Keeping Doulas at Births in Hospitals During Covid-19

Stages of Grief: Our community was thrown off-kilter mid-March 2020 with the official arrival and acknowledgement of COVID-19 as a global threat in the United States. It was upon us and as with any stressful event, many birthworkers, myself included, walked through the stages of grief in regards to the pandemic. First Stage Denial: Surely this wasn’t really a thing, was it? Second Stage Anger: I felt anger acutely as a doula. The restrictions on birth support hit me in the gut and I’m not ashamed to admit that initially I took it as a personal attack on doulas. Of course, I have since come to my senses and understand that at the heart of the decision by hospital administration was to keep everyone safe, including doulas, which brings me to the third stage. Third Stage Bargaining: Birthworkers explored how to continue to offer birth support, even if virtual, and they pivoted to accommodate the needs of their clients through FaceTime, Zoom, text, and phone. Fourth Stage Depression: Depression was in there too, and lingers today for many of us. As doulas, we yearn to be with our clients, sharing their birth space and offering physical support in their presence. It pains many of us when we are separated from our clients during birth. It’s truly a struggle that hits a doula right in the heart. And finally, we encountered acceptance. Fifth Stage Acceptance: COVID-19 will remain in our midst for awhile and have far-reaching implications on how births will look for the foreseeable future. It is our new, indefinite normal, restrictions, masks, hand sanitizer, and all. Acceptance is unacceptable. Doulas and birthing families have had six months of processing the restriction of doulas from physically attending births in the hospital setting. It’s time to push more aggressively to reintegrate doulas in-person at birth. If you are a birthing parent, I implore you to advocate for your doula, and for all doulas, to return to the hospital. Doulas should be permitted to attend in person because it is the right of every laboring woman to have support, but also because the research is extensive proving that the continuous labor support doulas provide improves birth outcomes. Doulas help everyone, including the staff and care providers! In fact, reputable birthing organizations such as The Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) have made statements early on defending doulas as essential members of the birth team, and encouraging them to be permitted to continue to serve in person DURING the pandemic. (https://awhonn.org/covid-19-archived-updates/) Advocacy: So what are we to do to affect change in hospital policies? There needs to be a push from the birthing parents to hospital leadership. Contact the manager of the labor and delivery unit, and the administrator of the hospital. Make a phone call. It’s harder to ignore a voice on the line. Follow up your phone call with an email and a letter. Paper trails are also hard to dismiss. If there are other hospitals who have allowed doulas to return, be sure to mention them as well. In Hampton Roads at the time of this writing the only hospitals permitting doulas to attend births alongside the primary birth partner are: Sentara Leigh, Sentara Obici, and Sentara Williamsburg. And don’t forget to express your wishes with your provider. Not just one, but to each doctor and/or midwife at every appointment. This needs to come from the birthing families, not the doulas. The amount of research in favor of the presence of a doula is dizzying. And the number of statements by various obstetric, nursing, and birth organizations is compelling. The evidence is there and the need is higher than ever. What’s lacking is the advocacy for the presence of doulas during the pandemic. I have compiled some links in an effort to cut down on your need to research data. You will find them at the end of this post. Feel free to use any or all that you see fit. And write those letters, send those emails, and make those phone calls. The change must begin with the birthing women. Not the doulas. We believe in you and we support you. Be an advocate not just for yourself, but for all birthing families. Below are some links to incorporate into your letters/emails/calls campaigning for the reintegration of doulas to attend births in-person. They are particularly timely and relevant since the statements were made in March 2020, right as the pandemic was taking hold in the US. Cochrane Database Evidence that continuous labor support may improve outcomes for mom and baby:  https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth AWHONN Position Statement for Continuous Labor Support for Every Woman: https://www.jognn.org/article/S0884-2175(17)30482-3/pdf ACOG (American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine’s joint document on the Safe Prevention of the Primary Cesarean Delivery: https://www.acog.org/en/Clinical/Clinical%20Guidance/Obstetric%20Care%20Con sensus/Articles/2014/03/Safe%20Prevention%20of%20the%20Primary%20Cesarean%20Delivery ACOG Approaches to Limit Intervention During Labor and Birth: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth March of Dimes Position Statement on Doulas and Birth Outcomes, January 30, 2019: https://www.marchofdimes.org/materials/Doulas%20and%20birth%20outcomes%20 position%20statement%20final%20January%2030%20PM.pdf