Posted by My OB said WHAT?!?.
Jan
19
Posted by My OB said WHAT?!?.
“…In My Medical Opinion, You Are Not Going To Dilate Anymore…”
“You’re at 7CM now, but in my medical opinion, you are not going to dilate anymore, I would recommend a cesarean section now.” – OB to mother in labor.
There are 63 comments to this post.
Like Pittsburgh Mama, I’d like to see the story behind this. If the mom was making good, regular progress then the doctor was just talking. If the mom had stalled for several hours and they had tried having her labor in several different positions to help descent and dilation, then I imagine the quote wouldn’t be here. If this statement was said after the doctor had also said, “You’re not going to get beyond 3CM” and “5CM is the most I’ve ever seen a woman like you reach,” then, well…welcome to the annals of MOBSW. 
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I was helping a mom trying to achieve a VBAC in a hospital. Well things were going slow, she was 4cm for nearly 24 hours! Well the OB came in the room and checked her and she was still 4 cm. So she said if she didn’t progress any in two hours then we should do a repeat section. Two hours went by and she was at a 7! That’s when this OB said the above quote. I almost had to leave the room, listening to all the BS this ob had to say! My client ended up with a repeat c-section because she couldn’t handle the back and forth emotions, being told she’d have a VBAC one minute and a c-section the next, poor girl was exhausted on all accounts and this was the last thing she needed to hear!
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I wonder if there is a way to encourage stupid from not coming out of their mouths in the first place. Like when re-checked and he said 7, could we throw a big party? With big 7 balloons? jump up and down and be so encouraging telling her- “You can totally keep going! Look at your progress now! Fantastic! Great work! Your totally getting your VBAC! W000 whoooo!!” Or something like that before idiot Doc has the chance to discourage her? As a doula, isn’t it your job to be sure she doesn’t get discouraged or listen to stupid crap from the doc? Isn’t it your job to provide support to prevent an unnecessarian? I’m confused by the “I almost had to leave the room.” comment. You can’t respectfully disagree, and armed with knowledge talk openly, with OB there about how in 2 hours she made it 3 cm, clearly she’s over being stalled, let’s wait 2 more hours and see how it’s going?
I’ve never seen a doula in action, so I really am curious, because I thought it was emotional support, and knowledge of evidence based medicine, that someone would hire you for? So if you don’t speak up for your client, disagreeing with the doc, to empower the mom, what exactly would the function of the Doula be? Stand by and watch her get cut?
I know that ultimately it is the mom’s decision, and she gave permission for the c-section, but you stated because it was because of emotion.
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Jen Reply:
January 19th, 2013 at 10:48 am (Quote)
Like any profession, doulas have a scope of practice, and we cannot step outside of that scope. We don’t have formal training in medicine, therefore we can’t give a medical opinion or advice. We may be 99.9% sure a doctor is full of crap, but we still can’t give a medical opinion. We can provide information in the form of studies and articles, but that isn’t really useful in the midst of labor (who can read a 10-page paper in professional language while dealing with transition contractions?).
There’s also the issue of doulas needing to work with the hospital staff on an ongoing basis. If we get beligerent and aggressive over this one case, we may end up causing the hospital to ban doulas, leaving other mothers without support. Is it okay to sacrifice the few for the sake of the many? What if we end up sacrificing the many for the sake of the few? One of those questions debated endlessly in ethics or philosophy classes.
We may be able to say something like, “Do you need some time to think things over before you make a decision?” Then when the doctor is out of the room, we can talk things through more openly. We may even be able to get creative by asking something like, “Doctor, I’m always trying to learn so I can better serve my clients. Could you help me understand what signs you’re seeing that led you to this conclusion?” But it really depends on the doctor and the situation whether something like that could work.
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Heather Reply:
January 19th, 2013 at 2:18 pm (Quote)
And here I thought the doulas job was to fight for their clients when they feel too vulnerable to defend themselves. I understand your standpoint but honstly, for me, it would defeat the purpose of even having a doula present.
I would expect a refund.
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VW Reply:
January 19th, 2013 at 6:32 pm (Quote)
If they are certified, they could lose their certification for stepping outside their scope of practice.
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Vanessat Reply:
January 19th, 2013 at 6:42 pm (Quote)
I’ve never had a doula so I might be wrong here, but don’t most doulas explain upfront at the initial interview what their scope of practice and role is? That they cannot and will not argue with the hospital staff, instead they support the mother to make an informed decision. This can include helping her ask more questions about alternative treatment options, or about risks versus benefits, but they will not tell the mother their personal opinion about the medical situation.
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Heather Reply:
January 19th, 2013 at 7:12 pm (Quote)
I never hired a doula, but often the attitude is that the doula is supposed to help the mother when she feels vulnerable. And some L&D situations are a battle, especially with emotionally abusive or aggressive doctors. Ether way, if I depended on this doula I would be sorely disappointed.
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WellBegun Reply:
January 19th, 2013 at 9:32 pm (Quote)
For me, this kind of screening happens at an interview. I go over my contract with potential clients at an initial consult. My contract specifically states what I do NOT do – clinical tasks, medical decision making for mom/baby, and speaking to staff on behalf of mom/partner. Does that mean I can’t be an advocate? Heck no. But how it’s done it’s not how some seem to expect. In almost every situation, I speak only to Mom and Dad. I can remind them of their preferences and options/information that we discussed prenatally; I can ask them if they need some time alone to think about it; I can feed them questions to ask, and alert them that they should be asking questions. This is one reason that an established relationship with a doula and good prenatal education are so important. If a mother wants me to holler at her care provider in her defense, I am not the right doula for her, and anyone who is the right doula for her may get doulas banned by that mom’s care provider or even the birthplace (if applicable).
