New Mexico has a long history of health disparities, particularly in rural areas and among communities of color. Doulas have helped fill those gaps by providing physical and emotional support during pregnancy, childbirth and the postpartum period. But with New Mexico hospitals declaring crisis standards of care due to an uptick in COVID-19 cases, giving birth has gotten more complicated. That’s according to Melissa Lopez, executive director of the Doula Association of Las Cruces.
MELISSA LOPEZ: It's been very difficult for myself and doulas, but really families across the state of New Mexico who've been put in a position to make choices about whether or not to have their partner or their chosen support person present for their birth. And that is increasing again, where they're having to make decisions without having complete information.
And so that's really what it comes down to the doulas are really trying to assist community and having informed consent be an integral part of all of the care that they receive. But the systems are at a capacity level where they're really beginning to gray that line with some of the policies like changing a birth plan from a natural birth plan to an induction at 39 weeks, because it's more convenient for scheduling purposes, has lifelong implications for that mother, that family and that baby.
KUNM: How can the healthcare system better include you and professionals like you?
LOPEZ: Well, I think that, especially at a time, like COVID, when systems are exceptionally strained. Where there's nursing shortages, where they're staffing shortages, and there's an increase in volume of patients, that the healthcare systems it would be advantageous to them to allow doulas into the space to provide some much needed relief to their staff.
Doulas are able to help fill the gaps in care. So, if you think of a birthing environment as sort of a glass, and then inside that space, you add in your providers, so maybe a doctor, your nurses, and then the doula is the water that fills in that space in the glass, and really helps to provide some continuity of care. No matter how amazing your nursing staff is, in birth, there's no way they can spend that entire birth process with you applying comfort measures talking you through everything. It's just not possible. And so, it's a role that the medical system isn't paying for. So, you think that they would be more open to it.
KUNM: Thinking of birth as a process is interesting. And because of this, what are your concerns on hospitals declaring crisis standards of care?
LOPEZ: Crisis standards of care are really scary to think about. Those that are planning hospital experiences for their birth are scared, they're scared about is there going to be a room available? Are they going to have to birth in a hallway and without additional support? And there are biological impacts of fear on the birth process. And we know that fear chemicals interfere with the ability for labor to progress. So that results in increased interventions, which likely includes medications for induction. Once we do that the risk of cesarean goes up as well. So, it's this cascade of interventions.
KUNM: You have to as mentioned the many barriers both doulas and people who may be pregnant face and thinking about the upcoming legislative session in January, what legislation could help people who are pregnant?
LOPEZ: I don't think it's going to happen this legislative session, but Medicaid coverage for doulas would change everything.
KUNM: Lastly, my question for you is, are there any questions that I didn't ask that maybe I should have or something you would like to say?
LOPEZ: Doulas helped make birth safer. And that's been proven in study after study. So, making the change to incorporating doulas into the birthing space I think is an incredible, powerful piece to improving birth and to making it safer and more positive.
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