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In her work guiding women through pregnancy, Shamsa Idle serves as a bridge between the approaches to birth from Somali traditions and conventional Western medicine.
As a doula, Shamsa is used to supporting women through the pain of contractions with hands-on techniques such as massage and assisting them into comfortable positions. But she’s had to put many of these practices aside as the COVID-19 pandemic has accelerated.
Individual hospitals have imposed restrictions limiting expecting mothers to one visitor for the entirety of their hospital stay. While she’s not effectively banned from assisting pregnant women in hospitals, Shamsa, like all of her doula colleagues employed by Everyday Miracles, has decided to not attend hospital births in person through the pandemic to protect herself and her family from contracting the virus.
The result has also placed financial strain on businesses like Everyday Miracles, which provides doulas to women from underserved populations. Shamsa is still, however, putting her practices to use when she can through online video applications like WhatsApp and Zoom. She’s assisted two mothers through birth virtually since the pandemic began in mid-March.
The coronavirus pandemic has been adding stress to an already stressful situation for expecting mothers, Shamsa said. “Mamas who are pregnant, they need somewhere that is stress-free,” she said.
While Shamsa can’t, for example, use her hands to guide a mother in labor to a more comfortable position, she can still instruct the mother to get into a squatting yoga position during contractions that she’s had her practice before.
The result, while not ideal, is better than nothing, according to Debby Prudhomme, executive director of Everyday Miracles, the nonprofit that employs Shamsa.
“You’ve got a familiar face, you’ve got a familiar voice,” Prudhomme said.
Shamsa’s experience with assisting births goes back to the mid-1980s, when she worked as a nurse and midwife in Somalia. There, she worked for the World Health Organization and distributed immunizations in rural villages near Mogadishu. Eventually, her work with the WHO took her to Rome to study prenatal and infant nutrition. Shortly after her return home from Italy, civil war broke out in Somalia. Shamsa and her family fled to Nairobi, Kenya. By 1997, she came to the U.S.
After arriving in Minnesota more than two decades ago, Shamsa started working as a teacher in early childhood education for the Minneapolis nonprofit Way to Grow. She also took her nursing and midwife credentials and became a certified doula.
While Shamsa is still getting paid for assisting births through video conferencing, none of it is coming from Medical Assistance, Minnesota’s Medicaid program. This is despite the fact that 95 percent of expecting mothers who use Everyday Miracles have insurance through MA. Many of these patients are Somali, Hmong, Latino and Karen.
The state Human Services Department, which manages federal aid programs, currently does not allow doula businesses to bill MA for teleconference support during the birth.
A spokesperson for the department wrote in an email to Sahan Journal that the state recently made this decision because of “the complexities and lengths of births.” The spokesperson added that telemedicine “can be very beneficial, but is not necessarily suitable for all services.”
The decision has been a huge blow for Everyday Miracles, Prudhomme said.
While her business still can bill Medical Assistance for pre- and post-natal doula services conducted by video, birth represents the biggest expense. In lieu of being able to bill Medical Assistance for its main service, Prudhomme has had to rely on donations and government grants from COVID-19 relief measures to get by.
“Right now I have money set aside for a certain number of births to pay the doulas,” she said. “But we’re having to limit the number of clients we can take.”
Shamsa’s nervousness over being in a hospital during the pandemic has also prompted her to not promise expecting mothers that she’ll be present in person for their upcoming births. If a new patient asks if Shamsa will be her doula, Shamsa starts by giving her the rundown that all meetings they have through the pregnancy will have to be done online and not in person.
“Some will say, ‘OK, but most important is, are you coming to the labor,’” she said. “And I can’t answer.”
Shamsa is currently working with three more expecting mothers who have due dates ranging from late May to late June. She’s hoping to be at the hospital in person to help during their births. But it will all depend on the course of the pandemic.
Shamsa is following her cues of Gov. Tim Walz’s stay at home order. When hospital restrictions limiting visitors to one person lift, she’ll go back to assisting hospital births in person. Until then, she’s in a waiting game like everyone else. “I’m ready to help my people, but we will see,” Shamsa said.
Non-hospital birthing can present challenges
Amid hospital restrictions limiting expecting mothers to one visitor for the entire hospital birth stay, some pregnant women are switching to other options like home birth and birth centers.
Birth centers, which are privately run, aren’t subjected to the one-visitor requirement. But women must have low-risk pregnancies and be willing to forgo epidurals and C-sections to qualify.
Rachel Voigt, a certified midwife at Roots Community Birth Center in north Minneapolis, said her organization’s patient volume is up 50 percent during the pandemic.
But anecdotally, she said not many of Roots’ current patients are new Americans. Roughly 60 percent of Roots’ patients use state-based health insurance plans and more than half are people of color. Roots, one of the six black-owned birth centers in the nation, typically serves a large Somali population, but Voigt wasn’t sure why immigrant patients seem few right now.
One reason could be how health insurance companies cover birth centers differently and in more complicated ways than hospital births, she said.
“So people wanting to switch away from a hospital into either home birth or birth centers may still have barriers to get through, even though there’s a pandemic,” Voigt said.