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/

Maternal and Child Health Advocate Running for Colorado State Senate

Hosting the annual ‘Big Latch On‘ with the Pikes Peak Breastfeeding Coalition

Back in high school, I heard a story about someone close to me being “unable” to give birth and needing major surgery to have her baby. She was healthy, and so was the pregnancy and the baby, but the doctor told her she was too “small”. Her whole story left me afraid for my own experience one day.

In college I stumbled across a book about maternity care and it opened my eyes to the travesty that is our healthcare system. The utter lack of respect for the normative course of healthy childbirth, and its participants, was leading to trauma, unnecessary interventions, and increasing risks to the mother and baby – not to mention, costly.

I’ve been working, for over a decade now, at the grassroots level with my birth-worker community to inform parents, maternity care providers, and the public about how the odds are stacked against them, and how to avoid unnecessary risk and trauma.

But I’ve become frustrated with the lack of action from the top, and so have my friends and colleagues. The lack of policy focused on protecting our most vulnerable; protecting our liberties, our choices, and our freedom – to choose where and with whom we give birth, to be free of trauma, to live.

There are simple ways that we could be saving lives, improving the mental and physical health of mothers and babies (and ultimately, our entire population), and saving a whole heck of a lot of money.

Training local Health Workers and Home Visitors as Breastfeeding Peer Counselors

Expanding access to midwives and doulas, for example, would save lives, improve experiences and outcomes, and save BIG on cost. Evidence shows that investing in home-visiting programs for postpartum and early childhood leads to better outcomes and cost-savings for individuals (as well as economies) across the life-span.

We won’t wait anymore.

It’s time to take this fight to the top.

I’m running for our Colorado State Senate and I need your support!

My race will take lots of teamwork to win. My opponent has more connections (he’s been voting against progress in the State Legislature for more than a decade already), and he knows more folks with lots of money. He votes against healthcare, votes in favor of companies that pollute and against protecting our communities, and he is far removed from what it takes to raise a family in Colorado today.

Please follow my campaign, make a $10 donation to show your support, and share this with a friend.

We’ll win this for families, together!

Peer Counselors, home-visitors, and community health workers save lives AND money!

About me:

I’ve been a birth doula (providing emotional, physical, and informational support to a birthing person/family), and provided postpartum support to families as an Internationally Board-Certified Lactation Consultant (IBCLC). I’ve served in Early Head Start and Head Start as a home-visitor and Parent Educator, and I’ve worked with children on the Autism Spectrum providing in-home and clinic-based ABA services. I have a Master’s Degree in Public Health, worked in state-wide hospital quality improvement, and directed multi-state public health programs.

Preparing for Coronavirus: What I Want My Community to Know

I began college with the plan to study pathogens and eventually become a Virologist; The Hot Zone (a book about Ebola) was one of my all-time favorites in high school and college.

I’ve been reading up on Coronavirus, and thinking about my family, community, and my State, and I want to share some things I’ve learned, resources, and things you can do.


It’s concerning to me that some folks, including our President, are saying the Flu is a bigger issue than Coronavirus because more people have died of the flu.

That’s because the Flu is already wide-spread here, Coronavirus has only begun.

Let’s look at where this could go. And then what we need to do.

Flu fatality rate = .1%
Coronavirus fatality rate = 2-4% (early estimation)

This means that when 10,000 people get the flu, 10 people die.
BUT, when 10,000 people get Coronavirus, 200-400 may die.

What is MOST concerning to me about this whole discussion is that our flu statistics actually indicate we aren’t very good at preventing the spread of respiratory illnesses in the United States.
We see 140,000 – 810,000 hospitalizations and between 12,000 – 61,000 deaths annually from the flu.

Imagine, then, if we have this many people every year getting, being hospitalized by, and dying of the flu, these numbers will be worse *when* it’s Coronavirus.

We need to be serious about this.
We can start right now by implementing better practices which decrease the spread of illnesses like Coronavirus and the Flu.


What to Do:

HUMIDIFY – I’m starting with this one because I think it is the least-well known and has significant potential to decrease the spread of respiratory and airborne illness here in Colorado. Humidify your home, worksite, classroom, business – this will help decrease the transmission of airborne pathogens. Research

WASH YOUR HANDS – Make it a religious practice. When you arrive home, get to the office, use the restroom, wipe your nose with your hand… etc

CARRY SANITZER – Hand sanitizer does not replace washing your hands, but helps when you touch the Subway rail, or run into Target. Use it between hand-washing opportunities.

COUGH/SNEEZE INTO YOUR ELBOW – Or a tissue, just not your hand. Teach children to do the same.

STAY HOME WHEN SICK – Seriously. Stay home.


I also want to get everyone thinking about, preparing for, and using a very effective public health measure to stop the exponential spread of a pathogen – Quarantine.
Quarantines really work. We should use them; we should heed them.

Stay home if you are sick. Stay home if others are sick. Order groceries for pick-up, or ask a friend to drop groceries at your door, work from home/allow employees to work from home, and generally limit public contact.

Quarantine can also come from the Government and in these cases, it is incumbent upon our public health professionals, government representatives, and local officials to share frequent and transparent information about the purpose and procedures being used to keep the public safe.

Keeping people isolated and separated, often in our own homes, is a very effective way to stop the public spread of an illness. We need to consider that we may be instructed to stay in our homes for a period of days, and that businesses, schools, and public events could be cancelled for a period of time. You can prepare for this similar to how we prepare for weathering out a big storm.

I like this article by NPR for personal preparation.

Preparedness is waaay cooler than panic, and the steps to prepare are simple, start taking them a few at a time.

Wishing you all the best of health,
~Randi


p.s. I’m running for Colorado State Senate and there aren’t enough Legislators with a background in public health and emergency preparedness. If that concerns you too, please donate $5-$25 to help me reach more voters and elect a Senator that values prevention and your health.  


More Coronavirus Resources: