Secretary to the Governor Melissa DeRosa Issues Report to Governor Cuomo Outlining the COVID-19 Maternity Task Force's Initial Recommendations

Secretary to the Governor Melissa DeRosa today issued a report to Governor Cuomo outlining the COVID-19 Maternity Task Force's initial recommendations. Governor Cuomo has accepted these recommendations in full. The recommendations include measures to diversify birthing site options and support patient choice; extend the period of time a healthy support person can accompany a mother post delivery; mandate testing of all pregnant New Yorkers; ensure equity in birthing options; create an educational campaign; and review the impact of COVID-19 on pregnancy and newborns with special emphasis on reducing racial disparities in maternal mortality. The task force's full report is available here.

"In the midst of this pandemic many women are struggling with additional stress and anxiety caused by the uncertainty of this virus and how it might affect their pregnancy or birthing plan," Governor Cuomo said. "I'm grateful to the task force for their quick work, and I am accepting all their recommendations which will help tackle the problems that so many women are facing and ensure safer, healthier pregnancies for all."

"COVID-19 has caused enormous stress for women and expecting parents who are preparing to bring a child into this world in the midst of this global pandemic," Melissa DeRosa, Secretary to the Governor and Chair of the New York State Council on Women and Girls, said. "I am proud that during these uncertain times, New York is leading the way in ensuring laboring mothers are properly supported and safely cared for. The policies being advanced today will be implemented immediately to address the very valid fears and concerns that so many women are now facing, and to address issues that impact pregnancy and infants."

Recommendation One: Diversify Birthing Site Options to Support Patient Choice

The Task Force members recommend that Governor Cuomo issue an Executive Order to allow for the immediate establishment of additional birthing surge sites operated by currently established licensed birthing hospitals and centers.

The Task Force also recommends that the New York State Department of Health be directed to develop a streamlined process to accept applications from licensed health care facilities, such as community health centers and federally qualified health centers, to convert unused space in their facility to dedicated labor and delivery spaces during an emergency. The Task Force also recommends that the State limit emergency birthing centers to licensed facilities.

Further, to increase access to midwifery services, the Task Force recommends DOH move to expedite, within the next 45 days, the finalization of the licensure process for the establishment of midwifery led birthing centers in New York State to ensure there are sufficient birthing facilities available to meet community need during emergency situations.

Recommendation Two: Extend Period of Time a Healthy Support Person Can Accompany a Mother Post Delivery
The Task Force recommends that Governor Cuomo update the Executive Order 202.13, authorizing at least one support person to accompany a pregnant individual for the duration of their stay in any hospital, birthing facility or postpartum unit, as medically appropriate. This order must clarify that "duration of stay" includes labor, delivery and the postpartum period, including recovery. This order should also clarify that doulas are considered an essential part of the support care team and should be allowed to accompany a pregnant individual during labor and delivery as an additional support person, as medically appropriate. Exceptions should be made only in limited circumstances and based on clinical guidance, such as availability of PPE.

Recommendation Three: Mandate Testing of All Pregnant New Yorkers
The Task Force recommends universal COVID-19 testing for all pregnant individuals and for all support persons accompanying pregnant individuals at birthing facilities, as testing becomes available.

The Task Force also recommends that DOH issue guidance for COVID-19 testing that defines pregnant individuals as a priority population for testing and states that pregnant individuals be tested during pregnancy and one week prior to their estimated due date or upon admission if the second test is not conducted one week prior to delivery.

The Task Force also recommends that DOH monitor the availability of testing supplies to support equitable access to testing kits and laboratory analysis for all pregnant individuals in all birthing settings.

Recommendation Four: Ensure Equity in Birthing Options

The Task Force recommends work groups charged with developing standards, policies and/or regulations related to birthing options develop include participation from community members.

The Task Force also advises that DOH identify and engage community members and representatives from maternal child health serving community-based organizations to join a NYS COVID-19 Maternity Task Force working group charged with the development of a messaging and education campaign aimed at those most impacted by racial/ethnic, economic or other disparate outcomes.

Recommendation Five: Educational Campaign

The Task Force recommends that DOH engage subject matter experts, community members and representatives from community-based organizations serving maternal and child health populations to create an educational campaign on behalf of the COVID-19 Maternity Task Force. This campaign would be designed to:

• Emphasize the safety of and rebuild confidence in maternity care at all certified birthing facilities;
• Explain infection control practices in each type of birthing facility; and
• Increase patient understanding of different levels of maternity care and types of birthing facilities as well as how to work with your provider to select the appropriate patient- centered delivery.

