Last updated 13-4-2020
To my wonderful clients and families and the Adelaide birthing community
We are living in uncertain times at the moment and many of you may be feeling anxious.
When I'm feeling like this, I like to make lists, research and be prepared. I reflect on what I know to be factual right now and check if am I having thoughts and feelings that are trying to predict the future. This post is long and contains extensive links for your own research.
My hope is to bring you calm and reassurance with this post.
First of all, I want to share with anyone who is pregnant the following resources to relieve any immediate anxiety. The current recommendations and evidence show that the virus is not passed between mother and baby in-utero and that the mother-baby dyad should be kept together after birth. Breastfeeding is highly encouraged for its immunological benefits. Your baby and breasts communicate to provide your baby with specific support for any pathogens that may be present.
I am following the best practices for health, with my clients and my own family. These preventative measures include:
I also know that COVID 19 is bringing changes to the way hospitals currently function.
As of today, Hospitals are asking to limit visitors to 1 support person at birth and postnatally. Other changes include the prohibition of gas for pain relief and labouring/birthing in water.
I have also seen one hospital recommend all women are asked to have an epidural ...
Please discuss all your options with your primary care provider or myself.
I can support you to labour at home or have a homebirth with a midwife present!
For my placenta encapsulation clients:
You are still able to keep your placenta and have it encapsulated. The only change that is necessary is that your partner or a support person will need to meet me at the hospital entrance to give your placenta to me. I am then not "visiting" you in hospital and this will also help minimise my exposure so that I remain well for all my clients.
You also have the option of taking your placenta home and I can collect it from there. If you would like to do this, please refer to your booking confirmation for details on keeping your placenta cold at all times or call me during business hours for further details.
For those who do not have collection & delivery as part of your package, you are still welcome to bring your placenta to me. Contactless delivery is practised at all times.
If you would like me to wear protective gear during our meeting (even though this isn't currently required if we are both healthy), just let me know so I can organise this in advance. I always sanitise my hands at hospital visits and after handling placenta containers anyway but I am happy to wear a surgical mask and gloves if you wish. Should you or I show any signs of having COVID 19, let's have that discussion when it happens. The limited research available shows that the virus is not found in amniotic fluid, breastmilk etc of infected mothers.
I am here for you so if I can reassure you in any way, please email me.
I also want to remind you of my standard infection control procedures. I only process one placenta at a time and my "placenta lab" and any equipment is thoroughly sanitised between each placenta. I wear personal protective equipment at all times and my sanitisation procedure includes the use of Clinell Wipes, Soapy Water, Viraclean Spray & Bleach Solution. I am well-stocked in these products and personal protective equipment.
For my doula clients:
Just like birth, we are dealing with the unknown. We don't know exactly what is going to unfold or how the timing of the event will play out. As a doula this is part of my job. I have a key skill set in dealing with the unknown and living with the now and I can't reiterate enough that I am here for you.
All pre and postnatal visits are still available. As with placenta clients, if you would feel more comfortable with me wearing personal protective equipment, then just let me know. I will bring hand sanitiser with me as well. If we all practise hand-hygiene that is a great way to prevent transfer. If anyone in your family is unwell or if I become unwell, we'll discuss our options. We can still talk over the phone or through video conferencing via Zoom.
When you are in labour, I will be there to support you to labour at your home as long as you feel comfortable to do so. This has always been part of my service, COVID 19 or not =)
As hospitals are currently only allowing 1 support person, unfortunately my physical support will need to finish at the hospital door. I will still be there for support via video calls at any time.
If you do not have another support person, I can accompany you into hospital.
If you are my client, you know that I am big on you having all the information to make an informed decision and on my clients feeling comfortable in advocating for themselves. So I'm laying it out for you here. The daily uncertainty of support should not be the thoughts of any pregnant person. Here is some information for your family, some steps you can take and things to discuss with your hospital:
1. Doulas are not visitors. I am a professional support person contractually hired by you. I work for you, not the hospital. The fact that you have hired me means you see me as an essential part of your wellbeing and care and hospitals should too. I also value the work I do and will not just step-aside as a "passive visitor" unless my clients ask me to do so.
