COVID-19 Hospital Visitor Restrictions May Fuel Obstetric Disparities

Obstetric disparities

Maternal mortality in the U.S. is frighteningly high, and Black women are three to four times more likely to die from pregnancy-related causes than White women. This disparity persists, even after controlling for socioeconomic and educational status. A web of factors contribute to this problem, but the breakdown in doctor-patient communication due to implicit bias and subsequent testimonial injustice—where a patient’s testimony, for example describing increased pain, isn’t treated as credible due to underlying prejudice—has been identified as a major constituent. Awareness of these disparities and their correlates has prompted efforts to study and eliminate bias and ensure equitable care. Unfortunately, in states where progress has been made in decreasing maternal mortality, racial disparities have not improved.

COVID-19 disparities

COVID-19, like other health crises, threatens to exacerbate underlying health disparities. Indeed, overall mortality related to the virus has had an outsized impact on Black communities—the current COVID-19 mortality rate for the Black population is 2.6 times higher than the rate for Whites. While data are incomplete, which makes it difficult to appreciate the etiology of the disparity, there appears to be disproportionate exposure, infection, and treatment outcomes for Black individuals. Additionally, well intentioned blanket policies for addressing the pandemic and mitigating infectious risks may inadvertently stress those most vulnerable.

COVID-19 hospital visitor restrictions

Hospitals are among the most important spaces for COVID-19 response policy, and several broadly implemented hospital infection, prevention, and control (IPC) policies, specifically as they affect obstetric populations, may contradict the progress being made with regard to ameliorating racial disparities in maternal morbidity and mortality. One major policy that has affected all hospitalized patients is the restriction on visitors. Hospital visitation has been curtailed to enforce social distancing, limit viral exposure, and conserve PPE. Labor and delivery has been spared the complete ban on visitors due to the widely acknowledged health value of continuous labor support. However, national and local health organizations alike have urged limiting visitors to the minimum necessary, typically one asymptomatic adult who must remain for the duration of the hospitalization.

The therapeutic value of visitors

These visitor restrictions may disproportionately impact Black women. Health-related advocacy of visitors is critical for these patients given the known negative impact that implicit bias has on maternal outcomes, including testimonial injustice. The policies also presume a particular family model that may not reflect all patients. Furthermore, they require a support person of the patient’s choice to be able to financially and logistically adhere to the new restrictions. Socioeconomic constraints may not make it possible for one person to be able to take time off work for the duration of the hospitalization, or for childcare for any other children to be arranged independent of this support person, leaving women with the possibility of laboring without continuous support or any additional advocating voices.

Visitor policies are directly limiting the availability of in-person advocacy on a patient’s behalf. As a result, there is a possibility of increased facility-based complications without timely intervention. Black women experienced higher rates of significant complications during and following labor and delivery prior to the COVID-19 pandemic, and the potential is high for the morbidity and mortality incurred from these complications to be exacerbated by the COVID-19 visitor restriction policies. Clinicians must ensure that visitor restrictions do not compromise excellent patient care during the pandemic. Now more than ever, listening to and advocating for your patient is essential.