While the world anxiously watches on, news of COVID-19 saturates television networks and media outlets. We are told to stay isolated at home to avoid the risk of infection. But one forgotten group of society, whose members cannot simply stay at home, face an increased risk of physical and mental illness: pregnant people.
Australia has a history of poor and misinformed treatment of pregnant people. Up until the 1970s, Australian hospitals would isolate and sedate people because it was thought that they couldn’t cope with the emotional and physical burden of childbirth. In the late 20th century, pregnancy was even categorised as a medical illness.
As the normative experience of childbirth shifted from being a reproductive activity located in the home to a medical activity located in a hospital, those pregnant were increasingly thought of as ‘guests’ and were expected to cooperate with the ‘house rules’ of the hospital. The period between 1920 and 1970 was known as the ‘golden age’ of the medical dominance of pregnant people in Anglo-American societies, during which the medical profession enjoyed full state support largely at the expense of women’s autonomy and wellbeing.
Since then, Australia’s modernised health-care services have been increasingly concerned with delivering a positive childbirth experience in line with the World Health Organization’s (WHO’s) guidelines. The WHO has emphasized the importance of improving patient-centered outcomes, acknowledging that the process of childbirth requires continued care and support of the birthing person. There are typically two or three non-medical support people present during labour and delivery. However, the current risk of parents, babies or medical staff contracting COVID-19 has made access to this level of support unattainable for birthing patients.
Since the outbreak of pandemic-induced panic, the childbirth norm of hospital delivery has been reversed. The Australian College of Midwives has reported a spike in the number of calls regarding home births; it is clear that Australian’s don’t feel safe at hospital, and that this will add further stress and uncertainty to their pregnancies.
For those with low-risk pregnancies it may be possible to avoid hospital birth altogether, however many people require medical attention during labour and some births can only occur by caesarian section. According to the Australian Institute of Health and Welfare, almost 30% of those giving birth for the first time had a caesarian section in 2017. Undergoing in-hospital procedures such as these during the time of COVID-19 further compounds stress during what is already an intense and often traumatic ordeal.
While exposure to COVID-19 poses a threat to the physical safety of pregnant people, there is also a threat to their mental health that has been largely ignored by the media. This threat to mental health is the complete ban on support people from hospital delivery rooms in certain countries.
The Midlands Regional hospital in Ireland has barred support persons from being present in the room during labour due to concerns about COVID-19. Other hospitals in Ireland are considering following suit. Implementing a zero-support-person policy directly contradicts WHO guidelines, which confirm the importance of having a support person present in order to achieve positive birth outcomes.
In March, New York City Presbyterian hospitals introduced one of the most restrictive visitor policies for maternity wards: barring spouses, partners, family and friends from the delivery room. In an attempt to protect the physical health of parents and babies, these hospitals inadvertently caused widespread anguish and despair.
A New York City doula, Jesse Pournaras, started a petition to review the restrictive visitors policy which has since received over 600,000 signatures. In response to public backlash, New York Governor Andrew Cuomo issued an executive order allowing pregnant patients at least one support person in the delivery room with them. He tweeted, “in no hospital in New York will a woman be forced to be alone when she gives birth. Not now, not ever.”
The Cochrane Review found that people who received continuous labour support were less likely to require a caesarian section, less likely to use pain medication, had shorter labours, and were more likely to be satisfied with their birth experience. The review also found evidence that parents who are satisfied with their birth experience have a lower risk of postpartum depression and anxiety. Having support persons present can also bridge the communication gap between laboring people and hospital staff in order to provide increased comfort to laboring people.
In response to COVID-19, Australian and New Zealand hospitals have limited the time of antenatal visits, replaced in-person visits with telehealth consultations, limited visitors while in hospital, and considered the early discharge of mothers and babies from hospital. These measures are in line with a directive issued by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
I interviewed Professor Kirsten Black, Joint Head of the Discipline of Obstetrics, Gynaecology and Neonatology at the University of Sydney, to talk further about the way maternity care has changed since the outbreak of Coronavirus. In her opinion, the focus is now on delivering quality care in a different way so that “less women are exposed to less risk”. What pregnant women need right now, she says, is reassurance that in-hospital care won’t be compromised because of COVID-19. Professor Black also went on to note that the definition of positive maternal care is “continual care” – care for women before, during and after childbirth. Thus, it is imperative that we recognise how COVID-19 may not only isolate pregnant people during their labour experience, but could also strip them of their support networks both prior to and following childbirth.
Australian hospitals will still allow one support person to accompany pregnant people through labour and delivery during COVID-19: a move that strikes the right balance between provision of safety and provision of care. We can’t yet know the long-term repercussions of restrictions on support services during childbirth for parents and families until we see them surface in the future. Allowing continuous support in a time of crisis recognises that pregnant people are entitled to a dignified birth experience, wherein both their mental and physical needs are met by hospitals.