Childbirth during a pandemic: parents decry separations

To prevent infections, some hospitals bar visitors from ‘triage,’ and that can mean women start labor alone.

Daniel Desrochers and his wife Lindsey Anderson were separated for hours during Lindsey's labor before she delivered their son Ethan at Baystate Medical Center.Lane Turner/Globe Staff

On a Sunday morning in late May, Alexis and Eric Orzeck pulled up to Brigham and Women’s Hospital, bursting with nervous excitement. Alexis was nine months pregnant, and her water had broken the night before. The time had come to meet their first child.

Eric went to park the car while Alexis checked in, expecting they’d reunite in no more than an hour. But when Alexis was brought to a small room, she got some surprising news: Eric could not join her.

Until that moment, the North Andover couple had been assured that the Brigham supported having a partner during childbirth, even amid COVID-19 visitor limitations.

But here they encountered a catch that has prompted a petition drive: At the Brigham, and some other hospitals, the woman has to be admitted before her partner can come in. And Alexis couldn’t be admitted because all the labor rooms were full.

Instead, she was in “triage,” technically still an outpatient. And she would be there for a long time. It took five hours until a labor-and-delivery room became available and Eric could attend the birth of their son, Ryder.

Ryder Orzeck looked up at his dad Eric Orzeck (left) and mom Alexis in North Andover. Erin Clark/Globe Staff

“It was very scary, very lonely,” Alexis said. “I’m a first-time mom. I had no idea what was going on. … I kept on saying to them, ‘I just want my husband to come up,’ and they said, ‘We understand.’ ”

But Alexis couldn’t understand: If Eric was going to come into the hospital anyway, why did he have to wait?

When COVID-19 arrived last year, hospitals seeking to prevent infections were forced to make decisions based on scant and shifting information about how the virus spreads. Barring visitors who might trek in germs and crowd small rooms seemed like a no-brainer. For a brief time, some hospitals extended this prohibition even to the partners of women in labor.

The ensuing outcry put an end to that practice. The support of a birth partner — usually a spouse, companion, relative, or friend — has such a powerful effect on the progress of labor and the baby’s health that this particular visitor is considered medically necessary.

Today, hospitals in Massachusetts and elsewhere explicitly allow a pregnant person to have one partner accompany her when she is admitted for labor and delivery. But a few hospitals, including the Brigham, Tufts Medical Center, and Baystate Health, deem it unsafe for visitors to come into the triage area, where women go to assess their labor.

Eric and Alexis Orzeck headed out for a walk with their 8-month-old son Ryder and dog Penny.Erin Clark/Globe Staff

The practice has prompted a petition, started by two childbirth and lactation specialists, which has been signed by more than 1,000 people. It calls on Governor Charlie Baker to order hospitals to “stop the separation of birthing families.”

“Countless pregnant people,” the petition asserts, “are being forced to labor ALONE for many HOURS or even multiple DAYS, without their partner or chosen companion for support.” Such practices “place patients at risk for longer, more painful and traumatizing labor experiences,” it says.

Alexis Orzeck waited alone in the triage room. Someone came in to put in an IV line and connect the fetal monitor. Eric sat in the car, parked on a side street. They texted each other as minutes crept into an hour, and another hour, then three more.

The Orzecks were finally reunited in the late afternoon. After Alexis received medications to induce her labor, Ryder was born around 2 a.m. on June 1. Though happy to have a healthy baby, Alexis, a 35-year-old real estate title examiner, laments that rigid rules made her birth experience more traumatic than it needed to be.

“I don’t look back on the birth of my son with joy,” she said. “I look back at it with loneliness and fear and sadness. I feel like I was robbed.”

Dr. Andrew Resnick, the Brigham’s chief quality and safety officer, said laboring mothers stay in the triage area for only a short time; women who are not in active labor are usually sent home. A prolonged stay in triage “really shouldn’t happen,” he said.

But it did happen, according to the Orzecks and two other women who told the Globe of their deliveries at the Brigham in April and January, as well as two women who delivered at other hospitals in recent months.

In a statement, Brigham and Women’s described its triage area as a “a very small ambulatory area with shared spaces” where visitors could not safely be allowed because of COVID-19 restrictions.

“The pandemic has created an unprecedented situation, and our top priority is to create a safe care environment for our patients, their babies, and our staff,” the statement said, adding that the hospital continues to “advocate for, and emphatically support, having a partner present for laboring mothers.”

