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D.C. hospitals continue to limit visitors for birthing mothers, meaning they sometimes cannot have doulas with them.
Mateus Campos Felipe/Unsplash
Savannah Babino is due to give birth at any moment. She's prepared as best she can for the event, planning to have her mother, her sister, and her fiance nearby as she brings her second daughter into the world.
She also plans to have her doula, Amanda Coles, present. Coles helped Babino labor and birth the first time around, and her presence was instrumental---Babino says that Coles is at once a trusted advocate, a knowledgeable professional, and a steady emotional support who provides security during a process that can sometimes feel frightening or overwhelming.
But in order to have Coles present at the birth, she had to make a choice. Babino will give birth at her home in Anacostia, instead of the hospital where she had her first daughter. Because of the pandemic, George Washington University Hospital would not have let both her fiance and another visitor inside the birthing room.
Even as the District has entered Phase 2 of its reopening plan and people have gone back to indoor and outdoor dining, manicures, pedicures, haircuts, and gym workouts, many hospitals in the District are still enforcing a strict visitation policy for birthing mothers. Only one visitor is allowed in the room, meaning that if a mother wants her partner or a family member with her, she cannot also have a doula.
"It really helps just to have that extra support and loved ones around you," Babino says. "It's really challenging to just choose one person ... So for me a home birth was better. I'm able to dictate who I want in the room."
Doulas are not present at a majority of American births, but they're growing in popularity. A doula plays a supporting role; they might talk a mother through contractions, provide massages or other kinds of calming touch, prepare a warm bath, or help translate the advice of medical professionals and advocate on their clients' behalf.
"The analogy that I really like to give is of a crowded pool during the summer. Our doctors, midwives, and nurses are our lifeguards," says Casey Runck, a certified doula in D.C. who has attended roughly 250 births. "A doula is not a lifeguard. They are not medically trained. As a doula I cannot stop a medical emergency---all I do is watch one swimmer. And so if my swimmer is starting to struggle, I have the language to go to the lifeguard and say, 'this is my swimmer, this is how they're struggling, please focus on them.'"
Research shows that people who have continuous support during birth are more likely to have a vaginal birth, and may even be less likely to develop postpartum depression. For some women, the idea of having a knowledgeable, calm advocate by their side during labor feels like an anchor---something to help root them in the present and push through an often grueling process.
"[Labor] is psychological. It's a mental process of, do you believe that you can do this and do you feel safe?" says Emily Goodstein, a Van Ness resident who is due to give birth to her first child in the fall. "It's going to be hard, and I want to believe I can do it, and I want to feel supported ... Knowing that I'll have my team there is like the one thing that will make me less anxious."
Goodstein hired Runck months ago, before the coronavirus pandemic altered life in the District and before she knew she might not, in the end, be able to have a doula at her birth.
When the city entered Phase 2 and she realized that hospitals still weren't changing their visitation policies for birthing mothers, Goodstein says she started feeling worried---and a bit annoyed. She was getting emails from her nail salon and couldn't understand how she was able to get a pedicure, but not have a doula at her birth.
She is hoping that perhaps the city can help alter the situation.
Other jurisdictions, like New York and New Jersey, have chosen to classify doulas as essential personnel rather than as visitors. That classification exempts them from the one-visitor policy, and allows them to attend hospital births along with the mother's chosen family member.
So far, D.C. has not made any such moves.
"It is up to the hospital to set their own visitation guidelines," says Alison Reeves, a spokesperson for the D.C. Department of Health, via email. "The DC Hospital Association has pulled together a small group of subject matter experts to provide recommendations and guidelines in an attempt to somewhat standardize the policies across the healthcare system."
Those DCHA guidelines outline that a patient giving birth should be allowed "one visitor or support person" while they're in the hospital. For Goodstein, Babino, and many other mothers who feel it would be impossible to give birth without their partners or a trusted family member by their side, that means no doula.
Hospitals in other local jurisdictions, including the INOVA hospital system in Virginia, are now allowing doulas to attend births in addition to partners, as long as the birthing mother is COVID negative. But D.C. hospitals contacted by DCist---including Sibley Memorial, the MedStar health system, GW Hospital, and Howard University Hospital---all follow the one-visitor policy.
Coles, Babino's doula, says it is especially concerning to her in D.C., which has a strikingly high maternal mortality rate, especially among Black women. As a Black doula herself, Coles says that she has noticed a difference in the way medical professionals respond to and treat her Black clients during birth.
"If someone is telling you, 'this doesn't seem right,' that person has been within their body for however many said years. They should know when something is wrong with them" she says. But sometimes, particularly with her Black clients, Coles says she notices that doctors are more dismissive of potential concerns.
"You see the difference," she says about her Black clients' interactions with medical staff. "You see the difference."
Babino, who is a Black woman, says she had a difficult interaction with a nurse of another race at her first hospital birth; the nurse did not want to let her into a room with a birthing pool in it because it was allegedly being saved for someone else. In that moment, Babino says, "it was really nice to have Amanda with me, to be there to help me, even though we didn't get the room."
Now, she will take those variables out of the equation. When Babino's younger child decides to make her grand entrance, she will call Coles, who will rush over to help. Coles will come armed with massage oils, a birthing ball, and the knowledge and patience that comes from having attended more than 60 births. Barring complications, Babino will give birth in her own space, with her family, a midwife, and Coles beside her.
"It kind of feels like you've known her forever when she provides her services," Babino says.
Goodstein, who plans to give birth to her baby in a hospital, remains hopeful that hospital policies in D.C. will change before she goes into labor.
Even as she knows she is lucky in many ways, being pregnant during the pandemic has been difficult, Goodstein tells DCist. She's had to give up ideas that she might have her birth photographed (in a previous career, Goodstein was a birth photographer herself), or that her parents might be able to meet their grandchild in the hospital soon after she is born. She has in fact settled into the emotionally heavy idea that, after the birth, she and her husband Ron will be taking care of their new baby alone, without the support of family she would have expected.
"But this feels like the one thing I really do need and want," she says. "This feels like the one thing that really should change."