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Hospitals Put Counter-Pressure on Doulas During Flu Season

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If you are pregnant and planning a hospital birth, check your hospital’s visitor policy to see if you’ll need to choose between your doula and your spouse, significant other or loved one during labor, or if your older children will be banned from visiting you in the hospital.

The hospital chain, Inova, publicized their new flu-season visitor policy on the Inova Health System web site. For inpatients, anyone with influenza-like symptoms are not allowed to visit, nor are visitors (including siblings) under the age of 18. Only two people may visit an inpatient at a time. Visitors may be required to wear masks or other protective clothing and if they refuse, may be asked to leave.

The two-visitor-per-patient rule does not apply to laboring women, who must choose between a spouse or significant other and their “support person.”

In all Women’s Units (including Labor and Delivery, Family-Centered Care and Post-Partum) the following restrictions apply:

Visitors to women in OB units are limited to one person, who must be either a spouse or significant other (boyfriend/girlfriend). If the patient has neither a spouse nor a significant other, a designated “support person” may visit instead. The visiting hours spelled out above do not apply to this spouse/significant other/support person. In addition, all maternity and pre-surgical tours have been cancelled during flu season.

While this is not technically a ban on doulas, it is forcing women to choose between a trained labor support person and their loved one. Read the research on the effectiveness of doulas.

Local maternity care activists have contacted Inova and initially received confirmation that doulas would be considered part of the medical team. However, Inova Health System rescinded the doula-inclusive statement and reconfirmed that laboring women would be allowed only one person to accompany them from admittance to discharge. This person must be the same person for the duration of the stay. One activist said (via e-mail) that there may continue to be isolated cases in which doulas are allowed along with the woman’s partner, but the one-visitor maternity policy will remain in effect until the end of flu season in March. 


Older siblings and other young visitors also banned from visiting maternity patients

The organization EmPoWeReD Birth posted a note on its Facebook fan page last week to voice concern over the ban on young visitors in Lehigh Valley, Pennsylvania area hospitals along with many hospitals across the United States. They stated their concerns about the ban as follows:

  • We believe that early visits between older siblings and the new baby are an essential part of family bonding. While web-casting, which is being considered at one hospital, is a nice attempt at compromise, we do not believe it is in the best interest of healthy families.
  • We are concerned that this ban could prove to have a greater impact on lower income families, or families who are new to the area, who may not be able to find accessible childcare.
  • We are concerned that this ban is being implemented without any evidence that children are more likely to be carriers of the virus, or to be more likely to “share” the virus. Even the CDC recommendations for hospitals do not include any mention of prohibiting children from visiting the hospital. As such, the bans represent blatant “age-ism.” Yes, children sneeze without covering their mouths. Yes, children fail to wash their hands enough. So do adults.
  • We are concerned that this ban could prove to be trend-setting. That is, we are concerned that it might get implemented again each year, resulting in children being unable to visit both new siblings, or ill relatives, for half the year. This would be a step back for the “family centered” changes that have been hard won in recent decades.
  • We feel that this ban is an over-reaction to the situation at hand. President Obama, in declaring the swine flu issue an emergency, reported that 1000 people have died this year from the swine flu—that is, 1000 people in 9 months.* To put this in some perspective, 1000 people die every 9 DAYS in America in vehicle crashes. Yet we don’t see the corollary marketing campaign going on to protect child passenger safety—“if you bring a child into the hospital, you will be required to prove that the child is using the appropriate child safety seat correctly before being able to leave.”


Is your hospital limiting visitors and forcing laboring women to choose between their significant other (or family member/friend) and their doula? Please comment and link to the hospital’s visitor policy page.


Pass this on to pregnant women due between now and March so they can prepare.



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Reader Comments (11)

Fortunately, I haven't encountered this at my local hospital. But I get e-mails from another city's doula listserv (where I used to live) and it has been a problem there. The problem is not just the policies, but how they're instituted (sometimes overnight) and how they're enforced (inconsistently). So women receive assurances from their providers that their doula is OK - or the doula talks to other doulas who have been permitted in - and then at the check-in desk they're forced to choose. I understand the concern over H1N1, but does it make sense to be so much more dramatic about it than the seasonal flu? It seems like a convenient way to ban doulas, if you were looking for a way to do it anyway.

To me, the idea of limiting women to one support person is cause for concern whether or not they want a doula. Often when I talk to people about the benefit of having a doula, I talk about how in a long labor their partner may need a break to nap, eat, etc. There should be someone else there so the partner can take a break if they need to. I also see many women who want the husband/partner to be there for the birth, but understand he won't be much use as support and bring a sister, friend, etc.

I was disappointed reading on another blog how "nice" the nurse thought it was when there wasn't a crowd of people in the labor room. Yes, it is convenient for the staff, but that's just another example of staff convenience superseding what patients want. The very first birth I attended after I finished my doula training, I was with a teen mom who had all her female relatives in the room. Before she started to push they joined hands in a circle and prayed. I thought it was a beautiful reflection of their support for her as she was about to become a mother. It's sad to think that teenager would not only not have had a doula or her relatives, but would have had to choose between her mom and her sister. Again, I understand the concerns around H1N1 but one person? It's crazy.

November 2, 2009 | Unregistered CommenterRebecca

I think Rebecca brings up a really good point--many women want the father of the child to be in the room, but understand he probably won't provide much in the way of support. That is what their mom/sister/doula is for. I can't imagine not having my mom in the room when my son was born. It was as important a moment for her as it was for me and my husband.

November 2, 2009 | Unregistered CommenterElita @ Blacktating

Thank you for the "shout out" Jill! I hope we are able to do something about this.

