FOR IMMEDIATE RELEASE - April 20, 2020
On March 29th, we, a coalition of concerned birth workers and patient advocates launched an online petition calling to mandate continuous, one-to-one birth support from a birth companion of choice for every birthing person in Ontario during the coronavirus pandemic.
Birth support from a companion of choice (often a partner or loved one) is an essential component of a safe and positive childbirth experience, whether the birth is unmedicated, induced, or by Caesarean section.
Policies vary widely between institutions, from limiting the number of support persons to eliminating support entirely. Hospitals have not been forthcoming with their policies, especially those affecting patients who may be COVID-19 positive. Most are now turning away all support for patients who are presumed to be positive for signs of the virus (screened for fever, cough, shortness of breath, cold symptoms, etc., upon admission), and in some cases, are not allowing midwifery clients with symptoms to remain under the care of their chosen providers.
Given that many individuals who test positive for COVID-19 have no symptoms at all (up to 87.9% in one study in the New England Journal of Medicine) screening for the virus at the time of hospital admission is not an accurate tool to gauge infection risk or make decisions about who can and cannot be supported during birth.
Disallowing support for patients who screen positive for signs of the virus is happening under the guise of protecting patients, their birth support, hospital staff, and other healthcare personnel. However, we know the most effective protections from COVID-19 are increased infection control measures paired with adequate access to PPE for all.
While we recognize the need to take action to slow the spread of the virus and protect frontline healthcare workers, we worry that these policies are already having a negative impact on patients, families, and their care teams, as well as disproportionately impacting those who are already at risk in the healthcare system without in-person advocacy and support.
In order to ensure a safe and equitable birth experience for all, it is imperative that every birthing person maintain the right to support and advocacy from a birth companion of their choice during the COVID-19 pandemic.
1345 individuals and 8 organizations signed the open letter.
Contact:
obstetricjustice@gmail.com for all inquiries
The Obstetric Justice Project
obstetricjustice.org
__________________________________
March 29, 2020
To:
Hon. Christine Elliot, Ontario Health Minister
Hon. Patty Hajdu, Minister of Health Canada
Dr. David Williams, Chief Medical Officer of Health, Ontario
Dr. Eileen de Villa, Medical Officer of Health, Toronto
cc:
Hospital Patient Relations teams across Ontario
Hon. Jill Dunlop, Associate Minister Responsible for Women's Issues
France Gélinas, Critic, Health Care
Harpreet Bassi, Director of Policy, Ministry of Health
Benjamin Levitt, Manager, Stakeholder Relations, Ministry of Health
__________________________________
Re: Birth Support for Every Birthing Person During COVID-19
Dear Hon. Patty Hajdu, Hon. Christine Elliott, Dr. Eileen de Villa, Dr. David Williams,
We are facing a global pandemic, and our governments have asked each community member to take drastic measures to assist in curbing the spread of COVID-19. We take the pandemic very seriously, and we are writing to advocate during these measures for the physical and emotional safety of each person receiving pregnancy, labour, and postpartum care.
At this time, new policies have come into effect limiting the number of visitors and support persons permitted in hospitals. In most cases, just one support person is permitted to accompany the labouring person for the duration of their hospital stay, and in some cases, the support person must leave soon after the birth, in the immediate postpartum stage. (1)
Currently, there are no standardized policies in place mandating continuous, one-to-one birth support from a birth companion of choice during the pandemic. Practises vary widely between institutions, and recent reports from doulas and community workers reveal that some downtown Toronto hospitals have begun to turn away support persons for patients who are presumed to be positive for signs of COVID-19; in places, individual hospital staff are reportedly making unilateral decisions not to allow support. These actions are not grounded in public health evidence or best practices for human rights in childbirth.
This is unacceptable.
Denying patients a support person of choice, regardless of whether or not the patients are at risk of, or have a confirmed case of COVID-19, is in direct contradiction to the World Health Organization’s updated guidelines for pregnancy, childbirth, and infant feeding during COVID-19.(2) The WHO has expressed that every birthing person, whether or not they have a confirmed COVID-19 infection, has the right to a safe and positive childbirth experience including the support of a birth companion of their choosing.
Denying this support is also not aligned with Canada’s own current public health guidelines that highlight the importance of “continuous physical presence of a caregiver during active labour and birth.” (3) Even while isolating or quarantining with other members of your household (ie: in the case of recent travel, experiencing symptoms of the virus, or having close contact with a suspected or confirmed case)(4), patients should be allowed accompaniment during labour and birth by a symptom-free member of their household, or a consenting companion of choice. Not allowing this does not protect the birthing person or the birth support person, and not allowing ANY support person is directly harming the birthing person’s sense of safety, control, and comfort during this significant life event.
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WHY IS SUPPORT SO ESSENTIAL?
It is not realistic to assume that patients denied a birth companion of choice will receive that same support from hospital staff. During this outbreak, it is likely that nursing teams will be stretched thinner and able to spend even less time one-to-one with patients in labour. Continuous one-to-one labour support has been shown to promote physiological labour processes, reduce the need for medical interventions, and increase feelings of control, confidence, and satisfaction with the birth experience (5). Numerous studies also have found that those who feel a LACK of support during labour and birth are more at risk of developing Postpartum PTSD and other significant perinatal mood and anxiety disorders.(6) Labour support is not a luxury - it is an essential component of a safe and positive birth experience! (7)
The absence of continuous, one-to-one birth support from a companion of choice would affect anyone giving birth during this time, but will have a disproportionate impact on individuals and communities who already experience marginalization within the healthcare system; including - but not limited to - Indigenous, Black, and people of colour, 2SLGBTQI+ families, those living on low incomes, people with disabilities, youth parents, and individuals with mental health or trauma histories.
