Being pregnant can always present unique challenges (surprise, you have gestational diabetes!), but a giving birth during pandemic is uniquely stressful. When COVID-19 landed in the United States, everyone from doctors to midwives had to ask hard questions about delivering babies while protecting public health. Early on, some hospitals in New York City mandated that people would need to give birth without a support person, a decision that was soon relaxed to allow one guest during birth.

Now, more than four months into the pandemic, COVID-19 cases are rising faster than before. So what does that mean for 2020 pregnancies? According to wellness expert Latham Thomas, a Brooklyn-based doula and activist who leads doula trainings, the answers are evolving weekly—even daily. Here, she shares her insights into what’s changing, what’s not, and why the pandemic is boosting interest in creating better birth outcomes.

Well+Good: Now that we’re well into the pandemic, what is happening with doulas and birthing?

Latham Thomas: Most of the support is virtual, and the hospital policies have been constantly in flux. Some hospitals allow doulas, while others don’t. Unless there’s a home birth, everyone wears PPE (personal protective equipment) for the birth, and you have to stay in the delivery room. Once the birth happens, the doulas leave. It’s challenging because it’s new for all of us, but many people have figured out how to support and advocate for people the way they normally would—just virtually. Because we know that if families do not have the support they need, and people go into the birth process without adequate tools, they don’t always have the outcome they desire.

Many people have figured out how to support and advocate for people the way they normally would—just virtually.

You mention advocacy, and we know that for Black people, the mortality rate from childbirth is significantly higher than it is for white people. What does this particular community lose if people have to choose between bringing a loved one and their doula to the hospital?

Well, a couple of things happen. Black people have a complex history with the medical system that is bound in mistrust. First, people can lose their dignity and a sense of autonomy if they don’t have somebody to help them navigate what’s going on and help as different issues come up throughout the process. So for instance, if there are procedures that are proposed, people need to understand what they’re signing off on; informed consent is a huge issue. There are things a doula would see that you, as the person who’s birthing, might not see because you’re focused on what’s happening in your body. So you lose that sense of perspective, where somebody can look at the trajectory of what’s happening and anticipate what is needed in a given moment.

Also, it’s possible to lose a sense of the power that you galvanize through the birth team, and some birthing people feel less effective in speaking up and protecting themselves. Some people don’t have partners, so they’re going alone. Or they may go with a family member who doesn’t have that [birthing] education to help them through the process. So another thing that you can lose is confidence. All of the things that you learned about birth can go out the door when you’re afraid, because you’re now hooked into fear, tension, and pain and because your stress hormones are active.

In that case, how are doulas shifting their messaging to clients?

One of the biggest things is to help them understand what consent means: how to actually consent to procedures, what informed consent means in the hospital setting, and how we can start that process of getting comfortable seeking consent for every single procedure. That means making sure that doctors, nurses, and everyone who’s interacting with you understands what your desires are. It involves being able to ask the questions and get the information necessary so you can make decisions about your care. Sometimes that means having your doula on Skype or FaceTime. Other times, it means huddling up with your family or maybe getting a second opinion. When someone’s in the room, obviously it’s easier. But when they’re not in the room, we have to create spaces to facilitate that level of safety.

You’ve shifted to virtual doula training during the pandemic. How has that adjustment gone?

At first, I was very much against doing virtual trainings, but they actually translate well for us and allows us to expand the audience. It’s been amazing. We have always had an international community of doula trainees and now with online, we have folks from the UK and Europe, in addition to every corner of the states—it’s a very international group. People are also excited to support through scholarships for folks who are low-income, LGBTQ+ people, and for Black and brown women. We’ve seen a lot of interest since COVID-19.

What do you think is driving that?

I think people have the time. They’re thinking about what they want to do with their lives, slowing down and going inward. I think there’s also been a steady push in the media and on social media around the maternal health crisis. People are seeing things that inspires the courage to do something themselves. We have a lot of university students who are going into medicine or public health, and they’re interested in learning the foundations to do the work and create policy change. Then you have nurses and a couple of OB/GYNs in class, too, which is great because they can go into their hospitals and make a difference. There’s also the backdrop of having essential workers who are lauded for putting their life on the line. I think that there’s something around that, too—people think, I could do something to help people.

The other piece is that this moment is really centralized around social justice and looking at the harms that have been done through systemic racism. I think that is driving people to find organizations that are teaching from the lens of how to dismantle some of these historic frameworks. Again, people want to feel like they’re part of the solution.

We have to re-envision what the in-person experience looks like.

It’s hard to predict the future beyond the next week or so, but where do you think birthing and doula work are going—especially since we’ll be living with COVID-19 for the foreseeable future?

We’re definitely going to continue to offer education and services virtually. Then, we have to re-envision what the in-person experience looks like. I think we’ll also focus on infrastructure: creating relationships and protections for birth workers when they go back into hospitals, birth centers, and home-birth settings. We want to work toward figuring out how to address a moment like this, if it happens again. What will be in place for that so that doulas are aligned across the nation for the same ability to show up aligned and protected?

And what do you think will change for birthing people?

If we start to empower patients and clients to understand more about the bodies, they’ll be more educated. That might involve taking your own weight, or learning how to do a urine strip test to see if protein is present. We have to empower patients to feel that they are part of the process—to go to the doctor and, ideally, they confirm things that you should already know about yourself as you’re learning how to be connected to your body. I also want people to feel like they have options; out-of-hospital birth should be on the table. Building up your birth team to include folks you trust, which may include midwifery support, doula support, a lactation consultant, mental health provider…. We need to rebuild the birth village.