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In New Maternity Guidelines, Doulas Are Essential Workers

Janmaris Perez, Host: On Monday May 4th, Governor Andrew Cuomo approved new maternity guidelines for New York hospitals. Doulas are now considered essential workers. That means they’re part of the limited number of workers allowed into delivery rooms during the pandemic. Doulas aren’t doctors or nurses. Instead, they provide emotional support during birth. But hospitals are already struggling to supply personal protective equipment to their own staff. And as Emily Pisacreta finds out, that means some big questions for doulas — many of whom are contract workers.

Emily Pisacreta, byline: Myla Flores has never needed anyone to remind her that her work is essential.

Myla Flores: I have been drawn to this work really since i was a child supporting my big sister as she gave birth to my nephew. That was a time that I just experienced the beauty of birth,

and the importance of support. She was a single mama.

Emily Pisacreta: Flores is a certified doula. She works with parents to-be during pregnancy, labor, and birth. Here’s a clip from a class she gave on Mom Life TV. She helps future parents prepare for the big day, and comforts them during the really hard part. But she says that doulas like her also play the role of advocate for people giving birth — especially in hospitals.

Myla Flores: We’ve been there when lives have been saved. We’ve been there when someone has been bleeding out and we told someone to pay attention to this ASAP, you know?

Emily Pisacreta: That’s one important reason why state and city officials in New York have looked to doulas as one of several ways to address a serious problem. According to the state Department of Health, Black women in New York are more than three times more likely to die during or soon after childbirth than white women. But research also shows that having consistent emotional support like the kind provided by doulas can reduce the risk of complications.

So to Flores it made sense when New York State released recommendations last week that doulas counted as essential workers.

Myla Flores: We consider ourselves essential in that way because we know our presence makes a huge difference...

Emily Pisacreta: For several weeks before, doulas like Flores had been largely barred from hospitals in New York, and now they’re allowed back in the delivery room. But that means they’re faced with some big questions. will hospital provide doulas personal protective equipment (or "PPE") and train them to wear it properly? It’s not clear. Many hospitals have struggled to provide adequate PPE for staff, and some health care workers have even died. And most doulas are contract workers. They’re not employed by hospitals, but by the expectant parents.

Myla Flores: A part of me —The wishful side wants to believe that we are valued and that they will find a way to ensure that our safety is a priority as well, but the reality may be different.

Emily Pisacreta: If they don’t feel safe going to the hospital, there is an alternative — working virtually. But Flores says some doulas and parents are unsure if helping with a birth over the phone or on Zoom will be the same.

Jaime Cruz from Westchester is a mom who experienced virtual doula care first hand. Today she’s feeding her newborn baby who was born just a few weeks ago. Cruz gave birth during the week that New York hospitals were barring anyone from the delivery room other than doctors and nurses — meaning she couldn’t have her husband or her doula there with her. As her due date approached and social distancing requirements changed, she was terrified.

Jaime Cruz: It definitely caused a lot of anxiety. A lot of sleepless nights and weird dreams.

Emily Pisacreta: This was Cruz’s fourth baby, and she’d experienced complications before. The thought of not having her husband and doula there had her considering switching to a homebirth. But then her baby showed up two weeks early, and things were moving fast.

Jaime Cruz: I ended up laboring in the parking lot because I didn’t want to go in. I was too afraid to go in because I knew I’d be by myself. So we stayed in the parking lot with her and my husband supporting me for about 40 minutes before I said I have to go in. They came out with a wheelchair and I went in. And um that was that. The rest of via speakerphone with both Denise and my husband.

Emily Pisacreta: She had her doula, Denise Bolds, in her ear the whole time, coaching her from right outside the hospital. The birth was so quick that Bolds’ phone didn’t even run out of battery. Cruz says she would’ve rather had Bolds there in person, but having her on the phone worked surprisingly well.

Jaime Cruz: For any pregnant woman that’s worried about it right now with the COVID-19, it absolutely is doable having a virtual doula. Once you’re laser focused on your delivery, it’s pretty powerful having that doula present for you.

Emily Pisacreta: Denise Bolds is a member of the National Black Doulas Association and a certified childbirth instructor. She’s attended hundreds of births, both in-hospital and at home. She feels strongly that virtual care works, and that if doulas can’t safely visit hospitals, they should continue promoting virtual care.

Denise Bolds: If this was the 70s, we could never do this. Today we can do it. Virtual doula support works. It really does work. And women need to believe that because there’s been telemed for doctors and mental health and wellness care for a long time, and doulas are doing the same thing, and it works very, very well.

Emily Pisacreta: And Bolds says hospitals in New York City aren’t always doula friendly to begin with.

Denise Bolds: There are many nurses who feel that we are imposing. There are doctors that feel that we are imposing. ‘Why’d you bring this stuff?’ Well, this is doula support stuff. Things that we use as comfort techniques.

Emily Pisacreta: Things like birthing balls, or massage oils. Bolds says these kinds of experiences makes it even more difficult to trust hospitals to welcome them into the delivery room in the age of COVID-19 and get them adequate PPE.

When asked about whether they would provide PPEs for doulas, three of the largest hospital systems in New York, including New York City Health and Hospitals, Mt. Sinai, and New York Presbyterian did not respond to requests for comment in time for air. NYU Langone declined Uptown Radio’s request for comment.

But one thing is clear: even full time hospital employees are having trouble getting PPE. Dr. Samantha Penta teaches emergency preparedness at the University at Albany.

Dr. Samantha Penta: Covid-19 has just created a demand that has far exceeded what we as a country, and we as a society have anticipated.

Emily Pisacreta: She says hospital supply chains weren’t set up to address a crisis that emerged so quickly. And she says that sometimes important steps in the chain get left out of emergency preparations.

Dr. Samantha Penta: One of the things that extreme events like covid 19 or other kinds of disasters do for us is highlight the ways that we are interconnected that we didn’t anticipate -- whether that has to do with where important supplies are coming from, or people who actually have really crucial roles in organizational or societal functions that we didn’t appreciate before.

Emily Pisacreta: The next hospital birth that Denise Bolds has been hired to help with is in June, and she’s hoping by then the curve may have flattened. But for now… both she and Myla Flores say they plan on working virtually with their clients. Emily Pisacreta, Columbia Radio News.

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