The world just passed the one year anniversary of the declaration of the COVID-19 global pandemic, and vaccinations are being rolled out in many countries with varying degrees of access and participation.  In the meantime, birthing parents continue to welcome their babies, and many families have done so with a doula by the side.  This week is also World Doula Week. Birth doulas support the family with emotional, physical and informational support during labor and birth, with prenatal and postpartum visits on either side.  There are also postpartum doulas who support families after the baby is born.

I wanted to share my experiences as a birth doula throughout this pandemic, and how this pandemic has impacted birth doula support.  I want to acknowledge that I live in Seattle, WA, USA and this part of the country is very “doula friendly” and we have many, many doulas here. Doulas practicing elsewhere in the world, may have different experiences than mine.

1.  Interviews, prenatal visits and postpartum visits have been conducted virtually.

For the safety of pregnant families and doulas, the doula’s family and other clients, interviews, and pre and post birth meetings have been done on Zoom or similar virtual meeting platforms.  Surprisingly, these meetings feel very similar to the in-person experiences of the pre-COVID times.  There is still a genuine opportunity to build a relationship and connection and by the time I arrive to support  my clients at the birth, I feel like we have already met and know each other well.  With practice, a doula can become very good at offering lactation support virtually during the postpartum meetings.  I have found it does not impact how I can help my clients to feed their babies.  In the typical postpartum visit, I try to use my words rather than my hands to support my clients during those first days at home, and I can do that on Zoom as well.

2. Virtual support when I cannot be there in person.

There was a very brief period of about two weeks in the very beginning of the pandemic that hospitals were only permitting one support person and the birthing person, not surprisingly,  chose their partner or family member.  As a doula during this period, I made use of all the technology available to me in order to be fully present during the labor and birth once the client arrived at the hospital.  Zoom, Facetime, video chat, text, email, phone calls and more.  I was happy to join my clients for any labor that occurred at home, and then offer virtual support when they departed to the hospital.  Birth centers and home births allowed continuous support and did not require a shift from in-person care.  Not being able to support my client in person was disappointing to all of us and to me, it felt less effective, but clients were very appreciative and found the virtual support extremely helpful.

3. One support person in the operating room.

Typically in most facilities in my area, doulas are routinely permitted to join their clients in the operating room for a cesarean or multiples delivery.  During COVID-19, the ability to stay with clients as they are moved to the OR has been spotty, and is just starting to come back in full force.  This past fall, my twin client was allowed one support when she was taken back to the operating room to push her twins out, and she chose her partner.

4. We are all confined to the room.

When arriving at a hospital to join my client, we are all instructed to stay in the labor and delivery room.  My clients cannot walk the halls to promote labor progress, I cannot go to the nourishment room to grab food or drink for the laboring person and I must also use the labor room bathroom and take any meals in the room.  When a client is laboring on the toilet (a great position!), or using the shower or tub, the bathroom is clearly not open to others to use! Depending on how things are going, that can get tricky.  Also as a doula, it is nice to be able to leave the room for a brief break, stretch your legs, check in with my own family and give the family some privacy.

5.  Back up doulas for a long birth are not permitted to relieve the original doula.

I work in an amazing doula partnership where each doula supports the family for an approximate 12-hour shift during a labor.  This has turned out to be tricky if a birth goes very long and the first doula has been up for a long time and the entire labor would benefit from a fresh and rested doula to come in.  In some situations, especially at the beginning, last March, we were not permitted to swap out.  In fact, I could not even come to the hospital to deliver some food for my doula partner.  And that birth was over 36 hours long.  We have found that for the most part, we have been able to relieve each other, but always prepare ourselves and our clients for the possibility that only one doula could provide support.  This is disappointing because many of our clients want the fresh doula, appreciate both of our skill sets and have developed a relationship with both of us, and both of us with them too.

Conclusion

COVID-19 safety requirements have meant that birth doulas have needed to shift and adapt how they are supporting their clients.  Each geographic region around the world has instituted their own policies about how doulas can operate within their facilities.  Some states have identified doulas as essential workers and acknowledged the important role that they play in supporting expecting families.  This meant that there were no restrictions on their ability to support their clients during labor.  They have also included doulas in the first wave of people who are eligible to be vaccinated, so most doulas in my area are now fully vaccinated which provides extra protection.

The research on doulas is positive and birth outcomes are improved when a doula attends the birth.  COVID-19 has required flexibility and creativity as the world struggles to shut the pandemic down.  Families should not hesitate to work with a doula during this unusual time, as there are definitely many ways that doulas continue to help families have more positive experiences despite the restrictions.  During World Doula Week, please join me in thanking all the doulas for their commitment to families and babies.

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