As Some New York Hospitals Ban Birth Partners, a Doctor Weighs In

New York–Presbyterian Hospital - coronavirus continues to spread across the United States on March 15, 2020 -H 2020
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"Make sure that the questions that might be in your mind that create anxiety are being addressed proactively. And don’t hesitate to ask those questions of the health care professional," advises Dr. Rahul Gupta of March of Dimes.

Update: On Saturday, New York Gov. Andrew Cuomo announced that an executive order would be issued requiring all hospitals in New York, both public and private, to comply with the New York State Department of Health's guidelines to allow one non-sick support person in labor and delivery settings. Shortly after, both NewYork-Presbyterian and Mount Sinai Health System tell The Hollywood Reporter they will comply with the executive order, effective immediately. "Our highest priority continues to be the safety and wellbeing of our patients, their families, and our staff," reads the statement, in part, from NewYork-Presbyterian. Mount Sinai revised their statement say, "In partnership with New York State, effective today, we will permit one healthy partner to join the expectant mother for labor and delivery. We have always — and will always — make these difficult decisions with the best of intentions and safety of the mother, baby and our staff as our guiding principle."

When two leading New York hospital networks announced that expectant mothers would have to deliver without their birthing partners, the reaction was swift.

On Monday, NewYork-Presbyterian and Mount Sinai Health System each released updated guidelines on their visitor policies as New York City geared up for what has become the most taxing week on the city's health care system since the outbreak of the novel coronavirus. As of Friday, the United States has surpassed all other countries in the number of COVID-19 infections, with New York having the highest amount of cases among all states.

According to the new visitation rules outlined by NewYork-Presbyterian, no visitors — including birthing partners and support persons — are permitted for obstetric patients. Pregnant women will be tested and given a mask upon arrival. "Even a basic bodily function (such as a cough or a sneeze) by an infected birthing partner could pose a potential threat to maternal-fetal welfare across our department," said the hospital of what they called a heartbreaking but necessary decision. Instead, visitors are encouraged to rely on virtual means of connection, including Skype, FaceTime or the phone. The Mount Sinai Health System quickly followed suit in barring visitors, including in labor and delivery and postpartum units (with mothers only allowed in the NICU), to "prevent avoidable exposure to mothers and babies," effective the following day.

The restrictive policies came two days after the New York State Department of Health, in accordance with the World Health Organization's coronavirus guidelines, updated its recommended visitation guidelines amid the pandemic to still include one support person for labor and delivery, calling that one spouse, partner, sibling, doula or person of choice "essential to patient care throughout labor, delivery and the immediate postpartum period."

In response to the measures taken by the New York hospitals, a petition to safeguard the right of all laboring people to have support quickly circulated, calling on all NewYork-Presbyterian and Mount Sinai affiliated hospitals — as well as Staten Island University Hospital after they adopted the policy — to reverse their decisions. As of Friday, the petition had received more than 500,000 signatures. 

Throughout the week, the ban has received significant attention in the news cycle and on the morning talk shows, prompting New York City Mayor Bill de Blasio to confirm that the city's public hospitals would not be adopting any policies to ban support people. New York Gov. Andrew Cuomo reiterated that the NYS guidelines still stand for New York City public hospitals on Friday. Also on Friday, Carson Daly spoke out about his wife's birthing experience at a hospital outside the city and in Long Island, sharing that he was able to be in the hospital for the birth only.

Dr. Rahul Gupta, senior vp and chief medical and health officer for maternal and infant advocacy group March of Dimes, spoke to The Hollywood Reporter about the divisive decision. "We are just encouraging hospitals within this very difficult time that we totally understand to be cognizant that it’s a human being on the other end," says Gupta of laboring women. March of Dimes — which counts NewYork-Presbyterian among its network of New York and New Jersey consulting hospital systems — educates medical professionals and the public about best practices, supports lifesaving research, provides comfort and support to families in NICUs, and serves as an advocate for mothers and babies across the country. Below, Dr. Gupta answers the questions now weighing on expectant mothers' minds amid the pandemic, including best practices for women who will be affected by the new policies.

