This article was originally published by The Boston Globe
By Kate Mitchell, Hagar Palgi Hacker, Tejumola Adegoke and Katharine Hutchinson
Because of COVID-19, the transformative experience of delivering a baby has become more traumatic in many places around the world than it has been for a long time. That’s true for mothers, partners, and newborns. It’s also true for health workers.
Maternity wards in wealthy and poor countries alike are introducing sudden changes to the ways women and newborns are cared for in an effort to prevent the spread of COVID-19. In some settings, these emergency measures include compulsory or strongly encouraged induction of labor, reliance on forceps and cesarean deliveries that are not medically necessary, separation of mother and newborn, prohibition of birth companions, and restrictions on breastfeeding.
These measures, often applied to women regardless of their COVID-19 status, may be well-intentioned. But there is little evidence they will slow the spread of the novel coronavirus. Indeed, the World Health Organization has issued explicit guidance, based on the most current data and robust evidence for infection control during childbirth, upholding practices such as the presence of birth companions, keeping mothers and newborns together, and use of cesarean section only when medically necessary and agreed to by the mother.
What too many hospitals are doing instead represents a return to long-abandoned harmful practices — resulting in disrespectful care of women and newborns and violations of their human rights. They also put lives at risk.
The underlying premise of these measures is that safeguarding the rights of women and newborns during childbirth and protecting health workers from COVID-19 are mutually exclusive goals. But they are not. This way of thinking positions human rights against safety and women against health workers.
Research shows that having a companion of choice during labor and delivery and keeping mothers and newborns together after childbirth reduces the need for interventions and the risk of subsequent health complications for mother and baby. These practices also reduce workload and exposure for health workers.
Some hospitals, short on personal protective equipment (PPE), have ruled out birth companions for all women in order to reduce the number of potential transmitters of the virus in the room. But doing so can extend labor and increase the need for interventions like cesarean sections — requiring more health workers and more PPE.
While health workers are understandably worried about becoming infected, and infecting those around them, many are also distressed by being put in the position of enforcing harmful policies. Facing pressure to remove infants from their mothers, some providers may even hesitate to perform needed COVID-19 testing on mothers.
The authors of this piece — a midwife, a physician, a lawyer, and a public health practitioner — have come together in search of a common perspective on how best to support growing families and health workers during this pandemic. Some of us are moms and one of us is expecting a new baby this summer.
Together, we propose a new narrative for maternity care during COVID-19: All women need respectful, rights-based maternity care and all health workers need to feel safe delivering such care, especially during times of crisis.
The Respectful Maternity Care Charter, published by an international coalition in 2011 and updated late last year, spells out the 10 basic rights of childbearing women and newborns. The charter lists best practices for maternity care consistent with WHO’s maternal and newborn health guidelines. The charter is also grounded in international human rights law and demonstrates how the rights of childbearing women and newborns align with evidence-based clinical care practices.
The charter details the rights of newborns to remain with a parent or guardian at all times, and for women to breastfeed, have a companion of choice, receive necessary information, and be able to consent to or refuse any medical procedures. It calls for respectful communication and collaborative decision-making during childbirth, meaning that health workers provide factual and unbiased information and women hold the ultimate right to make decisions for themselves and their newborns. This is particularly important in the context of COVID-19, when health workers and women alike are concerned about the implications of delivering a baby mid-pandemic.
We have all been called to relinquish some autonomy to protect the health of our communities during this pandemic. But the rights of women and newborns during the vulnerable moments surrounding birth should not be sacrificed based on little evidence that doing so will enhance safety — particularly when solid evidence shows that these practices make childbirth riskier and more traumatic.
We aren’t opposed to adapting and innovating during times of crisis. “Pop-up maternity centers” at hotels in the Netherlands are bringing growing families and maternal health workers out of COVID-19 hot zones in hospitals into safer spaces for low risk birth. Technology-based approaches to delivering prenatal and postpartum education and care in multiple countries are keeping mothers and health workers connected and safely separate.
Forward-looking innovations like these hold sacred the rights of women, newborns, and health workers, while doing a better job of keeping everyone safer, together.
Kate Mitchell is a doctoral candidate at the Boston University School of Public Health. Hagar Palgi Hacker is a lawyer and masters candidate at the Milken Institute School of Public Health. Tejumola Adegoke is an obstetrician-gynecologist at Boston Medical Center. Katharine Hutchinson is a midwife at Boston Medical Center.