As we navigate the uncertainties of social distancing and the COVID-19 era, cracks in the healthcare system as it pertains to perinatal care and delivery are being exposed. Fear that the rate of negative birth outcomes will increase during the pandemic must pivot us all to action to ensure that all expectant patients can advocate for the total protection of themselves, their babies, and their right to a positive birth experience – not only now, but always.

The Mama Glow Webinar – ‘Pivoting to Action: Patient Advocacy, Preparation & Protecting The Birth Village’ with Malika Hodge, Program Manager and Doula at NYC Centering Healthcare Institute and Latham Thomas lead to a comprehensive discussion about what it means to protect the birth village, and the impacts that COVID-19 will inevitably have on the birth movement overall. 

The webinar was held in response to a ban that was put in place in late March  in New York City by NY Presbyterian Hospitals and the Mt Sinai Hospital systems revoking the right to labor support during birth. This decision followed the swell of COVID-19 cases that overwhelmed NYC hospitals. This policy meant that patients would not even have the support of their partners or doulas. Other private and city hospitals have restricted support to one person, so doulas have been physically pushed out of the birth process in hospitals.

Days following that decision, New York State Governor Andrew Cuomo issued an executive order requiring all hospitals in New York, both public and private, to allow women to birth with the support of their partners. All hospitals would need to comply with the latest health guidance by the NY DOH. With this new order in place, we have some level of assurance that women in hospitals would not have to birth alone and could have the support of their partner (or person of their choosing, such as a doula) through the labor and delivery. New York has become the epicenter for the coronavirus in the United States and Hodge who is a public health nutritionist and certified full-spectrum doula, says that the trends in NYC are what you should be preparing to expect in other cities; the hope is that other states will follow New York’s precedent, but this will also depend on if the compliance in place stays safe and effective. This means that New York-based birth workers and birthing people should use your experiences, if able, to advocate for what should or should not be done elsewhere.

She also points out that while New York State has intervened to make sure that hospitals allow one partner in the delivery room, there are ways to get around compliance. Confusion will continue to happen, which means the rules can constantly be in flux and what you believe to be your rights will stay in question, especially in vulnerable communities. This is the time to learn how to use the power of your voice and the skills that you have, educating in order to spark change (something that is not happening in spaces that are steeped in misogyny and white supremacy). Even if that might feel uncomfortable, Thomas reminds us that “if we jump in the water, we have to expect the water to move, make waves.”

We won’t know the stats on the impact of the pandemic on the birth experience until we come out on the other side of the coronavirus threat; for now, we have to make waves and use what we have and know to preserve it to the best of our abilities. It’s up to us to create the infrastructure we’re envisioning. So, what should a person’s birth village be doing to protect them during the pregnancy and through postpartum? Depending on your role in that pivotal, intimate community, Thomas and Hodge have some recommendations.

Prepare Them For Reality: Supporting The Birth Village

A lot of people still don’t know what’s going on with their bodies, so its the responsibility of doulas and other birth workers to facilitate a guide that shows people all the parts of this process, as it is now. Hodge recommends that doulas have a welcome packet for clients to do the reading and research on their own so they can feel empowered to make their own decisions. It isn’t preferable for a birthing person to want their doula to choose for them, so give them a spectrum of information.

The unfortunate reality, says Hodge, is that birth outcomes will be worse during the pandemic. For this reason, it’s critical that we all galvanize behind galvanize behind the importance of a birthing village, whether or not we ourselves are birthing people or birth workers. As more and more coronavirus cases were reported in New York, many people fled the city and state to be in a place that they felt was more “safe” for them, including birthing people who wanted an alternative to  hospital deliveries. Thomas reflects that “It’s a shame that for hundreds of years we’ve had propaganda that made it impossible for midwives to thrive in this country, and now people are seeking this option and there aren’t enough midwives to support the demand for out of hospital births” Systematically, as a culture that is built against women supporting women, we’ve made it impossible for everyone to turn to midwifery at this time, as the infrastructure is not in place to support their work on such a great scale.

Establish A Network of Providers

Thomas and Hodge suggest that doulas establish a network of midwives that you can connect with as an option for your clients if they are interested in birth center or home birth, so that you can communicate that option and expectations effectively. While in-person visits may not be possible at this time, use home visits via Zoom to prepare your client for the delivery experience. Postpartum virtual meetings will be super important to help them process the birth experience and feel really confident in their mothering abilities, too.  Loop in a mental health provider early on or make sure they have access to options for maternal mental health. Giving what we have now is about figuring out how to make the best of it — maybe this means talking really candidly about fears and expectations for both the birthing person and their partner. Do a “fear inventory” to check in with where people are, giving space for that which they might not voice on their own in an appointment. 

Be Present + Facilitate Virtually 

At doctor’s visits or in the hospital, Thomas and Hodge say that pregnant people should feel free to have your doula on speaker phone, overhearing what’s going on so that they can be informed and able to check in. Having someone on the phone can be empowering because it gives license to someone who is able to mother you, so that you can receive the support and have that extra voice in your corner.

Furthermore, doulas can help facilitate, virtually, conversations between pregnant women and their villages. Encourage clients to talk to their partners concretely what they need from them, approaching it from a place that the partner will be able to give support when it’s needed, so long as they know what to give. As for the family members who may not be able to involve themselves in the birth process in ways that they had previously anticipated, doulas can start a whatsapp group with the mother’s loved ones and friends to keep them connected, even if they can’t be together physically. The mother will likely miss out on the many ways families and friends come together to support during the postpartum period and will need to have regular check-ins to monitor how she is adjusting. Postpartum doula support will be an important part of your offering.

Remember that Hospitals are Constrained 

It’s important to note that COVID-19 fears are causing perinatal mood disorders, even before the postpartum period, which could increase need for c-section or result in postpartum hemorrhage. In light of COVID-19 and the current strain it’s placed on hospitals, Thomas informs that many hospitals aren’t doing elective surgeries, so the only c-sections being done are in case of emergency or when there’s no other option. The current medical model, especially now, does not always meet the needs for an ideal birthing situation, but Thomas says that doctors will try to avoid c-section and push for vaginal delivery because resources are limited due to the pandemic.

Decisions around birth in the COVID-19 era and beyond need to be informed, and not fear-based. Thomas and Hodge remind birth workers to stay connected to your doula sisters and abreast of the ever-shifting information available in order to support and be supported. We’re all learning as we go, and all of us are equally experts and learners, so share your resources with one another because we all have more to learn.

Here are a few resources Hodge recommends consulting:

• The National Perinatal Association’s Essential Information and Resources Guide for COVID-19
• Evidence-Based Birth Video series on ‘Birthing In the Time of COVID-19’
• A Swift Doula’s Blog Post on Using Your “B.R.A.I.N”

General Resources

• American College of Nurse Midwives(ACNM)
• American College of Obstetricians and Gynecologists (ACOG)
• Black Mamas Matter
• Centering Health Care Institute
• The CDC
• CDC’s Guidelines for Pregnancy and Breastfeeding
• Harvard Medical School 
• Johns Hopkins University
• March of Dimes
• National Birth Equity Collaborative
• The World Health Organization’s Advice for the Public