A health care system in New York is taking a major step in protecting pregnant people set to deliver during the coronavirus pandemic. The move is not necessarily calming the fears of these women, however. New York-Presbyterian hospital announced on Sunday that it would be banning all birth partners and support persons.
The policy is a jarring one. A study by the World Health Organization found that the role of birth partners is a critical one.
“They provide informational support about the process of childbirth, and bridge communication gaps between clinical staff and women. Companions also provide practical support, including encouraging women to remain mobile during labour, providing emotional support and non- pharmacological pain relief such as massage and meditation,” the findings reveal.
“Companions act as advocates for the women, speaking up in support of her and her preferences. Labour companions also help women feel in control and build their confidence through praise, reassurance, and continuous physical presence.”
Dena Goffman, MD, chief of obstetrics at Columbia University Medical Center, emphasized that New York-Presbyterian’s decision was a “very difficult decision and not one taken lightly.”
“For the time being, we really do need to exclude all visitors, including partners, for women admitted in labor,” she explained. She also noted the hospital system has decided to test all women in labor for COVID-19 who are admitted to labor and delivery units, regardless of symptoms.
The decision to test all labor and delivery patients came after doctors noticed they had a number of women with no symptoms or atypical symptoms later test positive for COVID-19.
“Many symptoms of labor and of pregnant women really mimic some of the symptoms of Covid-19,” Dr. Goffman noted. “As a result, these women were not identified by our usual screening, infection prevention and control, or testing processes, and therefore our practices for protection for Covid-19 were not implemented. In this case, many staff members were exposed.”
By testing women in labor, it will allow doctors to isolate newborns who may have been exposed to the virus. This can be an important preventative measure to keep an outbreak from happening in well-baby nurseries and NICUs. This is especially important in New York, where the state’s cases account for nearly half of the national total.
Dr. Goffman noted that the hospital system is looking into other ways of allowing birth partners and other loved ones to be part of the experience. This could occur through the use of technology.
“We recognize that we will need to provide additional support for moms, as well as mom and baby pairs, as they’re in the hospital through the duration of their stay,” she said.
The WHO’s stance on child partners has not changed, however. It believes that “all pregnant women, including those with confirmed or suspected COVID-19 infections, have the right to high-quality care before, during and after childbirth.” That includes “having a companion of choice present during delivery.”
The concerns about hospital policies and capacities have many women exploring other options. The Washington Post reports that midwifery practices are seeing increased requests as women examine possibilities outside hospitals. The Centers for Disease Control and Prevention found that about 1% of all births in the country take place at home, and about 9% are delivered by certified nurse-midwives.
Many midwives are now booked to capacity through the summer. As a result, midwives are reaching out to both medical providers and elected officials to see if licensing restrictions on their practices can be lifted in light of what’s going on.
Several states require physician supervision for licensure of certified nurse-midwives. There are also states that do not allow licensing to midwives who are not also certified nurses. This is especially a concern during this time, as emergency services will also feel strain throughout the duration of the pandemic.
Women are being urged not to change any plans if they are late in pregnancy. This is especially the case considering the insurance implications for midwives themselves, which remain to be defined in such an unprecedented situation.
For women earlier on in pregnancy, the idea can be worth considering. In other countries, midwives are utilized much more regularly in the birthing experience.
Midwives are also working on social practicing with patients where it’s possible. They’re conducting check-ins, information sessions, and more online. The information sessions have especially seen a spike in participation as couples consider the possibility for the months ahead.
The biggest barrier for most folks is cost. Insurance relationships with midwives vary by state, with some offering no coverage. As a result, there are substantial out-of-pocket costs that are particularly difficult for families who have seen a loss of income at this time.
There is some good news amid the serious information to digest and decisions to be made. There is currently no evidence that those who are pregnant are more susceptible to COVID-19. There’s also no evidence indicating they’re more likely to get a severe case if infected.
The WHO is still offering information on how women with COVID-19 can breastfeed. It offers both direct and indirect options, meaning that it is possible to be around your baby even if you are ill.
Things are definitely scary and evolving by the minute, but planning and flexibility make it possible for women to have a relatively normal birthing experience. Make sure to consult your medical team with any questions or concerns you may have.