For Pregnant Women During the Pandemic, Doulas are More Important than Ever

By Sarah Javaid

As the first wave of people receive the COVID-19 vaccine, pregnant women—not included in clinical vaccine trials until this month—have been given confusing and contradictory advice: the CDC recommends that pregnant women consult their doctors before getting the vaccine while the World Health Organization advises against pregnant women receiving it. This is just one example of the many ways pregnant women have been left behind during the pandemic. Pregnant women received limited early recommendations from the CDC on how to continue prenatal care while acknowledging COVID-19 exposure risks. In addition, the healthcare system during COVID-19 limits prenatal, labor and delivery, and postnatal care and support, while uncertain guidelines contribute to anxiety and stress for pregnant women. Given our knowledge about the negative implications of limited support, anxiety, and stress during pregnancy and delivery, we must act to maintain the wellbeing of mothers and newborns during the COVID-19 pandemic. Increasing the use of doulas, trained, non-medical specialists who assist women and families through childbirth, can provide this critical social support through the process of labor and delivery, potentially saving lives.

Pregnant women are already at an increased risk for developing mental illness and health conditions. When pregnant women experience traumatic events or chronic stress, the mental and physical health effects can be long term and increase risks for poor birth outcomes. During the COVID-19 pandemic, some of these stressors may be job loss, financial hardship, homeschooling children, difficulty accessing prenatal care, loss of loved ones, or general COVID-19 worries. High stress and anxiety during pregnancy, as seen throughout the pandemic, negatively affects maternal and infant health, whether through preterm labor or fetal neurodevelopment issues.

Cleary, COVID-19 has stretched the resources of the American healthcare system. Yet women’s overall health must be prioritized, especially considering some health practices that have arisen during the pandemic, such as reduced care and support during labor, inductions, separation of newborns and mothers, and discouraging breastfeeding. Some of these unnecessary actions may actually cause more harm than good. Separation of newborns and mothers can disrupt temperature regulation of newborns, raise the risk of postpartum depression, and lower breastfeeding success. With research indicating very limited COVID-19 transmission through breastmilk, preventing women from breastfeeding is not only unnecessary, but harmful considering the known health benefits of breastfeeding. These actions combined with the mental and physical vulnerability of pregnant women demand support for women to protect their health and that of their child.

Any parent will verify the common saying “it takes a village to raise a child.” However, in our current situation, new mothers are limited to the support found in their household. It’s likely this social isolation will only increase the risk of postpartum depression, as the birth experience strongly influences postpartum mental health. A positive birth experience, consisting of complete support during labor, decreases the likelihood of post-traumatic stress disorder and depression. During the pandemic, restrictions typically allow only one support person to be present during labor and no doulas. Yet such limitations create an environment ripe for adverse effects on mothers and newborns.

Doulas have been proven to positively impact both the birth and postpartum experience by lowering anxiety, shortening labor, reducing the need for extra medical interventions (such as c-sections), promoting self-esteem, lowering postpartum depression, increasing breastfeeding, and empowering mothers to feel that they can care for their babies.

The current strain on the U.S. medical system limits the medical personnel available to those in labor, and as such reducing restrictions on doula presence during the pandemic would positively impact women, newborns, and hospitals. The presence of doulas has even been shown to encourage father’s support during labor and increase mother’s satisfaction with their partners six weeks postpartum, which is especially important considering the social isolation women and their partners will face in the postpartum period due to social distancing measures.

While the COVID-19 pandemic has negatively affected health throughout the United States, pregnant women are in especially acute need of support and care to prevent long-term negative health effects for themselves and their newborns. Anxiety, stress, and COVID-19 restrictions on care and support can do outsize harm to the mental and physical health of mothers and their infants. Using established support people such as doulas has the potential to protect and positively affect women’s health, while not reducing the medical personnel necessary for COVID-19 patients.

Photo of a doula and a patient in labor by JennaRich is licensed under Creative Commons

Sarah Javaid is a master’s student in Epidemiology at the University of Michigan School of Public Health. She works as a research assistant at the Institute of Social Research’s Aging and Biopsychosocial Innovations. She also volunteers as a research team lead at the Lunar Doula Collective, a nonprofit organization focused on providing pregnancy loss support through doulas. Her areas of interest include maternal and child health, mental health, and public health policy.