Sabrina and Chris welcomed their third child together, Bodi King Ro, on March 12, 2021, much to the excitement of his big sisters! This birth was completely different than the others, including being their only son whose gender was a surprise until birth. As you can surmise, this pregnancy occurred during the pandemic and Sabrina felt strongly that she wanted to have her chosen support people in attendance. She was not interested in the limitations of the hospital and also preferred to have her own babies nearby. This was achieved at her previous birth in the hospital for she had them asleep on a blowup mattress beside her birthing bed. However, this was not an option during COVID. Sabrina decided to welcome this baby in her own home where she felt safest and where her babies would be close.

Things proceeded without incident until the final weeks in which at an appointment her homebirth midwife noticed the baby’s heartbeat was less reactive than desired. She recommended an immediate NST at the hospital to determine next steps. Sabrina’s baby was tired, as they described it, and at 41 weeks they recommended induction. She was told to return that evening. However, when she returned there were no available beds. A call to another hospital yielded the same predicament, no beds. Her baby was cleared with a good NST and so she was sent home. Sabrina’s midwife came the very next day to monitor baby and Sabrina also had another NST at the hospital. That would be the plan—very close monitoring and a call to the hospital (or induction) if anything wasn’t right. This was a roller coaster of a ride for Sabrina who went from a homebirth to a hospital induction, and then to a possible homebirth, depending on baby. It was a challenge but she perfected the art of letting go and seeing what her baby had in store. It was all she could do and it would be the secret to being able to roll with her labor.

Just three days later, Chris texted me at 12:40 am to say that Sabrina was having regular contractions at 3-4 minutes apart already lasting over a minute. They started 45 minutes earlier and they were already going like gangbusters. Since this was Sabrina’s third birth and I had been at her previous births, I knew that she had a high pain tolerance and would be calm through pretty much all of it. Subtle signs would mean big progress so when Chris said she was stopping and bracing for her contractions I knew I’d be heading to their house soon.

Then about 10 minutes later, Chris texted to say that Sabrina’s water broke “all the way” and the labor was “getting really fast.” That’s all I needed and I was out the door. Things were escalating quickly and they had also contacted the midwives who were on their way to the house. I arrived about 20 minutes later at 1:15 am to find Sabrina on her hands and knees leaning against the bed. The midwives arrived one by one soon after, setting up their things and seamlessly drifting into Sabrina’s birth. They listened to the baby’s heartbeat regularly and it stayed strong, even better than the previous days as if baby wanted to show everyone that all was well.

Within the hour Sabrina felt a lot more pressure in her bottom and she required steady counter pressure from me and Chris. But no matter how deeply her labor drew her in, there was always a part of her that was tuned in to the monitor on the bed. The moment there was a peep from one of the girls Chris disappeared upstairs to calm them. Sabrina was surrounded in support so when Chris had daddy responsibilities, she was never alone. In fact, having him available to soothe the restless sleepers helped Sabrina to let go and labor.

By 2:22 we could hear Sabrina become more vocal with her contractions, and within 10 minutes we heard her familiar mantra of “okay, okay, okay,” which had been her landmark transition sign in previous births. We stayed close and applied steady pressure to her sacrum, reassuring her she was strong and capable and her baby was almost here. And in three minutes she said, “I feel the baby coming.” Her breath changed in that moment from a deep inhale and exhale to the catch in breath the precedes the urge to bear down. Sabrina pushed for maybe 10 minutes as her midwife sat at her bottom encouraging her, Chris lay beside her, and I sat nearby. Her other two midwives were attentive and saying words that uplifted and empowered her and in the midst of the support Sabrina opened and birthed her baby. First the head, and then the rest tumbled out at 2:41 am, just 2 ½ hours after her first contraction. The baby’s cord was wrapped around the leg twice and the ankle once but did not slow down descent. It might have explained the low heart rate detected a few days earlier but we will never know.

He cried robustly and was soon declared a boy and greeted with tears from his mother as she grabbed him upon her chest. Tears of love, elation, relief, and ultimate release that comes with giving birth. This journey had been rife with drama, the likes of which Sabrina never would have wanted. But even when she had resigned herself to an induction in the hospital, her baby’s journey to birth took a U-turn and had her meet him right at home where she had planned from the beginning. 

Bodi weighed 7 lb. 9 oz. and was nursing shortly after birth. One of his sisters woke up as well, sending Chris bounding back upstairs to settle her before coming back down to cut the cord. There was no rush to cut it though. Once delivered, the placenta remained in a bowl nearby in the meantime. It stopped pulsing naturally when Bodi was through with it. The first hour was magical and reserved for exclusive skin-to-skin between mom and baby. And even after the first couple of hours passed and it was time for the newborn exam, Bodi hardly cried as the midwife gently assessed him with a tender touch and soft-spoken words. It’s really beautiful how serene the newborn exam is at a homebirth. And it inspired some thought-provoking discussion about homebirth and what normal birth looks like when it is left alone, undisturbed.

