Support for Expecting Moms

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This letter is written to you and your state officials to thank you for your swift attention to the COVID-19 pandemic and for all of your hard work so far.

Currently, in our state, our hospitals have instituted restrictions on the number of visitors in their Labor and Delivery Units, which is completely understandable for our sick patients. What is somewhat comforting is that they are allowing a healthy laboring mother to have 1 support person with her. However, part of the birth team is being ignored and not allowed to support their client… The Doula. This is a direct contradiction to the recommendations by leading birth experts at The Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN), and (ACOG) “Doulas are not visitors and should not be blocked from caring for patients in the antepartum, intrapartum and postpartum period.”(1)

Alabama is known to be a proud Pro-Life State, we must protect Mothers and Infants prenatally through birth and postpartum just as we do with other legislation. Finally, in addition to all of this, higher rates of intervention which doulas are known to help prevent will lead to extra costs to Alabama at a time where the state is already being buried by unexpected expenses.

Doulas are a very important part of the birth team, and by hospitals not allowing a patient’s doula to be present at birth, many mothers are looking to birth out of the hospital. Not only that, but many are discussing unassisted births which means to birth without any medical personnel present to render medical aid. This can place mothers in a very dangerous situation. However, this is what some mothers are feeling forced to do to achieve the best possible outcomes without their labor support present. Given the lack of Midwifery in Alabama, women have no option to birth elsewhere with qualified licensed professionals. Midwifery Regulation that includes CPM Licensure and Hospital Credentialing for Certified Doulas are both issues that need attention too, but we want to handle the immediate issue during this time of uncertainty.

Evidence has shown time and time again that Professional Labor Support provided by a Certified Doula minimizes potential complications and interventions throughout Pregnancy, Birth, and The Immediate Postpartum Period. To deny a patient their paid for and contracted doula, is to possibly contribute to unnecessary interventions and Poor Outcomes including but not limited to: Unnecessary Cesarean Sections, Preterm Birth, Birth Trauma, and even Maternal and Infant Mortality.

Furthermore, Doulas are a known extra set of hands in a very busy birth community. As brought to our attention in The Journal of Perinatal Education study “Impact of Doulas on Healthy Birth Outcomes” by 3 medical professionals, “Modern hospital maternity care practices have reduced the availability of an attending nurse to remain with a mother during labor.”(2) This is where a doula steps in. Doulas are trained in labor support, and comfort measures for effective pain management. This allows our busy nurses to care for both mother and baby on the medical side.

Nurses are already spread thin, and overworked. COVID-19 has magnified the issue on the shortage of healthcare workers. Doulas can help bridge the gap with the laboring patient in the hospital. Doula care will not bring a huge influx of traffic into the hospital, and Doulas are willing to submit to screening and certification verification upon request. Even the CDC states “if restriction of all visitors is implemented, facilities can consider exceptions based on end of life situations or when a visitor is essential for the patient’s emotional well-being and care.” (3)

While we understand the severity of this illness and would never want to lessen the importance of minimizing the spread of this virus to help flatten the curve, the cost of that should never be a woman’s basic human right to have the professional birth support she has hired and relied upon throughout her entire pregnancy. Doulas are an essential part of the birth team for many women as you have seen in the research provided below. This professional support, which aids in the good physical, emotional, and mental health of birthing people is essential in all routes of delivery to ensure healthy mothers and infants.

Lastly, I would like to also bring to your attention the great act by Michigan Governor Gretchen Whitmer in her executive order 2020-07 stating, “…labor qualifies as an exigent circumstance under this order. Therefore, a partner and doula may accompany a laboring mother, if they pass the health evaluation required by section 2.”(4)

Thank you for your time and we appreciate your expedience in rectifying this issue statewide.

