Pandemic presents challenges for labor and delivery
Support during labor and delivery is essential, and for some women, it can mean the difference between life and death. Research shows that continuous emotional support during labor and delivery leads to improved outcomes for the birthing person and their baby. This is especially true for people of color and people living in rural areas, who face the greatest risks during birth, such as preterm birth, babies born with low birthweight, and infant and maternal death. A growing body of evidence indicates the importance of social support during birth to improve outcomes for mom and baby across the board. Unfortunately, constraints on personal protective equipment (PPE) are causing policymakers and hospital administrators to rethink their rules around supportive personnel in the delivery room during the COVID-19 pandemic.
In order to slow the spread of COVID-19 and due to the limited availability of PPE, many hospitals nationwide are changing labor and delivery room rules in an effort to limit the risks to the patient, protect their new baby from exposure and safeguard the health of hospital staff. In March, some hospitals in New York banned visitors from supporting pregnant people in the delivery room, leaving them afraid and alone during one of the biggest moments of their lives. Recognizing the potential harm that could come from this policy change, Gov. Cuomo prohibited this rule on March 28 and New York-area hospitals are now required to allow one person to accompany the pregnant person through labor and delivery. Most hospitals nationwide .
Additionally, women with a positive or suspected case of COVID-19 have been separated from their babies at some hospitals. Pregnant people around the country are faced with incredibly challenging decisions, such as having to choose between a doula and a partner as their only support in the delivery room or having to pick a healthy, non-exposed family member who can visit the newborn while the new mother is quarantined. Many pregnant people are afraid they won’t be adequately supported during labor and delivery and are seeking different options for their birth.
Unfortunately, these rule changes disproportionately affect black, American Indian/Alaska Native, and Latinx women, who are two to three times more likely to die of pregnancy related causes than white women and significantly more likely to report mistreatment by health providers or health systems during childbirth. Limiting access to a planned support system for labor and delivery can have life-threatening consequences. Although Gov. Jared Polis has not yet issued a rule on birth support and separation in Colorado, some Colorado hospitals have made the tough decision to limit supportive personnel in delivery rooms to one person, causing birthing people to choose between their partner, family members, or independent birthing support.
Advocates, community members, policymakers and health care providers know these are trying times that often do not allow for best-case scenarios. These stakeholders have begun to rally together to think creatively about how to encourage equitable, safe, and patient-centered care for people giving birth during the expected pandemic surge over the next few weeks. Elephant Circle and Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR) co-authored a letter to Governor Polis, elevating the role of community birth in a pandemic. The Colorado Department of Public Health and the Environment, in partnership with the Children’s Campaign, has started to bring a variety of stakeholders together to promote the healthiest and happiest birth outcomes possible during the pandemic surge.
For now, we urge policymakers, hospital administrators, and health care providers to take the needs of people facing the most barriers into special consideration There is evidence that people of color, especially, can most benefit from additional support personnel in labor, and these considerations must be balanced against available PPE and protecting the health and safety of health care providers. Also, we encourage providers to foster shared decision making as much as possible in addition to providing information about what to expect when giving birth at your hospital during the pandemic. It is important that pregnant people and their families can make informed decisions and prepare themselves accordingly.