STATEMENT OF RECOMMENDATIONS TO POLICY MAKERS, REGARDING DOULAS AND OTHER MATERNITY CARE SUPPORT PEOPLE IN NEW MEXICO DURING COVID-19

New Mexico Doula Association
STATEMENT OF RECOMMENDATIONS TO POLICY MAKERS, REGARDING DOULAS AND OTHER MATERNITY CARE SUPPORT PEOPLE IN NEW MEXICO DURING COVID-19

JANUARY 30, 2021

All families birthing in New Mexico deserve a positive and supported birth experience regardless of the extenuating circumstances with COVID-19. We know that positive experiences most often happen when families can express their needs and have them acknowledged, heard, and honored. Positive birth and postpartum experiences in New Mexico must always include the option of doula support.

The New Mexico Doula Association recognizes the challenges that our state, country, and world are facing regarding limiting the spread of COVID-19, including the reduced availability of PPE, sufficient testing, and vaccinations. We gratefully acknowledge the courageous efforts of our state government, medical professionals, hospital staff, and other essential workers.

We also acknowledge the limits placed on visitors to hospital obstetric units to be in alignment with important safety measures during the COVID-19 pandemic.

HOWEVER, ENSURING ACCESS TO OBSTETRIC UNITS AND COMMUNITY BIRTH CENTERS FOR BOTH A PATIENT’S CHOSEN VISITOR AND A DOULA MAY REDUCE BOTH RISK AND COST, WHILE SIMULTANEOUSLY IMPROVING OVERALL OUTCOMES AND BIRTH EXPERIENCES.

Both of these support people may be screened and, when available, tested for COVID-19 infection and provided with PPE.

Trained and professional birth and postpartum doulas have a unique role in supporting optimal experiences and care outcomes of birthing and postpartum parents. They do this through continuous support, education, comfort measures, and supporting the birthing person’s self-advocacy while receiving and accessing appropriate care.

Doulas understand that maternal health care providers are under increased pressure due to the current pandemic and can help “fill-the-gap” by providing much-needed support, not only to the birthing family, but also in support of the medical team’s goal of realizing optimal care outcomes and reducing overhead cost for providers & facilities, and out- of-pocket costs for birthing families.

The New Mexico Doula Association position is that doulas are not visitors. (AWHONN MAR STATEMENT1)

Doulas are allied professionals well-situated to enhance the delivery of safe, evidence-based care; filling a gap in the US maternal healthcare system. (ACOG, AWHONN, ACNM)

The evidence-based health benefits of doula care for families (ACOG, AWHONN, ACNM, WHO) and families of color (CAP, Wint et al, Ireland et al) must continue to be accessible to birthing families.

Doula care has been shown to reduce families’ risk for medical intervention, cesarean surgery, and postpartum depression (COCHRANE).

RECOMMENDATION #1
THE NEW MEXICO DOULA ASSOCIATION STRONGLY RECOMMENDS THAT DOULAS BE INCLUDED IN BIRTH CARE TEAMS, FOR ALL BIRTHING PEOPLE WHO REQUEST DOULA SUPPORT.

The doula support role has the power to raise BIPOC (Black, Indigenous and People of Color) families’ confident access of safe, respectful care through facilitation of meaningful connection between a family. Doulas support the integration of a family’s cultural experiences, language preference, lived hardship or trauma, family members, and parenting style into and through and the care experience.

Given the ongoing COVID-19 pandemic, families are already at an increased risk for mental and emotional difficulties during and after birth. Without in-person doula care during childbirth and through the duration of their stay, these families are at an increased risk for undesired outcomes and longer hospital stays. Under the current guidance, families who planned to include a doula no longer have that choice and as a result, face compounded risk without the continuous in-person presence of their trusted doula.

RECOMMENDATION #2
IF THE PHYSICAL PRESENCE OF A DOULA IS NOT POSSIBLE, WE RECOMMEND HOSPITAL SUPPORT FOR A FAMILY TO ACCESS THEIR DOULA VIA TELEHEALTH OPTIONS IN L&D UNITS.

Doula telehealth support can include intermittent as well as continuous virtual labor support. (McLemore; what about EBB) Many families will have their own devices with which to access virtual doula support. For those who do not, birthing facilities should provide a phone or tablet with access to WIFI and video/audio capabilities. Additionally, we hope that hospital staff will be accepting and supportive of working as a team with the family and their virtual doula.