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WHAT SHOULD A POLICY LOOK LIKE?
Templates for such policies already exist. On March 21, 2020, The New York Department of Health issued updated guidance specific to obstetrical care settings during COVID-19 after two private hospitals attempted to ban labour support (8):
"For labor and delivery, the Department considers one support person essential to patient care throughout labor, delivery, and the immediate postpartum period. This person can be the patient’s spouse, partner, sibling, doula, or another person they choose. In these settings, this person will be the only support person allowed to be present during the patient’s care. This restriction must be explained to the patient in plain terms, upon arrival or, ideally, prior to arriving at the hospital. Hospital staff should ensure that patients fully understand this restriction, allowing them to decide who they wish to identify as their support person." (9)
A similar policy must be implemented here immediately.
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THE POLICY MUST:
-State that every birthing person has the right to a support person of choice throughout labour, delivery and postpartum period while admitted in hospital, and that this support is essential to patient care;
-Be clearly defined and not subject to individual healthcare workers’ discretion or interpretation;
-Be posted publicly online, in hospitals, and clearly communicated to patients and families, ideally ahead of time so each patient has the opportunity to make plans and back-up plans for their birth support;
-Have clear mechanisms in place to approve accommodations for patients who require additional in-person supports (ie: language translators, ASL interpreters, Indigenous cultural practice resource persons, other essential accommodations, etc.) to ensure a safe and equitable birth experience for all
__________________________________
IN CONCLUSION
We urge you to take action now by mandating that ALL pregnant and birthing people maintain their right to a birth companion of choice throughout labour, childbirth and the immediate postpartum period during the coronavirus outbreak, regardless of their confirmed or perceived infection risk, as clearly defined in the World Health Organization’s guidelines for pregnancy, childbirth and breast-/chestfeeding, in relation to COVID-19. Immediate action is required to ensure that not one more person is forced to birth alone during this global pandemic.
Respectfully,
Organizations:
The Obstetric Justice Project
Ocama Collective
Birth Mark
National Aboriginal Council of Midwives
Association of Ontario Doulas
El Parto es Nuestro
Birth Trauma Ontario
Ottawa Valley Doulas Association
and 1345 individuals.
Sources Cited
(Accessed March 28/29 2020)
(1) Sunnybrook Health Sciences Centre Visitor Policy
https://sunnybrook.ca/content/?page=novel-coronavirus
(2) World Health Organization Q&A on COVID-19, pregnancy, childbirth and breastfeeding
https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-pregnancy-childbirth-and-breastfeeding
and World Health Organization infographics on COVID-19
https://www.who.int/reproductivehealth/publications/emergencies/COVID-19-pregnancy-ipc-breastfeeding-infographics/en/
(3) Public Health Agency of Canada, Care During Labour and Birth
https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-4.html
(4) Government of Canada Coronavirus Update
https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html
(5) Cochrane Review: Continuous support for women during childbirth
https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth
(6) Post-Traumatic Stress Disorder Following Childbirth
https://openaccess.city.ac.uk/id/eprint/5036/5/Chapter_final_version_%281%29.pdf
(7) WHO Guidelines: Intrapartum Care for a Positive Childbirth Experience (Executive Summary) https://apps.who.int/iris/bitstream/handle/10665/272447/WHO-RHR-18.12-eng.pdf?ua=1
(8) New York Times: ‘Women Will Not Be Forced to Be Alone When They Are Giving Birth’ https://www.nytimes.com/2020/03/28/parenting/nyc-coronavirus-hospitals-visitors-labor.html
(9) New York Department of Health COVID-19 Health Advisory Update http://coronavirus.health.ny.gov/system/files/documents/2020/03/doh_covid19_obpedsvisitation_032720.pdf
Recommended Reading:
New England Journal of Medicine: “Universal Screening for SARS-CoV-2 in Women Admitted for Delivery”
https://www.nejm.org/doi/full/10.1056/NEJMc2009316
The International Confederation of Midwives (ICM): ”Women’s Rights in Childbirth Must be Upheld During the Coronavirus Pandemic”
https://www.internationalmidwives.org/icm-news/women%E2%80%99s-rights-in-childbirth-must-be-upheld-during-the-coronavirus-pandemic.html
Birthrights UK: ”Birthrights calls for protection of UK women giving birth during coronavirus”
https://www.birthrights.org.uk/2020/03/31/birthrights-calls-for-protection-of-uk-women-giving-birth-during-coronavirus/
We’re monitoring policies as they change across Canada during the COVID-19 pandemic. Visit our Calls to Action section on our Community Story Blog to participate:
Do you have an experience with childbirth or reproductive healthcare during the COVID-19 pandemic? Consider sharing it on our Community Story Blog. You can choose to remain anonymous.
Now welcoming story submissions from patients and professionals across Canada.
No One Should Give Birth Alone During the COVID-19 Pandemic
