Birth companions in the time of COVID-19

15 Mar, 2020 | 10 comments

Birth Companions in a Time of Pandemic

Many NHS Trusts in the UK have made announcements restricting visitors to hospitals and this has also been the case with maternity units. Indeed, some hospitals are now saying that each woman can only have one birth companion during labour.

As a radical, independent midwife (IM) I could be up in arms about this, joining in the chorus of voices on social media extolling the virtues of doulas and independent midwives and explaining about the significant impact of continuous support throughout labour. This is outrageous – women’s rights must be prioritised! But hang on. Rights to what? What actually is the wise course here? Of course, all the evidence points to improved outcomes when a woman in labour has continuous support. I know personally how important this kind of support can be for the woman, impacting the physical progress of labour and the emotional and psychological aspects of birth – indeed it’s not really possible to separate the mind and body in birth. If the mind and heart are happy then the labour is more likely to progress well as oxytocin is released, mediating the labour and tending to lead to better outcomes all round.

Not a normal situation

There is a great big BUT. BUT – we are not in any kind of normal situation. We face an epidemic of the novel coronavirus known as COVID-19. We do all need to adapt and support our NHS colleagues as they face the biggest challenge that has happened in our country since the Second World War.

The maths is quite simple. Viruses transmit by contact. If you cut the contacts by 50 per cent, you will reduce virus transmission. Therefore, it does make rational sense for hospitals to restrict birth companions and visitors. This is not petty territorialism. There is little point in providing the most excellent labour and birth support if we have unintentionally been a vector for disease – and all the modelling is telling us that we all have to assume we could be carrying COVID-19 without knowing it. Some of us will be. It is therefore logical for hospitals to restrict those entering and leaving the premises in order to protect childbearing women, babies, other patients and staff.

Doulas and IMs are not ‘visitors’

I rankle at the idea that I am a ‘visitor’ if I am engaged as an independent midwife to support a client in labour. I should be regarded as a colleague – indeed the NMC and GMC Codes demand that health professionals treat each other with respect. In the past, I have been pleased when I have been well treated and my client’s wishes have been respected and I have been ‘allowed’ (even that word rankles!) to be with my client as she gives birth. Conversely, I have been hurt and angered at times when a client’s wishes have been swept aside and my own dignity undermined when denied the right to accompany a client in labour or in maternity theatre – join the Association of Radical Midwives to see the latest copy of Midwifery Matters for excellent articles by doulas Sarah Marsden and Dee Coe on this very issue.

However – in the case of trying to reduce the transmission rate of COVID-19 the situation is completely different.

Doulas and IMs can still provide help and support

Doulas and independent midwives, there is no doubt that your support at this time for your clients is more important than ever before. Many clients have only engaged a doula or IM because they have severe anxiety or previous trauma. No doubt you are providing excellent care and support and the importance of this cannot be too highly stressed. You are providing the continuity that is so important, even if that is during the antenatal and postnatal period, or online, rather than during the birth itself.

I am not having to face this situation as I am not currently on call for births. My heart goes out to you all in this time of tremendous difficultly. I hope it does not sound overly complacent on my part to suggest to doulas and IMs that if your client does need to make a choice between her partner and her doula (or IM) to be a companion in labour, help her to make that decision with the wise understanding that sometimes plans must change. There is an excellent article by Birthrights on your rights at this time, including the legality and proportionality of any restrictions. It may be that in some cases the risk to the woman from not having companions does outweigh the risks of those companions potentially transmitting the coronavirus. Every case is individual and must be treated as such. How will COVID-19 affect my right to maternity care.

It may also be a good time to consider having a home or birth centre birth and avoiding hospital altogether if the maternity service is able to provide the staff to enable these options. This subject is worthy of another article but I do hope that such provision continues where possible as it would seem another way of avoiding transmission of disease, as well as ensuring that the mother can have the birth companions and surroundings of her choice. However, if the maternity service cannot provide the staff in this emergency then this may not be an option. I do not recommend switching to freebirthing or unassisted birth. The ambulance service is likely to be swamped too so I urge people to consider that there may not even be paramedics available to help should complications arise.

