For months, Meg Fitzgerald has been preparing to have a vaginal birth after Cesarean section, or VBAC.
So the 34-year-old Connecticut-based mom, who is expecting her third child, hired the doula she’d worked with during her second birth. Fitzgerald said the doula helped her maintain her sense of calm and perspective, even as it became clear she was not going to have the vaginal delivery she hoped for.
Now, with 14 weeks to go in her third pregnancy, Fitzgerald longs more than ever to have that kind of support — not necessarily just so she can have the birth experience she’s dreamt of. She wants someone who can help her manage the stress of delivering a child during a global pandemic.
“My goodness, I feel like I need her,” said Fitzgerald, who was quick to add that the health needs of her baby, her health care providers, and her community must come first. “How likely will the VBAC be if I don’t have her physically in the room? ... What will the hospital even be like at that point?”
“I think I am calm, overall, about all of this,” she continued. “Then I ‘visit’ panic.”
Fitzgerald is not alone. As COVID-19 continues to spread through all 50 states, pregnant women are finding themselves navigating very different pregnancies, and facing very different births, than what they envisioned just weeks earlier.
Many hospitals have now instituted policies allowing only one support person during labor, so doulas — trained professionals who provide emotional, physical, and educational support to women before, during, and after birth — can no longer be in the room. In places like New York City, now an epicenter of the pandemic, even stricter rules are being set. Women who deliver at any of the NewYork-Presbyterian hospitals, for example, recently were informed they cannot have their partners with them.
“We’re just in this very unknown, unprecedented time for all of us,” Rachel Goldstein, owner of the New York-based Astoria Doula Collective, told HuffPost. “How do we still support our clients? And how do we take care of our own health and our own families?”
Doulas are not medical providers, yet research shows they can have significant and measurable health benefits, including lowering the chance of birth complications for moms and babies. Doulas — who are overwhelmingly women — provide a range of services, from prenatal visits where they might address everything from past traumas to postpartum gear, to hands-on help in the delivery room and after. A 2017 Cochrane review found that continuous support during labor may lead to shorter labors, higher marks on tests of babies’ health immediately after birth, and even decreased risk for maternal postpartum depression.
But now, many mother-doula relationships have been severed.
“I’m 32 weeks pregnant, and I happen to [have] a high-risk [pregnancy] for about five different reasons,” said Kyley, a 26-year-old mom of two from the Midwest who asked to use only her first name for privacy reasons.
“I also happen to have a history of PTSD, anxiety and depression. And my first two births were traumatic,” she added. Her first son was immediately whisked away because as he fought to maintain his oxygen levels and body temperature; her second child was born prematurely.
“This time around, my husband and I really wanted to have that extra support,” Kyley said. “So we were preparing to hire a doula.” But when coronavirus began to spread, she canceled their planned meeting. Now, she is emotionally and mentally preparing for the possibility of laboring alone.
“I think I am calm, overall, about all of this. Then I 'visit' panic.”
It is not yet clear what these sudden changes mean for the doula profession. DONA International, one of the primary doula training and certification organizations, has made it clear it believes doulas should still be allowed in the delivery room. Other accrediting groups, like ProDoula, have taken a clear stance that in-person doula support is not appropriate at this moment. Randy Patterson, president of ProDoula, said the organization has received pushback to that recommendation.
Many doulas are trying to adjust to coronavirus restrictions by turning to technology when possible. They’re having prenatal and postnatal visits with clients via video chat or on the phone. Some are even trying to beam into labor.
For many, the COVID-19 pandemic has profound financial implications, as they grapple with whether to issue refunds to clients who may not be able to work with them in the way they’d originally hoped. They’re suddenly staring at month after month of no new business.
“It puts a financial strain on a doula who might already be underpaid, and is trying to navigate what comes next,” said Chanel Porchia, founder of Ancient Song Doula Services, which offers free and low-cost doula services to women in New York and New Jersey. She added that her organization has made the painful decision to close for the next several months. She stressed that many mothers, and many doulas, do not have access to technology like iPads, cellphones and computers.
Even when they do, there are obvious limits to what a doula can do remotely. She cannot be there to rub a woman’s back during a contraction, or to give a reassuring squeeze before entering the operating room. The kind of steady, hands-on support that can make doulas such an asset to women in childbirth is impossible to fully recreate remotely.
“Everyone is handling it a little bit differently,” said Goldstein, the Queens-based doula. “We’re all trying to do our best.”
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