June 17, 2020

To Orlando Health, AdventHealth & Governor Ron DeSantis:

We, as the wider doula community of Orlando, are committed to being vigilant and as helpful as possible during this time to the clients we support and their chosen health care providers and birth locations.

We acknowledge that you are following CDC guidelines and will respect the protocols and procedures that you are putting into place. We hope you will take into account the important role a doula plays in the health and well being of birthing and newly postpartum families. Our community of doulas takes great pride in the professional relationships that we have formed with your doctors, nurses, and staff over the years. We have been a strong support for your patients during flu season, SARS, H1N1, etc., and we take seriously the safety and health of our clients, your patients, and your staff. 

As professional doulas, we are committed to:

Following proper hand washing/sanitizing protocols personally and professionally
Staying away from clients and birth location if we ourselves are sick, or exposed to illness
-Using back-up doula support 

Following hospital regulations, including:

• wearing hospital-provided masks, gloves, protective equipment when required and/or available
• limiting movement to the patient’s room as much as possible
• limiting personal items to bring in only what is needed for personal nourishment and hygiene
• Encouraging all area doulas to enroll in specific training for COVID-19
• Bringing identification of our professional doula training/certification, registering with hospital staff as a visitor/support person, or supplying other requested documentation.

We know the difference that doula support can make, especially when we are working in partnership with the medical side of their care. We are committed to working with your institution to support the healthy outcomes we all want for birthing parents and their families.

You are likely already aware of the statements issued by AWHONN and DONA on this topic, but we are attaching them below for your convenience. We’ve also attached some more supporting documentation including ACOG’s Consensus on Obstetric Care.

You are likely also aware that large metropolitan areas such as New York City and Chicago have allowed doulas back in as essential hospital personnel to support laboring people during this pandemic. We ask that you do the same.

Thank you, Large Community of Doulas of Orlando

 

AWHONN’s Position on Doulas with Patients During COVID-19

AWHONN recognizes that doula services contribute to the woman’s preparation for and support during childbirth and opposes hospital policies that restrict the presence of a doula during a woman’s active labor.

“Doulas are not visitors and should not be blocked from caring for patients in the antepartum, intrapartum and postpartum period.  Most doulas have been contracted by patients weeks to months ahead of time and have established provider relationships.  They are recognized by AWHONN and ACOG as essential personnel and part of the maternity care team,” said AWHONN member Nancy Travis, MS, BSN, RN, BC, CPN, CBC, Florida Section Chair.

AWHONN supports doulas as partners in care and acknowledges their ability to provide physical, emotional, and partner support to women.  AWHONN opposes hospital policies that restrict the presence of a doula in the inpatient setting during an infectious disease outbreak.  Read more about AWHONN’s position on continuous labor support for every woman here.

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DONA Statement:

Regarding doulas attending births in the hospital setting

Recently, we have heard reports of hospital restrictions which could inhibit a family from working with their doula during labor and birth.  As supported by both The American College of Obstetricians and Gynecologist (ACOG) and The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), doulas are an important part of the care team and provide informational and emotional support as well as comfort measures for patients during birth.  Numerous clinical trials show that when doulas are present for families, healthier outcomes are possible. According to the Cochrane database,  “Continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score and negative feelings about childbirth experiences.”(2017, Bohren et al. ” Continuous support for women during childbirth.” 2017.  At this time, it is our position that doulas should continue to be permitted into the birth room as an essential component of the patient’s well-being and care, and it’s our hope that any hospital visitor restrictions will exclude doulas.

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Fetal Medicine (SMFM) joint statement: Obstetric Care Consensus: Safe Prevention of the Primary Cesarean Delivery says this about the effect of labor support:

“Increasing women’s access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates.”

“Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.”

“…the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery.”

“Given that there are no associated measurable harms, this resource is probably underutilized.”

Read more here: https://www.acog.org/~/media/Obstetric%20Care%20Consensus%20Series/oc001.pdf?dmc=1&ts=20140220T0709497934

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Is there a difference between hospital staff or a family/friend support person and a professional doula?

The researchers also looked to see if the type of support made a difference. They wanted to know—does it matter who birthing persons choose for continuous support? Does it matter if they choose a midwife, doula, or partner for continuous support? The researchers were able to look at this question for six outcomes: use of any pain medication, use of Pitocin during labor, spontaneous vaginal birth, Cesarean, admission to special care nursery after birth, and negative birth experiences.

For two of these outcomes (designated with asterisks*), the best results occurred when a birthing person had continuous labor support from a doula– someone who was NOT a staff member at the hospital and who was NOT part of their social network. The researchers found that overall, people who have continuous support during childbirth experience a:

• 25% decrease in the risk of Cesarean; the largest effect was seen with a doula (39% decrease)*
• 8% increase in the likelihood of a spontaneous vaginal birth; the largest effect was seen with a doula (15% increase)*
• 10% decrease in the use of any medications for pain relief; the type of person providing continuous support did not make a difference
  Shorter labors by 41 minutes on average; there is no data on if the type of person providing continuous support makes a difference
• 38% decrease in the baby’s risk of a low five minute Apgar score; there is no data on if the type of person providing continuous support makes a difference
• 31% decrease in the risk of being dissatisfied with the birth experience; mothers’ risk of being dissatisfied with the birth experience was reduced with continuous support provided by a doula or someone in their social network (family or friend), but not hospital staff

What about women of color, specifically black women who had a doula with them, what were the outcomes for them?

• participants had significantly lower rates of preterm birth and low birth weight
• they found that doulas play an important role in Agency. Agency is defined as the capacity of individuals to act or to make their own choices. Doulas helped their clients to understand their options and they facilitated communications with care providers so that clients felt a sense of empowerment or ownership over their care.
• Doulas also contributed to feelings of personal security. When women felt scared by their care providers, they were comforted and reassured by their doulas.
• There was a consensus in the interviews that a doula’s presence facilitated greater respect and autonomy in decision-making.
  Doulas also played a critical role in transferring knowledge about the pregnancy and birth process. They connected clients with resources and “translated” information received from care providers during clinic visits.
• Finally, doulas helped women with connectedness so that they would not feel socially isolated. Many of the participants described stressful life situations and desired a doula with similar life experiences, someone who shared their culture and background.

Information is taken from Evidence Based Birth: Found here: https://evidencebasedbirth.com/the-evidence-for-doulas/​

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/