I know, I know, can we just stop talking about it already?!? No, we can’t. Because basic human rights are being violated. These are bizarre times, and everyone is feeling the impact that COVID-19 has made on our lives. Whether it’s having the kids home 24/7, needing to work from home, not being able to work from home and therefore losing income, still having to go to work in spite of dangerous conditions, getting extremely sick, or losing a loved one, we will all be forever marked by this rapidly changing virus. But my job is to educate and support people in labor. Childbirth is arguably one of the most challenging, vulnerable, and powerful experiences in ones life. It is most definitely not an experience that should be over-shadowed by policy and procedure. Don’t get me wrong, I am a HUGE advocate of self-isolating, quarantine, and social distancing. I haven’t seen anyone up close (except my husband and kids) for 5 days. I take limiting the spread of this virus VERY SERIOUSLY. But current hospital policy in Northern Colorado limiting birthing persons to 1 visitor in a 24 hour period, including partners and doulas, is simply wrong.
The Association of Women’s Health, Obstetric and Neonatal (AWHONN) released the following statement in regard to doulas and 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.”
When one of my clients recently submitted an exemption request to our local hospital regarding the ban on doulas (if a partner is present), this was the response she received:
“I am very sorry but we are not permitted to make any exceptions to the visitor policy for the safety of our patients and babies. I realize what a hardship this poses, but we are in alignment with the other hospitals in the state and are doing everything we can to ensure the safety of our patients. Our nurses have all been trained in labor support techniques and will partner with their patients to provide them the best experience possible.”
I understand that nursing staff is trained in labor support, but it is simply not the same. I have spent 20+ hours getting to know my clients one on one prior to their births. We’ve explored past traumas and fears that may arise during childbirth. We’ve bonded over ancestral experiences and poop jokes. We’ve spent numerous coffee dates ironing out the ideal birth plan that accounts for every possible intervention and scenario. And while my goal is for my clients to be completely prepared and in their power for their births, supporting them in person is also a crucial part of my role in their birthing team. Why? Because a birthing brain does not function the same way and neutral state brain does. Get nerdy with me for a minute. The primary drivers of the brain during childbirth are the limbic system (hormone master) and the rhombencephalon (aka, the hindbrain) that is composed of the medulla oblongata, the pons, and the cerebellum. The hindbrain coordinates functions that are fundamental to survival, including respiratory rhythm, motor activity, sleep, wakefulness, heart function, blood pressure, muscular movements, and contractions. As for the limbic system, labor and birth are involuntary processes controlled by hormones from ancient parts of the brain, namely the Hypothalamus and the Pituitary Gland. During labor, these ancient limbic system structures are the most active. This is a reversal of the way the brain operates in everyday life. Every other day of a woman’s life, impulses from the limbic system are inhibited by the pre-frontal cortex. The pre-frontal cortex is a part of the brain which is responsible for our abilities to focus our concentration, plan ahead and behave appropriately for a given situation, among other functions. The pre-frontal cortex does this via nerve projections which go down into the Hypothalamus. The frontal cortex prevents behaviors which might be considered socially inappropriate or anti-social. In simple terms, 70% of the brain is there to inhibit the other 30% of the brain. In labor, inhibitory control of the limbic system by an active frontal cortex is problematic, because it is precisely these parts of the brain which are running the show.
Photo Credit: Jai’ Ma Birth
A birthing person is less able to make critical decisions based on their previously determined wishes. With the prefrontal cortex working at a minimum, they are more likely to concede to procedures and interventions that are not in line with their actual desires. This makes consent during labor a tricky state of affairs. The birthing person might be saying yes to a cervical check/pitocin drip/breaking of waters, but sometimes it’s because they do not have the ability to analyze options and decide accordingly. THIS IS WHY DOULAS EXIST! While I cannot speak for my clients, I can remind them of the questions we practiced asking in these moments. I can assist them in finding alternative options. I can remind the medical staff of their wishes. I can support them emotionally if they do in fact have to veer from their visualized birth. I can’t tell you how many people I’ve held in my arms while they cried because of a scary and unexpected turn of events. I can tell you that, out of sadness or joy, I have cried at every single birth I’ve attended. I’ve sat with partners as they held their newborn babies and quietly wept while the love of their life was undergoing emergency postpartum surgery. I’ve held the shaking hands of women who are getting stitched up while their baby and partner had to rush to NICU. And I’ve been in the middle of a magical bear hug consisting of myself and a new little family. These are services I absolutely cannot provide through a Skype session. These are also services that cannot be provided by hospital staff.
Photo Credit: Monet Nicole Photography
There are some remarkable nurses in our local hospitals. Truly, I’ve seen them do selfless, miraculous things. They are the hardest working, kindest, most dedicated people I’ve ever worked with. But the bottom line is they work for the hospital. They will be compassionate and gentle as they carry out the procedures they are required and ordered to do. But they have other patients. They have charting. They have shift changes. They are spread thin, especially now. They are not aware of your triggers and nuances. They don’t know that your partner suffers from white-coat syndrome and will agree with anything the doctor says. They don’t know you in a non-labor state, and therefore cannot always make educated decisions based on your birthing behavior. This is NOT an “us against them” situation. It is a "we/us”, a “both/and” situation. It shouldn’t even be a consideration that one can replace the other. I cannot put in a I/V or check your cervix or give you fentanyl. And they can’t stay with you 24/7 and advocate for your wishes to the extent a doula can. It’s apples and oranges.
The bottom line here is this: a birthing person deserves and is entitled to high-level support. They should ALWAYS have their partners there (if they are able), because it is their birth too. They should ALWAYS have their doulas with them, because we are their safety. And they should ALWAYS have their care provider available. This is not negotiable. The fact that hospitals are enacting policies that ban the doula, and sometimes even the partner, from the birth is asinine. Again, I completely understand the desire to minimize the spread of this virus, but I can assure you that most doulas are still visiting with their clients leading up to the birth anyway. The same way doctors are still seeing patients in their clinics. We are already in their field of company and are taking necessary precautions to prevent the spread of germs. And we are professionals who are trained in sanitary hospital measures and can easily adapt to any new ones as needed.
So what can we do to change these policies?
STEP ONE: Contact your care provider and demand that your doula be present at your birth.
STEP TWO: Sign this petition.
STEP THREE: If you are low risk, consider birthing at home or at a birth center.
This is just another example of birthing rights being curtailed by sweeping policy that does not take in to account the spiritual experience of childbirth. And it needs to stop. Immediately. We are all in this together.
Do you have thoughts on this new policy? Comment below if you do.