2. I am happy to comply with the same personal protective measures that the hospital requires of its midwives and doctors. That may include registering at reception and completing a screening by their staff. And of course I will wear any protective equipment they require.
For your extra information I have always done and will continue to do the following:
3. I am not a lay person. Doulas are para-professionals in the birth space. I have undertaken extensive training from numerous organisations. Not only in perinatal support but also in hand-hygiene, infection control and the governments COVID 19 training. If your hospital would like to see copies of my certifications, please let me know. I have attended enough births that would be required of a student midwife to complete their studies. Doulas are an irreplaceable part of your health care team.
4. I hold my own insurance.
5. Please print out this letter and give it to your care provider during your antenatal appointments. Tell your provider that we all want to be on the same page and ask them to advocate for you and your doula at any facility policy meetings.
Have these discussions as soon as possible and let me know any outcomes. We will work together for the best outcome for you.
6. Ask the manager or director of birthing services for written verification that I will be "allowed" to remain on your birth team in hospital.
7. If you receive support from a mental or allied health professional, ask them for a letter of support requesting that I continue as part of your care team for the benefit of your wellbeing.
8. You care about the quality of your birth experience and desire the best possible outcome for you and your baby. Evidence shows that continuous support can decrease the risk of cesarean, the use of medications for pain relief, and the risk of a low five minute Apgar score.
Labour support also increases satisfaction and the chance of a spontaneous vaginal birth. Continuous support may also shorten labor and decrease the use of synthetic oxytocin. These outcomes are backed up by solid research and evidence. You can access a summary of the research at this link.
9. It is your human right to decide who attends your birth. If the hospital denies your choice of professional labour support attendant, they are negating your human rights.
The World Health Organisation includes support from a companion of choice as one of their recommendations for a positive birth experience.
10. AWHONN (the Association of Women's Health, Obstetric & Neonatal Nurses) released a statement on 11-3-20 stating that they recognise that doula services contribute to the woman's preparation for and support during childbirth and opposes hospital policies that restrict the presence of a doula during a person's active labour.
"Doulas are not visitors and should not be blocked from caring for patients in the antepartum, intrapartum and postpartum period. Most doulas have been contracted by patients weeks to months ahead of time and have established provider relationships. They are recognised by AWHONN and ACOG as essential personnel and part of the maternity care team."
You or your provider can read more about their statement here.
11. Practise with your partner what you want to say to your provider. You can use these statements to advocate for your right to doula support:
"My doula is not a visitor. She is an essential support person and member of my care team."
"No matter the restrictions, this hospital should acknowledge my values and personal agency."
"I will not give birth here without my doula."
12. When you call the hospital to let them know you are in labour and heading in, tell them "We are bringing our professional doula with us. She will complete the screening process along with my partner."
13. We can plan for me to accompany you to hospital regardless of any uncertainty. It is harder for staff to turn me away if I am already present and you are insisting I support you.
14. If your hospital refuses to let me physically support you, you can:
15. In the case of my clients or myself being unwell, the hospital refusing entry to myself or you choosing not to have me present at the birth, we still have the options of using a backup doula or utilising technology so that I can be a virtual presence in your birth space.
Your options will depend on the situation and what you are comfortable with.
But as with birth, you always have options. It is always your choice, even if it is a hard decision to make and I will always support your choices.
These are unforeseen circumstances and I will do my best to provide you with the support you hired me for. Let's all support each other and our communities.
Be alert but not alarmed. Be well.
Prepare for an easier fourth trimester with these 25 Secrets From A Postnatal Doula!
Kelly Harper is the owner of Elemental Beginnings Doula & Placenta Services in Adelaide. She provides placenta encapsulation and doula services to families during pregnancy, birth and in their fourth trimester.