Supporting Your Clients During the COVID-19 Pandemic

What a time to be alive, eh? Are things as wild in your city as they are here in Seattle, the epicenter of the US COVID-19 outbreak? I hope you've been staying safe, healthy, and updated with the latest news in your neck of the woods.

Here in Seattle, we've been on community/social distancing for about a week now. I shared about this on my personal Facebook page; the first school district shut down about two weeks ago. A week ago today, my family's long-planned for trip to Ireland to chaperone my son's high school marching band St. Patrick's Day parade trip was cancelled. The next day our high school was closed for one day for cleaning. The following day, the whole district closed for two weeks. Last Thursday, all Seattle area school districts closed until the end of April (followed shortly by a statewide district closure).

Now, like so many other major cities across the country, we are in very strict social distancing. All schools, events, restaurants, bars, libraries, bowling alleys, gyms, and more are all closed until at least the end of March.

And, most importantly to our line of work, hospitals are basically on complete lock-down to visitors.

So where does that leave the Doula? In Seattle at least, our labor & delivery units are closed to all visitors under the age of 18, unless they are the parent of the baby. Laboring people are allowed one partner, and one support person. Initially, the support person was a doula only and family support people were not allowed. In the last week, this has changed and now a laboring person may bring their partner and one support person who is either a doula or a family member. Of course, if any of these people show signs of illness, fever, or of COVID-19, they are not allowed into the unit.

I have heard of other regional hospitals, and certainly hospitals across the country are closing their L&D units to the laboring person + partner; no doulas, family, or support person at all. You should know that the nursing association, AWHONN, has released a position statement on Doulas with Patients during COVID-19. They say, "AWHONN supports doulas as partners in care and acknowledges their ability to provide physical, emotional, and partner support to women.  AWHONN opposes hospital policies that restrict the presence of a doula in the inpatient setting during an infectious disease outbreak."

Additionally, DONA International has released a letter, a statement, and incredibly robust toolkit that doulas can use for developing relationships with their local hospitals, in the hopes of maintaining doula support for their laboring families.

Here are some ideas and tips based on my experience in Seattle:

Know your local hospital policies

• Preparation ahead of time is key! Take the time to thoroughly explore what your local hospitals have in place. Ask local colleagues what their experience has been. Ask L&D nurses, check the hospital website. As a last resort, call the charge nurse or L&D nurse manager to ask their policies. Keep in mind that they are incredibly busy right now managing all the new guidelines.
• Does the hospital require ID? Hospitals in Seattle originally started asking for some kind of ID that the support person was a professional doula, and not a family or friend. Having a Doula Name Badge can set you apart from family and friends.

Prepare your clients

• Ask your clients what they have learned from their care provider. Remember that our job is to foster trust and confidence in their care provider, and asking what they've learned is a good place to start. If their care provider hasn't provided them any information, share what you've learned in your research and/or experience.
• Plan for the worst, hope for the best. Because of the rapidly changing landscape of this pandemic, explain to your clients that things may change daily, up until the day of their labor. You may not be able to go with them. Of course, you'll have to use your best doula skills to share this information in the way that is best for them that doesn't create anxiety. Help them know how to advocate with their care provider if necessary. I've learned of some doulas who have a virtual doula plan in place, should hospitals change their policies at the last minute.

Consider Going Virtual

• Try online consultations and prenatal visits. The only way to slow this virus down and not overwhelm our hospitals is by socially distancing ourselves from one another. This is SO HARD when our very job depends on connections with people, and spending intimate time in each other's space. However, this is an unprecedented time and we have to be nimble enough to take unprecedented steps to keep ourselves and our families, our clients and their babies save and healthy. Here are some tools:
• FaceTime: If both parties have Apple products, you can use FaceTime. I talk with my hands a lot so I like to use my iPad Propropped up on it's keyboard stand. 
• Skype: Skype is a great alternative if one or both parties have a non-Apple product. It's free to use, and has camera capabilities. I use Skype on my laptop with webcam and a headset. Skype also has apps for mobile devices.
• Zoom: I use Zoom for all my consults and prenatals now. I have a paid plan because I do a lot of group calls for teaching and mentoring, but if all you are doing is 1:1 consultations and prenatals, the free plan works great! 

At the birth

• When you arrive, be prepared with your Name Badge, government identification, business cards, and anything else that can establish you as a professional doula, not a family member or friend.
• Plan to stay the whole time. Many hospitals are not allowing in/out privileges. If you work in a doula partnership or need to have a backup relieve you, that may not be allowed. Also, you may not be able to leave to grab food for you or your clients, take nursing/pumping breaks, or otherwise leave the facility.
• Make sure your bag is well stocked.It's time to replenish your bag with snacks, electrolyte drinks, and personal toiletries for yourself so you can stay for a long duration. Of course, it's always a good time to restock with the basics!
• MOST IMPORTANT: Remember Penny Simkin's Motto: how will they remember this day, the day they give birth? Let this guide your support - this may not be with all the people your client hoped for, or support in the way you had hoped - but this is their birth day, and help them remember things in a most positive manner.