In an effort to prevent medical professionals and hospital staffers from potentially being exposed to COVID-19, hospitals in the New York City area have announced new visitor guidelines that would prevent pregnant women in labor from having visitors, whether it be a spouse, birthing partner or doula.
“At this time, no visitors including birthing partners and support persons are permitted for obstetric patients,” an online notice from the NewYork-Presbyterian network reads. “We understand that this will be difficult for our patients and their loved ones, but we believe that this is a necessary step to promote the safety of our new mothers and children.”
According to CNN, Dr. Dena Goffman, chief of obstetrics at Columbia University Medical Center, said it was a decision not “taken lightly,” but a necessary one, given New York state’s skyrocketing coronavirus cases, which totaled more than 25,000 on Tuesday morning. During a leadership briefing Sunday, Goffman also cited instances in which pregnancy and labor masked COVID-19 symptoms like shortness of breath, only for patients to later test positive, by which point staffers and newborns had been exposed.
On Monday night, the Mount Sinai network — which runs multiple hospitals in New York City — announced that it too would be cutting off visitors in the maternity ward.
“The COVID-19 crisis has reached new levels,” a statement sent to Yahoo Lifestyle reads. “In response, Mount Sinai Health System is taking additional steps to provide the safest environment possible to protect our patients, staff and visitors. Effective Tuesday, March 24, we are prohibiting all visitors in maternity and postpartum units across the System, including partners or guests of patients in labor, and allowing mothers only in NICU units, to prevent avoidable exposure to mothers and babies. These steps are critical to ensure that we can continue to slow the spread of COVID-19.
”We do not take this decision lightly, but these are unprecedented times that require unprecedented steps to protect our patients, their families and their new babies. We know how important it is to connect with loved ones while in our hospitals and we will do everything we can to virtually connect patients with family and friends. We appreciate everyone’s understanding and compliance during this difficult time.”
The crackdowns — expected to be adopted by other hospitals across the country, which have already scaled back maternity ward visitors — have caused anguish for expectant mothers who now face the prospect of giving birth alone. While some commenters to NewYork-Presbyterian’s Facebook post sharing the news praised administrators for making a difficult, but ultimately prudent, decision, many parents-to-be have expressed their frustrations and fears on hospital profile pages and in Facebook groups like Pregnant During COVID-19 Pandemic. Adoptive parents and those welcoming children via surrogates are also uniquely impacted by the policies, which would prevent them from witnessing their baby’s birth in person or enjoying early bonding moments like establishing skin-to-skin contact.
One expectant mom due to give birth to her first child at a NewYork-Presbyterian hospital spoke to Yahoo Lifestyle about the anxiety she’s experienced over the announcement. As of Tuesday afternoon, her doctor had not contacted her by phone to discuss the changes, though the medical practice did send a form email to all obstetrics patients.
“I am very stressed out and now scared of delivering my baby without my husband beside me,” the mom-to-be, who preferred to not publicly share her name, says. “One doesn't know how the child birthing process will turn out — what if there is some complication with the mom or the baby and to know that you are out there alone without your support person is extremely scary. I don't think any hospital can guarantee anyone that it will be all OK, and there will be no problems or complications during labor. The mother’s mental well-being should count.
“While I very much so understand that times are different and we are all trying to get through this whole COVID-19 situation together, I do not think it is fair to have us put through tremendous mental pressure during such a delicate time in our lives. There has to be a better solution ... I can't wrap my head around having my baby alone and I am still yet to process this piece of information.”
Josh, a Manhattan-based dad who preferred to share only his first name, tells Yahoo Lifestyle that he and his wife are also reeling from the news that their New Jersey hospital is also expected to shut off visitors. She is scheduled to give birth to their second child via C-section in late April, and the couple has been told from contacts within the hospital that a no-visitor policy is imminent. Having been present for his first child’s delivery via C-section, which left his wife groggy and in need of his support, Josh sees these crackdowns as a safety risk.
“My wife’s rights as a patient are completely disregarded here — to have an advocate of her choice there for a major surgery,” he says, noting that his wife and her sister, who is also pregnant, are “completely stressed out” over the situation. “And for the baby, God forbid if any complications happen ... My wife would be under a lot of drugs — I remember the first time, she was very loopy and out of it and in no condition to make decisions or to really watch the baby because she’s in the recovery room afterward.”
“They have to give appropriate care to everybody,” he adds. “They can’t just disregard the life of a surgical patient.”
The strict new measures have also prompted one New York City doula to start a Change.org petition protesting the policies. As of Tuesday afternoon, more than 315,000 people have signed.