Experts say the childbirth experience, beginning with the earliest stages of labor, has a deep and lasting impact on a woman’s life.

Deborah Issokson, a Massachusetts psychologist who specializes in the mental health issues surrounding childbearing, said a woman’s “birth story” starts the moment something happens related to birth. For someone like Alexis, “the beginning of her birth story was, ‘I was all alone.’ No woman should be alone during her birth experience,” Issokson said.

And while it’s joyful to get a healthy baby, the path to that birth makes a difference. “We can say, `well, I got to my destination … but along the way our car got hijacked and we ran out of food.’ The journey matters,” she said. “It’s how they launched into parenthood.”

Issokson, who has offices in Wellesley and Pembroke, said that her clients have not experienced such separations. They’ve suffered from other pandemic restrictions — undergoing ultrasounds alone, having no visitors to hold their newborn. But most have reported happy, peaceful birth experiences in Massachusetts, Issokson said. However, she added, most of her clients delivered at small community hospitals.

Indeed, barring visitors from triage is not a universal policy among hospitals.

At Boston Medical Center, after the initial check-in, the woman’s partner can be with her as long as she is in the hospital, said Dr. Christina D. Yarrington, medical director for labor and delivery.

“Whether starting in the triage room or the labor-and-delivery room, the partner is welcome,” she said.

Nationally, it’s not common practice to separate laboring women from partners during triage, said Cyndy Krening, president of the Association of Women’s Health, Obstetric and Neonatal Nurses. At the Denver hospital where she works as a perinatal clinical specialist, and in most of the country, women are “allowed to have one support person from the time they enter the hospital,” and no distinction is made between triage and admission, Krening said.

Variations in policies among hospitals probably reflect differences in their physical layout, said Dr. James Wang, immediate past chair of the Massachusetts section of the American College of Obstetricians and Gynecologists. Some just don’t have room for visitors in the triage area, when social distancing is critical amid a pandemic, he said.

Wang, who works at Baystate Health, acknowledged the restrictions can be stressful, but called them necessary to avoid COVID-19 outbreaks. “We all have to make sacrifices in situations like this,” he said.

But this practice carries hazards, according to Jeanette Mesite Frem, owner of Babies in Common, a Northborough company that offers courses in childbirth, breastfeeding, and baby care, and Melissa Anne DuBois, an obstetrical nurse who now works as a visiting nurse, childbirth educator, and lactation consultant.

Frem and DuBois are spearheading the petition drive targeting Baker. They say that some women stuck in triage have been told that if they agree to have their labor induced, their partner can join them, making them feel coerced into accepting the procedure rather than letting labor continue naturally. Using medications to induce labor can cause it to progress rapidly and painfully and sets the stage for other medical interventions.

Resnick, of the Brigham, denied that anything like that happens at his hospital. Induction is offered only when medically necessary, he said.

But Amy Fish said she felt too “worn down” to protest a doctor’s advice to induce, after she had labored alone in triage for several hours at the Brigham on April 30. She knew agreeing to induction would mean being admitted to a labor room and finally seeing her husband.

“As soon as I was with my husband again, my body knew, and my labor took off like a jet,” Fish said. The labor was so intense and rapid that Fish suffered a tear that required surgical repair.

Fish, a 34-year-old postdoctoral student, believes her labor might have progressed more steadily if her husband had been with her all along. Either way, spending the majority of her labor alone “made the experience more upsetting and harder to recover from emotionally,” she said.

Fathers also suffer from these separations. Daniel Desrochers of South Hadley sat in the car for the first eight hours of his wife’s labor at Baystate Health last July. He found the experience so troubling that he decided he didn’t want another child, though he has started to reconsider.

His wife, Lindsey Anderson, a 35-year-old physical therapist, sat in the waiting area for two hours, and then spent six more hours laboring in triage, before Dan could join her in a labor room.

Dr. Robert S. Wool, Lindsey’s obstetrician, said the triage area is so “snug” there’s barely enough room to walk around each bed. Barring partners from there is hard on patients, but necessary for safety, he said. “Every time somebody walks in, they walk in with all their germs,” Wool said.

But Dan, 35, a marketing coordinator for Nichols College, recalls his hours in the car as “sitting in a void, unknown,” rendered useless at a time when he needed to be there to support his wife.

“I don’t want to experience it again,” he said.