Should COVID-19 Impact the Labor and Delivery Process and the Presence of Support Guests?
In the effort to slow the spread of COVID-19 and protect health care workers, hospitals are enacting increasingly strict policies regarding visitation. But the most restrictive edict so far has come from two New York City hospitals who announced that they would not allow any family members, including partners and spouses, or outside support persons like doulas, to enter the delivery room. In response, New York Governor Cuomo issued an executive order mandating that all hospitals in New York State allow one support person to be present for a patient giving birth. While hospitals must comply with the order for the duration of the birth, some hospitals are banning support persons for the postpartum period, as the executive order only specifies a support person may be present at the time of labor and delivery. Although Governor Cuomo’s staff have stated that the executive order will be amended to allow a support person in the postpartum period, hospital websites still state that support persons are not allowed in postpartum units. While these hospital rulings are intended to protect mothers, newborns, and staff from the pandemic, it might very well do these patients more harm than good.
The most recent study in maternal mortality showed that the United States has the highest maternal mortality rate of any developed nation, with approximately 700 women dying per year due to complications in pregnancy and childbirth. For Black women, the statistics are even more appalling, as Black mothers are dying at a rate of three to four times that of non-Hispanic White women, and all women of color are more likely to experience complications than White women.
Additionally, anywhere from a quarter to a third of women report that their childbirth experience was traumatic and that they believed that either their child’s life or their own was in danger. This definition ranks emotional threats to the mother and child equally with physical threats, and for good reason, as women have developed post-traumatic stress disorder (PTSD) and post-traumatic stress effects (PTSE, characterized by PTSD symptoms that are less severe or shorter in duration) as a result of traumatic births. In short, the United States is not good at helping women give birth even in the best of times.
One common suggestion to improve both the physical and emotional results of childbirth is having a support person. Doulas often fill this role. Even when they aren’t medically trained, doulas offer emotional support to the laboring person and act as their advocate, working to ensure that throughout the birth, women are making decisions about their own body and baby. Having a doula present has shown a demonstrable improvement in obstetric outcomes as well as the emotional health of women post-birth. A doula’s role as an advocate can be just as important. Women might find themselves needing to self-advocate throughout childbirth for any number of reasons, but often feel unable to, a helplessness that stems from factors that range from confusion to exhaustion to coercion from health care workers and administration. As health care workers inevitably reduce the attention they give to people in labor in order to attend to the pandemic, support persons will be instrumental in making sure mothers and infants receive the care they need. For Black women especially, doulas’ advocacy can directly fight against the institutional racism and implicit biases that created the racial disparity in the maternal mortality rate, which will be increasingly important as COVID-19 “exacerbate[s racial] health care disparities.” Given the state of American childbirth experiences when there is no pandemic-induced anxiety, banning partners and doulas from the delivery room is not a decision hospitals should make lightly, as their work is especially critical now.
Of course, COVID-19 means stricter rules must be enacted and new precautions followed, but banning all “non-essential” persons from the delivery room likely won’t help mothers and newborns. If anything, this rule has the potential to increase the time pregnant people are in labor and their risks of complications, forcing them to remain in hospitals longer, have more exposure to COVID-19, fill more beds, and use more medical equipment in the long-term. Other hospitals, like Monmouth Medical Center in New Jersey, restricted expecting mothers to a single guest, who, along with the mother, is screened for COVID-19 before entering the hospital. Health care centers in Georgia are allowing a partner and birthing coach into the delivery room, despite their new limits on visitation. For those who cannot afford a doula (most people must pay out of pocket for doula services), having their allowed partner serve as a “lay doula” can still have beneficial results. Policies like this that allow for a single partner’s presence still work to reduce the spread of COVID-19, but not at the expense of mothers and newborns.
The lengths that New York City hospitals are going to in order to protect their patients are admirable. However, we must remember that COVID-19 is not occurring in a vacuum. Childbirth and the postpartum period are processes that have always needed support and advocacy, and while current events demand we limit the resources dedicated to that support, we must continue providing as much of it as we are able. As hospitals around the country restrict their visitation policies to fight COVID-19, we must remember that in childbirth and the postpartum period, support persons are not a luxury, but a necessity. If we want to save the lives of mothers and children in the midst of the pandemic, we cannot lose sight of the threats to their health that have always existed.
Olivia Snavely is the NWHN Communications Intern.
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