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As the COVID-19 pandemic continues to disrupt practically every sector of society, life literally goes on. There were 22,965 births in Virginia between March 1 and Monday.

And the United Nations estimates 116 million babies will be born globally before the pandemic ends. The uncertain nature of COVID-19 has challenged doulas and other birth workers to innovate in providing support to mothers and infants, inside and outside of hospital settings. 

“The main way my practice has changed is that I am no longer seeing clients in person,” said Cheyenne Varner, a doula based in Richmond. “Prenatal meetings … [now] happen through Zoom. So I’m not able to offer some of the physical education to clients, like demonstrating hip squeezes and counter-pressure techniques, and showing how they can move around during labor to relieve pain.”

Nikiya Ellis, a doula, reproductive justice and food advocate and executive co-director of Birth in Color RVA, also had to adjust her methods in recent months. 

“Most of my clients were already pregnant [before the pandemic], and we’d met in person. When COVID came, we had to go to phone conversations,” Ellis said. “Another one of my clients, I didn’t have the opportunity to meet her until she came to the hospital in labor.”

Most hospitals limited visitors to reduce the spread of the virus, starting in the early weeks of the pandemic in March. Doulas in the Richmond region say they were shocked, however, to find that they had been barred from visiting some of their laboring clients, as well.

“It felt like a slap in the face,” Ellis said, “especially with the years of work and advocating we’ve been doing to get hospitals to see us as part of a pregnant person’s care team.”

Although they are not medically trained, doulas provide education and support to expectant mothers and families, and studies have shown that doula care increases healthy birth outcomes for mothers and infants. Additionally, Ellis said doulas are strong advocates for laboring mothers in medical settings, and can help ensure Black women – who die giving birth at three times the rate of white women in Virginia – receive quality, equitable care. 

“There have been small microaggressions against Black women, and I think that’s because experienced doulas and birth workers were not in the room to advocate for them.” 

In early April, Emily Bruno, a doula and co-founder of MyBirth in Richmond, spearheaded an effort to get doulas back into birth rooms. She, in collaboration with Mellisa Wirt of Latched Mama nursing apparel, drafted an open letter to area hospitals asking for access, and sent it with the support of dozens of area doulas on April 20. Bruno says the needs and concerns of her clients pushed her into action.

“I personally have had five clients change to [an] out-of-hospital birth, either birth center or home births,” she said. Once some expectant mothers learned that restrictive hospital visitation policies would block their doulas from being present during labor, “A lot of people were like, ‘If this is the system you’re offering, I’m not going to give birth in that system,'” Bruno said. While they have not attended home births, both Ellis and Varner said more people have reached out to them with questions about if or how they could birth at home.

A statement from Bon Secours, which operates hospitals in the Richmond area, said the hospitals allowed doulas to FaceTime with their laboring clients, and that “several” of their labor nurses are “doula trained.” Bruno says that hospitals opened up to doulas on June 1. Bon Secours’ statement ends, “Currently, we are delighted to have the doulas back in the hospital and have received very positive feedback from them.”

HB 687, introduced by Del. Lashrecse Aird, D-Petersburg, and passed during Virginia’s 2020 General Assembly session, is what Aird calls the “first step” toward state certification of doulas and streamlining doula care in hospitals and birth centers statewide.

“Confronting and reducing the reality of maternal health disparities is at the center of this piece of legislation,” Aird said. When she started studying these disparities in 2018, she learned that Virginians’ access to doulas was limited.

In reviewing existing law and talking with community birth workers, she found that “there have been mixed messages around doulas and their access and role as part of a pregnant person’s team.” 

In an effort to lay the groundwork for doula reimbursement through Medicaid — a critical factor that could determine whether expectant mothers can access a doula — Aird’s plan is trifold. Her legislation, which was signed by the governor in April and took effect Wednesday, creates a state doula certification that “codifies the rules concerning doulas, so the state [Board of Health] will recognize them,” Aird said. Secondly, the legislation establishes a state registry of doulas, “so that they are easily identified, and more women will have more access to their services,” she added.

Finally, Aird said the legislation will empower a workgroup of advocates and medical professionals to review standards of doula certification and reimbursement across the country, “to ensure Virginia’s best practices are in line with the best practices of states who have emerging doula reimbursement programs, such as New York.” 

Aird, with Del. Cia Price, D-Newport News, pushed an amendment to the state budget that earmarks $365,000 to support the efforts of the Virginia Neonatal Perinatal Collaborative, a group that works to ensure Virginia mothers have “the best possible perinatal care,” and every infant in Virginia “has the best possible start to life.” 

Aird called it a step in the right direction for Virginia, to the benefit of birth workers and families. “We are taking an active stance, and Virginia is beginning to fully embrace doulas and recognize their work, which is so important for the health and well-being of our whole community.”

Though Varner, Ellis and Bruno have all worked through the challenges posed by the pandemic, Bruno says there’s a silver lining to the situation. “It’s really reinforced that [doulas] are very good at innovating, and thinking fast, and changing everything that we normally do to meet the needs of our clients.”

This article originally appeared in the Virginia Mercury.

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