There has been a lot of talk in the last two months about birthing during COVID19 with what to do if a pregnant person has symptoms or is positive. Should you keep the baby with mom or separate mom and baby? For how long? Allow a support person, or don’t allow? There isn’t always a clear answer and policies differ widely depending on where you are.
What has happened is they got rid of the doulas very quickly. That one extra person is too much of a risk. Doulas are expendable. “We would let them in, but it’s just not safe.” Like doulas are these germy people who don’t understand universal precautions, and are not sheltering at home. In reality, it seems like doulas are one of the smaller risks. I stay home, don’t even go to the grocery store, am washing my hands, wearing mask, monitoring my health, etc, as are all the doulas I know. Whereas the medical staff have to care for many patients, we are with our clients in their room, and nowhere else. We are happy to stay masked and 6 feet away if required and still doula our clients.
Support your clients virtually, we are told; it’s just as good. But then when we do virtual support, there are unspoken rules that no one was told about. Turn the camera away when any medical procedure is done such as vaginal exams, turn the phone off when pushing because the doula might be recording things and that is against the rules. So the virtual support that hospitals encourage is not really doable, and definitely not effective. Some have suggested pregnant people stay home until they are close to pushing so they can have their doula with them. But what if that birthing person wants an epidural or needs antibiotics? Not to mention it is not just a matter of walking in and going to labor and delivery in the current situation. Now you have to get your temp checked, answer questions. This can take a while.
So the pregnant person and support person are finally put in a room, and staff sometimes say wait to call your doula until we get you checked in; staff say we know you wanted a doula but this is safer, we will be here for you, we will support you. Don’t get me wrong, I have great admiration for the nurses, midwives, and OBs I regularly work with, but they are not doulas. How are they going to provide the support a doula does when they have heart tones to check, blood pressures, temps, IV to put in and monitor, mounds of documentation and paperwork to fill out, other patients to care for? Our roles are very different.
Doulas are there to give assurance, suggest positions, explain slowly and answer questions in between contractions. A doula can tell when their client is having a contraction by how they hold their body, a slight catch in their breathing, the look in their face. Medical staff that are coming in and out cannot because they don’t know them like the doula does. When a client has a contraction, we know to stop conversation and be there in silence or offer a few soft words. We know if it is important to our client that she be covered at all times. Staff doesn’t. Trying to get that across if we happen to be on camera is difficult.
The doula and clients have built up trust over the weeks and sometimes months they have built a relationship that will serve them well during their labor and birth. The support person probably knows these things, but they are watching the person they love going through a difficult process. They are both excited and scared and nervous; to expect them to remember everything is too much and that’s why they hired a doula. They don’t know the nurses and might not even know the midwife or OB. At the most, they have seen them for a few appointments. And once one shift is over, another new group comes in. The doula is the one constant they thought they could rely on.
A doula works to create a safe space for the clients. She knows how they want the lights, temperature, she remembers the favorite blanket or music. Perhaps she has essential oils she wants. We remember that because we have talked about it. The support person knows too, but having the doula there allows them to be with the birthing person and not have to worry about those things.
We know what positions work for them. What adjustments have been made in consideration of their height, the support person’s bad back, or sore elbow or old knee injury.
Can we do some of this virtually? Yes, but it is very difficult and not the same as being able to see clients’ faces, to feel their energy, or their fear, and address it. It’s very hard for us to create that safe space when we are not in the room. The birthing person and support person then have to be thinking all the time, or following the doula’s directions which pulls them from the emotional level they need to be during labor while the doula is thinking and calm.
What is not being addressed as much, is what this does to the new parents over time. They are giving birth in such a scary time, made more so by extra procedures. Medical staff are staying In the room as little as possible and the doula they hired and worked with is just a face on a screen or just a voice or text.
What people hire doulas for is their presence and how she makes them feel when she is with them. This doesn’t transfer well electronically. Families are coming home from giving birth exhausted and many with PTSD. Some have been coerced into making decisions at a very vulnerable time, without the presence of the one person they wanted and counted on to help them advocate for themselves and their baby.
Please don’t see this as blaming the care providers. They are working under great strain, working long hours with what I imagine is a constant fear of getting this deadly virus or taking it home to their families. They also want their patients to be healthy and well and they are having difficulty sometimes figuring out how to do that when the situation is constantly changing. Some decisions about how that care looks are being made by people who have never been in their shoes.
I have been a doula for 19 years. I have worked and continue to work with some of the most amazing and best nurses, midwives, anesthesiologists, and OBs there are. But they are not doulas. I once had a midwife say to me, I don’t know how you do what you do; I could never do it, sitting with them for hours and hours anticipating the needs of not only the birthing person, but their support person. I’m so glad you are with them. My response was, I could never do what you do so I guess it’s good that we are all here!
We have known for years that doulas change outcomes, and one of the most important to me is birthing families are more satisfied with their experience when a doula is present with them. The US has not been doing a good job of caring for pregnant families. We spend more money and have worse outcomes than any other industrialized country. Doulas have been helping change that by giving birthing people the confidence and strength to advocate for themselves to birth their baby in a way that is best for them, simply by our presence, giving them strength and our watchful eyes. This is what clients have told me over and over again. Moving doulas out of the birthing room during a time when they are most needed is going to move us backwards.
Hospitals need to let the doulas in. It is to their benefit. Other states (I’m in Pennsylvania) and other hospitals have and there doesn’t seem to be a sudden spike in positive cases.
If you want to help pregnant families get the care they want and need at a crucial time in their lives, contact the governor’s office and tell them you feel this issue is important. Tell them about the difficulties that families are facing in getting the help they need, and how it is affecting them. Yes, social distancing and preventing the spread of disease is important and we can do that, but we also need to take care of each other. We all know what an intense, emotional, significant, life-changing, and potentially traumatic event giving birth can be; let’s help families get through it as best they can.
Here is also a letter from DONA International to share with care providers and decision makers.