This past week, news broke that two major hospitals in New York City – where COVID-19 cases are most staggering – would no longer allow pregnant women to labour alongside a support person, such as the baby's father, the woman's partner, a relative, a doula, or a midwife. The outcry was immense – a petition to overrule the decision received more than 600,000 signatures. In response, New York Governor Andrew Cuomo issued an executive order this weekend that required all hospitals – both public and private – to allow women to have a partner in the labour and delivery room.
The Department of Health also notified hospitals that they are required to allow one person to accompany a woman throughout childbirth.
However, the medical community is torn on whether this is the right call.
In a new petition, doctors and nurses are imploring that the governor reconsider his decision to allow an additional partner "with no emergent medical need" onto the labour floor.
"Doing so will use up desperately needed personal protective equipment already being rationed," the letter stated. "The safety of the specialised health care workers saving mothers' and babies' lives remains in the best interest of all New Yorkers and must guide your decisions. Putting health care workers at increased risk puts every mother and baby at increased risk. This is not about today, but tomorrow and the next day. We implore you to let the reality of the current situation, not emotion, rule the day. Allow medical practitioners to make medical decisions."
Although it's true that these support people are "non-medically necessary," one doctor maintains that banning partners from labour is a step backwards with troubling implications.
Giving Birth Alone Places an Undue Burden on Patient and Healthcare Team
Dr. Chitra Akileswaran – an Ob/Gyn who is the co-founder of Cleo, a resource for working parents – said that it places an "undue burden" on not only the person in labour but also on their care team and the healthcare system.
"Ninety percent of a nurse's energy is on activities other than emotional well-being."
"As the responsibilities of healthcare professionals increase, especially in the midst of a pandemic, I will certainly be looking increasingly to a birthing person's doula or partner to be another spokesperson for that patient," Akileswaran said in a blog post. "I cannot tell you the number of times a support person has come out of a room to say that someone is feeling an urge to push, is nauseated, or even just that a machine is beeping."
Because physicians are attending to many other patients, they don't have an active role in the long process of labour.
"The reality of traditional hospital birth is that you may see me, your obstetrician, for a few minutes throughout the entirety of the process and no more," she said.
Even nurses, who are often in and out of the room, are responsible for the medical aspects — monitoring parent and baby, administering medications and IV solutions, and charting and reporting on progress. "Ninety percent of their energy is on activities other than emotional well-being."
Giving Birth Alone Leads to Worse Outcomes and More Strain on Resources
If hospitals dismiss the need for a support person in the name of public health, Akileswaran fears we will be trading one theoretical short-term gain for a longer-term loss – namely, increased birth-related interventions and unnecessary cesarean births.
"There are few childbirth interventions proven to help people have a vaginal birth and feel positive about their birth experience," she wrote. "Continuous birth support – having a person with you who is focussed on supporting you emotionally and physically throughout labour and birth – is one of the evidence-based ways to achieve these outcomes."
Without this, she predicts more use of epidurals to cope with the stress of labour, more stress-based need for medical interventions, and ultimately, more c-sections.
"Cesareans in particular mean more extensive care teams, like anesthesia and operating room staff, and the use of operating rooms, which will then have to be sanitized," she added. This means more personal protective equipment – masks, gloves, gowns, eye protection, and soap – used by a larger team.
Give Birth Alone Causes Longer Postpartum Recovery
A "myopic, non-data driven policy" such as this could lead, she wrote, to more birth-related trauma, postpartum depression, and anxiety.
"On the other end of this, families will face longer postpartum recovery both in the hospital and at home, with likely less social support," she said.
She also noted that one of the "critical functions" of a support person is serving as an advocate for the woman giving birth.
"Birth can be a challenging and sometimes even traumatic event," Akileswaran said. Without that support person – who is not currently experiencing the physical intensity of labour – present and able to ask questions to ensure the birthing person's wishes are being followed, it's up to the laboring women to weigh the pros and cons of each decision alone, while in a great deal of pain.
"Taking this one step further, one could frame a lack of personal support during childbirth as an anti-women, misogynistic step backwards."
"Obstetrics is an inherently litigious field, and many legal actions taken by families are explained by a lack of shared decision-making that must occur during the uncertain course of labour and birth," she wrote. "Without a support person in the room, it is unclear whether obstetricians and care teams will feel comfortable communicating the most personalized, safest recommendations to a birthing person, rather than simply taking a defencive approach. Taking this one step further, one could frame a lack of personal support during childbirth as an anti-women, misogynistic step backwards. We used to isolate and sedate birthing women up until the 1970s in this country, as part of a paternalistic sentiment that women couldn't 'handle' the emotional and physical difficulties of childbirth. Policies such as this one surface this tension, and reinforce distrust in our healthcare system."
Although families should do their part to serve the greater public's health during this coronavirus outbreak, Akileswaran said we must still "hold what is sacred to us as human beings," birth being one of them. Whether or not hospitals across the nation will share this viewpoint or push for greater restrictions on their labour floors remains to be seen.