UPDATED STATEMENT OF RECOMMENDATIONS REGARDING DOULAS AND OTHER MATERNITY CARE SUPPORT PEOPLE IN NEW MEXICO DURING COVID-19

The New Mexico Doula Association has been publicly advocating for role of doulas in hospital settings since January 2021. Since that time, some hospitals have opened their doors back to doulas (with varying & rapidly changing policies still occurring). Other hospitals in New Mexico have outright denied patients their right to their doula since March 2020. 

GALLUP, NM UPDATE: October 5, 2021

Rehoboth McKinley Christian Health Care Services (RMCH) labor and delivery unit closed last week, forcing many soon-to-be parents to find a faraway delivery room and making it harder for women to access health care in Gallup, N.M., and the surrounding area. When it was open, the nurses and four obstetrician-gynecologists delivered between 30 and 40 babies a month, many of them to mothers who come from rural areas like Navajo Nation and Zuni Pueblo.

The population served by RMCH represent some of the most vulnerable in the state and these birthing persons are being traumatized mentally, physically, emotionally, spiritually, and financially by the decisions of out-of-state management companies and administrators. This latest closure is not an isolated incident but rather a symptom of years of mismanagement, racism, and corruption; and is also representative of a larger statewide problem. 

• While supporting this petition may do little to help those immediately effected in Gallup and surrounding areas, it may help those affected who desire secondary support to have it, at ANY and ALL New Mexico hospitals.
• Action on this petition also strengthens the case for more indigenously trained doulas who can provide culturally-relevant and compassionate care to those birthing in ANY and ALL New Mexico hospitals.
• Allowing secondary support persons to be present costs the hospitals nothing as those individuals may volunteer services or are paid directly by the client; not by hospitals or insurance companies.
• If hospitals prioritized improved patient outcomes, satisfaction and finances, they would welcome secondary support persons/doulas as complementary members of the birth team. 

Letter Originally published JANUARY 30, 2021

All families birthing in New Mexico deserve a positive and supported birth experience regardless of the extenuating circumstances with COVID-19. We know that positive experiences most often happen when families can express their needs and have them acknowledged, heard, and honored. Positive birth and postpartum experiences in New Mexico must always include the option of doula support. 

The New Mexico Doula Association recognizes the challenges that our state, country, and world are facing regarding limiting the spread of COVID-19, including the reduced availability of PPE, sufficient testing, and vaccinations. We gratefully acknowledge the courageous efforts of our state government, medical professionals, hospital staff, and other essential workers.

We also acknowledge the limits placed on visitors to hospital obstetric units to be in alignment with important safety measures during the COVID-19 pandemic. 

HOWEVER, ENSURING ACCESS TO OBSTETRIC UNITS AND COMMUNITY BIRTH CENTERS FOR BOTH A  PATIENT’S CHOSEN VISITOR AND A DOULA MAY REDUCE BOTH RISK AND COST, WHILE SIMULTANEOUSLY IMPROVING OVERALL OUTCOMES AND BIRTH EXPERIENCES. 

Both of these support people may be screened and, when available, tested for COVID-19 infection and provided with PPE. 

Trained and professional birth and postpartum doulas have a unique role in supporting optimal experiences and care outcomes of birthing and postpartum parents. They do this through continuous support, education, comfort measures, and supporting the birthing person’s self-advocacy while receiving and accessing appropriate care. 

Doulas understand that maternal health care providers are under increased pressure due to the current pandemic and can help “fill-the-gap” by providing much-needed support, not only to the birthing family, but also in support of the medical team’s goal of realizing optimal care outcomes and reducing overhead cost for providers & facilities, and out- of-pocket costs for birthing families. 

The New Mexico Doula Association position is that doulas are not visitors. (AWHONN MAR STATEMENT1)

Doulas are allied professionals well-situated to enhance the delivery of safe, evidence-based care; filling a gap in the US maternal healthcare system. (ACOG, AWHONN, ACNM) 

The evidence-based health benefits of doula care for families (ACOG, AWHONN, ACNM, WHO) and families of color (CAP, Wint et al, Ireland et al) must continue to be accessible to birthing families. 

Doula care has been shown to reduce families’ risk for medical intervention, cesarean surgery, and postpartum depression (COCHRANE).

RECOMMENDATION #1
THE NEW MEXICO DOULA ASSOCIATION STRONGLY RECOMMENDS THAT DOULAS BE INCLUDED IN BIRTH CARE TEAMS, FOR ALL BIRTHING PEOPLE WHO REQUEST DOULA SUPPORT. 

The doula support role has the power to raise BIPOC (Black, Indigenous and People of Color) families’ confident access of safe, respectful care through facilitation of meaningful connection between a family. Doulas support the integration of a family’s cultural experiences, language preference, lived hardship or trauma, family members, and parenting style into and through and the care experience. 

Given the ongoing COVID-19 pandemic, families are already at an increased risk for mental and emotional difficulties during and after birth. Without in-person doula care during childbirth and through the duration of their stay, these families are at an increased risk for undesired outcomes and longer hospital stays. Under the current guidance, families who planned to include a doula no longer have that choice and as a result, face compounded risk without the continuous in-person presence of their trusted doula. 

RECOMMENDATION #2
IF THE PHYSICAL PRESENCE OF A DOULA IS NOT POSSIBLE, WE RECOMMEND HOSPITAL SUPPORT FOR A FAMILY TO ACCESS THEIR DOULA VIA TELEHEALTH OPTIONS IN L&D UNITS. 

Doula telehealth support can include intermittent as well as continuous virtual labor support. (McLemore; what about EBB) Many families will have their own devices with which to access virtual doula support. For those who do not, birthing facilities should  provide a phone or tablet with access to  WIFI and video/audio capabilities. Additionally, we hope that hospital staff will be accepting and supportive of working as a team with the family and their virtual doula. 

RECOMMENDATION #3
WHEN A DOULA IS NOT DESIRED OR IS NOT AN OPTION, WE RECOGNIZE AND ADVOCATE FOR THE RIGHT OF THE BIRTHING PERSON TO CONTINUE TO HAVE A SECOND SUPPORT PERSON OF THEIR CHOICE WITH THEM DURING THE ENTIRETY OF THEIR STAY AT ALL NEW MEXICO BIRTHING FACILITIES (WHO, MCLEMORE,…) AND LOCATIONS INCLUDING IN-HOME.

The New Mexico Doula Association welcomes the opportunity to further these conversations and to work with the communities of New Mexico to build mutually supportive relationships. Board members and supporters of the New Mexico Doula Association are available to provide additional insight, resources, evidence-based studies, and insight from national conversations around the importance of doula care during COVID-19. 

We encourage you to connect with us at newmexicodoulaassociation@gmail.com. You may also access additional information about our organization at https://www.nmdoula.org/

Signed,

Letter Contributors:

• Carrie Murphy, MFA, NMDA cofounder, full spectrum doula, cofounder and volunteer coordinator, University of New Mexico Hospital Volunteer Birth Companion Program
• Jessica Lujan-Garcia, Indigenous Women’s Health & Reproductive Justice Program, Tewa Women United
• Karen Brown, doula with Sanguine Journey, LLC
• Melissa Marie Brice, MBA, NMDA executive director & full spectrum doula with Melissa Marie, LLC
• New Mexico Doula Association Board of Directors
• New Mexico Doula Association Steering Committee

Co-Sponsoring Organizations:

• Indigenous Women’s Health & Reproductive Justice Program, Tewa Women United