Good news, folks. We made it through April. It might have been a wild and crazy mess of a month (it certainly was for me!), but now we're in May, and it seems like the world is taking
a collective deep breath and making plans for a new way forward.
We still have no idea what the next few months are going to look like, and we're rewriting the rules as we go. But in all that chaos, there's a lot of hidden opportunity.
Here are a few of the amazing opportunities that have evolved over the last month:
We're now able to offer sliding-scale services for families facing financial hardship.
We've seen a huge uptick in out-of-hospital births, and a corresponding increase in our work as birth assistants.
Our Centering Groups are up and running, helping to combat the isolation so many families are facing while navigating pregnancy and postpartum.
We are working with the Coalition for Ethical Maternity Care and other organizations to help protect families' birthing rights, under COVID and always.
But with all the good, some troubling trends have also materialized.
Most area hospitals have put policies in place limiting support to one person (typically a partner) -- which effectively bars doulas from offering in-person support in the setting where we are often most needed [violation of your right to support].
Some hospitals are not only implementing mandatory COVID testing, but also implementing policies that mandate quarantining of babies when parents test positive [violation of your autonomy].
In spite of "official" language emerging from hospitals and providers, we are hearing from families that they are being encouraged toward care that is not evidence based (e.g., getting an epidural as soon as possible upon arrival at the hospital... ostensibly to limit the use of PPE in the event of an emergency Cesarean?) [violation of your right to informed decision-making].
I understand we are in a worldwide pandemic.
A crisis does not strip you of your fundamental human rights.
Let me say that again.
A crisis does not strip you of your fundamental human rights.
We do not have to yield our individual human rights to protect a hospital's liability considerations. Instead, we must continue to hold medical facilities and providers to high ethical care standards. It is possible to protect your health and safety AND your individual rights simultaneously.
From the Coalition for Ethical Maternity Care:
"Medical ethics is a system of moral principles that apply values to the practice of clinical medicine and in scientific research. Medical ethics is based on a set of values that guide professionals when decisions cannot be made in black and white. Above all, medical ethics uplift the role of the patient as the director of their own care. Medical ethics are framed by four basic principles of health care; a medical practice, policy, or procedure cannot be considered “ethical” if it does not respect all four of these principles: autonomy, beneficence, nonmaleficence, and justice. Safety versus ethics is a false dichotomy.
It is all too easy during a crisis to fall into the trap of making fear-based decisions, with the additional risk that these fear-based decisions may implement short-term actions with long-term consequences. Families cannot thrive when support persons are removed, when birth options are limited, and when the birthing person and new baby are separated. Though these actions are purported to be in the best interest of the family, they serve only the short-term aim of limiting the spread of the virus; they do not attend to the long-term needs of a family’s lifecycle health. The price of these short-term actions will be paid by families in the long term — with a strikingly higher price for families of color.
But instead of basing our decisions on fear, as a collective we can choose instead to make ethics-based decisions, uplifting the rights of individual birthing people and protecting the sanctity of the birthing time. We do not need to default to aggressive, limiting policies based on emergency decisions; instead, we can use this opportunity to envision a better model and reevaluate rules and policies that are not adequately and intentionally serving any of the players in the birth landscape — not the healthcare workers, not the support staff, not the community, and certainly not the birthing people themselves.
Each day we wait to enact legislation or policy that protects the basic human rights of these birthing people, many families are at risk of having an unsupported birth experience. In a country where the maternal and infant mortality rates are on the rise, where there are drastic health disparities for birthing persons of color versus their white counterparts, and where a for-profit healthcare system limits patients’ ability to choose their preferred provider, further limitations on their rights and access to support are a recipe for disaster. Waiting means that more birthing people and babies will be harmed by administrative policies that do not align with ethical principles.
What we need now is a truly collaborative care model. We — patients, healthcare workers, support people, and advocates of all sorts — need to find innovative ways to work together as a community to make birth safer for individuals, rather than stripping away individual liberties and making fear-based decisions with long-term implications for the lifelong health of birthing families. We need to mobilize doulas and others in the capacity of community health workers. We need to open out-patient health and surgical centers — most of which are not seeing a regular client load at the moment — for low- to moderate-risk out-of-hospital birth. We need to streamline communication among healthcare and healthcare-adjacent workers at ALL levels, to protect the holistic health of the clientele we all serve within our own communities.
And above all, we need to work with policymakers and legislators at all levels to bridge the divide between the emergency Executive Orders and states’ Patients’ Bills of Rights. Where there is vague language, permitting hospital administrators to make sweeping policy decisions in time of crisis, we cannot trust that these policies will fall in favor of protecting individual rights; hospital policies are written to shield the hospital from liability.
We can find meaningful solutions that meet the needs of the struggling healthcare system while upholding our high ethical standards, together."
Change is happening so quickly, and it feels like birth rights are being taken away one by one. But we are not without hope or without options! There is still time to make meaningful changes to protecting your birthing rights.
Hospitals are profit-driven organizations, and many of their administrative decisions are financially focused. Even with a new state-level executive order, as we've seen in New York, hospitals will not be driven to make change until they hear from their consumers: YOU.
Absent a full COVID-19 Maternity Task Force in the DC area, we've put together a few toolkits and action items so that you can join us in grassroots efforts to improve the birthing landscape for all families, both by protecting birthing rights and by promoting doulas' access to hospitals.
Additionally, we ask that you sign and share one of the petitions to local mayors and governors to follow the lead of Governor Cuomo of New York to "Safeguard the Right of All Laboring People to Have In-Person Labor Support" via executive order protecting doulas' access to hospitals:
Please join us in taking action to promote birthing rights, under COVID and always. Call your governor or mayor. Call your hospital's Patient Relations line. Sign and share a petition. And above all, please exercise your voice in helping to promote access to safe, healthy, and evidence-based birth options!
For more information on evidence-based birth practices, read on....
Free E-book of Babies Are Not Pizzas
Many of you may know that Rebecca Dekker of Evidence Based Birth® published her first book -- Babies Are Not Pizzas: They're Born, Not Delivered -- last summer. This labor of love is a non-fiction book + memoir that shares the life-altering effects of receiving evidence-based care during childbirth.
Now through May 9th, the e-book of Babies Are Not Pizzas is available for FREE in the EBB Shop!*
Please download the e-book for yourself (if you haven't read it yet), or forward the link to a friend or family member who might want to read it! We're excited that this free e-book can help spread the word about evidence-based care and limiting trauma in childbirth.
*Note: This offer applies only to the digital e-book in the EBB shop, not on Amazon or any other platform.