Heidi Schreck spent a long time trying to get pregnant — “a very, very long time,” she says.
After years of frustration and multiple rounds of in vitro fertilization, she and her husband, who both work in the theater and put off having kids while they were establishing their careers, found out last year they were going to have identical twins. Since Schreck is in her 40s and the babies share a placenta, the pregnancy is considered high-risk. But she was lucky enough to avoid most of the numerous potential complications.
Then came the coronavirus.
“We managed to make it through all of those phases only to confront this very unexpected thing at the end,” says the playwright and actress, now 32 weeks pregnant, by phone from her home in Brooklyn. “The pandemic.”
This week, Schreck, who is scheduled to deliver via C-section in late April, was one of thousands of pregnant women in New York City who learned they would have to give birth without anyone in attendance: no partner, no doula, no family member.
In quick succession this week, two of the city’s leading hospital systems announced stringent new policies barring visitors of any kind to its labor and postpartum units. The policies have been enacted in an effort to stop transmission of the disease and slow the surge of COVID-19 patients overwhelming the city’s hospitals.
New York Presbyterian was the first hospital system to announce such restrictions. “We understand that this will be difficult for our patients and their loved ones, but we believe this is a necessary step to protect patient safety,” it said in a statement Sunday.
A day later, Mount Sinai Health System announced similar measures, which it said were “critical to ensure that we can continue to slow the spread of COVID-19.”
“We do not take this decision lightly, but these are unprecedented times that require unprecedented steps to protect our patients, their families and their new babies,” it said.
In the largest city in the country — and what has now become the epicenter of the global pandemic — many people will have to deliver alone, a practice that will not only mean parents will miss out on witnessing their child’s birth but, more urgently, may put laboring patients at more risk and place additional pressure on nurses and doctors already stretched thin.
The announcements have been met with resistance from childbirth professionals and expectant parents in the city. A petition urging the hospitals to reconsider the ban has drawn half a million signatures as of Thursday morning.
What is at stake for these families is not necessarily the loss of the picture-perfect shared birth. Evidence shows that continuous support throughout labor and the initial postpartum period, whether from a doula or a family member, reduces the risk of complications such as C-sections. The maternal mortality rate in the United States has sharply increased over the last two decades and is the highest of any country in the developed world. It is particularly high for women of color.
“This is about safety. It is about reducing collective trauma in an already traumatic time,” said Jessica Pournaras, a New York City doula who drafted the petition, which cites guidelines from the World Health Organization and New York State Department of Health emphasizing the importance of support throughout birth.
According to Stephanie Schiavenato, a doula in New York who has several clients due in the next month, the policy may be counterproductive, leading to complications that result in longer hospital stays and more re-admissions. It is also likely to place additional burdens on doctors, midwives and nursing staff by asking them to do things doulas and partners often do, such as “wiping a sweaty brow or catching vomit” or “holding a leg during the pushing process,” Pournaras says.
Doulas in New York are sympathetic to the plight faced by hospitals and have worked with their clients to come up with creative solutions in a time of crisis, figuring out how to provide support via FaceTime or Zoom, for example. They are helping their clients understand how to make informed consent in case of medical interventions and urging them to make use of the call button.
But even with these inventive backup plans, some women are racked with anxiety at the thought of having no one present during labor and the vulnerable days post-delivery.
Adrienne Stortz, 35, is 36 weeks pregnant with her second child and is due in late April — when coronavirus cases in New York state are expected to peak, according to projections shared by Gov. Andrew Cuomo.
“I’ve been in full zombie apocalypse mode the last month or two just preparing for the possibility that things could be really challenging in a way that’s not a normal birth scenario,” says Stortz, who works at the Arts Initiative at Columbia University and will deliver at Mount Sinai West near Columbus Circle in Manhattan.
Even before the ban was announced, being pregnant in a pandemic was stressful. Each checkup required a long ride via subway or car from her home in Brooklyn to midtown Manhattan. This week she learned her husband, who was already barred from her checkups, would not be able to attend the birth.
“It’s just the worst nightmare to think about being in a hospital in labor for hours alone. It’s not even about having some sort of magical experience that my husband is missing or this birth story not being what I’ve always dreamed about. It’s about surviving this. I’m just scared about the basics.”
Right now Stortz, who calls herself an “NYC version of a prepper,” is largely consumed with practical issues. She bought a backup battery and a tripod for her phone so she can communicate with her husband and doula through video conferences. But she wonders about how, without a partner, she’ll do basic things like go to the bathroom by herself or get fresh clothes from her suitcase after her newborn soils them.
