How Michigan Doulas Secured Their Position in Hospitals during COVID19 Pandemic
Updated: Mar 19
First off, I just want to say that this was a GROUP effort! There is absolutely no way that I could take full credit for this insane roller coaster of political support & policy change. With a group effort, we went from repetitive in-hospital denials to 1 online petition and then 29 hours later receiving an official Governor statement of "partners AND doulas" allowed to support laboring patients!!
Below are the steps we took. I won't lie, it felt like we were running a million miles a minute while also running with cement blocks on our feet.. We are on a time clock! The window to do this is closing. As numbers rise the chance of protecting your role as a doula lessens. Clients are birthing without their doulas right NOW! Steps need to be taken now!
***Tune in for a webinar on 3/19/20 at 8:30pm EST featuring myself, Cristen Pascucci of Birth Monopoly, Rebecca Dekker of Evidence Based Birth, Emily Fontes of Tiny Giant Marketing, and Chante Perryman - a doula leading the way in Kentucky on doula hospital policies.
"Pandemic isn't the time to discount research and best practice" - Nicole White, CPM
My why? Honestly, I got pissed. Our doula profession has been slapped in the face and progress reduced by a decade when hospital administrations deny role as Essential. We are evidence based care providers that should be viewed as an integral part of the birth team. Denying evidence based care providers puts clients and their babies at an increased risk, especially for POC! I was not about to let our clients birth without us!
Hospital systems have the ability to consider doulas "Essential" personnel -Margaret Rodeghier, CLC, Doula
Interested how we changed our doula, placenta encapsulation, and lactation practices during social distancing mandates? Click here to read more. *We strongly advise that if you want support getting into a hospital, then self-quarantine now to help make your case!
WHAT WE DID THAT WORKED
(and what didn't work)
Doulas contacted all professional connections we have ever made with Doctors, CNMs, Nurses and Nurse Managers. We asked them to advocate for us from the inside. Once our Governor released an executive order to limit visitors to those "provisioned for medical care", doulas were cut off, and most of our inside contacts & advocates were told to STOP asking. Do not let this deter you!
Some success acheived with step 1 only:
Two hospitals, University of Michigan, and Southfield Providence with the Alternative Birth Center, did return to accepting doulas with the push of from nurses, midwives and the nurse manager's support, AWHONN denouncing denial of doulas, and CDC statement of "Facilities can consider exceptions based on end-of-life situations, or when a visitor is essential for the patients emotional well being and care."
*Other major hospitals were blaming the Governor's executive order which limited visitors so our goal moved to take it to the Governor!* I would like to note that hospitals ABSOLUTELY have the ability to support doulas and consider doulas as essential parts of the birth team!
Ask all providers we knew for a quote on their support for doulas. Our Medical Support Statements were included with current hospital visitor policies and ACOG comments on doulas. You can find that document here. Feel free to use ours if you can't find support locally, but local teams, hospitals, and providers to you will make a bigger impact.
You'll see here who truly has your back and actually respects doulas as part of the birth team! True colors will shine. Feelings may get hurt with a denial, but just move on and put your energy towards people who support you.
Step 3 - Completed! Just keep sharing!!
We started an online petition! This petition is currently for nationwide use! Use the 3000+ signatures to your advantage and share it! Use it! Its for all doulas everywhere! http://chng.it/CZ4FjsBz
I shared this in every Facebook doula group and parenting group I am apart of and recommended everyone share with their clients and supporters. I recommend you do the same!
** This would be a good point to contact media if you have a family willing to speak to the news about how they have been denied doula care, and the impact to them and their birth*
I did contact news stations, however step 4 and 5 happened so quick, that news media was not required.
You can retrieve our supporting documents here
Ask on your social media how to get the Governor on the phone for 5 minutes. While, you will NOT likely get a Governor on the phone at this moment, you WILL start seeing people tagged who are politically connected and commenting for multiple sources offered to you! Aim high, catch everything that comes along!
-Message each connection and ask for their email to send a formal letter to regarding the protection of doulas in hospital birth settings and ask if they can send it up the chain for consideration.
-We were able to connect with an office staff member (THANK YOU JENNY!) for State Representative Andy Levin who took this directly to the Governor's office.
-Via social media, other office staff members were tagged and they helped bring attention to the Governor's office on this topic as well! So many people went behind the scenes here to help and I wish I could thank them all personally.