RECOMMENDATION #3
WHEN A DOULA IS NOT DESIRED OR IS NOT AN OPTION, WE RECOGNIZE AND ADVOCATE FOR THE RIGHT OF THE BIRTHING PERSON TO CONTINUE TO HAVE A SECOND SUPPORT PERSON OF THEIR CHOICE WITH THEM DURING THE ENTIRETY OF THEIR STAY AT ALL NEW MEXICO BIRTHING FACILITIES (WHO, MCLEMORE,…) AND LOCATIONS INCLUDING IN-HOME.

Below, we have provided reference materials in support of our evidence-based position and recommendations. The New Mexico Doula Association welcomes the opportunity to further these conversations and to work with the communities of New Mexico to build mutually supportive relationships. Board members and supporters of the New Mexico Doula Association are available to provide additional insight, resources, evidence-based studies, and insight from national conversations around the importance of doula care during COVID-19.

We encourage you to connect with us at newmexicodoulaassociation@gmail.com. You may also access additional information about our organization at https://www.nmdoula.org/.

Signed,

Letter Contributors

Carrie Murphy, MFA, NMDA cofounder, full spectrum doula, cofounder and volunteer coordinator, University of New Mexico Hospital Volunteer Birth Companion Program

Jessica Lujan-Garcia, Indigenous Women’s Health & Reproductive Justice Program, Tewa Women United

Karen Brown, doula with Sanguine Journey, LLC

Melissa Marie Brice, MBA, NMDA executive director & full spectrum doula with Melissa Marie, LLC

New Mexico Doula Association Board of Directors

New Mexico Doula Association Steering Committee

Co-Sponsoring Organizations:

Indigenous Women’s Health & Reproductive Justice Program, Tewa Women United

MOST RECENT SUPPORTING DOCUMENTS PRODUCED WITHIN NEW MEXICO DURING THE 2020 PANDEMIC
Perinatal Emergency Recommendations Considering Disparities & Outcomes: COVID-19 & Beyond

Expanding Access to Doula Care - Birth Equity & Economic Justice in New Mexico

SAMPLE EXECUTIVE ORDER LANGUAGE
New York Governor’s Executive Order “requiring any article twenty-eight facility, shall, as a condition of licensure, allow any patient giving birth to have present with them: a support person, who does not have symptoms of COVID-19, for the labor, delivery, and also the remaining duration of the patient’s stay and/or a doula who does not have symptoms of COVID-19, for the labor, delivery, and also the remaining duration of the patient’s stay.”

REFERENCES CITED
Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). Update March 11, 2020: AWHONN’s position on doulas with patients during COVID-19. AWHONN website. https://awhonn.org/novel-coronavirus-covid-19/covid19-practice-guidance/. March 11, 2020. Accessed April 15, 2020.

ACOG Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth. Obstet Gynecol. 2019;133(2):e164–e173. doi:10.1097/AOG.0000000000003074 [https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth] Accessed April 15, 2020.

AWHONN Position Statement: Continuous Labor Support for Every Woman. J Obstet Gynecol Neonat Nurs. 2018; 22(1): 93–94. doi:10.1016/S1751-4851(18)30035-7. AWHONN website. https://nwhjournal.org/article/S1751-4851(18)30035-7/fulltext. Accessed April 15, 2020.

Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews. 2017; 7(7):CD003766. Published 2017 Jul 6. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003766.pub6/full Accessed April 15, 2020.

World Health Organization. WHO recommendation on companionship during childbirth. 2018. WHO website. https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-during-childbirth/who-recommendation-companionship-during-labour-and-childbirth. Accessed April 20, 2020.

McLemore MR. COVID-19 is no reason to abandon pregnant people. Opinion in Scientific American. March 26, 2020. https://blogs.scientificamerican.com/observations/covid-19-is-no-reason-to-abandon-pregnant-people/ Accessed April 14, 2020.

The White Ribbon Alliance for Safe Motherhood. Respectful Maternity Care: Respecting the Universal Rights of Childbearing Women. 2012. https://www.who.int/woman_child_accountability/ierg/reports/2012_01S_Respectful_Maternity_Care_Charter_The_Universal_Rights_of_Childbearing_Women.pdf Accessed April 14, 2020.

New Mexico Doula Association
4367 Calle Amarilla Arc.
Las Cruces, NM 88011
Melissa Marie Brice
(575) 567-3350

The New Mexico Doula Association is an inclusive, birth-justice focused organization that works to make doula care more accessible throughout the state of New Mexico through advocacy and education. We believe that all New Mexican families have the right to affordable, non-judgmental, and culturally-competent support for pregnancy, birth, postpartum, and other reproductive experiences and outcomes.

This release was published on openPR.