Being Pregnant in a Pandemic, and Preventing Disrespect and Abuse in Childbirth

As a reproductive healthcare expert and advocate, I didn’t imagine myself making a big announcement about my pregnancy, but here I am doing just that.

I’m pregnant.

And I am constantly thinking about COVID-19 from the lens of a researcher, an advocate, a parent to two teenagers—and now, a pregnant person. 

And as timing would have it, this week marks the sixth annual International Day for Maternal Health and Rights, a day to champion and promote a rights-based maternal health care framework for women.

For the past six years, I have written about disrespect and abuse in childbirth and respectful maternity care—but this year is something entirely different. 

I had been trying to get pregnant for about six months on last year’s International Day for Maternal Health and Rights. I had started fertility treatments. I realized that I might be pregnant while conducting research on sexual and reproductive health and rights in Malawi, so I switched to a different anti-malarial; the kind that a pregnant person can take.

Aside from pregnancy planning, my day-to-day engagement was somewhat as it always had been: conduct research, advocate.

As the year passed, I kept trying to get pregnant. I looked at calendars and hoped conferences and travel didn’t align with ovulation. Then, one day, it happened: I found out I was pregnant. 

While discussing research methodologies on a conference call with a colleague I had never met, I miscarried on the toilet. I put myself on mute, put the fetal remains into a cup, and took a car to the clinic to drop off the remains for testing.

I joined my next conference call destroyed. I mourned. I threw myself into work. I tried to get pregnant again. 

I finally got pregnant in 2020. And then there was the coronavirus.

I knew my husband wouldn’t be allowed into my appointments anymore. I wasn’t sure about delivery. As my nuchal scan approached—the scan where the doctor looks for fetal abnormalities and viability—I considered how and where I would get a dilation and curettage (D&C) if I were told the fetus wasn’t viable.

If I had to get a D&C for a very wanted pregnancy, would I do it in a hospital—and would I then end up exposed to coronavirus? Would that mean that I would spend 14 days in isolation in order to ensure that I didn’t pass the virus to my family?

I know what it feels like to lose a wanted pregnancy. I wasn’t fully prepared to handle that in isolation.

I started to think about what else I couldn’t handle in isolation: things like disrespect and abuse (D&A) in childbirth.

What Is Disrespect and Abuse (D&A) in Childbirth?

D&A—sometimes referred to as mistreatment, obstetric violence or dehumanized care—can be defined generally as “interactions or facility conditions that local consensus deems to be humiliating or undignified, and those interactions or conditions that are experienced as or intended to be humiliating or undignified” (Freedman et al., 2014).

The definition of D&A in childbirth gives us a clear path to navigate not only disrespect and abuse in childbirth, but also what is happening right now with COVID-19. D&A is defined at the individual level, the structural level and the policy level.

D&A isn’t only experienced at the individual level—it is enforced by structural inequalities upheld by policies that fail to support providers in giving proper care.

In COVID-19 conversations, the problem is pitted at the individual level—whose rights are more important: those of the pregnant person laboring alone, or those of the medical provider taking care of them without the proper personal protective equipment? 

This is the wrong framing. We need to focus on the structural and policy level. My dearest friends, people I have loved for years, are the doctors at the frontline of the COVID-19 response in Manhattan and Brooklyn. They are the ones saving our lives. They are sitting with us as we die alone. I refuse to accept the argument that our needs cannot both be met. I would suffer any pain in isolation to protect their health.

But I shouldn’t be asked to. Why are the laboring people and those on the front lines forced to give up their rights to health and safety?

 D&A: Signaling a “Health System in Crises”

The definition’s authors describe D&A as a signal of a “health system in crises.”

Certainly, that is what is happening with COVID-19.

The struggle of patients and doctors to stay alive; to keep each other alive, is the alert signal of a system collapsing without the strong support of hospital infrastructure and government accountability. Answering a heroic call to duty, doctors are reporting to respond to COVID-19 outside of their trained specialities, at times without assurance that they will be protected.

In the meantime, the United States is recklessly trying to limit states’ access to stockpiles, ignoring recent guidance from the WHO that states that ensuring “space, staffing, and supplies are adequate for a surge” should be the highest priority for countries. Doctors, left without PPE, are demanding support from the government—even as their jobs are threatened by their hospitals for speaking out.

Of course, there are impressive state legislatures leading the response, even ensuring that a support person is present for labor and delivery continues through the pandemic.

However, the lack of coordinated response at the federal level, with policies in place that protect providers and patients is ultimately a failure of leadership. 

On this International Day for Maternal Health and Rights, I am thinking about more than the individuals, more than my pregnancy, more than my doctor friends.

This isn’t an argument for my safety over my friends’ safety.

I have a problem with this system that harms us both, that neglected our health and put us at risk. That decided our rights could be ignored. These incompetent, irresponsible and cruel policies that have left us all stranded, without the support of PPE, without the support of each other.

The coronavirus pandemic and the response by federal, state and local authorities is fast-moving.

During this time, Ms. is keeping a focus on aspects of the crisis—especially as it impacts women and their families—often not reported by mainstream media.

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Bergen Cooper is the Director of Policy Research at the Center for Health and Gender Equity. She graduated Magna Cum Laude from Barnard College with a B.A. in Women’s Studies and received her MPH from Columbia University where she concentrated in sexual health.