Doula Support in Nebraska Hospitals during COVID-19 Outbreaks

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Dear Governor Ricketts,

We are experiencing an unprecedented public health and national emergency. However, in the midst of a pandemic, mothers are still giving birth and are now facing additional stress and anxiety caused by the uncertainty of this virus, a change in their birthing plan, healthcare, and even their healthcare provider. Due to COVID-19, all hospitals across Nebraska have enacted a variety of policies that limit the birthing mother to one birthing partner and prohibit professional birth doula support from entering the birth space. But, in an effort to save lives, these policies are putting the birthing woman and baby at a higher risk. 

Studies have shown that continuous birth support from a doula has a dramatic effect on mom/baby outcomes. [From Evidence Based Birth]

* 39% decrease in the risk of Cesarean; the largest effect was seen with a doula (39% decrease)*

*15% 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

*Shorter labors by 41 minutes on average

*38% decrease in the baby’s risk of a low five-minute Apgar score

*31% decrease in the risk of being dissatisfied with the birth experience

COVID-19 is taxing our hospital systems, and yet many hospitals are prohibiting the very people who could help carry the burden. In study after study, it is evident that doulas reduce the rate of unnecessary interventions and cesarean births (which requires three to four times as many health professionals as vaginal births do). Vaginal births also shorten the length of hospital stays, which means that more hospital beds will be open and families will be able to isolate at home much sooner. 

In the midst of this crisis, obstetric organizations agree that doula support is essential. 

AWHONN (the Association of Women’s Health, Obstetric, and Neonatal Nurses) released the following statement on Wednesday, March 11th:

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.

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." [https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html?fbclid=IwAR0ZIHF8h6UUYoBvhs66cPcd6UxDs82GeBuD041kI4J_XoEdA_LmRkdBuJE

The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-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.”

We are asking that Governor Ricketts follows suit of New York’s Governor Cuomo’s executive order that clarifies “doulas are considered an essential part of the support care team and should be allowed to accompany a pregnant individual during labor and delivery as an additional support person, as medically necessary.”

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/042920_CMTF_Recommendations.pdf

We are asking that you please confirm the use of doulas as an essential personnel team member in hospital births and follow New York and Michigan in protecting our role in the birth space.