Are We Shooting Ourselves in The Foot?
January 9, 2010 5 Comments
Recently I had a prenatal massage therapy client come in for an appointment; we’ll call her “Client A”. On my prenatal massage client form, I have a spot for the client to request information about my birth doula service. If she requests that information, I take a few moments to discuss what her desires for birth are and explain how my support can help enhance her birth experience and help her have a positive memory of how her baby was born. I did this with Client A.
Allow me a moment to briefly share my background: I have 2 boys who were born vaginally, but with medical interventions. I have personally experienced induction, episiotomies, use of vacuum extraction, narcotics in labor, epidural, spontaneous water breaking, and AROM. I know how some of these interventions were beneficial to me or my baby and some were harmful. Fortunately, my children are healthy, happy, and show no signs of birth trauma. Knowing what I know now about these interventions, I am sure that I would have made some different choices if faced with the same circumstances today. I have provided support to 16 sets of parents and 17 babies as they entered the world, some in hospital settings and others in our local birth center. I am neither pro-intervention, nor am I against intervention. I am, however, pro-knowledge. I believe that if a woman is fully informed of both the risks and the benefits of an intervention, she can in good conscience make the best decision for her and her baby; this is her birth after all. As her doula, I support her in any well-informed decision that she makes. I carry with me The Thinking Woman’s Guide to a Better Birth by Henci Goer along with OB/Peds Women’s Health Notes to help my clients if they are faced with an intervention decision during labor. I show them the information, which includes the pros and cons, and allow them to make the decision with which they are most comfortable. I feel that this is the best way I can serve the birthing women who have invited & honored me to join their birth team.
Now, back to Client A. She has indicated to me on several occasions during prenatal massage appointments that she would like to have a doula-supported birth. This is her first child and she is apprehensive about how labor will go. She has indicated that she is not opposed to interventions, although she would prefer to be able to do things such as walk and be in a tub (which is not available at the hospital she toured). She spoke with her OB who told her that the hospital is a teaching hospital and therefore, she would be subject to the presence of and examinations by various residents and other staff. She also was told during her tour that the hospital protocol is that everyone is hooked up to a fetal monitor. While her OB is not opposed to doula support, she made sure to tell my client that the doulas that she has worked with have stepped over the line and tried to tell her how to do her job as the doctor. This caused my client to express a wish to not do anything that may cause any kind of drama or confrontation during her labor and birth.
Here’s my question: In our efforts as doulas to support women and advocate for gentle births, are we shooting ourselves in the foot? While being zealous about birth and wanting to help as many women as possible to become educated about their choices, are some of us going beyond our scope of practice and code of ethics and actually REDUCING the choices to women because we are creating battle lines with their medical providers?
As Doulas, we are not supposed to perform clinical tasks, nor are we supposed to speak for our clients or make their decisions for them.
I have no illusions about the world, myself, or birth. I know that we are in an uphill battle against insurance companies, OBs with “God-complexes”, and women who question their abilities or rights to decide how their babies are born. I know that I am not the end-all, be-all of birth professionals. I am, however, a mom who has had interventions because I didn’t know any better. I am a doula who just wants my clients to feel empowered and informed enough to own the decisions that lead to how their births evolve. And I am frustrated when a client decides to not have a doula because she is paying the price for another patient whose doula was a little over-zealous and put her OB on the defensive.
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Great question! I ask myself this a lot, but moreso, I wonder about the question before the question…What do women even want out of their birth? Do they care about gentle birth or is it lip service? Do they really care about natural childbirth or do they just know what the huge majority of women (and cable birthing shows) do for American birth…give me the drugs? Do women even know their options? Do they know the pros/cons etc?
I have HG’s book and think it’s nothing short of fabulous. I read it during pg #1 and it threw me into a tailspin. At month 7 of said pg, I opted out of OB care and had a homebirth. I’m planning hb #3 for this spring.
So I think the info is out there, but is it just the path of least resistance as in “My dr. says…” or is it read, educate, seek, learn and decide for yourself?
And unfortunately, doulas are caught in the middle. I have had women tell me “I want you to be my doula so you can fight with my dr.” I was like, “that’s not my purpose, so you’ll have to find someone else.”
Knowledge is power in this situation. An educated, well informed woman will have the most awareness of her options and likely have a desirable birth. Seems like the ones who wing it tend to wonder what the heck happened.
I don’t know…keep asking great questions though:0
Thanks Kiki! I totally agree with your set of questions too. And we are caught in the middle sometimes. I think that with all the information that’s out there, as opposed to my “pre-internet”, “pre-televised birth”, “pre-youtube” pregnancies, women have a duty to research and examine their options and rights. And then they have a duty to stand their ground when they believe their rights are being trampled on. As a doula, I have a duty to back her, whatever her choices are; but I can’t fight her fight for her.
Congrats on your HBs! I look forward to reading your blog and keeping up with you!
I think women are looking to doulas to be their voice. They want the doula to be their buffer between an experience they have no reference for and a system that they know can be disrespectful.
This puts doulas in a difficult position. I can’t say how many times I have read on a doula websites as part of their job description “advocacy”. I know to me and certainly to a concerned mother, that implies that the doula will step up AND speak up to protect the woman’s wants and wishes.
I make it clear to parents that while I will support them and be their personal advocate – that I will not speak to their healthcare providers about them wanting or not wanting interventions. I tell them that my job is to the best the one person they can count on to be nice to them no matter what…to really bring home the point that I am not there to be absorb any negative attitudes from their caregivers regarding their decisions.
I agree that it’s frustrating, but so is the system that our clients are trying to navigate. I think in days gone by that part of the “doula’s” role was to protect her friend, family member from anyone who might not be a positive influence on their birth and would have spoken up for her, told people to leave, protect her – but that was when birth was still considered normal.
Hi,
First I want to commend you on your blog. This is a very touchy topic indeed.
I think that any birth professional must keep in mind that the most important people in the situation are the mama and the baby. I think that the reason there is so much contention between OB’s and midwives, doulas, and even patients is because OB’s often approach a situation with “You must do this because I say so” and not “Here are your options, the risks, benefits and likely outcomes and what would be my recommendation as the best course of action.” I think that if more OB’s approached their patients in this way there would be less contention and less of a fracture in the practice of Obstetrics as a whole.
As for your other point, I am a physician assistant by training and I always have to be conscious of what I say and how I say it so that I don’t go beyond my “scope of practice”. I think that it is not only okay but your duty as a doula to offer your clients resources so that they can make informed decisions. From what you have written, this seems to be the case. But if and when you start “advising” clients to do one treatment or the other, then you have crossed the line because you are not a clinical provider and have overstepped your boundaries. It seems to me that you are doing a great job of explaining your practice scope to your clients and allowing them to make their own decisions while being there to support those decisions. From where I am sitting, you’re right on the money!
Hi Darline,
Thank you so much for your encouragement, I really appreciate it!