“Will I give birth alone?” is one of the key questions being asked by pregnant women and birthing people as hospitals adapt their policies to minimise the spread of Coronavirus.
As a doula, I’m an additional birth supporter, working with partners and midwives and medics to create a support team around the mother or birthing person. I recently supported a birth in London as the only birth partner where a family member had self-isolated, and where it was treated as a suspected Covid-19 case — the first the hospital was dealing with. (Article updated 12/5/20 to reflect new UK hospital policies and RCOG guidance)
Many hospitals in the UK are changing their guidelines and restricting the number of people coming into the building — surgery is being cancelled, visitors restricted to one or none. Doula Lauren Mishcon shared this analogy: ‘remember the photos of the firemen running into the twin towers as everyone was running out? That’s the medics right now’. Birthing in a pandemic wasn’t in your birth plan, so what changes can you expect?
Guidelines are changing daily as more is becoming known about the spread of Coronavirus. The guidance for pregnant people in the UK is (as of 17th April) on version 8. And this is only two months since version 1 was published. People giving birth are generally being asked to bring only one supporter who must not have symptoms (this varies by Trust as each can make its own decisions) and can stay for a short time after the birth. Of course, this guidance may change again to limit the spread of Coronavirus even more. Antenatal and postnatal services are moving to online or phone consultations where possible. Staying in hospital after a birth is being reduced to the minimum safe times, for example to 24 hours after an uncomplicated caesarean and to 3–6 hours after a straightforward vaginal birth with partners not being allowed on most antenatal or postnatal wards or for scan appointments.
“Will I birth alone?”
Apart from the small number of births each year that are so sudden that neither a midwife or paramedic can get to you, or where you can’t get to a hospital, you will not birth alone. Labour support is the priority of the midwifery services even in a crisis, so even if you don’t have your expected birth partner(s) with you due to their symptoms, you will be cared for by a midwife whose job it is to support you through your labour and birth. At the moment Trusts in the UK are allowing one supporter for the birth. The Royal Colleges of Midwives, The Royal College of Obstetricians and Gynecologists and the World Health Organisation have issued guidance supporting the necessity of having a birth partner of choice for labour and birth, which is some reassurance to those giving birth in the UK.
This wasn’t on your birth plan, and your partner, planned birth supporter or doula will be gutted not to be there physically with you if they have symptoms or hospital policies have restricted how many people can stay. But these rules will help to keep you and your baby safe from Coronavirus, and to make it possible for the midwife to support the next birth and the next.
“What can I expect?”
- You can expect to be treated with respect, kindness and compassion — human rights don’t disappear in a crisis.
- You can expect increased levels of infection control, with staff wearing masks, gowns or other protective clothing. This can make it harder to tell who everyone is, to hear them or to see facial expressions, so staff should be working hard to overcome these barriers.
- You can expect a symptom-free partner or companion to be able to accompany you in labour and for the birth.
- You can expect to be together with your newborn, unless one of you needs specialist medical care after the birth.
- You can expect a shorter hospital stay (if you’re birthing there), no visitors and reduced face to face contacts for appointments before and after the birth (although you should still be seen a minimum of 6 times face to face during your pregnancy).
- Home births may increase or decrease, dependent on your hospital trust’s staffing decisions. Home births keep people out of hospitals but the benefits have to be balanced with the lack of availability of ambulances to transfer to obstetric care if needed.
- Planned elective caesarean births are currently going ahead in the UK, unless the Trust does not have the capacity to honour the commitment.
For people who are not self-isolating due to a family member with symptoms, and who don’t have symptoms themselves, the main changes are around restrictions on the number of people you can have with you in hospital settings and in moves to online/phone appointments where possible. Having supported a birth recently, the biggest changes were around minimising the risks of infection with the use of masks and protective clothing for us and for staff, and changes to where things happened (for example not moving rooms after the birth to a postnatal ward). When we got home, some postnatal visits were conducted by phone instead of in person.
“What can I do to plan ahead?”
- Keep up to date with your hospital trust’s current policies via their social media accounts, through your midwife or the local Maternity Voices Partnership.
- Minimise all contact (social distancing) for you and those living with you by following government guidelines, self-isolation if you or someone you’ve been in contact with has symptoms, and good hygiene at all times.
- Talk through your birth preferences with your midwife and birth partner/s. Think about what things are the most important to you and how these can be best achieved. Now is the time for plans A through to Z!
- Find out what local online support there is for new parents — and make connections now to ensure you are supported after your baby arrives.
- Consider whether sustainable parenting choices such as cloth nappies/wipes will be right for you to reduce reliance on shops.
- Look into hiring a doula for phone and skype support, or as a back up for your partner if they are self-isolating or ill. Doulas are also volunteering with online support for many vulnerable or disadvantaged people so if cost is a barrier do ask about this.
- Consider who else could be your birth partner if yours has to self-isolate.
- Consider planning to breastfeed. Not only will it support your baby’s health, there will never be a shortage of breastmilk at the supermarket. The Team Baby online learning course from the Association of Breastfeeding Mothers is a good place to start if you want to learn more.
- Hospital services such as food outlets and restaurants are closed to the public (the birthing person will get meals), so for partners bring snacks and Pot Noodle style meals which can be made with hot water.
- Phones, cables and portable charges have never been more important to pack if you own or can borrow these.
- Take care of your mental health. It’s really normal to feel anxious, and organisations such as the Maternal Mental Health Alliance have some great resources to help you cope.
“Are there any positives right now?”
With groups moving online, there is a groundswell of support for expectant and new parents, along with a feeling of all being in it together which may help tackle the isolation new parents often feel. Extended homeworking means that partners may be around and able to flexi their time well beyond the statutory 2 weeks paternity leave usually offered. Being encouraged to labour at home for as long as possible and/or birth at home is likely to lead to less intervention in birth, giving a long-lasting reminder of the benefits of birthing without interruption and showing the midwifery profession’s core skills of supporting physiological birth. And with no known increased infection risks to pregnant people compared to the general population, and because in all known cases of newborns with Covid-19 the baby remained well, the biggest positive will be the birth of your baby — just don’t name them Corona!
This article is written in the author’s capacity as a private doula. It does not constitute medical advice, and is not representative of the views of any voluntary organisation with whom she works nor any hospital Trust.