Born in Captivity: The Experiences of Puerto Rican Birth Workers and Their Clients in Quarantine

Abstract

In this article, I seek to understand how the COVID-19 pandemic has impacted childbirth in Puerto Rico, an island that was already in recovery following the occurrence of two devastating hurricanes in the fall of 2017 and a major earthquake in the winter of 2020. Thus, I argue that it is important to discuss not only how individual disasters impact birth, but also how their compounding effects do so. In order to address these research questions, I conducted remote interviews with Puerto Rican birth workers and researchers. During times of crisis, this pandemic included, home and midwife-attended births have become increasingly more popular. However, Puerto Rican midwives and doulas currently have less institutional support than ever. In a time of quarantine when home births are rising, we need to consider whether society is designed to facilitate these models of care. In Puerto Rico, pre-pandemic, there was a less than 1% home birth rate and there still is a lack of legal recognition and protections for homebirth midwives. As this article demonstrates, an acknowledgment of the near-invisible labors of these birth workers is needed, in addition to supplies, support, and protections for them—and not just in times of “crisis.”

Maternity care during COVID-19: a qualitative evidence synthesis of women’s and maternity care providers’ views and experiences

“…There was a focus on reducing in-person appointments with a move to virtual or telephone appointments, where possible, which required maternity care providers to be innovative and adaptive in identifying alternative ways to provide care [ 17 , 64 , 66 , 71 , 72 ]. Maternity care providers also described a reduction in the numbers of women accessing certain types of maternity services (e.g., inpatient antenatal care, postnatal clinics, and infant immunisation appointments) due to concerns about attending in-person [ 72 , 78 ], while, concurrently, the demand for midwifery care at home and homebirth in some settings had increased [ 59 , 69 , 71 , 72 ]. A feeling of uncertainty was dominant in maternity care providers’ narratives, largely influenced by the rapid speed with which care protocols were changing [ 17 , 60 – 63 , 65 , 68 , 70 , 72 , 74 ].…”

“…Constant change and inconsistencies across settings often led to confusion and differences in interpretation [ 66 , 70 , 73 ]. Some expressed that this may have negatively influenced the care that was provided as it was unclear if the new care protocols were sufficiently evidence-based [ 69 , 70 , 76 ]. “Departmental protocols…were changing rapidly, leading to confusion and unclear interpretation by staff members… variation in practice and misinterpretation of guidance were expressed…especially where limited evidence is available” [70, p.1125].…”

“…Many maternity care providers also believed that the pandemic exacerbated existing inequalities in maternity care. The closing of some services or moving maternity appointments to virtual or tele settings were viewed as having a greater impact on at-risk communities as this group were less likely to be able to access these types of alternative services [ 61 , 64 , 67 , 69 , 71 , 72 ]. Furthermore, some maternity care providers held the view that other providers were instigating racist or sexist practices based on inappropriate or misconstrued beliefs around the risk of COVID-19 in certain population groups, subsequently exacerbating the existing challenges that pregnant or postpartum women may already be facing [ 61 , 68 , 74 ].…”

“…Some providers also held a belief that other maternity care providers were using pandemic associated changes as an excuse for inadequate care [ 69 , 75 ]. “COVID has also given practitioners justifications for many unnecessary and excessive practices; when negligence is not the issue, increased intervention is” [69, p3].…”

“…Some practice changes, however, were viewed as having a positive impact on care due to fewer women attending services which increased the time available to spend with each woman and which facilitated a more efficient service [ 73 ]. Despite the pandemic and the associated changes to care structures and provision, maternity care providers were emphatic in describing that the need for maternity care did not stop as “women’s health care needs …could not be put on pause” [15, p.3]; something which was considered unique to maternity care provision [ 15 , 60 , 62 , 63 , 69 ].…”