Throwing Mom and Baby Out With the Bathwater: Maternity Care and Coronavirus in the United States

During a pandemic it makes sense to adjust our maternity care, but it shouldn’t be at the expense of maternal and newborn wellbeing and safety. Yet, here we are, called once again to defend the humanity of giving-life and the normalcy such an experience demands.

I have a Master’s Degree in Public Health, with a concentration in Maternal and Child Health, and I’ve worked as a birth doula, Internationally Board-Certified Lactation Consultant (IBCLC), and I’ve directed multi-state MCH programs; now I’m running for Colorado State Senate.

The following are my perspective and thoughts, none of this is medical advice.


Get the facts from global experts. The United States has a spotty record on maternity care (we have the worst infant and maternal mortality rates of the developed nations), and now we have a poor record of pandemic response — look to global experts for their knowledge and advice about both.
I recommend starting with the World Health Organization.

Be informed about your rights as a consumer. In everything you do, make sure you know how much power you have (it’s usually much more than most people will let on). Stand up for yourself, speak to what you need. How you feel impacts how well you are & how well you will heal.

Choose a caregiver and birth location with intention. Giving birth in the U.S. (vs another developed country) means you are already at a disadvantage (less choice, poorer outcomes), especially if you are a person of color. It’s important that you are engaged in your care, and that you feel safe and respected. Find the right maternity care provider for you.

YOU *CAN* CHANGE PROVIDERS – you are giving them your business, make sure you are being respected and feel right about paying this person and bringing them into your birth care.

Look for Midwives. Midwifery care is more person-centered than OB care, and has better outcomes for low-risk moms and babies. There are sometimes midwives in hospitals (though pretty rare and needs to happen way more), and you can also give birth safely outside of the hospital, at home or in a birth center (if you are considered low-risk) with a trained midwife. Resource

You should have a trusted companion at your birth. I’ve heard that some hospitals may have said that no one can accompany a birthing person (including partners), I hope this isn’t true, but in case it is, let’s cover a few things…

1. Birth is safer for moms and babies when there’s someone with the mother all the time. Conversely, birth is riskier when the mother doesn’t have a companion at her side. For example, a partner attending a birth decreases the risk of a C-Section by 25% and babies have higher APGAR scores. (Source)

2. Under normal conditions, nurses only spend about 31% of a labor with the mother, and only about 12% of that time providing emotional, physical support, or informational support (the rest is monitoring, vitals, etc). That’s not continuous support for the person giving birth, and with a shortage in healthcare staff, having someone attend the mother just makes sense.

3. Doulas need to be allowed too. I completely understand the reason for not having numerous people attend a birth during a pandemic – an exception MUST be made for trained birth doulas.

 “If a doula was a drug it would be unethical not to use one.” ~Dr. John Kennell

Birth Doulas (trained birth companions) provide emotional and physical support to a birthing person and tons of data shows how effective they are in reducing the need for interventions, like pain medications and C-sections; in fact, professional doulas decrease the risk of a C-section by 39%! That’s extremely important in a time like this where we don’t want all the additional risks of a major surgery AND when our health care professionals are otherwise occupied & hospital resources are scarce.
Doulas are an important part of safe maternity care and they need to be included in the precautions and preparations we make during this pandemic, and continuing thereafter.

You can breastfeed (and you absolutely should if you want to!), even if you are positive for Covid19. Breastfeeding is an important protective measure to prevent illness and infection in an infant, and it provides other life-long health protections to both mother and baby.

But don’t take it from just me, here’s more from the global experts –

“All international world health guidelines agree: Breastfeeding should continue and be supported during the COVID-19 epidemic, with appropriate precautions.”
~International Lactation Consultant Association (source)

“Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother could can [sic] continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures described in this document.”
~World Health Organization

ROUTINE SEPARATION POLICIES GO AGAINST INTERNATIONAL GUIDELINES. They are inhumane and have the potential for too much negative risk, we need to treat and support each dyad individually.

Keep mom and baby together. Separating mom and baby should always be a last resort. There are critical biological processes that occur in the moments, days, and weeks following birth, that if disrupted, have the potential to contribute to lifelong negative outcomes.

Also, separation makes it really really hard to have an effective breastfeeding relationship, and breastfeeding is an important part of normative and healthy development. By taking extra hygienic precautions, most mothers and babies will be able to stay together – and this will keep them healthier in the short and long term, than if they are separated.

More from the World Health Organization:

“Mothers and infants should be enabled to remain together and practise skin-to-skin contact, kangaroo mother care and to remain together and to practise rooming-in throughout the day and night, especially immediately after birth during establishment of breastfeeding, whether they or their infants have suspected, probable, or confirmed COVID-19.”

“In situations when severe illness in a mother with COVID-19 or other complications prevents her from caring for her infant or prevents her from continuing direct breastfeeding, mothers should be encouraged and supported to express milk, and safely provide breastmilk to the infant, while applying appropriate IPC measures.” (source)

Remember, “First, do no harm”. Separating children from their caregivers, and infants from their mothers, does irreparable and life-long harm.


Women and children in the U.S. began this Pandemic at a disadvantage, especially those of color, and I will not stand by quietly as we roll back the progress made in protecting their well-being and lives.

Birth Matters.
Birth Experiences Matter.
Women Matter.
Mothers Matter.
Black Lives Matter.
Indigenous Lives Matter.

And there’s not one single excuse left not to act like it.


One final note:
How I’d do it if I were in charge …
I’d like to see more low-risk healthy mothers receive care at home from trained and certified midwives. Doulas should be encouraged at all births because of their high reward. Additionally, in an effort to reduce the number of healthy people receiving care in a hospital overburdened by treating Covid19 patients, we could look at temporarily converting local Birth Centers to high-risk labor facilities and setting up a surgical suite in a birth room. People that risk out of a home-birth would be directed to the birth center converted for high-risk care. Just some Pandemic, public health, thoughts. Thanks for reading.


Resources:

World Health Organization on Pregnancy, Childbirth, Breastfeeding and COVID19 –
https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-pregnancy-childbirth-and-breastfeeding

Evidence for Doulas –
https://evidencebasedbirth.com/the-evidence-for-doulas/

Out-of-hospital birth with professional Midwife –
https://mana.org/blog/home-birth-safety-outcomes

More out-of-hospital birth –
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30142-7/fulltext

Keep mother & baby together –
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235060/

Breastfeeding & Covid19 Information –
https://ilca.org/covid-19/

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