November 2, 2009 | Unregistered CommenterEmPoWeReD Birth

My local hospital is not allowing any visitors under the age of 18 for the duration. Doulas are fine though (I was at a birth last week).

November 2, 2009 | Unregistered CommenterKatie B.

I read about this on At Your Cervix. I have a doula client I am going to have to talk to about this, in case it's happening around here. Coincidentally, I have the dreaded Hamthrax right now. Ehhhhh. Luckily my client isn't due until December.

I have to say, Jill, I love the title of this post. Very very clever.

November 2, 2009 | Unregistered CommenterMomTFH

Wait, if this rule is for "all Women’s Units (including Labor and Delivery, Family-Centered Care and Post-Partum)" and "[t]his person must be the same person for the duration of the stay," does that mean that if/once your labor support person leaves, NO ONE ELSE can visit you until you leave the hospital? If you choose to have a doula during the labor, then after the baby is born and she goes home, your husband can't come up to the hospital?? If your husband is there during the birth, your mom can't come see the new baby even if your husband has to go back to work??

What if a mom chooses to have her doula, and then has an emergency c-section? I don't know about other women, but when I am afraid for my baby's life and being cut open hip-to-hip, I want my husband and no one else! And what about after an unexpected c-section? Suddenly your hospital stay is extended two or three days (at least!), you can't even sit up on your own or lift your own baby, but your doula's gone home and no one is allowed to visit you at all?

Furthermore, why should people who are actually sick be allowed more potentially flu-carrying visitors than moms who are NOT sick, but just having a baby? Having a baby does not compromise your immune system, and the baby should be at least somewhat protected by immunities passed by the mom in breastmilk. If the concern is just that flu is more dangerous to babies, then are there similar limits in the pediatric ward? How about among the elderly?

November 2, 2009 | Unregistered CommenterMichelle

Michelle, for those very reasons (which are far from being small details or impossible exceptions), I have a feeling they're going to have to tweak their policy. How could they not?

I'm hoping some sensible health care providers comment. If the fear is liability, i.e. fear that patients will suffer a catastrophic outcome as a result of contracting H1N1 in the hospital and sue, then couldn't they just treat it as any informed consent deal? Or maybe they already have "you may contract swine flu here" on their consent forms. Anyone?

November 2, 2009 | Registered CommenterJill

I am not at all surprised that Inova hospitals have put in place a policy that is basically a de facto ban on doulas. Depending on the source of information, the Inova hospitals have anywhere from a 45-75% c-section rate. In fact, a L&D nurse at one of their facilities told one of my clients that the hospital's c/s rate is about 80%. (?!) And when I was helping a friend try to find a doula for her birth a year and a half ago, she was told by a couple of them that they no longer attend births at certain Inova hospitals due to the fact that they are not doula-friendly, not mother-friendly, and not baby-friendly. It's got nothing to do with H1N1, but it sure presents a convenient excuse.

November 2, 2009 | Unregistered CommenterLori

In August, my BFF planned to drive about an hour to a small community hospital for her second VBAC (even though there are four hospitals closer to her that also allow VBACs - but grudgingly so), and she asked me to be with her as her doula. Two weeks before her EDD, I traveled to the hospital to meet with the midwife and get a look around. The midwife and I chatted - she already knew me, she knew I was going to be there, and BFF had it all documented in writing that I was her doula.

So, she called me on her way to the hospital while in labor, and off I went to be with her. But when I got there, I was told by the nurses station attendee that I would not be allowed in there. She went as far as to ask me to leave the hospital, which I refused to do. "I did not drive an hour to be with my best friend when she ASKED me to be here and when the midwife KNEW I would be here, only to turn around and go home." I offered to wash my hands in front of them as often as they'd liked, and even wear a mask, but no compromise. So I waited in the waiting area and contemplated making a break for it, but I wasn't sure which room she was in, and it was a busy night (all three L&D rooms were occupied), and I didn't want to take any focus away from my friend.

It was a different midwife than her PC, but still, it was documented in her birth plan and all that I was to be there. And even more so, if policy changed, and my presence was going to be a problem, then why didn't they let the mother know? As best as I knew, her husband was the only other person in there with her - a well-meaning husband who loves her but pretty much only stayed in the birth room because it's what is expected of him and not because he can actually offer any kind of nurturing support (he doesn't do well when he's not the center of attention and is grossed out by the whole process.) But I digress.

Fortunately, they did tell her I was there, and she says she drew strength from knowing that. Also, she had a really fast labor and I only had to wait about an hour after I got there before her husband came out and announced the arrival of their little girl. I later learned that her mother had been in there the whole time as well, so I was very relieved and grateful. I think, in the grand scheme of the universe, her mom was "meant" to be there... they needed each other... but again I digress.

Her two older sons were not allowed to see their new sister, nor were any aunts, uncles or friends. Just parents and grandparents.

Since then, the bigger, closer hospitals have been implementing more rigid standards, mostly keeping out anyone under 14. I think that's rotten, especially since in a lot of these places around here, the maternity floor is quite well-separated from the sick units.

November 2, 2009 | Unregistered CommenterRachel Z

I just attended a birth at Rose Medical Center in Denver, CO and the mother was told she had to pick two people to stay. She had her husband, her mother and my (her doula). The three of us alternated in and out of the room for many hours until mom finally pestered the head nurse enough that she allowed all 3 of us at the same time. I really don't understand how this policy is reducing the spread of HINI. If anything all of us were potentially contacting more viruses in the waiting rooms, doors and hallways than if we just stayed put!


November 2, 2009 | Unregistered CommenterWellspring Childbirth
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