Doulas Gone DigitalHow to Self-Advocate If You’re Forced to Labor without Support

Photo credit: Sergiu Valena/Unsplash

According to the World Health Organization, receiving support from a companion of choice during labor is a human right that helps lower mortality rates and morbidity. The presence of a trusted companion during all stages of labor and delivery promotes better communication between medical providers and patients, offers practical and emotional support to keep patients more comfortable and relaxed, and helps pregnant people remain in control of their birthing experience. Despite knowing this, in the wake of the COVID-19 pandemic, some New York City hospitals didn’t allow anyone to accompany pregnant people into labor and delivery rooms for a few days in March.

While an executive order from New York Governor Andrew Cuomo reversed this policy, hospitals in other areas across the United States can still require pregnant people to wait in triage without a partner, while others can mandate that they give birth alone. Many hospitals and birthing centers have restricted the number of people who can assist a pregnant person, allowing only one support person to be present for all or some aspects of triage, labor, delivery, and the rest of the hospital stay. A pregnant person must choose who they’d like to accompany them, and typically, that person is the child’s other parent or another close companion—not a birthing professional.

Additional support people, including doulas and other birthing coaches, midwives who don’t have hospital privileges, and family members or other close advocates, are often not permitted to attend births at hospitals or birthing centers right now. This lack of additional support can feel scary for new parents and is especially unsettling for those who are marginalized. Alynson Sloan-Anderson, a certified doula who’s currently enrolled in the Uzazi Village Perinatal Doula Course, says that Black children have an infant mortality rate that is 2.3 times higher than their white counterparts, and Black women are 2.5 times more likely to die in childbirth than white women. Naima Beckles, cofounder of For Your Birth, a New York-based doula and childbirth education practice, is also concerned for pregnant people of color and notes that those who are queer and trans, single, young, or are otherwise marginalized are at increased risk due to disparities in access and quality of care.

In lieu of their ability to be physically present during pregnancy, labor, and postpartum, some doulas are still finding ways to prepare people for birth. As more information becomes available about COVID-19, hospitals are amending their policies and states are shifting their guidelines, sometimes by the hour. That has also increased the importance of self-advocacy training for those planning to give birth. “Self-advocacy should be taught as early as possible in the pregnancy, but if you’re just a few weeks out by now, it’s not too late to learn as much as possible,” Beckles, a certified doula and childbirth educator, told Bitch. “Everyone should make it a priority.”

Even if you can’t receive in-person professional advocacy during your labor and delivery, these tips from Beckles and other experts can help expecting parents become stronger advocates for themselves or their partners.

1. Seek Expert Advice and Education

Beckles says that self-advocacy is rooted in being educated about what’s physically happening in the body during childbirth. “People need this knowledge so they can make informed decisions about the care they seek,” Beckles says. Childbirth education helps empower pregnant people and their partners or support persons. “Some people don’t realize the intense muscular work the body is doing during labor,” Beckles continues. “They don’t know [that they have] to stay hydrated and rest. People don’t always realize what they need. Education reinforces that their bodies are capable and reframes birth as something that doesn’t always need to be medically managed.”

A doula or a different kind of childbirth educator can help pregnant people and their partners learn more about what to expect throughout each stage of labor and provide them with more information about pain relief options, positioning and movement, breathing and relaxation techniques, and more. For those worried about the potential costs of care, there are a number of organizations that can help. Certified doula Dawn Star Sarahs-Borchelt volunteers for an organization that offers access to doula services by pairing expectant parents with a no-cost or sliding-scale practitioner. Prices can range between no-cost care and $1400, but no matter what’s charged, pregnant patients receive the same quality of care. Beckles’s practice also offers sliding-scale classes and virtual support.

Sloan-Anderson notes that her group, Community Doulas of South Jersey, is utilizing creative efforts to extend low-cost support: “As a community organization that is accustomed to inviting community members to open forums and education classes, we’ve had to adjust the way we do this, but we are working diligently to still provide classes such as yoga and [chest] feeding to the community through open forums like Facebook Live.” The doula hashtag on Twitter also connects users with people leading free Q&As and workshops, posting educational videos, and talking about their birthing experiences.

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Beckles recommends enrolling in a virtual childbirth class, since technology has made it possible for childbirth educators to share information remotely. For Your Birth classes explore a number of topics, including preparing for childbirth, learning to perform infant CPR, and breastfeeding. These classes can be taken privately or with a group and they offer both weekend sessions and day-long intensives. Beckles recommends taking classes with childbirth educators that use evidence-based birth techniques. For instance, Birth Freely offers a class that acclimates pregnant people and partners to birthing rooms and hospital experiences. If you can’t enroll, consider watching free videos, like this series from Baby Center, that offer brief overviews. There’s also an evidence-based birth podcast that features guests who discuss their experiences of giving birth as well as tips from experts who want to help pregnant people prepare to give birth.

Technology can also keep pregnant people and their families connected with a professional during labor. Kate Watts and Anand Petigara, a couple who lives in Philadelphia, hired a doula who isn’t able to physically support them during labor, but they’re going to use FaceTime and phone calls to communicate with her during labor. Their upcoming virtual check-in will focus on teaching them advocacy skills they can employ during labor.

