[Update: On Saturday, March 28, Gov. Cuomo's office announced people giving birth in New York will not be forced to do it alone. Read more here.] eople giving birth in New York will not be forced to do it alone. Read more here.]
Hospitals are doing everything they can to prevent the spread of COVID-19, and in some hospitals that now means that birth companions are not being admitted. On Sunday we learned hospitals with the New York-Presbyterian system in New York City were no longer allowing partners or birth companions of women in labor into the hospitals (even if they do not show any symptoms of coronavirus).
This contradicts the World Health Organization's position on childbirth during the COVID-19 pandemic. The WHO states: "All pregnant women, including those with confirmed or suspected COVID-19 infections, have the right to high quality care before, during and after childbirth [which includes] having a companion of choice present during delivery."
But officials in the NewYork-Presbyterian health system say this difficult decision was not reached lightly and is necessary. "For the time being, we really do need to exclude all visitors, including partners, for women admitted in labor," Dr. Dena Goffman, chief of obstetrics at Columbia University Medical Center, said Sunday.
Most hospitals in North America have not yet taken the extraordinary step of banning birth companions, but visitors are restricted in most health facilities. That means that for many women only one support person will be admitted.
Dr. Regan Theiler is the Mayo Clinic's obstetrics chair and in an interview with Minnesota Public Radio, Theiler recognized how hard hospital policy changes are on women who have spent months making birth plans. According to Theiler none of the changes being made to prevent the spread of COVID-19 are going to perfectly accommodate families planning a birth.
"These are uncertain times, and women's birth plans do not accommodate this pandemic," Theiler told MPR. "We're making changes left and right and trying to balance safety of the patients and making some sort of good patient experience at birth. And it's tough. It's really tough."
At Sunnybrook Health Sciences Centre in Toronto, mothers in labor are limited to one support person in the labour and delivery room. "It can now have a significant impact on their childbirth experience, which is a shame really, because it's a once-in-a-lifetime thing really, and you may want your family around and now you can't have it. It's a pity," Dr. Jon Barrett, the hospital's chief of maternal fetal medicine tells CBC News.
"This has been, reasonably, upsetting," Dr. Rachel Pilliod, an OB-GYN who teaches obstetrics and gynecology at Oregon Health & Science University tells NPR. "We understand that giving birth is more than a physiological process."
Parents agree, delivery ward changes are difficult and even distressing at times.
Minneapolis mom Natasha Givens spoke with the St. Paul Pioneer Press shortly after having her fourth child at M Health University of Minnesota Masonic Children's Hospital. Givens' husband, Danny, was allowed in but her children, other relatives and her birth photographer had to stay home. "I just can't believe my son was born on the first day the hospital was locked down. It's like … what kind of world is it going to be now?" Natasha said.
"We were hoping to be surrounded by family after the process and just even having a time of prayer as a family," Danny Givens told the newspaper. "But there was none of that."
However, the couple understand why the restrictions are so necessary. "I am thinking this is a newborn baby. We have to make sure that this baby is thriving," Natasha explained.
Changes are being made to protect newborn babies, mothers and entire hospitals.
According to the World Health Organization, "pregnant women do not appear to be at higher risk of severe disease," and perinatal professionals are reassured by investigations of pregnant women in China.
"The good news is that thus far there hasn't been any indication that pregnant women are more severely affected" by the novel virus, says Dr. Denise Jamieson, chair of the department of gynecology and obstetrics at Emory Healthcare tells NPR.
Newborns are not immune to the virus, but the small studies that do exist on the topic of maternal to newborn transmission suggest that even when moms get COVID-19 during pregnancy or birth babies are typically healthy. These are small studies, but any data we can get at this point is important.
When moms who have COVID-19 give birth to a baby who does not, the procedure is to isolate the baby from the mother for a quarantine period, something no one wants to do. Policies restricting visitors also protect hospital staff and other patents from people who may have COVID-19 and not yet know it.
"We keep pregnant women and their newborns safer by keeping everyone around them healthy as well," Dr. Pilliod, the Oregon OB-GYN tells NPR "It takes a village to keep us all safe."
