A birth plan during coronavirus: I am grateful for all my options, including doulas

COVID-19 has affected communities differently and revealed inequities that exist within Washington state. As hospitals began to prepare for the pandemic and elective surgeries canceled, women who were pregnant or working as birth workers were furiously digging for information. Questions arose about what was being done to protect women and doulas and most important, how were hospitals ensuring the safety of pregnant women during and after birth?

Statewide, hospitals implemented visitor regulations. Some allow in a spouse or partner plus a support person, such as a doula. However, the rules can change daily and are inconsistent depending on multiple factors. The policies and restrictions create anxiety and elevate the trauma that already exists for parents, especially in communities of color. The fear of birthing alone, testing positive for COVID-19 or accidental exposure to the virus to birthing families adds to stress and fear.

Rainier Valley Midwives, a South Seattle practice, is seeing a big increase in the number of inquiries it’s receiving from expectant mothers. In response, Clinical Director Jodilyn Owen and co-founder Tara Lawal joined midwives and experts from across our state as part of the Washington State Midwifery COVID-19 Response Coalition to help providers and birthing people navigate options.

Midwives are concerned there may not be enough doulas to serve everyone. The coalition sent a survey and found 40% of the midwife practices have seen an increase of 25% to 50% or more of patients wanting midwife care, and 15% of the practices reported 100% increases in services.

In response, they created a resource page and website (birthduringcovidWA.com) for birthing people and providers to explore options and connect with midwives. They also recognize the importance of risk assessments, and some births categorized as “at risk” are not eligible for these services. Each birth is assessed on a case-by-case basis. They are offsetting costs by private grants and working with the state health-care authority to determine billing options.

Doulas are more important than ever, providing an important bridge for birthing options. Kate Dewey and Camie Goldhammer, expert doulas, are offering free training for all doulas and midwives around pandemic preparedness, and current regulations and birth options, so they can adequately and safely support families during the pandemic. They are receiving advisory and thought leadership from Jane Drichta, a global health expert in maternal health.

One program that the coalition and Rainier Valley Midwives are leading is the Home to Hospital program, which “provides a midwife at home to ensure mother and baby stability and safety through early labor.” This is important for families who want to birth in a hospital but want to stay out of the hospital for as long as possible.

Hospitals, such as University of Washignton Medical Center — Northwest, are discharging mothers for uncomplicated births but are requiring visits by midwives to the homes of newborns and moms. Midwives are partnering with obstetrics nurses, and visiting homes to run newborn screens, check on wound healing, assess vitals for mom and baby, and conduct postpartum mental-health screenings.

As someone who is 28 weeks pregnant, these programs reduce my personal anxiety and give me hope for a positive, healthy birth. I love my OB/GYN, who has walked me through multiple miscarriages and the birth of my first child, but given the circumstances, I need to understand all my options.