures which take newborns away from the mother’s bedside and those which restrict parental presence in the nursery. Further restrictions on patients’ and support persons’ mobility also run counter to FCC.
According to study findings, the question of visitation policies on FCC is complex. The involvement of family and other sources of social support in the perinatal period has associated with reduced pregnancy risk factors, lower maternal stress and depression, and improved birth outcomes (Ginja et al., 2018; Harris et al., 2012; Milgrom, Hirshler, Reece, Holt, & Gemmill, 2019; Racine et al., 2018). In studies of family-centered postpartum care, both mothers and fathers expressed the desire for visitation policies that allow visitors (family or otherwise) at flexible times during their stay (Gaboury, Capaday, Somera, & Purden, 2017). And yet, mothers also value “quiet time” without visitors, to allow them better rest and recuperation as well as private family time (Beake, Rose, Bick, Weavers, & Wray, 2010; Gaboury et al., 2017). Mothers have also identified having visitors in the room as a barrier to skin-to-skin care (Ferrarello & Hatfield, 2014).
FCC places a central focus on patient and family education and empowerment. Empowerment is to be achieved through personal relationships with health care professionals who take the time to assess their unique needs and strengths and provide personalized education through sensitive and collaborative interactions with the patient and family (Curley et al., 2013). Studies of postpartum women’s learning needs and preferences have found that mothers value one-on-one instruction and time spent with their nurse, saying that it empowers them to better care for themselves and their newborn at home (Buchko, Gutshall, & Jordan, 2012; Gaboury et al., 2017). They have also expressed the desire for greater attention and support for fathers, and for mothers and fathers to be treated as individuals, with distinct needs for learning and support (Gaboury et al., 2017).
Study participants reported that, prior to the start of the pandemic, their hospitals had no restrictions on visitation. Findings of this study suggest that unlimited visitation may pose challenges both for nurses who are trying to provide care and education during this brief but critical time, and for families who are trying to incorporate a large amount of information in a short time span while bonding with their new baby. Many nurses in the study said they hoped restrictions would continue after the pandemic, and one said her director was already planning to retain some of the COVID-era visitation policies in the long term, because of the observed benefits to patients and their families.
Family-centered postpartum units are encouraged to restore policies that favor patient and family access to their infants, restore autonomy (e.g., mobility), and provide for hands-on teaching and learning (perhaps with additional virtual options for those who prefer it). Findings of this investigation suggest that, rather than a wholesale return to unrestricted visitation, hospitals may wish to explore options that balance patients’ access to family and social support, with the benefits of rest, bonding time, and individualized education for the mother and support person(s).
However, more research is needed before specific policies can be formulated or recommended. Studies exploring patients’ preferences for postpartum visitation policies, as well as impacts of different visitation models on patient satisfaction and health outcomes are needed. Nurses in this study perceived benefits of restricted visitation for patients including more rest, more breastfeeding and skin-to-skin care, and greater parent engagement in education and newborn care. Quantitative evidence is needed to verify these perceptions from more healthcare providers and importantly, from the families. Studies should not only assess impacts on health behaviors and outcomes, but on learning outcomes and parental competency and self-efficacy, as well. Additionally, research may identify a need to provide nurses with training and education to improve attitudes and practices toward FCC. Studies conducted in postpartum and other healthcare contexts have found that nurses often hold attitudes inconsistent with and experience challenges implementing family-centered models of care (Boztepe & Kerimoğlu Yıldız, 2017; Bruce & Ritchie, 1997; Buek, Cortez, & Mandell, 2021; H. Coats et al., 2018; Heather Coats et al., 2018; Coyne, Murphy, Costello, O’Neill, & Donnellan, 2013; Mirlashari et al., 2020; Petersen, Cohen, & Parsons, 2004).
 Participation in some aspects of care may not be feasible in the case of high-risk newborns in the neonatal intensive care unit. Parent involvement in care should be encouraged, in these cases, to the extent feasible given the infant’s condition.