Coronavirus restrictions are excluding doulas from many delivery rooms

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Yamel Belen is a registered nurse and owner of One Love Doula. She begins cultivating relationships with many of her clients before they are even pregnant.

The use of a doula, or a professional birth attendant, has become increasingly popular in the United States. But under new hospital guidelines, pregnant women may only allow one visitor, who may not be switched out at any point, with her through the entire hospital stay. With the exception of Tampa General Hospital, that policy includes doulas. Some say doulas should not be put in the visitor category.

Last week, Belen went in with a client and was screened upon intake for a temperature. But right before entering the delivery room, she was turned away.

“My client was literally sobbing,” she said. “You should still screen a doula, like everyone else. But do not consider doulas a visitor. ... We’ve been fighting for so long to make sure doulas are recognized as an essential part of the birth space.”

The Association of Women’s Health, Obstetric and Neonatal Nurses and American College of Obstetricians and Gynecologists put out a statement asking for doulas to still be allowed in delivery rooms.

“Doulas are not visitors and should not be blocked from caring for patients in the antepartum, intrapartum and postpartum period,” Nancy Travis, AWHONN Florida section chair, said in a statement. “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.”

Belen said many of her clients are now trying to switch where they are delivering to Tampa General Hospital or find out about home birthing options — though obstetricians say hospital delivery is still safer.

Rachel Penny is due the first week of April. She sought out Belen 10 months ago and is planning to deliver at Morton Plant hospital in Clearwater.

First, she was told she would be allowed to bring two visitors. The following day, it was just one. She’s read about deliveries in New York, where women can’t bring anyone in the room with them.

“It’s like a ticking time bomb,” she said. “I couldn’t imagine having nobody there. Say you’re in labor for 36 hours. It doesn’t matter how nice the nurse is, in my opinion.”

Now, Penny is planning to bring her husband with her.

“He knows how to support me,” she said. “But the doula knows what position I should be in or what words of affirmation I might need. It’s an energy or vibe.”

Doulas, Belen said, provide an essential service to both the mother and partner during the course of delivery and don’t leave the side of the patient, unlike nurses who might have multiple patients to tend to.

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Christie Collbran, of Buddha Belly Doulas, said doulas provide informational, emotional and physical support during labor. They’re offering their clients virtual services, she said, offering to be virtually present and consult on decisions such as epidurals or instructing a partner in how to assist. They’re also offering virtual consultations with mothers and their partners before hand to teach comfort techniques to practice during labor.

But they still can’t be there physically, she said, and some clients are canceling their contracts.

“(The physical component) is a pretty big role,” she said. “We believe it’s a very important role. Your doula is highly trained and experienced in supporting women at that time in their life. This is not something you can learn in a one-hour Skype phone call.Knowing when to do certain techniques, that just comes with training.”

Some studies have shown the presence of doulas lead to better birth and postpartum outcomes for mothers, including in shorter labor time and better lactation outcomes.

However, Collbran said she understands the regulations.

“It’s such an unprecedented time that we don't want to say doulas should be allowed,” she said. “If safety measures are so extreme that they need to keep people out of the hospitals, then who are we to say.”

Buddha Belly is changing their packages based on the services they’re now able to offer, she said. They think they will need to plan for this for the long term.

“Even after we flatten the curve, the hospitals will still be crowded,” she said. “We’re trying to turn it into the best possible outcome and services. ...We’re not doctors or nurses, but we do make a difference.”

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