2. Know Your Rights

Hermine Hayes-Klein, a lawyer who advocates for human rights during childbirth, tells Bitch that pregnant people are facing the same issues they’ve always encountered. “There is no more vulnerable experience than that of a pregnant person in labor,” she says. She notes that family separation, forced medical intervention, restrictions on where birth can occur and with whom, and discrimination toward marginalized groups are continual problems for pregnant and laboring people around the world. Hayes-Klein explains that hospital policies are often developed in order to prevent liabilities. For instance, requiring patients to sign forms before procedures demonstrates that the institution has upheld their legal responsibility without necessarily providing the patient with a thorough understanding of their rights. She even describes situations where hospitals have valued their policies over patient rights.

She notes that a lack of transparency is common in hospital settings, but every patient has the right to ask questions, demand answers, and stay informed. “[Nurses and doctors] have a legal and ethical responsibility to answer your questions, support you, and help you make the best decision for yourself—not for them or others,” Hayes-Klein says. Continually checking in with medical professionals throughout the process requires additional work, but asking the same questions repeatedly will ensure that answers have not changed without you being informed. “Our clients are fearing whether or not they’ll be listened to, if their concerns will be validated, if their questions will be answered,” Sloan-Anderson says. “ [If you’re a Black person giving birth], those are fears without a global pandemic occurring, but now knowing that they won’t be able to have the physical support of their doula, their fears are amplified.”

You have a fundamental right to say “no” and make autonomous decisions. You have the right to refuse medical interventions, including surgeries such as cesarean sections, and the right to privacy. Be prepared for pushback if you decline medical advice—but also know that subtle coercion and blatant threats are tactics to force compliance, not legal standings. “What medical professionals have to do is advise, but you get to make the choice,” Hayes-Klein says.

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3. Have a Birthing Plan, Though It Might Not Go as Expected

Beckles says clients should always have a plan A, B, and C. “This would have been a good idea a few months ago but [it] now feels urgent to make sure we’re really thinking through what each plan would mean and more carefully developing a more thorough postpartum plan, too,” she says. You should begin researching and purchasing what you need now because it might be difficult to find supplies once the baby is born. Beckles has compiled a resource to help clients build thorough plans, which includes questions they should ask their providers. It’s important for expectant parents and their partners to ask what the hospital’s policies and procedures are for parents or babies that begin showing symptoms associated with COVID-19. Check in to see if you’re allowed to walk the halls, seek an elective induction, or pursue other options that are typically available.

Though expectant parents should assume that their birthing plans will change, thinking through different options and having opinions on each possibility can be reassuring when the tension is high. Julia Hodgson’s parents, who live in North Jersey, are planning to watch her 2-year-old while she and her partner deliver a new baby in a birthing center in Pennsylvania. She fears that everyone will be placed at risk for developing COVID-19, but she doesn’t have other safe choices for childcare. Kate and Anand are now preparing for labor knowing their hospital is requiring them to wear masks throughout delivery; they joke that their baby will be welcomed into the world by a medical team in hazmat suits.

“I’ve had numerous conversations where a mother has just been told by the doctor that they will only be allowed one support person in the room after months of planning to have a partner/spouse as well as me, their doula,” Sloan-Anderson says. “To many of them it feels as though the rug has been pulled [out from] underneath them and I’ve been able to recenter and refocus them on the delivery of a healthy baby—reminding them that that’s always the goal.”

Pregnant people have a fundamental right to say “no” and make autonomous decisions.

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4. Demand Privacy if You Need It

You don’t have to make immediate decisions during labor, even if nurses and doctors are trying to force you to. Do your best to remain in constant conversation with your birthing partner before you arrive so that you’re on the same page—but if something comes up during labor, you can tell staff that you need privacy to discuss the matter with your support person. Tell trusted support people who aren’t able to be present that you’d like to keep in touch during labor, and call them if you need help deciding what’s best. If you’ve hired a doula, inform staff that you’ll be communicating with that professional throughout your stay; schedule calls or video chats and text to ask questions as they come up. Sarahs-Borchelt notes that doulas are used to working as members of a team and will communicate via video call with nurses and other staff if you feel that you need professional advocacy.

5. Rely on Trusted Resources and Remember to Practice Self-Care

Though it’s tempting to Google all your pregnancy-related questions, Beckles says it’s best to avoid those rabbit holes; instead of Googling, she says, “People can latch onto well-informed groups that [they] feel are speaking to them and providing a sense of community.” In addition to thinking critically about how to handle the birth itself, seeking psychological and emotional support is important for those with the resources to do so. We are living in a chaotic time, so it’s natural for postpartum depression and anxiety to become issues that simply have less support around. Finding virtual therapists, peer-support groups, and other new parents can help quell the feeling that you’re alone.

The Virtual Birth Circle Group, a public Facebook group, is one resource dedicated to connecting birthing people throughout the world. The group offers Zoom sessions and other opportunities for virtual bonding. Birthing and Breast or Chestfeeding Trans People and Allies, a private Facebook group, focuses more specifically on supporting trans and gender-nonconforming folks who are pregnant, chestfeeding, or otherwise recently postpartum. Postpartum Support International offers the opportunity to connect with experts and also offers weekly digital support groups that focus on a variety of topics and experiences. Local therapists and organizations can also help you find support at a variety of care levels—from individual counseling to intensive outpatient programs—that have all moved online. Even if you’re feeling alone as a pregnant person in the midst of COVID-19, you’re far from it.

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Lauren Rowello is interested in sharing stories of authenticity and resistance. You can read her work in HuffPost, Vice, Scary Mommy, GO Magazine, and elsewhere. She is a writer, educator, and activist who is often reporting and reflecting on experiences of queer identity, parenthood, sex work, and mental health concerns. She is the founder of Quarantined Kids Magazine, a space for young people to share work during and about the COVID-19 crisis.