Some pregnant people are changing their birth plans as hospitals restrict visitors during the COVID-19 pandemic.
Non-hospital birth centers are reporting an increase in calls from mothers seeking to change their birth plans, multiple news outlets report. Amy Johnson-Grass, midwife and owner of Health Foundations Birth Center, tells MPR (Minnesota Public Radio) her phones have been ringing non-stop as moms seek to switch to non-hospital settings—especially as concerns about zero visitor policies spread.
"They don't want to go to the place where sick people are going," she tells MPR. "What we're hearing is, 'Oh my goodness. Is it going to change even more and will I be by myself?'"
Most people do not want to give birth without a supportive companion present and it is understandable that pregnant people are trying to make new plans that will allow their partners to be present at their birth.
Manavi Handa, an Associate Professor at Ryerson University's Midwifery Education Program says she is "specifically advocating for home births, or out-of-hospital births, during a pandemic."
"Birth centres, or other out-of-hospital birth locations, should be considered and opened as places for low-risk people to give birth and for healthy newborns to stay," Handa writes for The Conversation.
Experts suggest that before making changes to birth locations, expecting moms should talk to their care providers about new COVID-19 policies in their birth location as well as contingency plans in case they or their support person gets sick with COVID-19. Just like the response to the coronavirus, birth and postpartum plans are constantly evolving during this challenging time.
It is also important to consider what role Facetime or other video conferencing apps could play in your birth if your hospital does decide to restrict birth companions. "Pregnant people might want to start considering the possibility of virtual support—if you have a smartphone, tablet or iPad, plan to have it charged and ready to go in case your support person will need to help you from afar," says Motherly's Digital Education editor and midwife, Diana Spalding.
It's not fair that this is happening while you are pregnant, mama. And hospitals don't have perfect policies right now. Policies are changing rapidly as the situation demands—but you don't need to panic.
Here are some steps to take to understand your birth situation during the COVID-19 pandemic:
- If you are due soon call your OB or midwife and discuss their policies and hospital policies.
- Some hospitals have cancelled birth classes (in response to this Motherly is making our Becoming Mama™ Online Birth Class free.)
- Start to mentally prepare yourself for deviations from your birth plan and the possibility of limited visitors/support people.
- Talk to your partner or birth support person about the possibility that they won't be by your side and talk about how you could use technology to stay connected.
- Pack an extra cell phone charger in your hospital bag.
- If this is stressing you out, consider calling/video chatting with a mental health professional.
Hospitals are trying to keep everyone, including you and your baby, as safe as possible.
This isn't fair. But you are strong, mama.
Petition to allow partners + support people into hospitals for births goes viral
After the New York-Presbyterian system and other hospitals announced their decision to exclude partners and birth companions from accompanying laboring pregnant people this week, New York City doula Jess Pournaras launched a change.org petition.
The petition to allow partners and support people onto labor and delivery units has attracted tens of thousands of signatures in just a few hours.
Pournaras tells Motherly she is worried about the impact excluding birth support people will have on the people giving birth and the nursing staff trying to care for them.
“I believe no one should give birth alone. We know that people have have access to continuous support during labor have faster labors with less pain, fewer unnecessary cesarean sections and other interventions, lower incidence of hypertensive episodes and hemmorhage, and are less likely to suffer from postpartum mood disorders.
I have great respect for nurses and I see them struggling right now—they are exhausted and terrified and overwhelmed. Even on the best days—which these are certainly not—nurses are over worked and incapable of being everywhere at once. Not only is laboring alone traumatic, it is dangerous. While there are safety nets in place in hospitals, like call buttons and fetal heart monitors, there is no replacement for someone being in the room 100% of the time when it comes to reacting quickly to an emergency situation.
These rules go directly against CDC and WHO recommendations that all people in labor and postpartum should have a designated, healthy support person of their choice. They increase risk and, I fear, our already abominable maternal mortality rate in the United States will increase significantly during this time.” Pournaras explains in a statement to Motherly.
[A version of this post was originally published March 23, 2020. It has been updated and will continue to be updated as the situation unfolds.]