Srividya Kannan Ramachandran was well into her pregnancy when she considered hiring a doula for the first time. The almost 35-year-old research lead at Facebook was attending a company-organized art class (Facebook offers extra-curricular courses to its staff to help mitigate work stress), and the instructor, who was also pregnant, asked her if she had enrolled in childbirth classes. She had not. The instructor passed along a recommendation for New York-based childbirth educator and doula Mary Esther Malloy’s popular Mindful Birth classes and Ramachandran enrolled a few days later. “I didn’t realize I wanted a doula until about three weeks into the class,” she says. “That’s also when I realized how many things I didn’t know.”
One of those unknowns, of course, is the changing landscape around pregnancy that has come with COVID-19: Ramachandran is now contending with the pandemic’s effects on how she—and women across the country—must retool their birth plans while considering new variables such as single-support-person mandates. While not implemented nationwide, the common practice to protect laboring mothers, their newborns, and healthcare workers from the virus’s spread often means making a difficult choice: whether to have your partner or your doula by your side during childbirth. If she had to make this decision right now, Ramachandran says she would consider choosing Malloy, who she hired for her own delivery. “My husband and I, neither of us know what to expect. That one day could be very traumatic,” she says. In contrast, doulas have attended many births and know exactly what to do in any number of scenarios. “Being able to have that expertise next to you is just so comforting.”
It’s also statistically proven to improve birth outcomes. In New York City, where 65% of women giving birth are on Medicaid, only 10% of women utilize doulas, which means that many people consider their services “a class thing,” says Malloy, versus a healthcare necessity. (Doula fees can range from under $1,000 to $3,000 and up, and are often an out-of-pocket expense that is not always covered by insurance.) “But doulas are not a luxury,” emphasizes Nan Strauss, a trained lawyer and the Managing Director of Policy, Advocacy, and Grantmaking for Every Mother Counts, the New York-based non-profit founded by Christy Turlington-Burns that is dedicated to raising awareness around fetal- and maternal-care safety. Strauss, who has been actively involved in making maternal healthcare policy recommendations for state and federal responses to COVID-19, has also been a vocal supporter of doula pilot programs in states such as New York, Oregon, and Minnesota. These initiatives aim to provide doula access to underserved communities, most commonly lower income communities and communities of color, where maternal death rates are far higher than the already dismal national average. “Doula care is an evidenced-based measure that has been found to be the most successful intervention when it comes to reducing the risk of preterm birth and delivery complications—and this is according to The American College of Obstetricians and Gynecologists,” Strauss says. Perhaps most notable is that these measures can help reduce the need for C-sections by 39%—a staggering statistic considering cesarean deliveries cost 50% more than vaginal births. “So across the board, more doula support could be saving the system healthcare costs. More importantly, though,” she continues, “most women don't want to have major abdominal surgery!” It’s for all of these reasons that Strauss has made expanding access to community-based doulas a big part of the advice she is sharing with congressional leaders and the National Governors Association as she works to secure the medical care of expectant mothers during the pandemic. “There's such a need for the information, system navigation, and emotional support that doulas can provide, now more than ever,” Strauss adds.
In broad strokes, for the uninitiated, that support typically entails moment-to-moment, non-medical care before, during, and after one of life’s most intense experiences. “It sounds funny, but even just having someone by your side to anchor your faith in your own ability and your body’s ability to give birth, provides a sense of safety to allow you to go as deep as possible into the process,” says Malloy. This vaguely amorphous description is something that you truly can't begin to process until you’re, say, into your 25th hour of labor and wondering if you will in fact be able to make it to the finish line. I myself am among the converted when it comes to doula appreciation. Malloy was my doula when I gave birth to my son two years ago, a 32-hour ordeal that I have nothing but positive things to say about thanks in large part to the doula care I received. What many first-time pregnant women and their partners often don’t understand until they are in the delivery room is that your doctor or midwife is not with you while you labor. They check in periodically to ensure things are progressing apace and return to safely deliver your baby. Having access to experienced support people throughout the process, however—to literally hold your hand, rub your back, wave a peppermint oil-soaked paper towel in front of your face to ease your nausea, help troubleshoot natural solutions to speed up dilation, and to count down every single contraction, for 25 hours straight, until you finally concede to an epidural—is another, entirely different, but no less essential service. Even the most well-intentioned partner cannot be expected to provide this kind of support. Which is why relegating doulas to FaceTime and Zoom in hospital rooms—an increasingly common new development—can be yet another harsh reality of the evolving impact of COVID-19 on pregnant women.
“There is still a tremendous opportunity for doulas to provide virtual support during birth,” insists Strauss, adding that there is an even bigger opportunity for their virtual support postpartum, especially as new families are now more isolated than ever. Malloy and many of her colleagues are adapting their models of support accordingly. “We’re encouraging partners to have a tripod so we, the virtual doula, can have a visual vantage point. But different families are doing it differently,” Malloy says. “Some are keeping their doulas just on speaker, or FaceTime. Some families want constant support, some just want periodic check-ins,” she continues. During our interview, Malloy is “attending” one such birth, and awaiting a text response from her client’s partner. She had just dropped the couple off at NYU Langone Medical center after laboring with them at home for hours. I can hear the pain in her voice as she describes the surreal nature of not being able to be with her client in person.
Ramachandran, who is due on May 22, is encouraged by the idea that some hospitals are allowing women to swap out their single support person—so a doula can be present for the active labor, and then a partner is permitted to relieve her for the actual birth, provided he our she is not symptomatic of, or has tested positive for COVID-19. But for now, she is holding out for good news in our fight against the spread of the coronavirus, and that increased containment could cause a change in many hospitals' one-support-person mandate. “I really do hope we’re in a different place by then,” she says. For her sake, and for all expectant mothers, so do I.
Originally Appeared on Vogue