Note: For more information and our March webinar on COVID-19 and Doula Support, as well as our hospital visitor policy tracker tool, please go here.
Note: The following article is dated March 13, 2020, and may or may not reflect current evidence and circumstances.
In times of uncertainty, it’s good to remember we aren’t alone, to refocus on what we do know and connect with others who are grappling with the same questions. Right now, families and businesses are all facing unknowns about how to cope with something most of us haven’t seen in our lifetimes.>
I’m hearing from folks around the country that due to the COVID-19 threat, hospitals are moving quickly to restrict visitors to as few as a single person accompanying the birthing person in labor. Thus, many doulas are being excluded in that sweeping effort.
This post is jam-packed with thoughts, information, and resources on how doulas and families can respond to these shifting circumstances, from the hospital to home, where many of us will be riding out this pandemic for a few weeks with our kids.
So, how to respond to changing visitor policies in the hospital?
1. Repeat after me: DOULAS ARE NOT VISITORS; THEY ARE ESSENTIAL SUPPORT PEOPLE AND MEMBERS OF THE HEALTHCARE TEAM.
AWHONN (the Association of Women’s Health, Obstetric, and Neonatal Nurses) released the following statement on Wednesday:
AWHONN’s Position on Doulas with Patients During COVID-19
AWHONN recognizes that doula services contribute to the woman’s preparation for and support during childbirth and opposes hospital policies that restrict the presence of a doula during a woman’s active labor.
“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,” said AWHONN member Nancy Travis, MS, BSN, RN, BC, CPN, CBC, Florida Section Chair.
AWHONN supports doulas as partners in care and acknowledges their ability to provide physical, emotional, and partner support to women. AWHONN opposes hospital policies that restrict the presence of a doula in the inpatient setting during an infectious disease outbreak. Read more about AWHONN’s position on continuous labor support for every woman here.
AWHONN shared the statement above as an image on social media, which you can share, too [AWHONN post]. Another resource in addition to AWHONN’s position statement on “Continuous Labor Support for Every Woman” is Evidence Based Birth’s classic “The Evidence for Doulas.” There is great information in both places about how doula support works and how beneficial it is.
In addition, the CDC (Centers for Disease Control and Prevention) has stated in its most recent (March 10) recommendations for infection control, “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) [link to statement].
[Update 3/13/20] Several nurses from our Know Your Rights community have informed me they are advocating themselves for doulas to be considered essential support people on their units–going to their managers to lobby for policy that doesn’t lump doulas in with “visitors” and collaborating with their communities to approach hospital management together.
In Southern California, a nurse led a group of doulas, midwives, and local advocates to quickly band together after local hospitals started restricting laboring patients to one visitor only, no exceptions. They drafted a letter to hospitals, supported by a bundle of information on current guidelines regarding the virus and patient support. After a community representative presented that information to one of the hospitals, the hospital decided to not count doulas as visitors, so that doulas can continue attending births there. The community plans to contact more hospitals in the area this week. They graciously shared their materials with us to share with you.
The full package includes:
– Community letter to hospitals [link]
– AWHONN position statement on continuous support [linked above and here]
– WHO (World Health Organization) brief on “Companion of choice during labour” [link]
– DONA (Doulas of North America) recommendations on “COVD-19 & Doulas” [link]
– ACOG and SMFM (Society for Maternal-Fetal Medicine) guidance for providers on treating pregnant patients suspected of or confirmed to have the virus [link]
– CDC recommendations for treating patients suspected of or confirmed to have the virus [link]
– CDC recommendations for inpatient obstetric healthcare settings [link]
– DONA letter to hospitals [link]
– ACOG practice advisory on COVID-19 [link]
– ACOG committee opinion on “Approaches to Limit Intervention During Labor and Birth” [link]
[Update 3/17/20] From California to Michigan to Tennessee and Virginia, we are hearing from advocates who have successfully lobbied for doula-inclusive hospital visitor policies. We’ll share some of those stories, how they did it, and more resources in our virtual Town Hall Thursday, March 19. Register here.
2. Please PREPARE your clients to advocate for their right to patient support.
“I will not give birth here without my doula. My doula is not a visitor. My doula is an essential support person and member of my team.”
Additionally, doulas are professionals in a contractual relationship with the client. The client hired them to be there. The client is the employer.
Clients can and should contact facilities now (ahead of labor) and communicate this to them. Clients can and should contact their providers now to communicate this and make sure they are on the same page, and ask their providers to advocate for them and their doulas at the facility policy level.
One doula, Traci Weafer in Alabama, shared with me how she’s getting ahead of things:
I’m having an open discussion with each of my clients on my books at least throughout the summer. We are talking about the real threat of the restriction of doula support upon the COVID-19.
The daily uncertainty of support should not be the thoughts of any pregnant person.
I’m advising each client to call the director of Women’s and Children’s services and voice their concern about the uncertainty of support and ask for verification that their doula (me) will be “allowed” to remain on their birth team. The client will ask for verification by email/letter that no matter the restrictions, the hospital acknowledges the client’s value and personal agency.
If the hospital cannot promise or refuses this letter…. my client can:
#1 Decide not to birth at that setting (but will the grass be greener at another facility?)
#2 Look into birthing at home if an attendant is available.
#3 Birth without me
The choice and journey is a hard one but in a time where doulas are still fighting for professional position, this fight is sadly up the the consumers who have hired us in the first place. All this in the privilege I stand in, I understand this will not work for all communities.
Juli Tilsner of Cornerstone Doula Trainings recommended that doulas plan to accompany clients regardless of any uncertainty, as “it is harder to turn away a doula when they are there already and the parent is insisting they let them in” [link to her post]. She also advised, “Be aware that the hospital protocols are changing daily and even hourly in some cases. What we hear this morning may be very different than what we get this eve from any particular hospital.”
3. Doulas, don’t be shy–reach out to your contacts at local hospitals directly and speak with them.
Let them know you are part of the team and a part of the solution; you would love to work with them to ensure safety protocols are being followed.
Embrace your value. The presence of a doula is known to positively impact physical and psychological healthcare outcomes. Don’t give that up; don’t step aside as “just a visitor.” Your clients need you. You are not just a bonus. You are ESSENTIAL.
The New Jersey Birth Doula Response Collective, headed by Britt Sando of Hummingbird Doulas, collaborated on a fantastic letter to their local hospitals and generously gave their permission to share it with others [link to letter]. Check it out! Although this letter is clearly coming after hospital policy changes have already taken effect, I urge those of you who haven’t yet seen these changes to be proactive and reach out now before changes are made. It’s always easier to help guide policy than to try to get it reversed later!
If you feel any discomfort reaching out to hospitals, let’s examine that. You are a powerful and vital team member! I’ve put together a bunch of totally free resources for you to get started on remembering your great value and sharpening your advocacy skills [link to page].
4. Let’s always remember that it is a human right of the birthing person to decide who attends their birth.
Public health emergencies are not nothing, but we can still be rational and thoughtful in decision-making when something extraordinary, like a pandemic, occurs.
5. Be safe and have a solid backup plan in case you cannot/should not attend births.
It is entirely reasonable for hospitals to do whatever they can to reduce transmission. This is a public health threat that needs to be taken seriously. However, there are multiple factors in an equation like this; eliminating doula support directly impacts and immediately harms patients.
I love how the DC Birth Doulas group showed transparency by publishing a blog post this week sharing the specific Basic Personal Safety and Extra Safety Measures they are already following and says that if necessary, “Our doulas will take and record their temperatures and report any symptoms to the team at the beginning of each call schedule” [link to their article].
6. If you aren’t going to be able to be present with your clients at their births, now it’s more important than ever that you’re educating and preparing them prenatally to advocate for their rights in childbirth.
If you haven’t taken Birth Monopoly’s Know Your Rights course now, drop everything and do it. There are handouts for your clients they can take right to the hospital with them, as well as great information for both of you. Another great, bite-size resource for your clients is “3 Things Every Parent Needs to Know About Hospital Birth,” a 30-minute on-demand video course that covers evidence-based care, hospital policy, consent forms, birth plans, and their basic rights in the hospital.
In my town, we just got the news that school will be canceled for the next three weeks or so, and I’m seeing similar reports from around the country. Seattle is going to be out for six weeks, G*d bless them. I don’t know about you, but the thought of my active 8-year-old home with me bored all day kind of makes me break into a sweat! I wanted to share a couple of wonderful resources I’ve happened across in the last few days.
1. Multiple educational companies are offering free online access right now to help out families dealing with school closures.
The folks from the Facebook group “Amazing Educational Resources” put together a list of those resources [link to spreadsheet]. I’m not familiar with this Facebook group, but might get it know it very soon!
2. I also came across this incredible list of “Sanity Saving Tips for Reluctant Homeschoolers” (ha! That’s me).
In addition to the list created by the author, Loving Earth Mama, there are more great ideas in the comment thread [link to post]. This is a seriously good list with not only specific ideas about how to spend your time, but how to structure your day, as well.
3. Now is the time to lean into the village.
I’m lucky to work from home, but I know that’s an unusual situation. I cannot imagine how many families are going to handle having kids out of school for weeks–my heart goes out to folks whose lives are going to be completely turned upside down by this. There is a lot of economic hardship creeping up that is only going to escalate.
I urge you to reach out to neighbors, friends, and even online social circles (like local moms groups) and get creative. In my area, I’m already seeing moms making plans to swap childcare and exchanging ideas about how they plan to cope in the coming weeks. I’m seeing my neighborhood Facebook group starting to coordinate grocery deliveries and other assistance for older people. It’s a wonderful thing to see. Lean into it! We cannot survive without community.
In Your Business
As a business owner, I’m also keeping tabs on what my business mentors, coaches, and other leaders are saying. One thing I’m seeing consistently is to prepare to be flexible, pay attention to good news sources and don’t waste your energy on the rest, and be open to changing your mind as new information emerges. I think that’s great advice. I will add: get ahead of the uncertainty by being transparent about how you are planning for, protecting from, and responding to this extraordinary situation. This builds trust with clients and your community.
This post was originally written as an email message to Birth Monopoly subscribers. You can get on that list by entering your first name and email address right at the top of my home page [here]–and I’ll also send you a free download of my Quick Guide to Informed Consent and Refusal in Hospital Birth plus a mini-course on consent by email.
We’re in this together!
Do you have any great ideas or resources, or want to share how your business is adapting to the pandemic or your community is responding to hospital policy changes? Tell me in the comments. I’ll update this post or create a new one.