Birth During Pandemic: Visitors, Policies & Help

20200325_121028_0000Obviously, a lot of changes are happening for pregnant and birthing people today. The current state of affairs has COVID-19 impacting policies and protocols in health institutions everywhere.

Please be aware that guidelines and policies are changing almost daily, so check in with your local, national and global health experts for the most up-to-date information.

Approaches to COVID-19

Also read my post on breastfeeding under quarantine.

A few important notes (subject to changes – please see links for updates):

  1. WHO and RCOG both recommend AGAINST separating newborns from mothers, even if infected, and don’t discourage against rooming-in. In some hospitals, mothers with COVID-19 are being told they must stay separated from their newborns for two weeks. The negative short- and long-term effects of mandated or suggested separation on bonding and feeding must be carefully weighed.
  2. There is currently no evidence that a person with confirmed COVID-19 infection cannot, for this reason alone, give birth vaginally or would be safer having a cesarean section.
  3. This is the CDC assessment & management algorithm for pregnant persons.
  4. Keep tabs on hospital policies with this tracker.

Visitor Restrictions

We’re also seeing restrictions on visitors in hospital labor rooms and bans on visitors in waiting rooms at some birth centers. This means people are laboring without their chosen supporters, and possibly with no familiar or personal support at all.

As hospitals become overwhelmed with increasing cases of COVID-19 and thinning staff, many are paring Labor & Delivery visitor allowances down to one or two, but this can easily turn to zero for a laboring person whose partner who is sick or must stay home to watch older children (banning all individuals under age 18 appears to be a popular hospital strategy). Some are even denying access to spouses and partners without exception.

As you can imagine, I have strong feelings about these developments and believe no one should have to labor alone (as is playing out in New York as of 3/24/20 — update 3/27/20: Governor Andrew Cuomo issued a statement that “Women will not be forced to be alone when they are giving birth,” reversing some NYC hospitals’ approaches with intent to reinforce a new health directive. Make no mistake: this was the result of hard-pushing community advocacy at play).

Should your birth place be restricting the attendants YOU want at your birth, you still have options.

  1. Contact your birth place & provider now. Find out what policy changes you can expect. What is the policy for L&D rooms, NICU, the OR? Is your provider scheduling cesareans and inductions routinely? What are your options in the event of miscarriage? Is your birth place allowing video support?
  2. Prepare to advocate for yourself and your wishes. I wrote a post on this topic here. If you can negotiate an agreement, get it in writing. This excellent letter penned by New Jersey Birth Doula Response Collective (and approved for sharing) may be useful.
  3. Understand why the policies are in place. Do these policies mitigate risk for you personally? Are you safest birthing in this location, or not? Is your baby safest being born here, or not? What other aspects of your birth plan will need to be amended? Read this synopsis of what is currently known about infection transmission in pregnancy/birth to make a better informed decision.
  4. Remember health care workers are trying their best. So much about this novel virus is unknown, and the medical community is working hard to keep everyone safe with the little information they have available.
  5. Look for other birth places & providers. Low-risk pregnancies can be supported by out-of-hospital providers who attend births at home or birthing center. Birthing out-of-hospital has a leg-up from an infection standpoint, as well. Find out which local midwives accept late transfers.
  6. Know that even if your doula is prevented from attending in person, you can work out a virtual support agreement that can still help tremendously. Details on my virtual support options here.
  7. Take an online birth class to feel better prepared for the unknowns. Birth Boot Camp has an incredible, professionally crafted online birth class curriculum. BBC instructors are also now offering Hybrid style classes so you get face-to-face time virtually with a local instructor in addition to the pre-recorded classes.

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Doulas Aren’t Visitors

A current partner or spouse and possibly children should be deemed core and essential (rather than expendable) support for the birthing person, providing the emotional reassurance that’s so necessary in all stages of labor.

As doulas utilize their training and education to improve birth outcomes, they don’t act within a visitor role, and plenty of evidence supports this. Doulas are employed by clients (birth givers) to fulfill a contractual agreement involving skilled labor support.

“If restriction of all visitors is implemented, facilities can consider exceptions based on end-of-life situations or when a visitor is essential for the patient’s emotional well-being and care” (emphasis added) – Centers for Disease Control, March 10th statement

Statement by DONA International

Position statement by AWHONN

Doulas are not visitors and should not be blocked from caring for patients in the antepartum, intrapartum and postpartum period. Most doulas have been contracted by patients weeks to months ahead of time and have established provider relationships. They are recognized by AWHONN and ACOG as essential personnel and part of the maternity care team.” – (emphasis added) AWHONN member Nancy Travis, MS, BSN, RN, BC, CPN, CBC, Florida Section Chair.

In light of the pandemic, however, doulas (and other workers who spend time at births like photographers, massage therapists, holistic treatment providers, chiropractors) may personally need or prefer to stay home.

As previously mentioned, many doulas offer a virtual support plan (mine is here). I’ve seen at least one birth photographer offer virtual coaching on birth photography and professional editing, for a special touch on images taken by another attendant. Have a discussion with your intended birth team members about how they can amend their services to keep everyone safe and satisfied.

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Mental Health Impact

Given the widespread health guidance to social distance, self-quarantine, work from home and close schools, trauma centers are predicting rates of domestic abuse will rise in the coming weeks.

Domestic violence is known to significantly increase when a victim is pregnant regardless of cultural background. In fact, being pregnant is a key factor in experiencing the start or escalation of domestic abuse. ACOG states that 1 in 6 abused women are first abused while pregnant.

If you’ve recognized you’re in an abusive relationship, tell someone you trust. Call 911 if you need immediate medical attention. Normally, you would be advised to find a safe space, have a suitcase packed with cash and extra items should you need to leave quickly. For help specific to your situation please use the Domestic Violence Hotline.

Rates of depression and anxiety are likewise expected to increase. Many therapists are offering virtual counseling sessions at affordable rates, which I urge you to try if feeling overwhelmed, restless, or experiencing signs of a Perinatal Mood Disorder.

Remember, social distancing does not have to mean social isolation.

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You Can Still Have a Great Birth

Remember everything you need to give birth is already within you. Though shifting birth plans and uncertain policies can make you feel disappointed, scared, anxious, and a myriad of other tough things, please know you CAN give birth without your favorite people, without your doula, without your photographer, should it come to that. You can still have an amazing birth and you CAN do this.

You’ve prepared WELL. You believe in yourself. You are confident. You are flexible. You know how to surrender to that which you cannot control. You have chosen health care providers you trust, and they want you to succeed.

You may feel alone, but you are never alone. When you labor, thousands of people around the world will be laboring right along with you. Breathing in together, breathing out together. Surrendering together. Connected through the surges. Transformed, together.

Here is why I want you to know this. Why I want you to let it sink in, to let the preceding words become your mantra for the coming weeks.

It’s unjust that birthing people are currently being put in unbelievable circumstances, making choices they never imagined they’d have to make. That the needs of vulnerable pregnant people are working against that of health providers, the very people who are entrusted to care for them, but who must draw tight boundaries for themselves, too.

Birthing rights are human rights, and even in the midst of a pandemic there is something to be said for patient autonomy and above all, consent or lack thereof.

I want you to know you are all you need — not because I’m diminishing the importance of labor support, proactive preparation, or your vision for birth… not because I don’t believe you deserve every facet of birth support imaginable (you do!)…

I need you to know this because if it was ever a time to believe in your power, it’s now. The time is now.

Don’t give up. ❤

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