March 20, 2020
To:
Honorable Governor Andrew M. Cuomo
Howard A. Zucker, M.D., J.D. Commissioner
Sally A. Dreslin, M.S., R.N. Executive Deputy Commissioner
To Whom it May Concern:
As you know, we are in a moment of crisis and the implications of COVID-19 are profoundly troublesome. The advisories the New York Department of Health has issued are made with the best information available and the best intention to help prevent the spread of this virus and keep our communities safe. Thank you.
At this time, it is imperative that clear guidance be given to all hospitals on how to best support people in labor, those who are giving birth, and those who have recently given birth. In the past two weeks, the environment for birthing in New York has changed dramatically to the detriment of pregnant people, their partners, and their babies. On the guidelines issued by the Department of Health, Labor & Delivery units across New York City have made a series of new policies that have limited a pregnant person’s support team during labor and postpartum. These policies have changed almost daily and remain inconsistent between hospitals. As of March 19th, most hospitals have moved to a strict one support person rule but others seem to be interpreting the most recent DOH guidance, issued on March 18th, as cause to ban all support people for laboring persons and those who have recently given birth.
We ask you to consider the long term physical and mental health impacts of making a pregnant person labor alone, give birth alone, and parent alone in those first critical days. Time and again, research shows that laboring people receiving continuous care from a designated support person have increased positive clinical outcomes and decreased negative clinical and mental health outcomes. Laboring people that receive continuous support have shorter labors, are less likely to require surgical deliveries and other medical interventions, their babies are likely to have higher APGAR scores, and they are less likely to suffer from postpartum depression. Collectively, all of these improvements importantly decrease the burden on the health care system during this crisis.
The implications of COVID-19 for our community, at large, are alarming, and we do not know all the potential complications it might hold for pregnant people and babies; however, we do know what the evidence shows for people who labor alone, and the implications of that are grave. We cannot expect already overburdened nursing teams to spend more contact hours with individual patients to make up for the lack of physical and emotional support partners can provide.
Partners are not visitors, they are essential care givers in birth and postpartum. They must be considered critical to the care of a laboring patient and of the postpartum patient and baby.
Doulas, therapists, obstetricians and midwives have adapted to the changing needs in this time of COVID-19 and new regulations in hospitals. Many have moved our practices largely to virtual support--providing care, advice, advocacy and an ear for our very scared, very concerned clients and their partners through video services and over the phone. While we can provide remote support, we must insist for the health and safety of pregnant people and their families, that hospitals everywhere continue to allow at least one support person for the duration of labor, birth, and postpartum.
We implore you to consider including language specific to the unique care situation that people in Labor & Delivery require in current and future advisories to hospitals while we are actively in this COVID-19 crisis, including, but not limited to:
Patients who are laboring or have given birth and are in postpartum are guaranteed at least one support person of their choosing, regardless of their relationship to that person.
Hospitals should be discouraged from making policies that specifically ban doulas from Labor & Delivery floors as it particularly impacts single parents and those with no other support.
With respect,
Jesse Pournaras
Labor & Postpartum Doula