We want Doulas to be classed as 'Essential Workers'

Some background: Since the start of the Covid-19 pandemic here in the UK there have been restrictions in place preventing birth partners from being present during early labour, birth and on postnatal wards. Some hospitals have reduced the number of birth partners to 1 and the majority to none at all. As highlighted by the #butnotmaternity campaign, these restrictions have meant countless stories emerging about increases in traumatic births, stillbirths, miscarriages and women birthing alone. We believe that this is contrary to birth, reproductive and human rights. 

Since the #butnotmaternity campaign was initiated, the Royal College of Midwives and Royal College of Obstetricians & Gynecologists have issued a statement on the reintroduction of visitors in maternity services in England. The statement says that a framework has been developed by the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives and the Society and College of Radiographers, in partnership with NHS England and NHS Improvement, to support maternity services with the local reintroduction of hospital visitors and individuals accompanying women to appointments.

Here is the issue: The framework is not mandatory & all Trusts are left to their discretion in relation to whether or not (and to what extent) they apply this framework. Whilst it is a good first step, it's not enough. 

The ACTION we are calling for: While we agree that the need for reducing numbers of general visitors in hospitals is a necessary policy, it is hindering the support we as doulas provide, because we are falling under the "visitors" category.  Whilst we appreciate and respect this effort, we have a duty to do right by our clients and these restrictions may actually be putting them at risk, particularly when it comes to black and brown birthing women and people in the community. We are calling on Professor Whitty, MP Matt Hancock and NHS England to support the inclusion of doula support for birthing people in all UK hospitals, firstly by identifying doulas as essential workers and secondly by recognising the need for the essential work of doulas within the NHS, particularly during this global pandemic.

We are asking that doulas not be considered visitors in the hospital setting, but instead, critical members of the health care team for labouring, birthing and postnatal women, people and their families.

There is undeniable evidence that doulas are integral to pain management and emotional support, reductions in intervention & more positive birth outcomes.
Some facts:

• doulas are a form of pain relief in themselves (Hofmeyr, 1991). With continuous support, laboring people are less likely to request epidurals or pain medication.
• women may avoid many medical interventions that often go along with an epidural, including Pitocin augmentation and continuous electronic fetal monitoring (Caton, Corry et al. 2002).
• the calming effect of the doula’s presence increases the mother’s own natural pain coping hormones (beta-endorphins), making labor feel less painful (Uvnas Moberg, 2014)
• A recent study compared first-time mothers’ anxiety and pain levels with doula support to those without doula support and found found that on average, the mothers who received doula support had less anxiety and lower average pain scores during labor. The authors concluded that the doula’s presence has a clinically meaningful impact on anxiety and pain levels in first-time mothers giving birth (Ravangard et al. 2017). 

We also believe that having a doula can contribute to the reduction in disparities in the maternal mortality rates that currently exist in this country, in. We acknowledge, following on from the MBRRACE report 'Saving Lives, Improving Mothers’ Care' that black women, in particular, are 5x more likely to die in childbirth than their white counterparts, as advocated by the #5xmore campaign and as discussed on Wednesday 30th September on Prime Ministers Question Time. We also understand from a recent study by the NPEU that "Pregnant women from black and ethnic minority backgrounds were more likely to be admitted to hospital for COVID-19".

Our aim is to offer the best and most evidence-based care to our labouring, birthing and postnatal clients whilst adhering to point 2.1 of the NHS England Framework in terms of mitigating the risk of transmissions through good hygiene, communication, PPE, regular monitoring of symptoms and appropriate social distancing. Through continuity of care and support in the birth setting, as well as the facilitation of improved communication, education and community connectedness prior to, during and after birth, we hope that we will provide relief from stressful situations for laboring & birthing people thus freeing up nursing and midwifery staff to focus on the most pressing needs. As doulas we have provided care to our clients during flu season, SARS, H1N1 so we understand and value the safety and health of our clients, hospital patients, and hospital staff. 

Bringing a child into this world during a pandemic is not something any birthing person should have to encounter alone - however, it is in times such as these that we should look to the evidence and deeply consider any exclusionary policies that may cause further unnecessary physical and emotional harm and long lasting trauma.  

Allow us to work together during this unprecedented time of uncertainty and heightened stress to provide better labour, birth and postnatal support to birthing women & people.

#MakeDoulasEssential