War on Better Birth: Hospital Doula Restrictions Threaten Patient Wellbeing
If we didn’t know it already, our bodies and our minds are telling us that we are living through an unprecedented time. We are all learning and adapting to this new life as we go. Some of these changes have shown us our individual and collective strength. Others are threatening to beat back progress we have made. These growing pains are exemplified in the changing policies regarding doulas in California hospitals. Unfortunately, some hospitals seems to be taking advantage of this collective crisis in order to further streamline birth, and restrict the autonomy of the birther.
At the beginning of the pandemic, a birther’s support was quickly limited to just one person--typically their birthing partner or nonbirthing co-parent--and in some cases, no support person was allowed at all. It goes without saying that it is a devastating experience for a birther to go through labor alone, and for the partner to miss the birth experience. There is no going back to change or undo these extraordinarily lonely and stressful birth experiences. Our hearts go out to everyone who has had to navigate this, and our appreciation goes out to the individual medical providers who became the main support systems for these birthers.
It goes without saying that it is a devastating experience for a birther to go through labor alone, and for the partner to miss the birth experience.
While some of these policies were necessary precautions to mitigate COVID19, especially early on when we knew little about the disease, there are serious consequences to limiting birth support. Anecdotally, our team has witnessed distressing increases in the number of interventions and cesarean births recommended by providers. Statistically, we know that professional doula support improves birth outcomes. According to numerous medical studies, doula support is tied to a 39% decrease in the risk of a cesarean section, a 10% decrease in use of medication, a 38% decrease in the baby’s risk of a low five minute Apgar score, a 31% decrease in the risk of being dissatisfied with the birth experience, and a 15% increase in the likelihood of a spontaneous vaginal birth. A nurse midwife once told me, “If a doula were a pill, it would be malpractice for me not to offer it to a birthing person.”
We have celebrated the increased acceptance of doula care over the last decades as these studies trickled down to obstetric practitioners and as the framework around birth began to shift, swinging back to a safer model that prioritizes patient bodily autonomy and informed consent. The role of the doula is to help center the birth around the birthing person’s choices, instincts, and wellbeing--goals that any good medical provider should share.
The role of the doula is to help center the birth around the birthing person’s choices, instincts, and wellbeing--goals that any good medical provider should share.
Unfortunately, those advancements seem to be fading. Over the course of the pandemic, hospitals have instituted ever-changing and contradictory policies regarding doula support. These policies have created a lot of confusion and uncertainty for expectant families. In the last month, more hospitals have allowed doula support again. But that permission has come with new, enormous restrictions that significantly limit a doula's ability to offer support. These restrictions seem designed to undermine patients’ relationships with doulas. They suggest that hospitals are taking advantage of this crisis to do what they have wanted to do all along: control birthing people.
Medical providers are under an unimaginable amount of stress. They have shown up to battle the coronavirus in the face of increasing fear and shrinking bandwidth. Afraid for their families and their own health, they are overworked, risking both their physical and mental health. While it is an understandable reaction to limit bodies and to try to make work for Labor and Delivery staff as streamlined as possible, this is not what is best for birthing people. Birthing people deserve to have full access to information and advocacy throughout pregnancy, birth, and the postpartum period.
These restrictions on doulas are an attack on birthers’ rights, a victory for fear-based maternal health care and an attempt to eliminate patient choice. Our greatest concern is that this elimination of choice will cement harmful hospital norms that endure long after the COVID-19 pandemic is over, destroying all of the progress we have made to improve maternal and infant health. COVID has understandably provoked fear in everyone. Doulas, birthing people, and medical providers must push back and prevent that fear from taking permanent hold. All birthing people deserve evidence-based information, the labor support they chose, respect for their wellbeing, and recognition of their humanity.
