Know Your Rights: Everything You Need to Know About Hospital Birth During the Pandemic

A recent ProPublica report found that Lovelace Women’s Hospital in Albuquerque, New Mexico was singling out Native American women for COVID-19 testing—and then separating them from their newborns as they awaited test results. This news, both unsettling and being described as a type of racial profiling, also goes against some of the basic rights pregnant women have when delivering in a hospital. Rights many people—and especially first-time moms—might not be aware of.

When I gave birth to my son, despite my birth plan in hand and pre-baby classes, I had no idea what I was getting myself into. At one point after my son was born, I remember asking a nurse permission to hold my baby in-between tests and screenings. It seems insane to think about now, but at the time I was recovering from a long labor, nervous, and overwhelmed by the movement and actions of nurses and doctors all around me. Yes, of course, I could hold my own son—and so much more.

"The bottom line is that pregnant people have the same health care rights as anyone else: the right to decide who touches them, the right to make all decisions in their health care," says Cristen Pascucci, advocate and educator for legal and human rights in childbirth, founder of Birth Monopoly, and director of Mother May I. "We—both parents and providers—often have this idea that our rights change once a baby is involved, but that is more of a cultural idea than a legal one. If anything, these basic rights are even more important during pregnancy and birth, when we are responsible for this little life we will be guiding and protecting for the next 18 years."

Here's what you need to know before giving birth in a hospital—especially now that things are a little different due to COVID-19 regulations.

While rules may vary a little state by state or hospital to hospital, the World Health Organization (WHO) says that "all women have the right to a positive childbirth experience whether or not they have a confirmed COVID-19 infection."

From the right to refuse medical intervention or treatment to simply asking questions about their care, there are clear standards when it comes to the rights of birthing women. But now, due to ever-changing COVID-19 regulations, things can get a little confusing.

"It seems like every hospital is doing something different, and there are lots of reports from nurses and parents of hospitals being more restrictive than what the state requires or what the CDC [Centers for Disease Control and Prevention] or WHO recommends—to the detriment of patients," says Pascucci. "As a patient, you are not legally bound by a hospital's policy, and if a hospital created a policy, it can change or revoke it. We are seeing families all over the country advocating for policy changes to make them more humane and consistent with World Health Organization guidelines."

If you'll be giving birth during the pandemic, here are just some of the rights you should be aware of:

"The practical application of the rights of childbearing women can be very complex," says Bonita Katz, president of the International Childbirth Education Association (ICEA). "Every person has the option of choosing their caregiver and changing their caregiver at any point in time, but in rural America your options may be very limited. You may have to choose between working with a health care provider (HCP) that you don't like or driving another 50-100 miles to find someone you would prefer to work with. Which will be safer for you and your baby? That's not an easy answer." 

In March, support people were banned from hospitals—meaning that pregnant people were forced to labor alone. And while the CDC does suggest limiting the number of visitors during the stay, their guidelines say that hospitals should allow "one essential support person and having that person be the same individual throughout the hospitalization."

The risk of being around a support person is probably low for the pregnant woman, says Katz. Why? They've likely already been exposed to their spouse, family member, or friend at this point. The greater risk here: "Being alone increases stress and stress has a negative effect on labor and on her postpartum experience," says Katz.

COVID-19 diagnosis or not, WHO guidance says that women should have close contact with their babies, skin-to-skin should be encouraged, and babies should share a room with Mom.

"The American Academy of Pediatrics (AAP) has updated their recommendation on separation of mothers and infants during COVID to be more in line with the World Health Organization," says Katz." It is now recommended that mothers and infants be kept together as much as possible."  

Unfortunately, as was the case in New Mexico, "forced separation is still happening around the country, and we know that inhumane practices are disproportionately enforced on groups of people who are perceived as vulnerable or "other": Native American women, Black women, teenage mothers, incarcerated women, immigrant women, just to name a few," says Pascucci. "This is one more way health disparities are perpetuated in maternity care."

In keeping with the AAP's recommendation that Mom and Baby be kept together even if a mother tests positive for COVID-19, both the AAP and WHO say that women should be allowed to breastfeed if they wish to do so—COVID-19 diagnosis or not. Research to date shows that the coronavirus cannot be transmitted through breast milk.

The AAP's Healthychildren.org cites three main benefits of allowing Mom to breastfeed:

The CDC recommends that mothers who are positive for COVID-19—or who show symptoms—practice proper hand hygiene and wear a face covering while breastfeeding if possible.

"It is always best to investigate your options in advance as much as possible," recommends Katz. "For the last 60 years, ICEA has advocated for the right to make decisions based on knowledge of alternatives. People need to understand that not all HCPs are the same and not all facilities are the same. Informed decision-making is foundational for a family who wants to exercise their rights. To make the decisions that are right for them I highly recommend a high quality childbirth education class. As the saying goes: If you don't know what your options are, you don't have any."

Pascucci agrees that knowledge is power. "My number one tip is to contact local doulas, childbirth educators, or other independent birth professionals to ask them for the inside info on what your local hospitals are doing, and what your options are," she says. "It can be really hard to figure this out on your own with policies changing so quickly and not being readily available for anyone to see."

One more thing to remember: You have the option not to deliver your baby in a hospital. Birth centers and home births are becoming more popular and could be good options to explore if you've had a healthy pregnancy and are considered low-risk.

Katz also recommends working with a doula, as they can help during labor and in the postpartum period. "Even if not allowed in the hospital during labor, many doulas are offering support virtually." It's not the ideal scenario, but they can still help to offer guidance and much-needed support to new parents.

"No matter where you are, know your rights and be confident that you are in charge of your body," says Pascucci. "You are absolutely capable of making these decisions. No one cares about your baby more than you—and you can do this!"