On March 21, the NYS Department of Health released new visitation guidelines amid COVID-19 and they included one support person for labor and delivery. How do you feel about several New York hospitals making decisions against those guidelines? 

Thanks for doing this story. It's really important because it speaks to the heart of: how do we deal in an epidemic and, certainly, in a pandemic? In our role at March of Dimes, we first of all encourage all businesses and health care institutions to follow the guidance being provided by the CDC related to COVID-19 spread. There is a limited amount of information, as we know, especially about this virus and how it impacts pregnant women and their unborn babies, as well as their infants once born. And we know that by slowing the spread of this virus through social distancing and other mechanisms we can prevent a spike, which would not overburden the health care system and would have better outcomes for at-risk individuals, including pregnant women. And that would help pregnant and new moms get the help they need.

We also support the recommendations of the World Health Organization as well as the state in allowing one birthing partner to support a laboring woman. The reason that’s important, of course, is because we know that leads to better health outcomes. Having said that, we concurrently also recognize that hospital systems, especially in a city like New York City, are undergoing tremendous constraints at this point. Both from a workforce standpoint as well as the number of people that they are having to see and be able to screen. We totally acknowledge that New York hospitals have to take some necessary steps in prioritizing the health and well-being of the woman that they are taking care of in the labor, as well as their health care workers, who are already high risk, as well as her baby.

Given that dilemma now facing these hospitals — to limit exposure and protect their health care workers while also support laboring women — what are you advising?

We are just encouraging hospitals within this very difficult time that we totally understand to be cognizant that it’s a human being on the other end. Delivering a baby is a special experience for that woman, in terms of giving birth to another human being. We would really implore hospitals to consider, to the extent that they are able within their resources, to make availability of a companion — and if not physically then remotely through telemedicine, telehealth and other options that may be available to them.

Obviously, this has to be within both the ability and resources available to those hospitals. But I just want to highlight that, as we look at folks who are at end-of-life care, we want to make sure we’re compassionate in providing all the help. And this is another extreme of life that is very important as well. We know that the outcome of that bonding of mom, baby and others has a tremendous impact by having that support in the time of delivery. At this time, we totally understand the challenges, but we want to encourage hospitals to continually assess the decision in the communities and ensure that there is a balanced reaction between available resources and keeping the mental and physical health of the laboring woman and her baby in mind.

NewYork-Presbyterian is now testing pregnant women. If the capability existed to test the partners as well, would that be a viable solution in order to re-allow that support person? 

Following the CDC guidelines would be the best science, evidence-based measure forward — keeping in mind the limited testing and supplies. It is important to test the woman who is delivering because of the baby. Still, there are a number of screening mechanisms that could be done — there is medical or clinical, like testing; as well as engineering and physical that could go a long way in ensuring that non-sick individuals are only allowed when those allowances are made. It’s a wise strategy to look at your resources: Do you have the testing ability to do that? Because these are finite number of births. If that’s not available, there could be screening questionnaires and other aspects that could be done as a method of screening to ensure that people who are sick are not exposing the infant, especially. We have seen a number of cases of some infants acquiring the disease coming out from China, so it has occurred. But there are screening mechanisms, including testing, that could be employed in order to reduce the chances of the baby acquiring the infection.

Is the goal for these hospitals that have restricted visitors to lift that ban as soon as possible? 

I think they are certainly trying. I would have to give the benefit of the doubt to the hospitals, because they also know the outcomes in health of having that birthing partner there. They know that for the mental and physical health of the woman and the baby, it’s very important to have the partner or spouse, or whoever that partner might be, in the room. It’s a question of striking the right balance with resources and that goes back to how we can limit the level of exposure through social distancing and other aspects within the community — which will mean that lower stress is being placed on these hospitals for their services, whether it is in emergency room beds or in labor and delivery. As that goes down, the hospital is then able to shift its resources in actively managing those patients to then being able to screen partners to be able to come in.