Let’s not make it ‘them and us’

We are being given, in a watered-down way, a glimpse of what many people across the globe live with every day of their lives. War, famine, disease – we in the United Kingdom often barely think about these things, apart from making the odd donation to charity. While many in our society do suffer because of poverty, the majority of us enjoy lives of relative privilege. And in spite of COVID-19, we are still privileged. Most of us have plenty of food, no bombs drop on us and neither have we been displaced. All we are being asked to do is make adjustments, even sacrifices, for our own and for the greater good.

A  doula or IM knows the importance of wisdom – the wisdom to know when to shout, to become a tiger – and when to stand by the mother’s side in person or in spirit – helping her to make the difficult decisions and have the best possible birth for her whatever the circumstances. This can include standing aside at times – this may be one of those times. Let’s not make it ‘them and us’. Instead, let us all work together, support each other, our wonderful NHS staff, and childbearing women. And we will get through this.

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  1. debi brunt

    Beautifully articulated as always Nicky. Difficult times ahead for us all.

    • Nicky Grace

      Thanks Debi. Yes, it’s such a fast-moving situation that my brain is struggling to keep up! Hope things are ok with you.

  2. Eva

    Thank you for writing such an open honest wise grounded article. A voice of reason.
    As a doula i havent really known what to do with this, my concern has been proving continuity for my clients whom i feel ive got to know well. Im understanding i cant attend hospital if she is transfered or induced. I did sign a petition though in the hope it may help those with current clients have a doula or IM as well as their partner.
    Your article today has just grounded me. I think ill print it to read again when i feel a need to not worry for my clients.

    Thank you!

    • Nicky Grace

      Hi Eva. How I feel for you! I think it does need a frank conversation but I hope that clients of doulas and IMs understand this is totally outside of your (our) control. I should have put in the article that I don’t think it is by any means a given that the one person to accompany the client MUST be the partner. It is worth checking with them both. We tend to make the assumption that the partner has to attend. The Paramana Doula training with Michel Odent and Liliana Lammers changed my perspective. I’ve cared for quite a few women as an IM who haven’t had their partner with them – sometimes a relief all round! So it may be worth the discussion and possibly it will be decided that if only one companion is allowed it should be you. You should be able to be with them at home prior to transfer into the hospital in any case? Or is it a home birth – in which case hopefully you won’t need to transfer at all. I’m glad the article helped in a small way – we have a lot of information flying at us. I think we all need to take a deep breath and let go of everything we can’t control. Sending love to you and your client.

  3. Jude

    Thank you for writing this and voicing all my own thoughts x

    • Nicky Grace

      That’s really kind of you to say so Jude. Stay safe. x

  4. Lynn Genevieve

    Indeed… ‘them and us’… I’m reminded of a situation in an emergency Caesarean section where I was supporting the parents having transferred in from a planned homebirth. It was a breech so not a blue light transfer or crash section… no problems expected but as per protocol a paediatrician was present. The baby unexpectedly needed resuscitation and I stepped up as it became apparent that the very junior paediatrician was out of her depth. The midwife assisting the doctor shouted at me that I wasn’t allowed to do anything clinical… I carried on until another staff member assisted. Afterwards she apologised as she realised how stupid this was… it was an emergency. Let’s hope it works both ways… ‘them and us’…
    Excellent article…

    • Nicky Grace

      That really means a lot thank you Lynn and what a difficult situation you were in – I’m so glad you carried on! I’m glad you understand where I’m coming from. I don’t mean, of course, that no doula or midwife should ever be allowed to be a birth companion! I have always been (as you know) a passionate advocate for continuity of care and how important it is. It is purely about reducing contacts during the pandemic and allowing the hospitals to make the very difficult decisions on restrictions to numbers of visitors coming in and out. I have had a few quite polite discussions on various social media platforms with people who disagree. I am not certain myself! It seems to me to be important to weigh up the relative risks in each individual case.

  5. Concerned Partner

    If women wants to do home birth, how do they go about making those arrangements? Who do they contact? And how far in advance can women arrange it?

    • Nicky Grace

      Hi, do get in touch via the contact page if you are interested in independent midwifery. Best wishes, Nicky.



  1. The Covid-19 Cohorts: real-life accounts of being a student midwife during the Covid-19 pandemic | All4Maternity - […] N. Birth companions in the time of covid-19. Birthing with Grace. Published March 15th 2020. Accessed: April 4th…

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