We are a collective of Doulas in Central Florida respectfully requesting that Governor DeSantis issue an Executive order in line with the Executive Order No 202.25 issued by Governor Cuomo of NY on 29 April 2020 to:

1. Identify Doulas as essential, evidence-based members of the maternity care team, and not visitors during the COVID19 pandemic (and longer-term into the future).
2. Reinstate Doulas back into the maternity care system in addition to the birthing person's partner. 
3. Ensure that Doulas are able to support birthing people for the full duration of their labor, birth, and postpartum hospital stay.

We firmly believe as professional Doulas, that every birthing person, irrespective of the challenges posed by COVID-19, has the right to respectful maternity care that protects their fundamental rights to dignity, autonomy, privacy, and equality.  We request to be reinstated as professional members of the maternity care team in addition to the birthing person's chosen partner and believe that this is integral to respecting and upholding the human rights of birthing people.

Restricting Doula support during the COVID-19 pandemic to an either/or scenario (birthing partner or Doula) does not mean that Doulas remain integrated within the maternity care system and no birthing person should have to choose between their partner or Doula, nor should Doulas accept this for their profession.  As Doulas, we do not accept the normalization of human rights violations within maternity care, and this includes addressing the misunderstanding of the role of the Doula and how devaluing the significance of the Doula role, devalues the significance of the right of the birthing person to have one.  We request that Doulas are reinstated within the maternity care system, as key evidence-based, professional members of the maternity care team as a matter of urgency.

We also bring to attention, variable restrictions, and policies currently being implemented within maternity hospitals throughout the Central Florida area, which have the potential for momentous detriment to the human rights and holistic health of birthing people, their babies, and families.

Key restrictions that must be addressed as a matter of urgency, include, but are not limited to:

1)  Birthing people who are under investigation for COVID-19 or who are COVID-19+, being restricted from having any chosen birth partner (or a Doula) present during their labor, birth, and postpartum stay.  

2) Birthing people may choose only one asymptomatic birth partner for support during their labor, birth, and postpartum stay, and this partner cannot be swapped out.  

4) Birthing people are being given fewer options for pain relief during labor, namely access to Nitrous Oxide.

5) Birthing people who transfer into hospital due to a postpartum complication following an out of hospital birth have been denied their baby being brought to them to breastfeed. They have also faced difficulties releasing their expressed colostrum and milk for their baby to be fed at home.  Birthing parents in this instance, have sought breastmilk donations when their intention was to breastfeed their baby their own milk.

6) Birthing people who choose to encapsulate their placenta have faced difficulties releasing their placenta to their contracted placenta specialist.  The lack of robust systems to enable staff to facilitate this process or to ensure safe refrigerated storage of the placenta has on instances, resulted in birthing people forgoing their right to consume their placenta.  

As a collective of professional Doulas, we conclude that all birthing people, irrespective of their COVID-19 status, have the fundamental human right to the presence of a birth partner of choice, and if desired, the additional support of a Doula, for the duration of their labor, birth, and postpartum stay.  Any restrictions placed upon birthing people due to COIVD-19 must be based upon current, reputable evidence, be proportionate to the risks posed by COVID-19, and must be carefully weighed up against the impact of restricting human rights.  The research for Doulas provides evidence from which to reintegrate Doulas back into the maternity care team, as they provide continuous support that increases rates of physiological birth and reduces the risk of exposure to COVID-19 for both birthing people and staff through shorter hospital stays, whilst simultaneously reducing staff burden.

Doulas, through collaborative working with care providers, can work to protect the hormonal processes that are essential for bonding, breastfeeding, maternal mental health, and the parent/baby microbiome as a platform for gut, immune and primal health. Reinstating Doula alongside a chosen partner for the duration of the labor, birth, and postpartum stay to promote physiological birth, skin to skin, breastfeeding, and bonding is vital to reconsider within the wider landscape of physical, mental, and primal health as well as trauma. 

We call for collaboration with Florida Government Officials and maternity hospital providers to:

1. Ensure that all birthing people, irrespective of their COVID19 status, have their human right to a chosen, asymptomatic partner present during their labor, birth, and immediate postpartum, respected and upheld.
2. Reinstate asymptomatic Doulas as key professional members of the maternity care team, in addition to a chosen birth partner, offering support to birthing people, (irrespective of their COVID19 status), during labor, birth, and postpartum, including induction, immediate postpartum and transfers into a hospital from an out of hospital birth setting.
3. Gain a clearer understanding of current care policies for birthing people who are low risk for COVID19, are under investigation for COVID19 and who are positive for COVID19 and to identify how Doulas can be safely reintegrated to offer support within these care policies whilst adhering to infection-control policies and minimizing spread.
4. Ensure that any restrictions being implemented within maternity care are based upon current, reputable evidence, are proportionate to the risks posed by COVID19, and are carefully weighed up against the impact of restricting the human rights of birthing people.
5. Ensure that the needs of marginalized and vulnerable groups, including Black and Indigenous birthing people, birthing people of color, and LGBTQIA birthing people are appropriately met.
6. Ensure that birthing people within our local community are fully informed of the nature of the care they will receive and how COVID19 may impact their care and birthing preferences, should they choose to birth in a hospital. This includes upholding their right to informed consent or refusal of care following the provision of adequate information.
7. Ensure that the care provided to all birthing people (irrespective of their COVID19 status) involves informed decision making based on their unique birth preferences. This includes care that promotes physiological birth, protection of mother/infant microbiome, delayed cord clamping, placenta consumption (if desired), skin to skin contact, breastfeeding and ensuring mother and baby remain together.
8. Ensure that restrictions do not cause an increase in the occurrence of routine medical interventions in the absence of evidence or medical need, which may increase the likelihood of maternal/fetal complications, surgical interventions and cesarean birth, interruption to key hormonal and biological processes immediately postpartum and extend hospital admissions and increase staff burden.
9. Ensure that birthing people continue to have access to a range of pharmaceutical and non-pharmaceutical pain relief options and that any restrictions for example, withdrawing access to Entonox or water tubs/showers or mandating the use of epidurals, are based upon current, reputable evidence.
10. Ensure that birthing people are fully informed of alternative birthing options in their community, including Midwifery led care within birthing centers and homebirth, how these services are accessed, and any restrictions and barriers that may exist.
11. Ensure that birthing people who transfer into hospital following an out of hospital birth (with baby remaining at home) are supported to express, store and transport colostrum/breastmilk for baby to be fed at home.

Allison Tate, Tamara Niedermann, Taylor Bland

Doulas for Human Rights
doulasforhumanrights@gmail.com