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As the coronavirus spread throughout New York, hospitals took the extreme action of limiting visitors who could transmit the virus. Several placed limits on visitors to delivery rooms, including the partners of women in labor.

New York Gov. Andrew Cuomo stepped in this weekend, forcing hospitals to allow non-symptomatic partners to be present during delivery. But Cuomo left in place another ban: one on birth workers like doulas, the nonmedical professionals some women hire to act as guides and advocates through the birth process.

“We’re really grappling with it as a profession,” says Domino Kirke, cofounder of the Brooklyn-based doula collective and training program Carriage House Birth.

Carriage House Birth includes about 100 doulas, whose work is by nature physical. On a sliding scale of fees from volunteer up to $4,000, the collective’s doulas spend time with pregnant women preparing for possible birth scenarios, advocate for them during labor, and help with breastfeeding or postpartum depression in the “fourth trimester” after birth. Kirke became a doula 11 years ago, six months after the birth of her own son.

Despite the ban, it’s work that many pregnant women consider essential. And it’s also a profession that doesn’t easily translate to the virtual realm, a reality that women who have already paid for doula services are well aware of. “There’s a feeling of abandonment and loss,” Kirke says. “We’re letting people go through the roller coaster of emotions, that they won’t have the team they paid for or envisioned.”

While doulas’ inability to accompany their clients to the hospital compromises their ability to do their job, Kirke says she and others in the profession expected the restrictions as the extent of the crisis became clear—“we were hunkering down”—and she’s torn about lifting them. “As someone trying to protect newborns…it’s a numbers game. The more bodies in the room, the greater likelihood someone could walk out of there infected,” she says.

As women nearing their due dates contend with these ever-changing restrictions and worries about the pandemic’s effects on hospitals, doula organizations are adapting. Brooklyn’s Ancient Song Doula Services, which serves women of color and low-income women, is offering virtual doula training to nurses and health care professionals interested in filling the advocate role while doulas are unable to be present during births. Founder Chanel Porchia-Albert notes that the patient advocacy role played by doulas is doubly essential for women of color, who face a greater risk of complications or death. “There’s the risk of fear-based coercion, reprisal for refusal of care,” she notes. Doulas across organizations are doing virtual prenatal appointments and appearing on FaceTime during labor.

Home-birth midwives—who typically take only three to five clients a month—are dealing with an influx of inquiries from women looking to radically alter their birth plans. Kimm Sun, a New York home-birth midwife who says that the number of calls she’s gotten in a single day has now exceeded the number of patients she typically takes per year, urges doulas to do what they do best: advocate. “They can go out and do the work of making sure the Department of Health and the government and the city are trying to get equipment to the hospitals. If they do that, there’s a big chance they’re not going to have to put in the policy of [isolating women],” Sun says.

Kirke herself is six months pregnant. She’s hoping New York will have passed its peak in the virus crisis by the time she gives birth and that the rules at hospitals will be more relaxed. “I’ve been laughing to myself,” she says. “Maybe I’ve been a doula for 11 years so I can be the best doula to myself.”