“I can’t see putting that work on to the nurses who are already overworked,” she says.
And her mind also goes to darker places: “I think about my husband being at home alone on the phone. What’s the situation if he’s watching on Zoom and I have a seizure and there’s nothing he can do about it or like I bleed to death and he’s just watching on a phone?”
Schreck, whose play “What the Constitution Means to Me” explores, among other things, women’s reproductive health, is also candid about the fear she is facing. Working on the play, she says, made her aware of how dangerous childbirth is in the United States. Her fear of dying in labor is one of the first things she brought up with her doctor at a visit last fall.
“I was scared to have a C-section before and now I’m even more scared that I’m going to go through it alone,” says Schreck, who will deliver at Mount Sinai on the Upper East Side.
At a checkup two weeks ago, everything was still somewhat relaxed, she says. But the climate has shifted drastically. At an appointment Wednesday, her husband was not allowed to accompany her. She was asked about symptoms, given gloves and a mask, and sat in a nearly empty waiting room. “Two weeks ago feels like seven years ago,” she says.
She plans to communicate with her husband and doula via FaceTime, but is still “incredibly nervous about the two to three days in the hospital when I’m recovering and have two babies and have no partner there to support me, or advocate for me or the babies.”
“I am aware that as a white woman with a savings account I am not the most affected,” she adds. “My view is that this policy is devastating for all pregnant people — especially black women and healthcare workers, and that it’s also likely necessary because our federal government failed to create a working healthcare system.”
Before the announcements by Mount Sinai and New York Presbyterian, most of the city’s hospitals had limited maternity patients to a single visitor, in some cases specifically barring doulas.
“I don’t necessarily think it is ideal for doulas to be in the hospitals right now because if we are supporting multiple clients per month, every time we go to the hospital we potentially expose ourselves and then we go into someone else’s home and expose them,” Pournaras says. “But these people should at the very least have someone from their inner circle present.”
New York Mayor Bill de Blasio has said that public hospitals in the city will continue to allow asymptomatic partners in the hospital during labor and the postpartum period, but that they must wear surgical masks. “To me, there’s just no more important moment in your life than when a child is born, obviously,” he said in a news briefing this week.
Many expectant families are exploring alternative options out of state, where such severe restrictions have not yet been instituted. Others have looked into the possibility of home birth.
Tanya Wills, a home-birth midwife based in New York, says the pandemic led to a sharp increase in interest from families wanting to avoid the hospital, many of them unfamiliar with the limitations of a home birth but desperate for a different option. Since the bans announced this week, she has been fielding about 20 calls a day but has not been able to accept any new clients.
The policies contradict guidelines issued last weekend by the New York State Department of Health that dictate that having one support person — whether a spouse, sibling, doula or parent — is “essential to patient care throughout labor, delivery and the immediate postpartum period.”
The American College of Obstetricians and Gynecologists similarly says that continuous support “is associated with improved outcomes for women in labor” and has urged hospitals to devise solutions to “ensure laboring patients have the support and stability they need through this chaotic and stressful time.”
Some healthcare providers are sympathetic to the hospital administrators, who are dealing with a lack of critical resources during an unprecedented pandemic. While some hospitals are able to test laboring patients and provide results in about 10 to 12 hours, rapid response tests, which could quickly identify the infected and obviate the need for visitor bans, are not currently available. As of Thursday, more than 5,000 people were hospitalized statewide.
“They are not making this decision lightly,” said Dr. Joia Crear-Perry, president and founder of the National Birth Equity Collective. “The chaos and lack of coordination at the federal level is trickling down to decisions like this.”
Both Mount Sinai West and New York Presbyterian declined to comment.
An ob/gyn who works within the Mount Sinai Health System but was not authorized to speak publicly has delivered babies to COVID-positive patients and has colleagues with pregnant patients intubated in the ICU. The doctor said it is likely that some patients “will have PTSD from this,” but ultimately supported the policy.
“For us to protect the patients that we have on the labor floor and their newborn babies, this is probably the best way. It seems draconian and awful and it is in many ways,” said the doctor, “but these are unusual times.”
And the gravity of the moment is not lost on women who will be laboring alone, despite their fears.
“They’re making decisions that I would never wish on my worst enemy, about how to keep people as healthy as they can in a situation where a lot of people are going to die,” Stortz says. “There’s no right answer to this stuff.”