You have to stay outside if you want to see Emi Louise Jander. You have to stand at the front window and peer through the glass at the tiny girl while her mother, Tina, holds her. No cradling her for a spell. No breathing in her baby smell.

But that’s all right. That Emi is healthy and home is enough. The day before Emi was born, her mother, Tina Jander, tested positive for COVID-19. She was one of a handful of women who have delivered babies at Swedish Medical Center while carrying the virus, and the only one to deliver by C-section.

Jander, 34, a physician assistant, had no symptoms of the virus on the morning of May 3 when, as part of hospital protocol, she went to the Swedish COVID-19 testing drive-thru and was swabbed. That afternoon, she got the positive result. Her cesarean, already scheduled, was the next morning.

“I have no idea where I got it,” Jander said of the virus. “I didn’t work with any COVID patients.”

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Melissa McHugh Short, the Swedish system’s executive director for Women’s Health & Pediatrics, called Jander’s case “quite unusual.”

There have been “between four and six” COVID-positive mothers out of the 1,000 who deliver babies at Swedish every month, she said. Most are asymptomatic or have had known exposure.

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Lisa Stromme Warren of the Washington State Department of Health said she could not provide data on COVID-positive women who have delivered babies since the pandemic began.

After Jander’s diagnosis, the hospital tested her husband, Ryan, and their 2-year-old daughter, Lucy, then close family members who would be helping after Emi’s birth. Everyone but Jander tested negative.

“I was big-time freaked out,” she said. “And being a health-care provider, I knew exactly what it meant.”

It meant that Ryan wouldn’t be in the delivery room with his wife, as they had hoped. It meant the staff would be in extra layers of personal protective equipment (PPE), and waiting a certain period of time before opening and closing the doors to the pressurized operating room, to limit air circulation. 

“Logistically, it was a lot more complicated,” Jander said. “It was very much uncharted waters for everyone. Everyone is walking this line of trying to protect you and the baby, and the protocols are being written in the moment.”

There has been no confirmation of any transmission between mothers and the babies they’re carrying anywhere in the world, McHugh Short said, but there are precautions new mothers need to take to remove the potential for transmission — isolation and hygiene chief among them.

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And Jander hadn’t had COVID-19 symptoms for two weeks; she was asymptomatic.

Still, she arrived at the hospital the next day knowing she would be “doing this by myself” — without her husband but with the doctor and nurses, all women.

“People rallied and did the best they could in an unfortunate situation,” she said.

Anesthesiologist Katie Haeck came in to work that day knowing there was a COVID-19-positive C-section happening, so there was time for the staff to make sure they followed the protocols, “talk things through and make sure everyone is comfortable,” she said. Especially Jander.

“It was a special day, and we didn’t want to ruin that for her,” Haeck said. “It’s nice that we have some leeway, too.

“I wouldn’t say I panicked,” she added. “Panic is a word we don’t like in anesthesia. We like to be the most cool and calm person in the room.”

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She has had two other COVID-19-positive patients, and two women with respiratory infections who were delivering via C-section, and labored under isolation.

Haeck is aware of a “heightened sense of awareness” around COVID-19 patients.

“I don’t want to say anxiety,” she said. “But there is a sense that this is something special and we need to respect and know this disease.”

And yet, she knew that Jander was a physician assistant, who understood what needed to be done.

“She had a good appreciation of the disease,” Haeck said, “and came at it with a really balanced standpoint.”

As the birth got closer, nurses helped connect with Jander’s husband on FaceTime — but only after putting her phone into a double biohazard bag. Haeck took photos with another phone, also bagged, which gave the shots a “dreamy quality,” Jander said.

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Said Haeck: “You always want to convey to the patient that even though you’re covered with three layers, I am a person behind this mask and I want to make this connection with you and make this experience as good for you as possible,” she said.

“Even with COVID, welcoming a baby is an amazing experience.”

Moments after Emi was born, Haeck held the baby against Tina’s cheek, which by then was streaked with tears. After a few moments, she placed the baby in the bassinet for standard Apgar testing — and put the phone, with Ryan still on it, beside her.

“We wanted to make sure he felt part of things even though he was out of the room,” Haeck said. “Usually, I don’t get to hold the babies, but helping Tina, and being able to facilitate her giving the baby its first kiss … Is there anything better than that? I don’t think so.”

Still, it was hard for Jander: “I just laid there trying to keep myself calm because it was so hard. I couldn’t see her, I couldn’t feel her. It was the longest five minutes of my life.”

Their first daughter, Lucy, was also delivered via C-section, but it was another time — and just two years ago. Ryan was there through the whole delivery. The hospital staff had open faces and people walked in and out of the room. Friends visited after.

This time after the birth, she was isolated at home, with the baby and her family, for 10 days.

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Beyond that, the Janders plan to stay put in an effort to stay safe and healthy through this wonderful, awful time.

“I think it’s going to be a long process,” Jander said. “And I am trying to work through it in a mindful way.”

Said Haeck: “Even in the worst adversity, there are good things happening. And being part of a birth during this pandemic is awesome and wonderful. It’s very cool.”