A letter to the Cornerstone Community
re: COVID-19, preventing transmission and L&D Restrictions. Updated on 3/20/2020
As of midnight March 17, 2020, six Bay Area counties -- Santa Clara, San Francisco, San Mateo, Marin, Contra Costa and Alameda are on mandatory shelter in place orders. As of March 19, 2020, ALL of California is now on mandatory shelter in place orders. This means that only essential travel outside of your houses is recommended. This will likely be happening in more and more cities in the days and weeks to come. When making the determination whether you will leave to attend your clients’ births, please take the following into consideration:
Your own health status: Have you been knowingly exposed to COVID-19 or do you have any symptoms: fever, cough, sore throat, shortness of breath, diarrhea. If you have any symptoms or have been exposed, please do not expose your clients or the healthcare workers who are taking care of them. Are you vulnerable to becoming seriously ill from this virus? Possible exposure at the hospital may be detrimental to your health. Take care of yourself and access your doula backup.
The health status of your family: Do you have a vulnerable person in your family that is at risk of becoming seriously ill from this virus? Any older adults in the home? People with diabetes, lung issues, heart issues, cancer, autoimmune disease? If you are putting yourself at risk of exposure by going to the hospital, you will be putting vulnerable family members at risk, as well.
LIMITED RESOURCES: You must understand that we, as doulas should not be using any of the hospital’s PPE (Personal Protection Equipment) - gowns, masks, etc. The supply chain of PPE has been halted due to this virus, which means that hospital personnel do not have enough PPE to protect themselves in the coming weeks, when the spike of sick patients will be entering their hospitals. We should not be using resources that are meant to protect healthcare workers and their patients. We are in an unprecedented global health emergency and need to support our healthcare workers in getting through this. If you have your own mask, bring it along to the hospital - but we are also advising against purchasing many masks online, as this is also impacting available protective gear for healthcare workers that are on the frontlines of this crisis.
How to protect your health and still save resources: Bring your own gloves to the hospital. If you have to use their gloves, practice hand hygiene (hand sanitizer or washing hands with hot water and soap for at least 20 seconds) before and after touching the glove box. Wear gloves and change them often. Wash your hands frequently - way more frequently than you do now. Don’t touch your face. Don’t touch doorknobs, elevator buttons or other surfaces - and if you have to, wash your hands after you do. Get sleep. Eat greens. Take immune support supplements. Stay hydrated. Practice mindful relaxation for your nervous system - viruses love stress. Stay at home as much as is possible, and practice social distancing. The only way that we are going to deal with what is coming from this virus is by flattening the curve - and the main way to flatten the curve is by social distancing. Hospitals will not be able to cope with the amount of sick people who will need their care in the coming weeks if this virus continues on its current trajectory. Be honest with yourself about your health and health status. Use your backup if there is any possible chance that you may be sick or exposed.
So far, we can report that most hospitals in the Bay Area are limiting visitors to only one person, if that. Each of these institutions are requiring health checks (fever checks) for anyone coming into the hospital at this time. If you or any of the laboring person’s support people have a fever, you/they are likely to be turned away. Further, If you or any other support persons have traveled out of the country in the last 30 days or have any cold or respiratory symptoms, you/they will likely be turned away. All visitors will not be able to leave and return to the hospital, so make sure that you are prepared to stay when you go with your clients or meet them at the hospital.
As of March 19, many major hospitals are barring visitors for all patients with very minimal exceptions - Labor and Delivery is still an exception at most hospitals as of now, yet the exceptions are widely reported to be limiting to only one support person. Some hospitals are counting Doulas as visitors, and some are not. We are expecting these restrictions to continue to change day by day, so please keep in contact with your communities to stay up to date on what is happening locally for you.
It is clear that doulas are not “visitors.” We are essential health professionals. It is encouraged that clients call their hospitals ahead of time to request that their doulas are granted access to the floor during their labor, and to stay up to date on what to expect should they need to access care during this time. Further, we recommend that you call your local hospitals to speak with administrators and nurse managers of labor and delivery and postpartum floors to discuss the benefits of having doulas present as essential health professionals through this crisis. When speaking with these staff, cite the Association of Women's Health Obstetric and Neonatal Nurses position: “Doulas are not visitors and should not be blocked from caring for patients in the antepartum, intrapartum and postpartum period. Most doulas have been contracted by patients weeks to months ahead of time and have established provider relationships. They are recognized by AWHONN and ACOG as essential personnel and part of the maternity care team,” ...AWHONN supports doulas as partners in care and acknowledges their ability to provide physical, emotional, and partner support to women. AWHONN opposes hospital policies that restrict the presence of a doula in the inpatient setting during an infectious disease outbreak."
If you are barred from being able to support your clients upon arrival at the hospital, please support them and their partners in continuing to triage in accordance with standard hospital protocol. If you would like to continue to advocate for your presence in the labor room with your client, you should seek to speak to the Charge Nurse and/or a Patient’s Rights Advocate at the hospital. We are in a time of global emergency, and hospital staff are extremely vulnerable at this time. Please keep in mind that hospital staff are facing an unprecedented health crisis right now, and policies are being created as they go along with the intention of protecting patients, healthcare workers and the public. There is a lot we can do to hopefully shift these policies together behind the scenes quickly. We are open to hearing your updates and suggestions, and are here to support you through this time, so you can best support your clients.
As this unfolds, we want to relay ways of still supporting your clients even with hospital restrictions.
Virtual support — supporting clients by phone or video.
Helping your clients stay at home as long as possible.
Accessing out of hospital midwifery care, if they are wanting/needing that, and if they have the financial means to do so.
Possibly redirecting clients to in-network hospitals with less restrictive policies in neighboring cities.
Keep in contact with one another to report last minute changes and updates.
Offer emotional support to our colleagues already in birthing spaces who are in the process of handling these emerging situations and are unable to leave the hospital without being shut out upon return.
We’re here for you! Let’s flatten this curve, keep ourselves and our communities safe, and advocate for our clients to get the care that they deserve. We know this is a very stressful and uncertain time. Please reach out to us if you need someone to talk to - we are self quarantining and are online and available.
Nickie Tilsner, Co Executive Director, Cornerstone Doula Trainings
Juli Tilsner, Co Executive Director, Cornerstone Doula Trainings
Jazz-Ylaine Baptiste, Birthkeeper Program Director, Cornerstone Doula Trainings
Emily Flynn, Policy and Legislature Chair, Cornerstone Doula Trainings
Samsarah Morgan, CD, Cht, LC, DD, Executive Director, Better Birth Foundation
3/13/2020: San Francisco Department of Health Order: