bringing vital support, education, and advocacy to a birth space. Their presence is even more crucial as families struggle to navigate Covid-19 in hospitals.

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Doulas are essential,

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Dear Governor Gavin Newsom and Dr. Nadine Burke Harris,

 

We request that you join Governor Cuomo of New York, the New Jersey Department of Health (1) and the California Department of Public Health in recognizing privately hired doulas* as essential members of the maternity care team, and therefore make an official directive that exempts doulas from hospital visitor policies.

 

On October 23, 2020 the California Department of Public Health issued a revised All Facilities Letter (2) recommending a doula be permitted to be present at the bedside of a birthing family regardless of county positivity rate, yet most California hospitals have not integrated these guidelines into practice. This has to change now.

 

Access to doula support is a health equity issue. Designated professional labor support, such as doulas and birth advocates, are essential for those who are most impacted by healthcare disparities: families of color (particularly Black and Indigenous populations), LGBTQ+ families, trauma or assault survivors, pregnant minors, English language learners, immigrants to name a few. Doulas serve to protect the well-being of these families at a vulnerable time.

Doulas are statistically shown to improve outcomes in maternal and fetal populations by decreasing interventions in labor, decreasing surgical birth rates, decreasing perineal tearing, and improving breastfeeding rates, among many other qualitative assessments of parental and newborn well-being.

 

In support of clients working with doulas during the pandemic, and in solidarity with those care providers dedicated to the comprehensive wellbeing of babies and their parents, we recommend that hospital staff might consider doulas as essential and beneficial to our shared goal of providing the evidence-based continuity of care which supports laboring peoples’ physical and emotional health (3). A nurse may find their rotations to be more effective with the consistent reports of a client who has a doula assisting them in communicating quickly and effectively with medical staff and providing continuous emotional and physical support.

The following organizations advocate for the use of a doula to improve birth outcomes for families:

In their 2020 recent statement, the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) recent 2020 statement urges that: “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 recognized by AWHONN and ACOG as essential personnel and part of the maternity care team” (4).

The March of Dimes recognizes that access to doula care improves birth outcomes and reduces disparities in maternal morbidity and mortality among women of color in the United States (5).

 

The American College of Obstetricians and Gynecologists (ACOG) recognizes that a doula is associated with improved outcomes for women in labor including reduced cesarean rates (6,7)

 

The World Health Organization recognizes that the support provided by doulas improves birth outcomes including decreased complications/cesarean and improved APGAR scores for infants (8).

 

A Cochrane systematic review including 26 trials and over 15,000 people. They found that a doula decreased a mother’s risk of cesarean by 39% and improved infant outcomes (9). The CDC currently encourages hospital facilities to permit support persons who are “essential to the patient’s emotional well-being and care” (10).

 

Countless professional and research organizations recognize designated doula support as essential in this way. Even so, doulas are currently prohibited from entering hospitals all over the state of California by facilities who are striving to follow their interpretation of executive orders. This small confusion has resulted in far too many families going without essential professional birth support at a crucial time.

 

Will you update current public health guidelines to recognize doulas as essential members of the maternity care team and therefore exempt from hospital visitor policies?

 

Thank you for supporting California’s birthing families.

 

Signed,

 

Members and Allies of the Doulas are Essential California Coalition

 

Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
California Nurse Midwives Association (CNMA)
International Cesarean Network (ICAN)
California Chiropractic Association (CCA)
The International Childbirth Education Association (ICEA)
Spinning Babies, Gail Tully
Aviva Romm, MD, Midwife, Herbalist
Dr. Emiliano Chavira, MD, MPH, FACOG Maternal-Fetal Medicine
Dr. Robert Altman, Director for Specialty Care, Sutter Gould Medical Foundation

Jen Kamel, CEO & Founder of VBAC Facts
Mindful Birthing and Parenting Foundation Board
Cristen Pascucci, Founder, Birth Monopoly and Executive Director, Birth Monopoly Foundation
Dr. Fineberg, MD and chair of OBGYN at Sutter Davis Hospital
Phillys Klaus, LMFT
Erin Ryan LM CPM, MPH Executive Director of National Midwifery Institute
Jennifer Joseph, Common Sense Childbirth Inc. / National Perinatal Task Force
Childbirth and Postpartum Professional Association (CAPPA)
Cornerstone Doula Training
Capital City Birth Collective, Sacramento
The Birth & Trauma Support Center
Pacifica Family Maternity Center
Tracy Donegan, Midwife & Founder of Gentle Birth
Oakland Better Birth Foundation
Attachment Parenting International
Birth Network of Monterey County
Birth Network of Santa Cruz County
The Santa Cruz Midwifery Group
Full Moon Family & Wellness Birth Center
CA Birth Center, Rocklin
The Birth Center, Sacramento
Wendy Root Askew, Monterey Peninsula Unified School District Board of Education

Jane Parker, Monterey County Board of Supervisors
Madeleine Wisner, LM, CPM
Lighthouse Wellness Center, Roseville
BirthLore Heather Ward CLD, PD, CCE, CLE
Modesto Birth & Beyond Doula Services, LLC
Henci Goer, author, Optimal Care in Childbirth: The Case for a Physiologic Approach
Joy Burkhard, 2020 Mom Founder and Executive Director
Nia Healing Center for birth and family life
Shiphrahs Circle Community Doula Program
Better Birth Association of Harlem, NY

 

*doulas are defined as designated labor support persons, birth advocates, patient advocates, or any member of the birthing person’s private care team that does NOT identify as the nonbirthing parent/partner.

 

References

 

1. Governor Cuomo of New York’s executive order and The New Jersey Department of Health’s executive directive.

2. CDPH All Facilities Letter from October 23, 2020

3. JOGNN 2018, Cochrane 2017

4. AWONN: Position Statement on Doulas

5. The March of Dimes Position Statement on Doulas and Birth Outcomes

6. ACOG: Approaches to Limit Intervention During Labor and Birth

7. ACOG: Preventing Preventable Cesareans

8. WHO: Companion of choice during labour and childbirth for improved quality of care.

9. Evidence Based Birth: Evidence on Doulas

10. CDC: Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings, February 2020