TO: Marschall S.

Runge, CEO of Michigan Medicine

FROM: Madeline DeMarco, University of Michigan School of Public Health
DATE: March 30, 2020
RE: Maintaining the presence of birthing partners in hospital delivery rooms

Executive Summary
The U.S. has the worst maternal mortality rate in the developed world despite annually costing
the healthcare system billions of dollars (GBD 2015). Maternal health outcomes get even worse
during disease outbreaks such as the current COVID-19 pandemic (Lewis 2020). Providing
pregnant mothers with sources of social support such as a spouse, family member, or doula, is an
easy, low-cost, low-resource strategy for improving maternal health outcomes. However, many
states are tightening hospital visitor policies to slow the spread of COVID-19, preventing
pregnant mothers from having the social support they need during labor and delivery. To
continue promoting maternal health and well-being, the Michigan Medicine System should
continue to allow birthing partners in the delivery room.

Background
Ensuring the health of new and expecting mothers is just as important as ensuring the health of
their children. Maternal health and mortality rate are frequently used as indicators for the overall
health of the country and the United Nations has included it among their Sustainable Health
Goals (Goal 3 2019). The U.S. reports the highest maternal mortality rate of any country in the
developed world (GBD 2015). In Michigan, the maternal mortality rate has been trending lower
than the national rate for several years, but the current COVID-19 pandemic puts this trend at
risk (Michigan Maternal Mortality Surveillance Program). Although there are certainly risks
involved, this policy memo advocates for maintaining the presence of birthing partners such as
spouses or doula in hospital delivery rooms for the sake of Michigan’s maternal health outcomes
(Committee on Obstetric Practice, 2019).

Mothers who have social support during labor and delivery experience fewer childbirth
complications and reduced rates of postpartum depression (Gierdingen et al. 1991). However,
this is harder to achieve during disease outbreaks as social interactions and the amount of support
people allowed in delivery rooms is limited (Novel Coronavirus 2019). Many hospitals around
the country, especially in New York, are restricting - or outright prohibiting – the support people
a woman can have in the labor and delivery room with her (Caron et al. 2020). This is leaving
many expecting mothers anxious and frightened at the thought of giving birth alone (Caron et al.
2020). Experts also worry that this will leave women vulnerable. Overburdened hospital staff
might not be able to fully monitor potential emergencies, there will be no one else in the room to
advocate for the patient, and expecting mothers might decide to have a home-birth at the last
minute without proper preparation (Caron et al. 2020).

Recommendation
As chief public health expert, I recommend you support maternal health by continuing to
allow no fewer than two support people in Michigan Medicine’s labor and delivery rooms
during the COVID-19 pandemic. This policy will allow for some combination of a partner,
family member, and doula to provide support for expecting women and ensure the best possible
health outcomes for mother and child.

Counterarguments
Risk of COVID-19 Infection: The chief argument against this policy is that allowing visitors in
the labor and delivery room will protect women and children from COVID-19. However, the
New York State Health Department explicitly states in its recently released hospital visitation
guidelines for the COVID-19 pandemic that hospital visitors should be suspended, except for
those deemed “essential to the care of the patient” (New York Department of Health 2020).
Those guidelines specify that a support person is “essential to patient care throughout labor,
delivery, and the immediate postpartum period” (New York Department of Health 2020). As
long as those support persons are asymptomatic and not suspected of having COVID-19, the
benefits of having them in the hospital room vastly outweigh the risks. Especially when one
considers that many of these potential support people such as a spouse, partner, or mother are
someone the expecting mother would be in contact with anyway at this time in her life, as long
as they are asymptomatic and not suspected of having COVID-19.

Conclusion
With your help, Michigan can continue moving toward better maternal health and well-being
outcomes. As the COVID-19 pandemic continues, more decisions will need to be made about
the health and well-being of our citizens. You must continue allowing support people in
Michigan Medicine’s labor and delivery rooms for the good of the state’s expecting mothers and
children.
Caron C, Van Syckle K. Some Pregnant Women in New York City Will Have to Deliver Babies
Alone. The New York Times. https://www.nytimes.com/2020/03/24/parenting/coronavirus-labor-
birth.html. Published March 24, 2020. Accessed March 25, 2020.

Committee on Obstetric Practice. ACOG Committee Opinion No. 766. Obstetrics &
Gynecology. 2019;133(2). doi:10.1097/aog.0000000000003074.

GBD 2015 Maternal Mortality Collaborators. Global, Regional, and National Levels of Maternal
Mortality, 1990–2015. Obstetrical & Gynecological Survey. 2017;72(1):11-13.
doi:10.1097/01.ogx.0000511935.64476.66.

Gjerdingen DK, Froberg DG, Fontaine P. The effects of social support on women's health during
pregnancy, labor and delivery, and the postpartum period. Family Medicine. 1991;(23):370-375.

Goal 3 .:. Sustainable Development Knowledge Platform. United Nations.

https://sustainabledevelopment.un.org/sdg3. Published 2019. Accessed March 25, 2020.

Lewis H. The Coronavirus Is a Disaster for Feminism. The Atlantic.

https://www.theatlantic.com/international/archive/2020/03/feminism-womens-rights-
coronavirus-covid19/608302/. Published March 19, 2020. Accessed March 25, 2020.

Maternal Deaths in Michigan, 2011-2015. Michigan Maternal Mortality Surveillance Program

https://www.michigan.gov/documents/mdhhs/MMMS_2011-
2015_Fact_Sheet_FINAL_635164_7.pdf. Accessed March 25, 2020.

Novel Coronavirus 2019 (COVID-19). ACOG. https://www.acog.org/clinical/clinical-

guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019. Accessed March 20, 2020.

Pregnancy and COVID-19 Resources for Health Care Providers. New York Department of Health;
2020. https://coronavirus.health.ny.gov/system/files/documents/2020/03/covid-
19pregnancyguidanceforproviders3.21.20.pdf. Accessed March 25, 2020