COVID-19 limited who could be present for childbirth. This policy change lets women choose
Lilianna Townsend had a specific birth plan in mind for her second child.
She would have her doula and her husband, state Sen. Bryan Townsend, by her side.
She wanted a fully unmedicated birth after having an epidural for her first son, and everything was going according to plan.
But when COVID-19 hit, the pair found out that only one support person would be allowed to be in the room with her while she had the baby. Restrictions imposed by officials at ChristianaCare and hospitals around the state limited the number of people inside the facilities during the pandemic.
"It was a really tough call for us," she said. "I wanted a hospital birth because I wanted my OB who only delivers at the hospital."
After much thought, the pair decided to have Lilianna Townsend's doula, Sarah Korbeck, accompany her.
On May 10, at 3:30 a.m., Bryan watched his wife get wheeled away at the hospital.
"It was very stressful," Bryan Townsend said. "I do think in the back of my head I thought, well, maybe when we get there, maybe they'll just look at us — you know the baby's mom, the father and a doula — and say, come on back guys. But they didn't."
The policy that restricts families from having more than one support partner is now being changed to allow for two, one of whom can be a doula. The Delaware Healthcare Association – which is made up of all the health care systems in Delaware and provides policy and advocates for them – sent a letter supporting the move to add a doula to the room during births.
"In order to acknowledge the important role that doulas continue to play during childbirth, particularly in the challenging pandemic environment, all Delaware hospitals offering obstetric services within the hospital as of the date of this letter will allow a Doula to be present during childbirth as a second visitor while the hospital has pandemic related visitor restrictions in place," said Wayne A. Smith, president & CEO of the Delaware Health Association, in a letter to Dr. Karyl Rattay, director of the Delaware Division of Public Health.
As a result, ChristianaCare modified its visitor guidelines to specify that a doula may serve as that second visitor during birth.
Doulas have to comply with all applicable requirements like being screened for coronavirus risk before entering the labor and delivery rooms.
"We were consistent with what the governor's orders, trying to limit exposures," said Matthew Hoffman, chair of the Obstetrics and Gynecology at ChristianaCare. "I think we have learned more since that time and have put in safeguards that we think are appropriate to welcome them (doulas) back."
State Rep. Melissa Minor-Brown, chair of the social determinants of health workgroup, worked with the Delaware Healthcare Association to get this policy changed.
Minor-Brown specifically had Black women – many of whom use doulas and midwives – in mind when she asked health care professionals to come to the table to see how best to prevent situations where mothers don't feel supported during birth.
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"It's unfortunate that we have to have something in place to protect Black women, but we have to have something in place to protect Black women," she said, citing high rates of maternal mortality in the Black community here in Delaware and across the country.
Michelle Drew, a certified midwife and doula, said doulas and midwives often spend the entire nine months of pregnancy with a mother, which is handy during births where women want a specific birth experience – as was the case with Lilianna Townsend.
"She'll be able to tell you and articulate for you what her plan for birth was, especially when she's in the throes of labor and she can't speak," Drew said.
Despite having that support system with her, Lilianna Townsend said it was hard not having her baby's father. Still, she said she understood why it needed to happen that way.
"On a good day, I feel sad about it," Lilianna Townsend said. "On a bad day, I feel a lot of guilt."
Before this policy change, if a family expected to have a hospital birth at any hospital in the state, they had to make this choice.
It's for that reason that some chose to take alternate routes, like using the Birth Center: Holistic Women's Healthcare in Newark, where the focus is on holistic women's care. The center – which employs doulas, midwives, nurses and doctors to care for women throughout their pregnancy – has always allowed women to bring their midwife or doula, as well as another support partner.
That was what Aisha Simms was going to do. The 28-year-old New Castle resident wanted an unmedicated birth so she chose the Birth Center.
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However, during the Aug. 13 birth, there were complications. Her water had broken over 24 hours earlier, but the baby still wasn't coming.
Simms, her husband and her doula were transferred over to ChristianaCare. There, Simms' husband, Samaad, and her doula, Janay Muhammad, had to switch out in order to be by her side until her daughter, Ari, was born.
"I wanted to do everything completely natural so that's what my doula was there for, to be my mouthpiece and my advocate for me not wanting to have medicine," Simms said. "But then my contractions got so bad. And she wasn't in there at the time, it was my husband, so I did end up having to get an epidural."
"If it was both of them in there, I feel like it would have been a completely different experience."
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While the change allows for a second support person, the Delaware Healthcare Association did state that each hospital may restrict all visitors, including doulas, if the need arises due to COVID-19.
Drew worries that as the pandemic continues on, this could cause problems down the line because if the support person goes back to just one allowed, people would be back to situations like that of Aisha Simms and Lilianna Townsend.
Hoffman at ChristianaCare recognizes this as an issue and said the hospital's policy could change again, but would be in response to COVID-19 concerns from the governor's office.
"We recognize that our community wants to support our families in all ways, but also sort of striking a balance with the safety of our patients," Hoffman said. "Hopefully we'll weather COVID well, but we've had challenges before."
As of Nov. 9, 722 people have died due to COVID-19 in Delaware, and there has been a steady rise in cases since the stay-at-home order was lifted on June 1. So far, there have been nearly 26,000 confirmed cases, with more than 14,200 people recovered.
Contact Marina Affo at firstname.lastname@example.org. Follow her on Twitter at @marina_affo.