Nationally, hospitals and health care systems have enacted social distancing and strict visitor policies in order to slow the spread of COVID-19. Here in Massachusetts, many hospitals are allowing just one person to accompany a laboring woman, forcing some pregnant women to choose between doulas and partners, or to connect with coaches and family members online during and after labor.
It’s understandable that health officials want to contain the spread of COVID-19 in the hospital, but pregnant women who are already at risk of being ignored or having worse health outcomes are being made even more vulnerable by visitation policies, according to midwives, some healthcare professionals, and other advocates.
“Any emergency [or] any change from the way we do things impacts women of color and poor women disproportionate to other women,” said Dr. Kameelah Phillips, an obstetrician and gynecologist at Calla Women’s Health in Manhattan. “I think it is incumbent, going forward, for hospitals, doctors, nurses, the medical associations — everyone — to have a keen sense for the most vulnerable, but even more so for women of color."
“In normal circumstances we deal with the effects of implicit bias in medicine," Phillips added. "To lose the people in our lives who would serve as our advocates — there’s a potential additional risk to those women in the hospital.”
In March in New York City, at the time the epicenter of the coronavirus outbreak in the United States, some private hospitals barred partners and other visitors from labor and delivery rooms, leaving moms to labor alone.
Those policies went against state department of public health guidelines, and the guidance of the World Health Organization and the Centers for Disease Control and Prevention, which state that that one support person is “essential to patient care throughout labor, delivery and the immediate postpartum period.”’
Hospitals quickly reversed course after Governor Andrew Cuomo issued an executive order stating that women would not have to endure labor alone or remain isolated from their partners and families.
Hospitals had enacted the policies to protect maternity patients at a time when very little was — or is still — known about how the disease affects an expectant mother or her unborn child. Doctors and other health care practitioners were conflicted about the policy because they must balance the perspectives of both patients and clinicians who are also vulnerable.
“Labor and delivery is a time of happiness and joy and families,” said Phillips, who is also affiliated with Lenox Hill Hospital, which did not adopt the strict no-visitor rule. “But, we had another doctor test positive . . . So leadership is having to make very painful and hard decisions to keep people safe. And it’s not just us. It’s the family down the hall who also just had a new baby.”
Sascha Conterelli, president of the New York State Association of Licensed of Midwives (NYSALM), said that the pandemic will exacerbate health disparities in our country.
“We can expect to see an increased rate of C-sections and operative deliveries. . . . We can expect to see a much higher rate of morbidity, “ she said. “I pray to God not an increase in mortality.”
NYSALM is in talks with other health care providers and hospitals about creating designated birthing centers during the coronavirus crisis, including designating clinics or specific wings separate from other general practice areas. The goal is to keep healthy laboring women from interacting with a general hospital population.
At many hospitals, including in Massachusetts, other precautions, such as requiring all hospital visitors to wear masks, and testing laboring women for COVID-19, are also being taken.
Public health researchers are also working to bring awareness about the impact of the virus to marginalized populations because of factors outside the hospital that affect their health. Marginalized women often work in low-wage occupations with increased exposure risk, such as service industries. Even if they seek health services, they may live in areas with limited access to those services or face barriers to care that could be exacerbated by the pandemic.
“Right now the biggest risk for mothers and babies in marginalized communities may be from the health systems reducing essential services, or widespread panic about hospital visitation policies,” said Betty Bekemier, the director of the Northwest Center for Public Health Practice at the University of Washington School of Public Health and a professor at the University of Washington School of Nursing. “My point is: All of these things, if they were bad [before], they’re going to be worse [now] because we’re not paying attention to it [because] . . . we have a crisis on our hands. All these things that we do, and try to do for marginalized populations are basically on hold. And yet those needs continue.”
In the meantime, women are also assessing whether home birth is an option. “We need to destigmatize midwifery and home birth for those for whom it is appropriate,” Conterelli said. “Midwives have standards that we adhere to. We work within the framework of the medical establishment. We are partners with doctors and nurses.”
She added, “There’s absolutely no reason why, unless they choose it, a healthy woman should have to labor in a hospital.”
Even during a pandemic, public health and health care officials need to think critically about how to ensure that pregnant women get the information they need to seek care at the right time and place. This is particularly urgent for pregnant women of color, and those in marginalized populations, to ensure they aren’t being left behind.
“In the best of times we know that Black mothers don’t always get the best treatment and that their concerns aren’t always listened to and their babies don’t always have the best outcomes," said Tamara Winfrey Harris, author of “Sisters are Alright: Changing the Broken Narratives of Black Women in America” and vice president of Community Leadership and Effective Philanthropy at the Central Indiana Community Foundation, which is responding to the coronavirus outbreak locally. “In a society where Black lives don’t matter, what happens to the most vulnerable of us in a health crisis?”
Katrina Miles is a journalist, a technology consultant, and co-creator and former coordinator of the United Nations global initiative: The Partnership for Technology in Peacekeeping. She lives in New York City.