Link up with local coalitions and established advocacy groups! Think of all your currently organized groups that advocate for doulas, family rights, paid leave acts, breastfeeding, etc. They already have the political connections established for offices that advocate for family rights or know who to forward this onto. The Michigan Doula Coalition (THANK YOU JENNIFER!) had reached out to their doulas, with a form to complete to collect examples of doulas being denied in their immediate area. Forward the letters to them, quotes of support and petition link and ask them to send to their political advocates to bring it to the Governor's attention. The Michigan Doula Coalition contacted their entire mailing list regarding the issue, along with the link to the petition. This led it being brought to the attention of the Michigan Breastfeeding Network. Shannon was an incredible resource as they are a bipartisan issue and have political connections! She also mentioned to consider going to national groups like Black Mamas Matter Alliance, and any affiliations your local hospitals have as well, such as the Michigan Hospital Association, for public statements.
- If you have any associations that are anti-homebirth, use them to explain how clients are leaving hospital birth to birth at home due to not being able to have their doula present.
- If you have associations that are pro-homebirth, they will be the associations that understand the important of doula care in the birth experience and will help advocate!
On point 4 & 5, is where we made the most immediate progress! On Point 4, we got our official letter into the Governor's office by State Representative Andy Levin's office. On Point 5 is where even more political officials moved it up the latter. The squeaky wheel gets the grease!!! STAY LOUD!! KEEP ASKING EVERYONE!
**We did create a letter for constituents to copy/paste to their government representatives. If you can, create a list of statewide representatives for constituents to easily send the letter to, you may help receive more noise and push. Letter is in files linked above.
Q: Can the partner and or doula of a laboring mother be allowed to accompany her during admission for labor and for a period after birth, so long as that individual successfully passes the health evaluation?
A: Yes, labor qualifies as an exigent circumstance under this order. Therefore, a partner and doula may accompany a laboring mother, if they pass the health evaluation required by section 2.
Ultimately, how to replicate this work:
You can retrieve our supporting documents here
1. Stick to the evidence
The groundwork has already been laid by WHO, AWHONN, ACOG, and the CDC. Don't make others do the research, provide them the numbers and statements.
2. Make every contact actionable
Don't just write to complain. Don't just write trying to defend our profession. Give them solutions!
If you have not had lockdowns yet:
"If you lock down visitors at hospitals, please include doulas as part of essential care providers"
"Include doulas as part of medical care team providers with any restrcitions on movements moving forward"
If you have had lockdowns restricting visitors:
"Include doulas as part of the medical care team and allow access to our clients in hospitals."
"Revise Executive Order #xxxxx to include doulas in addition to 1 support person in Labor And Delivery units"
3. Don't reinvent the wheel
Use our letters, use our petition. Show the work Governor Whitmer did in Michigan. Work as fast as possible! Our documents are linked above.
4. Use every relationship possible
Ask Facebook for connections: If you have your clients as friends on Facebook, it may be likely that your network is wider than you think. Reinforce contact with Coalitions and Advocacy groups. Try to find out who is advocating for Maternal outcomes for the Health Departments.
5. Call on constituents
Every single contact with a government official requires documentation of a contact. While getting our letter into the Governor's office was huge, the more people that made contact, the louder it got. The faster things get loud, the more officials don't want to be "behind" the issue, they want to be in front of it and get it addressed.
Contact your representative with this statement NOW. Provide a statement for them to copy/paste. I included ours in the supporting documents linked above
They can find their representatives here. Get loud and move fast!
6. Look into if your politicians who have advocated for Birth Equity
Governor Whitmer had addressed her support for Birth Equity in her State of the State address, and even had signed a proclamation for Michigan Doula Appreciation week in line with World Doula Week dates. Quote their statements, and ask them for their continued support for doulas and evidence based care in maternal health care by protecting doulas access to hospitals.
Now that we have executive orders from the Governor's office protecting our role, we are calling the Nurse Managers of Labor and Delivery units at each individual hospital. We are requesting their email addresses to forward the link to the order. Nurse Managers have been the contact point to forward it to the administration for policy change. If they don't provide their email address, ask them for their higher up.
So far, each hospital we have sent it to, has changed their policy to accept doulas. Some are taking longer than others, but it is working.
If this doesn't work, reach out to health departments, and the State Representative that has the district for the denying hospital to forge their connections to reinforce executive protections.
Margaret Rodeghier is a professional Birth & Postpartum Doula, Placenta Encapsulation Specialist, and Certified Lactation Counselor in Metro Detroit, MI. She has been providing professional services throughout Southeast Michigan since 2014, and attended her first birth in 2005. Margaret has 2 children that share her childhood love for Harry Potter and Lego building. To learn more about her services you can find her at ProfessionalBirthSupport.com and m.me/TheGPdoula