On the Outside Looking In: A Global Doula Response to COVID-19

Abstract

From around the world, report the impact of new COVID-19 restrictions on their ability to provide continuous emotional, physical, and informational support to pregnant people and their families. In a qualitative survey conducted in March and April 2020, we heard from over 500 doulas in 24 countries. Doulas practicing across the world revealed rapid changes to hospital policies. Even accounting for different public health responses across countries, the doulas in our study pointed to one common theme - their absence at births and the subsequent need to support birthing people virtually. In a follow-up survey and in interviews we conducted in July, we reconnected with doulas from our initial study to track their access to institutional birthing spaces. As countries experienced the effects of “flattening the curve,” we found that doulas were still not considered “essential” workers and the majority could not attend births. Our research shows that doulas have ambiguous feelings about the efficacy of virtual support, that they raise concerns about the long-term impact of COVID on their profession and that they are concerned about mistreatment and obstetric violence as birthing people enter hospitals alone.

The role of doulas in providing breastfeeding support during the COVID-19 pandemic

“…Although doula care has numerous advantages, accessing these services is not without difficulties, some of which have grown more restrictive since the COVID-19 Pandemic [ 32 ].To combat the spread of COVID-19, hospital systems implemented substantial modifications to their policies and standards at the start of the pandemic, including restricting visits and doula services [ 33 , 34 ]. Evolving guidelines, uncertainty, and subsequent mitigation strategies altered mothers' expected birth location and nursing intentions [ 30 , 35 , 36 ].This situation was further exasperated due to a lack of appropriate legislation or hospital policies to acknowledge the vital work of doulas: they were deemed non-essential and largely unable to participate in births, even though expecting parents had come to rely on doula support [ 3 , 32 , 37 ]. Additionally, Doulas struggled to transition to virtual services during this time to deliver much-needed services.…”

“…Most doulas still could not attend births—limiting their ability to provide needed services like emotional and breastfeeding support to new mothers. Doulas had mixed emotions about virtual assistance effectiveness [ 26 , 37 ]. They were concerned about COVID's long-term effects on their profession and worried about maltreatment and obstetric violence as birthing people enter hospitals unaccompanied.…”

“…They were concerned about COVID's long-term effects on their profession and worried about maltreatment and obstetric violence as birthing people enter hospitals unaccompanied. For various reasons, doulas prefer to work with their clients in person rather than virtually [ 37 ]. In evaluating the effect of the exclusion of doulas from delivery rooms due to COVID-19 restrictions, a shift in birth plans was noted by birthing people from hospital to home births where they could have doulas and partners present [ 31 ].…”

New life, new feelings of loss: Journaling new motherhood during Covid-19

“…Existing inequities in obstetric care for historically marginalized groups are also deepening, resulting in a greater likelihood of negative birth experiences and outcomes, which can lead to postpartum mental distress ( Davis et al, 2021 ; Norton et al, 2020 ; Obinna, 2021 ; Oparah et al, 2021 ). Anxieties about contagion, isolation, and quarantine, being separated from one's newborn at birth, or not being allowed birth companions during labor may be associated with a higher incidence for mothers of complications during labor and greater likelihood of medical interventions ( Friesen et al, 2021 ; Liese et al, 2021 ; Searcy and Castañeda, 2021 ). Increased episodes of obstetric violence have been reported in relation to these trends ( Sadler et al, 2020 ).…”

Труд Доулы, Публичный И Интимный: Профессиональная Забота, Самоорганизация И Активизм

“…С другой стороны, оказывая поддержку женщинам, доулы повышают их субъектность и таким образом выступают как контрагенты медицинских специалистов, чье авторитетное знание основано на отношении к пациенту как к объекту, делегитимизации и вытеснении других форм знания -телесного знания женщин и опытного знания немедицинских помощников [Davis-Floyd, Sargent, 1997;Hunter, Hurst, 2016;Денисова, 2019]. Тот факт, что медицинская система все еще воспринимает доул как чужаков, нашел подтверждение во время пандемии COVID-19, когда во многих странах доулам был закрыт доступ в больницы, произошло их «отсечение» от медицинского персонала [Johnson-Searcy, Castaneda, 2021].…”