Sincerely,

All expecting Moms

 

Citations:

1.) AWHONN - The Association of Women's Health, Obstetric and Neonatal Nurses. (2020, March 11). Retrieved March 18, 2020, from https://www.facebook.com/AWHONN/photos/basw.AbpKlhVbE340Mo6bMMczbAcJDLTMzGTcYAQcKW9IyS3Wm9fz6WhfnKuHABYY3XjY1_x1lFJj42hLod-N1Z6dW5eYDo7ToX_4naZ_0q1X_I8gGW5kAfT13P-32PHT-_uAkleUr_pKFED8K9VeI_ImkhOS.10157817317008801/10157817317008801/?type=1&opaqueCursor=AbryxdPyeIzGboVynvU2uupBymMT7EcPf5Cbc_5WrT9JDYB5x6lNXOOhqnOWjIm_kppSfNY4jGM2ZbifVv5s1Ks2BRJvkwQkPnGbXzvGidIZoQe5Q05t7g5ugsQBLkyRZgSGveFstuwBxK750nGQFzx1dMshwcDWwZtIVIWc1U-CoCxXl8uzl5qMgzemEJ_n-NXWzmT27H8J7pkgadi9jOgxQOZCh9Vin-s-ubNB0tIs6XdLHqbQVOb7V3ST6OcPELBWXPQ2eZC3DNrulXktGKpeaRgKGF6VZgXnpCo9FOEWukoERWLlYhK6BuO2kpa-wvMBtG6qNoducN8Edls3ZCvtJIejZ5j2eeu2pMiD49zL7jBuGI_-WYETLFSei3Zi7OBBeJsw23stxLPPozYU-nCKin0u3ymnL1Zpr3JODmun0k_h6LTOEEHproA1-ikEWSOdlxTSk6kgQ3tbunsQN2a5dbT3MasOZffUH4OyFDLfT_k7cl5B7sBCzg4WppHwd7H4ISKjoEcdRMHqO4E9fzyqbBJb5WffUqfodM1QJBwwn-aVvQ5T5SeJz4tEw2aq07TEFVBE_t9ExwvZVdPDDnhxmL6Ksy_RuHvAAFqjJMZxXIcZpMSQPNq9EcVqn7B1IRqyWVWtU0kvi_P2meP5Woc27UWpDg-tNO9jb172Mw0pnU0c0QOdPMrmqXPqZI3A87WoUMpMHxZS6o2oOw4eu-3tcmywEBESTsrcVJmwfr39OnksE_dP3bSY2W2JTjpfKUAs7Vowc-lK7A7c26eLt_0ITxTpKn0I8VSLbZn14KJ6Bg&theater

2.) Gruber, K. J., Cupito, S. H., & Dobson, C. F. (2013). Impact of doulas on healthy birth outcomes. The Journal of perinatal education, 22(1), 49–58. https://doi.org/10.1891/1058-1243.22.1.49

3.) (https://www.cdc.gov/coronavirus/2019-ncov/infection-control/controlrecommendations.html?fbclid=IwAR0ZIHF8h6UUYoBvhs66cPcd6UxDs82GeBuD041kI4J_XoEdA_LmRkdBuJE

4.) https://www.michigan.gov/coronavirus/0,9753,7-406-98178_98455-521874--,00.html

 

 

More Resources:

1- https://evidencebasedbirth.com/the-evidence-for-doulas/?fbclid=IwAR3WX3LHRd1nP-HaqMl7xkUSTBl5EbNewKP34lxEnrPVvlY_zibB9kEq4n0

2-  https://www.marchofdimes.org/materials/Doulas%20and%20birth%20outcomes%20position%20statement%20final%20January%2030%20PM.pdf?fbclid=IwAR2oRr4jzXJLBs9d9Xl68RU9yLwOMHZ_Kam-KVIlUpfgaxXlnlDL-Mhwg70

3- https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth?fbclid=IwAR2A4IJj1ClCTJXQVvMUIzJlizqj_hzzv8pWL4EqnYg7hVO6l7fQrYTpKY0

4- https://icea.org/wp-content/uploads/2015/12/Role_Scope_Doula_PP2017.pdf?fbclid=IwAR1Rfwf85kY-XUMUJ-2NzMxqjvC9DWVn39dbQ_9_vn3ljoy_Qqya_yEpiHA