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Recommendations for Labour Support During the COVID-19 Pandemic

There is no doubt about it - these are uncertain and rapidly changing times as together the world faces the unique challenges presented by the COVID-19 global pandemic. Coupled with compounded and multi-faceted health care challenges, the countries currently facing the greatest challenges are presently governed by populist leaders. Now, more than ever, we must look to the facts as we make decisions that impact the provision of health care services and women's and newborn's rights in such unique and evolving times. Decisions should be evidence-informed, not fear-driven.


Increasingly, women are reporting that they are birthing alone due to hospital policies that prevent the presence of companion support during labour, birth and in the immediate postnatal/postpartum period (labour companions can include partners, relatives, friends, healthcare workers or doulas). While hospitals pivot to implement infection control procedures aimed at protecting the public and their staff, many are neglecting to take a big-picture view that critically examines the evidence. To some extent, that is in line with the nature of the microorganism responsible for the pandemic, as our knowledge of the virus continues to evolve over time. That doesn't mean, however, that we can forget our existing clinical knowledge, evidence base and clinical practice guidelines. In addition to misguided policies denying companionship support to labouring mothers we are also beginning to see advice that undermines the principles of infection control and long-established and evidence supported birth practices, such as water births.


Decades of research into the time-honoured tradition of labour and birth support continues to provide evidence for its beneficial effects on positive birth outcomes for women and newborns. These include a reduction in medical interventions (such as inductions, episiotomy and assisted births), shorter labours, fewer caesarean births, and reported greater overall maternal satisfaction with their birth experience. The research supporting labour support is recognised by the World Health Organisation, who recommend that women birth with the support of a labour companion.


While COVID-19 presents unique challenges to global health care systems, practice recommendations should not diverge from the evidence, unless there is new evidence that demonstrates reliable reasons why practice guidelines should change to meet current circumstances. That is not the case with respect to the provision of companion support for labouring women. To date, the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM), the World Health Organisation (WHO), and the International Confederation of Midwives (ICM) unanimously support upholding the practice of labour companionship support during the COVID-19 pandemic based on all existing evidence, asserting that women's birth choices to access birth companionship should be upheld (RCM, 2020).


Specifically, all current guidance recommends that "An individual, asymptomatic birth companion should be enabled to stay with the woman throughout labour, birth and immediate postnatal period." (RCM, 2020). The RCM (2020) further argues that during these times when anxiety, uncertainty and fear is heightened, it is particularly important to continue to uphold women's human rights, especially if nursing workforce and institutional demands result in a reduction of midwifery support or redeployment of midwifery staff to support other workforce requirements.


Care and compassion should continue to remain at the centre of women's health and maternity care, especially during a time of unprecedented health crisis. This is one of the greatest challenges of our generation. Let's not fail to advocate for the health and rights of women and children. What's required in a balanced, informed and holistic approach to supporting women's birth choices and outcomes, that includes the voices of all professionals and and understanding of the changing and complex nature of caring for populations during times of crises.


In summary, all current evidence and recommendations continue to uphold the provision of labour companionship and support by an asymptomatic individual during the COVID-19 pandemic, despite decisions made to the contrary by some health care settings. Based on all current evidence, no asymptomatic women should be required to birth alone.


References:

The Royal College of Midwives (2020). Rapid Analytic Review: Labour and Birth Companionship in a pandemic. Companionship of choice for asymptomatic childbearing women in hospital throughout labour and birth. https://www.internationalmidwives.org/assets/files/general-files/2020/06/birth-companionship-in-a-pandemic-master-27-04-2020-002.pdf [Accessed 18/08/20].


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