Pregnancy during a pandemic: a difficult time for doulas

April Dawn, a Central Florida doula, has been coaching pregnant women through childbirth since high school. She remembers back to the beginning of COVID-19 this way: “I’d go into these places all the time and I could just tell that things were different,” said the founder of The Mothered Momma, a pregnancy care center.

In February, Dawn had a client who was a patient at AdventHealth Medical. The day she went into labor, the facility stopped letting anyone but partners or babies’ fathers or mothers into the delivery room.

“We went into triage, and it was the first time that I have ever been asked for credentials. They were harassing me asking if I was really a doula,” said Dawn. “I had to show them paperwork, my website and all of these things and then everything seemed fine. When they finally got ready to take my client back, the nurse told us that I wasn’t allowed to go back with them. The father of the baby had to get slightly nasty with the nurse just so I can be there.”

Doulas like Dawn say the pandemic has caused a major shift in the way mothers experience the process of bringing new life into the world.

Although all birthing locations follow the national CDC safety guidelines in place to protect against COVID-19, each hospital and midwife-birthing location is allowed to implement additional rules and guidelines as they see fit to help keep women and newborns safe.

One major change put in place limits visitors an expectant mother is allowed to bring during appointments and labor. Each facility website can specify individual rules, but count a hired midwife or doula as a visitor, potentially leaving others out and setting up difficult decisions.

Doulas act as guides and provide emotional and physical support before, during and after childbirth. Unlike doctors and certified midwives, doulas require no formal training — though they often have significant backgrounds.

DONA International published a toolkit for doulas to help them navigate working during the pandemic.

Dawn has helped deliver 10 babies since February, noting several of her clients were not able to have the birth they had planned due to COVID-19.

Two days after the February incident at Advent Health, another of Dawn’s clients went into labor and went to the hospital.

“We were at Oviedo Medical which is a very relaxed and small place. Everyone loves this fairly new hospital so I didn’t anticipate any problems,” said Dawn. “My client is in her delivery room, I am in the waiting room waiting to be admitted up and at that moment the rules were changed everywhere and I couldn’t go up. My client was in full-on labor begging and pleading for them to let me up and they said, ‘absolutely not’.”

Dawn recalls being in the waiting room demanding nurses let her speak to a supervisor. When the supervisor came, Dawn tried to explain that her services were already paid for, but it didn’t matter.

“I walked back to my car, threw off my mask and just cried,” she said. “It was so heartbreaking for me. My clients felt so unsupported and she ended up changing her whole birthing plan, and she didn’t get the birth that she wanted.”

April Dawn applying an acupressure technique to reduce pain levels as the mother works through the transition phase of labor, just before “pushing.” (Photo courtesy of April Dawn.)

Arissa Holland, a mother who gave birth to her first child recently, said she was scared throughout her pregnancy.

“I was pregnant and I have asthma, my little brother has asthma and at the time we were also taking care of our grandparents who are very elderly. We all did what we needed to stay safe,” said Holland.

Holland decided to leave her job as a server at a Texas Road House in Central Florida after the location announced it would stay open for food delivery and curbside pickup. She also said she decided not to have a gender reveal party or baby shower.

“As soon as things with COVID-19 started, I decided to stay home for my safety because I didn’t want to catch it, I didn’t know if I could give it to the baby and I didn’t know if I could lose the baby. I even depended on my mom to get groceries,” said Holland.

Many places began conducting some appointments over the phone or virtually.

“At first the baby’s father was able to come to the doctor appointments with me but then around March I had to start going alone,” said Holland. “Eventually some appointments they were able to do with me over the phone so I didn’t have to go in as much. Thankfully during my baby’s birth, his father and my mom were allowed to be with me.”

Since February, Dawn said 95% of her clientele who had previously planned to deliver in a hospital transitioned to planning home births.

“Not a lot of people felt ‘brave enough’ to do what they were planning to do before. I had a lot of people who were scared to go into a hospital,” said Dawn. “Now, I have clients who I have never actually met. Everything is virtual.”

Dawn believes that COVID-19 has allowed people to be more aware of their own bodies and their health. BUt it has made her job a bit more difficult.

“Through COVID, I have seen more dads or partners catch their own babies. With one of my clients who was at the hospital, the doctor actually let the father catch his own baby. This experience is becoming more intimate for families,” she said. “For me being there virtually, I can’t do most of the things I normally would to give comfort and assistance to the mother.”

Working during COVID-19 has drastically limited Dawn’s ability to interact with mothers in person. In order to help mothers prepare for their babies’ births, Dawn normally acts as a nutritionist delivering beneficial fruit water or making organic foods that benefit mom and baby.

“When you’re doing virtual support in birth, you can’t hold an acupoint or massage the lower back or put a cold or hot pack where it needs to go or provide aromatherapy,” she said. “There are so many things you cannot do to comfort a person this way. This is not conducive to what humanity really is. We need touch.”

It has been four weeks since Gov. Ron DeSantis lifted most of the COVID-19 safety guidelines, moving Florida into Phase 3 of the reopening plan.

Despite the lift, most hospitals and birthing centers are continuing to limit the number of visitors and requiring everyone to wear masks while in the doctor’s office or delivery room.

On Oct 9, the CDC updated its website saying, “Based on what we know at this time, pregnant people might be at an increased risk for severe illness for COVID-19 compared to non-pregnant people.”

According to CDC data, pregnant women with COVID-19 are more likely to die than infected non-pregnant women. 

There is still not a lot of information on COVID-19, but the CDC also states they are “supporting multiple efforts to better understand the impact of COVID-19 during pregnancy on both the mother and infant.”

Although the changes make an already difficult time more challenging, doulas are being as accommodating and accessible as ever for mothers who are doing all they need to keep their newborns safe.

“I think as we move forward, we are going to continue to become more aware that our own health is our own responsibility and the same is true for birth,” said Dawn. “If you want a specific birth, well, you have to take responsibility for that.”

Brea Jones, rising FIU senior, has experience writing, videography/photography, interviewing, using Adobe Software and currently works as  Promotion and Recruitment Director for FIU Student Media. She has worked with several publications and published over 30 articles; to see her profile click