How Coronavirus Bans on Birth Support Endanger Health and Don't Prevent COVID-19
In the wake of news that New York hospitals were banning spouses during birth, forcing women to have babies alone, Governor Andrew Cuomo acted quickly to ban the process. In Georgia and many other states across the nation, families aren’t so lucky. Hospitals across the country are forcing some people to give birth without any support at all, including from a spouse. And the majority of Georgia hospitals now limit birthing people to a single visitor, effectively banning doulas . This is a medically unjustified practice with no discernible benefits and numerous well-documented risks.
Sixteen percent of people have PTSD after giving birth, and a third describe their births as traumatic. The U.S. has the worst maternal mortality rate in the wealthy world, and rather than doing something to slow this crisis, our nation has sat silently as the rate rises. Things in Georgia are even worse. Georgia is the most dangerous state in the U.S. in which to give birth. You are more likely to die having a baby in Georgia than in Ecuador, Vietnam, and 100 other countries. These statistics are depressingly familiar. And now, in the midst of a pandemic where hospitals are forcing women to give birth alone, they’re more frightening than ever.
The decision to separate families during and after childbirth is a medically unjustified form of abuse, that will have long-lasting implications. It destroys mental health. It endangers the life of the mother. And it is not evidence-based.
Why Banning Support People Doesn’t Slow the Spread of COVID-19
Most of us have heard that minimizing social contact slows the spread of COVID-19. So at first blush, it might seem like keeping support people out of the delivery room offers some benefit. The problem is that hospitals and childbirth both present special cases for the following reasons:
Given the high rate of exposure to COVID-19 that healthcare professionals face, it is far more likely that a support person will get the disease from a medical professional than give it to them.
Pregnant women who live with their spouses or other support people have likely been exposed to COVID-19 if the support person has. This means medical staff and the baby will be exposed to the virus whether or not birth support is banned.
Banning support people will inevitably increase a birthing person’s reliance on medical staff. They will need more help from nurses, doctors, and other professionals. This means medical staff will have more opportunities to both catch the virus from and transmit it to the woman and her baby.
How Banning Support People Endangers Maternal Health
We don’t know a lot about COVID-19, but we know one thing for sure: separating birthing people from their spouses or chosen labor support people is traumatic and dangerous. It is not a temporary inconvenience. It may have lifelong consequences.
A spouse in the birthing room can help the woman assert her wishes, run interference between the woman and the doctor, and provide continual reassurance. Witnessing the birth may help the spouse bond with their child, gain a deeper appreciation for the work involved in birthing that child, and encourage them to support the mother during the postpartum period.
A Cochrane review that evaluated trials involving more than 15,000 women giving birth pulls no punches: “All women should have [continuous] support throughout labour and birth.” The review identified numerous health benefits to support during labor, including:
decreased need for pain medication (and therefore a lower risk of side effects associated with pain medication)
higher satisfaction with birth
shorter labors
fewer c-sections
higher APGAR scores among babies
fewer instrumental deliveries (and a lower risk of instrumental delivery-related complications)
The study also found that continuous labor support offered the most benefits when the person offering support was not part of the woman’s social network and not a member of the hospital staff. This means that hospital staff cannot substitute for support the woman chooses, and that allowing spouses is not enough. Professional support from doulas is the best option for better health.
The data on childbirth in the United States is terrifying. Abuse during childbirth is common. A third of birth workers say they have heard providers use racist language in the delivery room. More than a quarter of people who give birth in hospitals report mistreatment such as threats and verbal abuse. Some report sexual or physical abuse. Having someone else in the delivery room can lower the risk of such abuse. Research shows, for example, that spousal support lowers the risk of childbirth-related PTSD. Spousal support also significantly lowers the risk of postpartum depression. This is critical, because suicide is a leading cause of postpartum death.
And now, we want to send pregnant people into abusive delivery units alone. They won’t just be deprived of a partner or doula. They will not have any support. Nurses and other hospital staff do not have the time or resources to remain continuously present for people giving birth, especially amid a pandemic.
Women forced to give birth alone must also recover from birth alone. In those hazy early moments of parenthood, they will have no one to help them with the baby, no one to escort them to the bathroom, no one to call for help if they feel dizzy, confused, or just overwhelmed.
Taken together, these data points suggest that banning support persons from the hospital during childbirth may trigger a secondary public health catastrophe, with consequences such as:
higher rates of abuse during and after childbirth
increased mental health problems in the postpartum period
higher rates of suicide among new mothers
more interventions during birth, including more c-section
a higher maternal mortality rate
more birth-related injuries
worse outcomes for babies
And we’re not trading one harm for another here. There is absolutely no evidence suggesting that banning support during labor will prevent COVID-19 from spreading. So the real effect here is that we are abusing and traumatizing families, and getting nothing but worse overall health in return.
What Can Hospitals Do Instead?
Hospitals don’t have to ban spouses and other family members, or even doulas. A number of alternatives balance the need to flatten the COVID-19 curve with the very real need of birthing people to have support. They include:
Asking people giving birth and their spouses to self-quarantine beginning at 36 or 37 weeks.
Testing spouses or other support people for COVID-19 beginning a week or two before the due date.
Requiring all visitors to wear masks and wash hands.
Aggressively disinfecting all surfaces in the birthing suite.
These strategies, of course, are imperfect—as are all strategies for the prevention of COVID-19. But unlike other options, these tactics do not force pregnant people to give birth alone.
Your Rights if Your Hospital Bans Support People
The law protects the rights of people giving birth to decline medical interventions, receive quality care, and make decisions about their babies. There is no law that prohibits hospitals from banning support people—except in New York, where an executive order prohibits the practice. This leaves birthing people with few options if they intend to give birth in a hospital.
So what can you do?
Talk to your provider early, so you know what to expect. If your provider cannot give you specific answers, or their answers are not satisfactory, consider switching providers.
If you are low-risk, consider switching to a homebirth or birth center birth. This greatly reduces the risk of contracting COVID-19 in a hospital, and removes the possibility of having to give birth alone.
Educate yourself about your rights during childbirth. If you must give birth without a support person, knowing your childbirth rights in Georgia can reduce your risk of birth trauma. To learn about how COVID-19 affects your legal rights, click here.
Consider switching to a different hospital. Different Georgia birthing hospitals have different rules, so call ahead.
Record your birth. This gives you some recourse if you are abused or mistreated during childbirth.
Try other strategies for getting support, such as video chatting with a doula or your partner.