Recommendation Six: Reviews of the Impact of COVID-19 on Pregnancy and Newborns with Special Emphasis on Reducing Racial Disparities in Maternal Mortality

The Task Force recommends that DOH work with the University at Albany School of Public Health Maternal & Child Health Program to conduct a review of the impact of COVID-19 on pregnancy and discuss a summary of its findings with the Task Force and the Regional Perinatal Centers.

DOH will host weekly statewide interactive webinars addressing the management of maternity care during the pandemic as needed as part a collaboration with the New York State Perinatal Quality Collaborative in partnership with American College of Obstetrics and Gynecology District II. DOH will also host a webinar on obstetrical care and implicit bias within the context of the COVID-19. DOH will also collaborate with the Centers for Disease Control and Prevention on a COVID-19 Pregnancy Module that will capture supplemental data on COVID-19 during pregnancy.

This module will help describe risk for severe illness or adverse outcomes among pregnant individuals with laboratory evidence of COVID-19 infection up to delivery, and their newborns, to inform public health guidance and risk communication messages.

The Department and American College of Obstetrics and Gynecology District II will issue guidance on best practices, including prenatal care, during the time of COVID, with a special emphasis on reducing racial disparities.

About the New York State COVID-19 Maternity Task Force

In April 2018, Governor Andrew M. Cuomo announced a multi-faceted initiative to combat maternal mortality and racial disparate outcomes in New York State. Continuing New York State's commitment to improve maternal and child outcomes and recognizing the significant strain the COVID-19 pandemic has placed on hospital infrastructure and the concerns of many pregnant individuals across New York State, Governor Cuomo directed the NYS Council on Women and Girls, with the support of the New York State Department of Health, to convene an expert task force to address the impact of COVID-19 on maternity. Chaired by Secretary to the Governor Melissa DeRosa, the Task Force was charged with examining the best approach to provide mothers a safe alternative, when appropriate, to already stressed hospitals amid the ongoing COVID-19 pandemic.

Comprised of a multi-disciplinary group of maternal and infant health professionals from across New York State, the Task Force met remotely to discuss these issues and propose recommendations. Given the urgency of the COVID-19 emergency and its impact on pregnant people, meetings of the Task Force were held within a week in order to make an initial set of recommendations. Recommendations were compiled and analyzed by DOH staff and shared with Task Force members, who reviewed the submissions and made a collective determination to advance the recommendations outlined below.

As the COVID-19 crisis continues to unfold, the Task Force will stay in place and consider additional ways to address issues that impact pregnancy and infants, starting with review of relevant literature conducted by DOH and University at Albany School of Public Health's Maternal & Child Health Program.

Prior to the creation of the Task Force, New York State took several steps to expand access to access to maternal care during the COVID-19 pandemic, including:

• Expanding access to telehealth and telephonic visits;
• Expanding access to midwives to ensure sufficient personnel are available to provide maternity care;
• Mandating the presence of a support person throughout the birthing process and recovery;
• Authorizing out-of-state obstetrician-gynecologists and midwives from other states to practice in New York to improve surge capacity; and
• Identifying sexual and reproductive health services as essential.

Members of the COVID-19 Maternity Task Force include:

• Christy Turlington Burns, founder of Every Mother Counts
• Christa Christakis, MPP - Executive Director, American College of Obstetricians & Gynecologists District II
• Sascha James-Conterelli, DNP, RN, CNM, FACNM - President, NYSAssociation of Licensed Midwives
• Loretta Willis, RN, BSN, CCM, CPQH,- Vice President Quality & Research, Healthcare Association of NYS
• Lorraine Ryan, Esq - Sr. VP Legal Regulatory & Professional Affairs Greater NY Hospital Association
• Rose Duhan, President & CEO, Community Health Care Association of NYS
• ​Helena Grant, CNM Directory of Midwifery Woodhull Hospital
• Ngozi Moses, Executive Director Brooklyn Perinatal Network
• Nan Strauss, JD - Every Mother Counts
• Deborah E. Campbell, MD - Montefiore Medical Center
• Whitney Hall, CCE, LM, CLC - President, NYS Association of Birth Centers
• Natasha Nurse-Clarke, PhD, RN - Regional Perinatal Center Coordinator, Maimonides
• Dr. Dena Goffman, MD - NYP/Columbia
• Rev. Diann Holt - Founder/Executive Director Durham's Baby Café
• Cynthia Jones, MD, MPH - Mosaic Health Center