(Photo: JennaRich via WikiCommons)

Three weeks ago, Anna Dejesus’ water started leaking. It was two months before her due date, so she was rushed to the nearest hospital. Her medical team immediately began trying to halt her premature labor, with hopes of keeping it on pause until it was safe to give birth. Her hospital stay was expected to stretch up to a month, and with the Covid-19 crisis restricting visitors, she was told it would be a solitary one. In search of solace, support, and skills for braving the weeks to come, she decided to call her birth doula, Melissa Murphy.  

“I needed Melissa. Even though she could not be with me physically, she was on the phone with me the whole time,” said Dejesus. “She kept my head clear and made sure I was asking the doctors all the questions I had. She stood in contact with my husband and told him what to do for me and how to help me.” 

In the following weeks, Murphy zoomed with Dejesus and corresponded with hospital staff daily. Her consistent negotiations made it possible for Dejesus’ husband to visit the hospital twice. 

On April 29, Governor Andrew Cuomo announced that doulas would be allowed back into hospital delivery rooms. But many, like Murphy, are choosing to keep their services virtual. While the desire to stand next to their clients during labor and birth is profound, doulas received Cuomo’s decision with mixed emotions and largely spent the following weeks buffering up their remote services and offering them to a more diverse array of clients. 

Traditionally, doulas coach, support, and nurture women through their pregnancies. The nuanced work relies heavily on unspoken physical cues, making them talented intuits. Without proximity, doulas across the city were tasked with fine-tuning their emotional radar from far away. It was no simple feat, but they’ve graciously, effectively risen to the occasion and are now continuing to provide compassionate care on digital platforms. 

Many doulas, Murphy included, have received more requests for in-person services since they were allowed to return to hospitals. They haven’t, however, jumped at the opportunity. Many feel that entering a hospital still puts them at significant risk of contracting Covid-19, and they’re concerned about jeopardizing their ability to assist clients in any capacity later down the road. 

“It was great news on one level, right?” said Gili Levitin a New York City-based birth doula and hypnobirthing educator. “Like suddenly doulas can come in, but then let’s hold on and think about the potential consequences of having a doula joining a person in the hospital and then moving on to support her next client.”  

According to Levitin, virtual support is still the safest solution for everyone involved.  “It’s safest for the pregnant person and it’s safest for the newborn. It’s safest for the medical team that supports them. It’s safest for the newborn and her family..” 

While lacking the magic of physical touch, remote doula care actually achieves things that in-person care cannot. For starters, the information they provide is easier to access with a wider reach than it was pre-pandemic. 

Doulas are very often thought of as a service exclusive to privileged white women. According to New York City’s Department of Health and Mental Hygiene, most of the city’s doulas reside in Brooklyn and Manhattan. Of all the women surveyed for their study, 25 percent of those who gave birth without a doula said they were interested in having one present, with 39 percent of those respondents being women of color. The Cochrane Systemic Review claims that clients who receive doula support are significantly more likely to have a safe, complication-free birth. Women of color, however, are three or four times as likely to experience problems during labor and delivery. 

While there are a handful or community-based doula groups in New York City that offer donation-based care and place heavy focus on low-income neighborhoods, they make up the minority of birth coaching organizations in the city. On top of that, there’s a general lack of awareness that such services exist. 

Understanding that giving birth in the age of Covid-19 is incontestably daunting, doulas across the city have mobilized to make their care more visible, more accessible, and free to all who may need it. With 24 other doulas across various specializations, Murphy and Levitin formed a new 24-hour hotline intended to answer any and all pregnancy-related concerns. Pregnant women and their loved ones can request to join the Hotline Labor and Birth Support to be paired with a doula and communicate their concerns to them via call or text.

“I think the hotline is educating the larger community. For us, the education piece is reaching so many people,” said Murphy. “I know we’ve introduced doulas to a lot of new people, guaranteed.” 

In order to provide a range of skills– be it postpartum, birth, or hypnotherapy– the hotline doulas had to band together across practices. Such collaboration among doulas is largely unprecedented, as one in three work independently of any group. Those that work for or are trained by a specific organization largely conduct their tasks solo. Now, the 26 hotline doulas correspond with each other daily, sharing stories and ideas for how to strengthen their approach. 

Physically restricted or simply trepidatious about being in the same room as their client, doulas have also begun passing the baton to the next available person. This means working with partners, spouses, friends and parents on ways they can embody the fundamentals of doula-ing. Correspondence between doulas and family members has never been stronger.

This also extends to nurses and hospital staff. Prior to Covid-19, there was a popular notion that doulas and medical practitioners frequently butted heads, particularly in labor and delivery rooms. While perhaps true in certain cases, Levitin believes this narrative to be mostly false.

“The doula has a completely different role than the OB/GYN, and we are all working in partnership,” said Levitin. 

While caregivers and doulas have always worked together to some degree, the collaboration has become tighter and more prevalent during Covid-19. For Murphy, this became evident when she was checking in on her bedridden client, Anna DeJesus. “I couldn’t be with her personally, but I was in contact with her team regularly, from the hospital to the social workers, you know, all types of people. It was something I had never done virtually before. When the call came that doulas were allowed back, the hospital actually reached out to me to ask me what I thought the protocol should be. So it was really heartwarming to see that we had built this relationship so quickly.” 

It’s difficult to gauge exactly when all doulas will feel safe re-entering hospitals. It’s equally hard to outline the exact measures needed to inspire a complete sense of comfort as they do so. But doulas are hopeful that the birthing process will adapt to our socially-distanced world, and that dedicated birthing centers will be implemented into hospitals or even built separately. 

“I know there are some birthing centers in the works,” said Murphy. “That’s what I’m really looking forward to. I think those places that haven’t had someone sick in them is really where we need to go. Those are the spaces I’d feel most comfortable walking into.” 

Not only are the coming months and likely years going to reshape our idea of how childbirth is carried out, they may also change the public’s understanding of the birth workers themselves. In his announcement allowing doulas back into hospital rooms, Governor Cuomo stated that doulas were an essential service. With just a few words, he highlighted the importance of comprehensive support before, during, and after a pregnancy.