April 2, 2020
The Honorable Andrew M. Cuomo
Governor of New York State
NYS State Capitol Building
Albany, NY 12224
Dear Governor Cuomo,
Thank you for your decisive, unwavering leadership during these trying times. It is so necessary and reassuring. Thank you also for signing Executive Order 202.13, which included a directive ordering hospitals around the state to allow pregnant people support in Labor and Delivery units.
There has been confusion about the directive’s phrase “immediate postpartum period.” The result is varying interpretations and implementations of this policy across different hospitals. Some hospitals are allowing partners to continue their support in the Postpartum Unit (or Mother Baby Unit, in some hospitals). Other hospitals are forcing partners to leave within hours after birth, before the patient and new baby are transferred to the other unit. Some hospitals are also banning support people in the PACU (also called recovery), resulting in no postpartum support in the event of a Cesarean delivery.
We know support for postpartum patients is just as essential as for patients in labor. The postpartum period is not only physically and emotionally taxing, nearly 40% of maternal deaths happen because of postpartum complications, namely, hemorrhage, pulmonary embolism, and infection. Being alone in a room with a newborn to exclusively care for increases the risk of these complications going unnoticed. Further, new parents that receive continuous postpartum support have improved breastfeeding outcomes and lower incidence of postpartum mood disorders--the long term impacts of that are felt long after the stay in the hospital.
Newly postpartum mothers, especially those who have undergone a Cesarean delivery, should not be left to care for their babies alone. Last week, Dr. Lauren Shuffrey, who delivered her baby without partner support, via emergency Cesarean section at Columbia Medical Center, a New York Presbyterian Hospital, was left to care for her baby alone and fainted while holding her. It took a nurse 45 minutes to respond to her repeated calls. Fainting episodes like this are not uncommon--women in postpartum units are instructed not to stand up without assistance because it is so common--and are exceedingly dangerous for patients and their babies if they are alone. It increases both the risk to the patient (injury from falling) and baby (injury from being dropped or being suffocated by an unconscious parent).
In the past weeks, New York City has witnessed the problematic effects of conflicting policies from hospital to hospital regarding Labor & Delivery and Postpartum units. Expectant parents have fled the city to seek care elsewhere; have made late-term hospital and practice changes; are having increased extracurricular or unassisted out-of-hospitals births; and have flooded public hospitals and the few private hospitals who have allowed access to partners. These conflicting policies create an increased strain on hospitals that are interpreting the Executive Order to mean that partners may stay for the duration of the postpartum hospitalization. In fact, New York Presbyterian and Mount Sinai affiliated hospitals have both seen a remarkable decrease in L&D patient admissions over the past two weeks, whereas NYU and Lenox Hill have seen increased admissions from patients who have never received prenatal care from them or affiliated private practices. We have also seen an increase in patients who are discharging themselves against medical advice, earlier than recommended, so they can be with their partners.
Inconsistent policies regarding labor and postpartum support for patients has caused mass confusion and chaos among pregnant people and their families over the past several weeks. These policies increase risks to mothers and their babies while not actively limiting exposure to COVID for healthcare workers, other parents, or infants. I encourage you to clarify the Executive Order to specifically state: “The directive of Executive Order 202.12 requiring a support person for a patient giving birth is modified insofar as to cover labor, delivery as well as the PACU and the entire postpartum hospital stay.” This would ensure the safety of postpartum patients and their babies and would minimize the risk that patients make rash, and at times, unsafe decisions about their care.
Sincerely,
Jessica Pournaras