It is about a stressing of the resources. It’s in so many ways related back to the overall burden of the disease. It’s no surprise that New York has the highest cases of any state in the nation, and therefore it’s taxing the health care system and that’s why some of these hospitals are having to make this decision — in just a pure numbers game and in the sense that they don’t have the resources and the staff to be able to do that. None of us wants the babies, especially the infants, to acquire COVID-19. That would lead to a whole different parlay of circumstances; isolation and other things. So I think it’s already a taxed system and the way to reduce that burden and get to that place that we’re all hoping to get to is by ensuring that there is appropriate social distancing mechanisms that are in place and enforced so that our numbers can start to trend down.

Is one of the goals to be able to test pregnant women country-wide?

There are hospitals that are seeing shortages of testing and other things, so it’s hospital to hospital. Health care folks are having to wear the protective equipment and need testing supplies and other things, and are having to manage the supplies that they have. That’s been one of the challenges across the board. The first thing is to have the recommendations, but then the second issue comes across as: What do you really have the resources for? It comes to, in some ways, a rationing of those resources, and I think the best option at that point would be to go ahead and follow the recommendations being put forth.

Should pregnant women wear masks when going out in public? What about when going to the hospital or to their doctor’s appointments?

It’s important for pregnant women to make sure that they’re feeling both comfortable and protected, because that has to do with things beyond their health. It has to do with maternal stress, the time of delivery; potentially, maternal stress can lead to preterm birth, we know that in literature. So it’s very important that pregnant women are doing everything they can to reduce their fear and anxiety, panic and stress. When they are going to the hospital, whether it’s for labor and delivery or other factors — because there are a number of pregnant women across the country who have other underlying factors — it’s important for them to feel safe if they are going into a situation where there is going to be a higher population of people suffering from COVID-19. They have to make their own decision. But rather than making a recommendation, I think it’s important for them to make sure that they feel like if they will be better protected, then they should wear the mask if they have one.

There is a petition circulating that raises the concerns you mentioned about risks for women who are unable to have a birthing partner for delivery. To all the people who signed and who are concerned, what would you say to give them some reassurance?

What I would suggest, having worked with hospital systems, is that hospital systems are always making an effort to come in line with the policies that are recommended by their state and federal officials. In this case, that is New York State as well as WHO. There is no benefit to gain in not being in compliance with that guidance — there is no mal-intent here, I can tell you that. But the challenge that comes is one of supply and demand. It almost becomes a triage where you have to make sure that the supplies you have, the beds you have on an hour-by-hour basis are being monitored and maintained for the sickest patients and the most needy folks. That’s how you save lives. That’s the bottom line. They’re in the business of saving lives at this time of emergency and the way you save lives is to ensure doing the best with limited resources. Hospitals, especially New York hospitals, are very good at this — among the best in the world. We have to, first of all, trust that what they’re doing is allowed by the resources that they have. But on the other hand, we also have to hope — along with the trust — that as soon as the situation allows itself, to allow those partners. And that they are more anxious than anyone else to get back into alignment with the guidelines that are being provided by New York State as well as WHO.

What is your advice to women who will be delivering without their support person in the room or through telemedicine?

March of Dimes is definitely working to help those women. We have a ton of material, including our app, that is very much a resource for new moms, as well as other forthcoming COVID-19 resources in the works. To the laboring moms, make sure you have a list of questions you want to ask ahead of time when you’re going into labor and delivery. Make sure all your questions and concerns are being addressed. Do not feel intimidated or otherwise that you do not have a partner; consider some of the health care personnel that are there to be that person — they are there to help you through this process. And hopefully with the telemedicine and telehealth, you have someone on the other side of the camera that you can feel comfort in. Make sure that the questions that might be in your mind that create anxiety are being addressed proactively. And don’t hesitate to ask those questions of the health care professional. We owe it to you to make sure that this delivery in this time of need is happening in the most professional matter possible.

For more information on COVID-19 for pregnant women and babies, head here, or download March of Dimes’ My NICU Baby® app. To support moms and babies during the pandemic, read about the COVID-19 Intervention and Support Fund.

This interview has been edited and condensed for clarity.

March 28, 1:15 p.m. This story has been updated to include Gov. Cuomo's announcement of an executive order for New York's public and private hospitals.
2:30 p.m. Updated to include statements from NewYork-Presbyterian and Mount Sinai Health System.