“I think it is a horrifying prospect that people everywhere will give birth alone,” doula Jesse Pournaras tells Yahoo Lifestyle. “Since last week when hospitals across New York City began to limit the number of support people to one person [based on new guidelines from the New York State Department of Health]— usually it is two people, standard — and specifically began to ban doula support, I knew it was only a matter of time before they began to ban all support.
“It is one thing to ban doulas and additional support, it is another thing entirely to ban partner or spousal support. It is careless and dangerous and goes against the recommendations of the CDC and the World Health Organization and New York State's own Department of Health.”
The Centers for Disease Control and Prevention (CDC) recommends that hospitals screen visitors for symptoms, but notes that, in the case of all-out bans, “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.” There are additional, more stringent, guidelines in cases in which a pregnant patient has COVID-19 or is suspected of having it. The World Health Organization (WHO), meanwhile, recommends that pregnant women have “a companion of [their] choice present during delivery.”
Like many Americans, Pournaras has seen the outbreak negatively impact her business. But it’s her pregnant clients who are most vulnerable, she says.
“I am fortunate that I have had a thriving doula practice for the last six years, but yes, I have lost clients, I have lost business and all the doulas I know have as well,” she says. “It hurts right now, but the emotional toll this is taking far outweighs the financial toll.
“I am devastated. I have spent the last week fielding calls from sobbing clients. We have cried together, we have made contingency plans only to have those need to change moments later because of some new development, we have mourned the loss of any semblance of a birth plan. We have prepared the best we can for worst-case scenarios — of which there are many: giving birth alone, having an emergency cesarean section alone, losing a baby alone, dying alone. I am trying to assuage fears, but during this time of great uncertainty, it is impossible to tell someone it will all be OK.”
While Pournaras and other doulas are helping to mitigate the situation by offering childbirth support online — which allows them to stay home and do their part to flatten the curve — some clients are exploring other options.
“All of my current clients due in the coming weeks are impacted,” she says. “It is only a matter of time before every hospital institutes these policies ... I have clients who are leaving New York. They are going to Connecticut, to New Jersey, to Minnesota, all to find hospitals that are still allowing support and that have a lower risk of also contracting COVID-19 because of smaller populations. I have clients considering unassisted home birth, as all New York City home birth midwives are at capacity and cannot safely take more patients on.”
But for women like Josh’s wife who plan to have C-sections, those alternatives are extremely limited.
“Homebirth is not an option,” Josh says. “Switching hospitals is really not an option because this is her gynecologist and obstetrician for two decades, basically, and she delivered our first baby by C-section. She’s a great doctor and a great surgeon. We don’t feel comfortable switching to somebody else.”
While hospitals are cautioning patients that policies may change as they adapt to the spread of the coronavirus, and the tapped-out medical resources that are expected to follow, doulas like Pournaras are doing their best to advocate for their clients from afar.
“Almost every doula I know is offering virtual support,” says Pournaras, who is offering free emergency viral doula support to parents-to-be in need. “The NYC doula community is also pooling our knowledge and resources to send love and support to the nurses that are at the frontline of this and now having to work double-time to support their patients. We are offering training on how to physically support labor with hands-on comfort techniques, how to use labor tools like peanut balls and rebozos, and how to calm a patient down in a caring, loving way. Many of us are sewing masks to deliver to hospitals. We are all in this together — doulas, nurses, midwives, OBs. My hope is that as we increase access to personal protective equipment and increase the capacity to test and get results quickly that we will be able to reverse some of these policies.”
Dr. Christopher Zahn, vice president of practice activities for the American College of Obstetricians and Gynecologists (ACOG), said in a statement to Yahoo Lifestyle that the organization recognizes the need for extreme precautions to safeguard health care workers, but hopes that hospitals adopt “innovative solutions” that won’t exclude support for laboring women.
“The American College of Obstetricians and Gynecologists is thankful for the critical role hospitals and health care professionals are playing in combatting the COVID-19 pandemic,” Zahn’s statement reads. “ACOG understands that addressing this public health crisis has required hospitals to implement additional infection prevention control protocol, as well as other procedures to maximize the capacity for patient care and safety. We also recognize that these measures can have a significant impact on a laboring mother’s support in the delivery room. Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by a partner or support personnel such as a doula is associated with improved outcomes for women in labor ... Labor support can be particularly critical for women who already face health care disparities and other barriers to care.
“We understand that these are extraordinary times and that hospitals are working hard to maintain a safe environment for all their patients with enhanced infection control measures. As hospitals move forward with measures and policies in the face of this crisis, ACOG urges them to consider innovative solutions and localized, collaborative approaches that ensure laboring patients have the support and stability they need through this chaotic and stressful time.”
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