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Among all the chaos covid-19 has brought us, one thing hasn’t changed: People are still having babies.

But the landscape of how people are giving birth is changing dramatically. With hospitals overcrowding, concerns about supplies dwindling and our inability to detect who is a carrier of the virus, people due to give birth are feeling understandable anxiety.

In the hopes of limiting the spread of coronavirus, hospitals are instating new visitation policies that, in some cases, cut doulas out of the equation.

As a measure of prevention some hospitals are not letting anyone, not even the pregnant person’s partner — as two leading New York hospitals announced Monday — into the labor room, while others are keeping to a strict one visitor only policy, which means if the laboring person has a partner, their doula isn’t allowed in.

The celebration of World Doula Week coincides with these new policies being put into effect, and it begs us all to remember just how vital the principles of doula care are. Doulas have always operated in a gray zone, despite well documented stats that point to the effectiveness of doula care in improving outcomes.

In the current covid-19 recommendations for obstetric health care, the Centers for Disease Control and Prevention recommends that “facilities follow the … infection control guidance on managing visitor access, including essential support persons for women in labor.”

So, should doulas be considered visitors? Or are they essential persons for women in labor?

Across multiple states, advocates currently lobbying for doula-inclusive hospital visitor policies are having some success. This shows us that, perhaps slowly, we are climbing our way out of this gray zone and starting to be seen as necessary members of care teams.

Yet as governors are urging people to stay inside, doulas may no longer feel comfortable attending births or their clients may no longer want them there. Is adding doulas into the mix just too risky for public health overall?

Much is still uncertain.

What we do know is that both change and uncertainty spark some of our deepest fears and anxieties. It reminds us that we have way less control than most of us are comfortable with. And that working from a place of fear, anxiety and stress makes all of us more vulnerable to undesired outcomes, even with the best intentions.

While this virus is novel, the reaction to losing control is not. The history of obstetrics in America shows a clear pattern of not listening to the concerns of pregnant people, particularly people of color.

Doctors, nurses, midwives, hospital staff and first responders are continuously putting themselves at risk by showing up to serve others. Non-hospital-based midwives accepting the overflow of patients transferring out of hospitals are doing the same.

Still, giving birth in hospitals, particularly for people of color, can put them greater risk for not being listened to or for having their concerns overlooked.

We know that these are uncharted and terrifying times, but birthing people’s experiences matter. How we treat our pregnant people in labor matters. Lack of support and trauma during labor can have a major impact on their mental and emotional health, their ability to care for their babies and their physical well-being.

We must remember that safety is more than mere survival.

Doulas are uniquely trained for uncertainty: Holding space. Releasing control. Sometimes, doing nothing. Advocating. Educating. Promoting rest. Promoting movement. Facilitating grounding down. Helping to move moment to moment. Helping ensure everyone is communicating their needs.

The process of birth is uncertain. Try as we might to control it, we still don’t know exactly what causes labor to start, we don’t know when it will happen, how strong the contractions will be, how long the labor will last, or what the outcome will be. We can do no more than move one contraction at a time.

So we believe the real question we should be asking right now is: How can we all propel these tenets of doula care forward?

Access to hands-on doula care in hospitals may be slowing for now, but it is the perfect time for the tenets of doula care to be spread far and wide. And these tenets are something all of us, not just doulas, can learn from.

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