Sabrina was challenged to let go of the reins in this birth. And that is not something that comes easily for her. But she was ready to do anything to insure her baby’s safe passage earthside, even if it meant an induction and interventions. But in the span of a few days, she had her baby safely in her arms, born at home in the unmedicated birth she had envisioned all along. In the midst of a pandemic and so much uncertainty, I’m so thrilled this couple was able to welcome their newest baby in the comfort and sanctuary of their own home. There is no better time for a homebirth, I say. Welcome to the world, Bodi King Ro! You are the prince in your family and the king of your mom’s heart.

Our community was thrown off kilter mid-March with the official arrival and acknowledgement of COVID-19 as a global threat in the United States. It was upon us and as with any stressful event, many birthworkers, myself included, walked through the stages of grief in regards to the pandemic. First there was denial. Surely this wasn’t really a thing, was it? Then anger. I felt this acutely as a doula. The restrictions on birth support hit me in the gut and I’m not ashamed to admit that initially I took it as a personal attack on doulas. Of course, I have since come to my senses and understand that at the heart of the decision by hospital administration was to keep everyone safe, including doulas, which brings me to the third stage, bargaining. Birthworkers explored how to continue to offer birth support, even if virtual, and they pivoted to accommodate the needs of their clients through FaceTime, Zoom, text, and phone. Depression, stage four, was in there too, and lingers today for many of us. As doulas, we yearn to be with our clients, sharing their birth space and offering physical support in their presence. It pains many of us when we are separated from our clients during birth. It’s truly a struggle that hits a doula right in the heart. And finally, we encountered acceptance. COVID-19 would remain in our midst for awhile and would have far-reaching implications on how births would look for the foreseeable future. It was our new, indefinite normal, restrictions, masks, hand sanitizer, and all.

Now it’s time to act. We’ve had our six months of processing, doulas and birthing families alike. But the last stage of acceptance is unacceptable, especially when it comes to restricting doulas from physically attending births in the hospital setting. It’s time to push more aggressively to reintegrate doulas in-person at birth. If you are a birthing parent, I implore you to advocate for your doula, and for all doulas, to return to the hospital. Doulas should be permitted to attend in person because it is the right of every laboring woman to have support, but also because the research is extensive proving that the continuous labor support doulas provide improves birth outcomes. Doulas help everyone, including the staff and care providers! In fact, reputable birthing organizations made statements early on defending doulas as essential members of the birth team, and encouraging them to be permitted to continue to serve in person DURING the pandemic. On March 12, 2020, DONA’s statement for including doulas as an essential member of the support team was compelling, as was AWHONN’s pro-doula statement from March 11, 2020.

So what are we to do to affect change in hospital policies? There needs to be a push from the patients to hospital leadership. Contact the manager of the labor and delivery unit, and the administrator of the hospital. Make a phone call. It’s harder to ignore a voice on the line. Follow up your phone call with an email and a letter. Paper trails are also hard to dismiss. DONA has made this easier by drafting a letter to hospital administrators. They have already done the work for you. You can find that letter here. Simply print it and send it along. Furthermore, if there are other hospitals who have allowed doulas to return, be sure to mention them as well. In Hampton Roads at the time of this writing the only hospitals permitting doulas to attend births alongside the primary birth partner are: Sentara Leigh, Sentara Obici, and Sentara Williamsburg. And don’t forget to express your wishes with your provider. Not just one, but to each doctor and/or midwife at every single appointment. 

This push needs to come from the birthing families, not the doulas. The amount of research in favor of the presence of a doula is dizzying. And the number of statements by various obstetric, nursing, and birth organizations is compelling. The evidence is there and the need for one-on-one labor support is higher than ever. What’s lacking is the advocacy for the presence of doulas during the pandemic. I have compiled some links in an effort to cut down on your need to research data. You will find them at the end of this post. Feel free to use any or all that you see fit. And write those letters, send those emails, and make those phone calls. The change must begin with the birthing women. Not the doulas. We believe in you and we support you. You can do this! (Sound familiar?) Thank you so much for trusting us to serve you and for fighting for that right…for all of us.

Below are some links to incorporate into your letters/emails/calls campaigning for the reintegration of doulas to attend births in-person. Please don’t forget the links embedded a couple of paragraphs above to statements by both DONA International and AWHONN for having doulas attend births in-person DURING the pandemic. They are particularly timely and relevant since the statements were made in March 2020, right as the pandemic was taking hold in the US.

Cochrane Database Evidence that continuous labor support may improve outcomes for mom and baby

 AWHONN Position Statement for Continuous Labor Support for Every Woman

 ACOG (American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine’s joint document on the Safe Prevention of the Primary Cesarean Delivery

 ACOG Approaches to Limit Intervention During Labor and Birth

 March of Dimes Position Statement on Doulas and Birth Outcomes, January 30, 2019

 Evidence Based Birth: The Evidence on Doulas, Updated May 4, 2019