COVID19 is having an unprecedented impact on the lives of billions of people. But a robust and effective COVID19 response must not be a vehicle for denying access to essential health care services.
NHeLP is fighting to protect access to the range of critical services that people — especially low-income and historically vulnerable communities — need in order to live their lives. Yes, even in a pandemic. Especially in a pandemic.
People who are pregnant are among those who may be at higher risk of more severe illness from the COVID-19 virus. They face threats to their health and well-being from both the pandemic directly and its impact. Many pregnant people are nervous about giving birth in the hospital setting, fearful of contracting the COVID-19 virus from a contagious patient or health care worker. Accordingly, the rates of pregnant people seeking information about home births, birth centers, and midwives have skyrocketed since the outbreak of the COVID-19 pandemic.
Hospitals and providers are also trying to find ways to triage pregnancy care. For example, Kaiser Permanente’s Northern California network began offering induced labor to women at 39 weeks, in an stated attempt to “try to get patients delivered before this pandemic gets worse.” Conversely, some hospitals are so overwhelmed by COVID-19 patients that labor and delivery units are being transitioned to accommodate the overflow. The American College of Obstetricians and Gynecologists has issued one FAQ for physicians and one for patients on coronavirus, pregnancy, and breastfeeding.
In many hospitals across the country, patients are restricted to one accompanying visitor or support person. Doulas, who have traditionally provided support for pregnant and postpartum people cannot accompany many of their clients to the hospital. Their role has always included continuous physical, mental, and emotional support during labor and delivery, and this abrupt shift has been difficult as they work to support their clients by phone or videoconference. In New York, some pregnant people were forced to labor on their own, without a partner or any other support person present, until the governor issued an executive order stating one support person was permitted in labor and delivery settings so long as that person was asymptomatic for COVID-19. (On April 4, the Centers for Disease Control released similar guidance.)
The postpartum period, which can already be difficult and isolating for many new parents, is now exacerbated by the requirements of physical distancing. Friends and family members who had planned to help the new family may no longer be able to travel, or may themselves be too vulnerable to provide support. Without targeted intervention, pregnant people giving birth during the COVID-19 pandemic could be at greater risk of postpartum depression.Like all individuals and families across the country they are struggling with the tremendous economic and financial impacts of the COVID-19 pandemic; anxiety about the safety, health, and well-being of their friends, families, and neighbors; and the emotional and mental effects of physical distancing.
There are some potential solutions to explore. States can pass emergency orders to open up capacity for home births, birth centers, and midwife-assisted births. Doulas and doula organizations are creating toolkits, and sharing tips on supporting clients from a distance and on how to be a virtual doula either by phone or by videoconference. Some hospitals are explicitly allowing a doula to accompany a pregnant person during labor and delivery, in addition to a partner or support person. States can also loosen restrictions to facilitate the provision of prenatal and postpartum care through telehealth, including telemental health services.
Pregnant and postpartum people in the United States already face the highest rates of mortality of similarly economically situated countries. This is especially true for pregnant and postpartum people who are Black, who die at rates two to three times that of pregnant and postpartum people who are white. We cannot allow COVID-19 to push what is already a crisis of maternal mortality to the breaking point. It is critical that we come together to meet the additional challenges raised by the pandemic.