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himom Reply:
January 20th, 2013 at 10:15 am (Quote)
During prenatal meetings, I do role-playing situations with clients, so that they are aware of certain situations that may come up, and have practiced a response. They may forget a certain situation-response while in labor, but I can remind them with a simple question, like “Wasn’t your preference in this type of situation to do XYZ?”, rather then have to do a whole education and discussion right there that certainly CAN lead to an adversarial confrontation with staff.
When a doctor feels like his power is being threatened, he can and will have the doula thrown out by hospital security. It has happened at least once to almost every experienced doula I have known. That is one of the reasons that a well-defined scope of practice, well-written contract of service, and clear discussions in prenatal meetings helps alleviate misunderstandings.
Note: I HAVE and I DO speak directly with the medical staff when it is appropriate for me to do so. Such as when a nurse is about to administer routine postpartum pitocin and the mom and doc have agreed that it would not be done unless medically necessary. I just remind the nurse that the mom has not yet consented to the dose, and the nurse needs to verify with the mom and doc before giving it.
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Kristin Reply:
January 19th, 2013 at 8:18 pm (Quote)
A doula is not a doctor.
Just like a cashier is not a pharmacist.
I’m a cashier and tons of people ask me about medications, which one they should take, how much, what dose, etc. I am required BY LAW to refer them to a pharmacist. Because I have not gone to school for pharmacology, nor do I have a degree, or a license, nor malpractice insurance (if required). Therefore I CANNOT give out medical advice. I cannot even tell someone that they can’t take a decongestant if they have high blood pressure even thought I KNOW that a decongestant will make their blood pressure go higher.
A doula cannot dispense medical advice either, unless he/she is ALSO a licensed medical professional like a midwife, RN, or physician.
They can state their opinions, and if the mother makes a decision, help voice that decision, but they can’t spout off medical advice, even if they know they are right.
It can be awful to know something but not be legally allowed to tell it to someone.
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Kit Reply:
January 20th, 2013 at 5:20 am (Quote)
I am a teacher. I can have a student in my class that I am 100% sure has ADHD or autism. But I cannot tell a parent that. Schools and teachers cannot make medical diagnoses. I can tell a parent that I observe behaviors X, Y, and Z that concern me. I can strongly suggest to them that they make an appointment with their pediatrician and discuss these symptoms. But I can’t ever give that child a label. Every profession has its legal limitations.
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Goldilocks Reply:
January 20th, 2013 at 11:13 am (Quote)
That is really interesting, you might not know this, but this does this apply to special needs teachers in your area as well?
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Aunt4God Reply:
January 20th, 2013 at 11:35 am (Quote)
Yes, it applies to all teachers. There have been cases where parents have sued teachers and the teacher ends up paying for the child’s glasses, and one where the teacher ended up having to pay for the child’s ritalin for as long as he needed it. When I was preparing for student teaching, this point was stressed to the max. We do NOT make diagnosis, and we must even be careful in how we talk to the parents about things we have been observing/suggesting to take to a doctor.
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ash Reply:
January 20th, 2013 at 12:12 pm (Quote)
Then how have schools in TN that I know personally able to tell parents to get their kids tested/put them on medication or the kids would be expelled? This happened to several friends of mine and even my 5 year old nephew, as long ago as 15years and as recently as 2 years ago.
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Kristy Reply:
January 20th, 2013 at 1:04 pm (Quote)
Cause no one in *that/those* school district(s) has been sued yet so they are still overstepping their bounds without regard to the laws.
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Aunt4God Reply:
January 20th, 2013 at 1:09 pm (Quote)
It’s not taught as a legal requirement, it’s taught as a thing where the student’s parents can and have taken legal recourse after a teacher has made comments that were diagnostic in nature. If a school does that, they are taking the risk that the parent(s) will fight back in court. There is no actual law prohibiting teacher/schools from doing this. Please don’t take your anger out on me, just because I’m trying to answer a question.
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ash Reply:
January 20th, 2013 at 2:13 pm (Quote)
I’m not trying to take my anger out on you. It was a legitimate question based in you saying that the policy “applies to all teachers” when it clearly does not.
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Ninjachc Reply:
January 20th, 2013 at 6:49 pm (Quote)
It does, as others have stated. A parent can take legal action against a teacher or school if something such as previous posters have mentioned were to happen. In the cases you mentioned, legal action could very likely have been taken but I would say now it’s probably too late, as there is probably a statute of limitations on such matters. Teachers are strongly discouraged from making diagnostic judgements in regards to their students at the risk of being sued. This I discovered first hand at a rather young age when I was not yet a teacher and didn’t know what I said could have been interpreted as diagnostic in nature.
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Kit Reply:
January 20th, 2013 at 3:38 pm (Quote)
I can’t say specifically how that would be allowed. I can tell you in my state and school district it doesn’t. My guess is that students who are identified as having an emotional or behavioral disorder cannot be expelled or suspended because of their disorder. This can cause major issues in some cases, but I think the situations you are referencing are using those rules to coerce parents into testing/ medication that the parent would not do otherwise. I would like to point out that even in your description you said that the parents had to go get them tested. The school is still not doing the testing/diagnosing. For the record, I think the school’s approach as you described it is wrong, antagonistic to parents, and legally questionable. I’m sorry for the way they treated your family.
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I started swelling at 7cm with my first and I’m sure that had I been in a hospital they would have wheeled me off for a c-section. Instead my midwives were able to have me up and marching around (a benefit of no epidural) and fed me arnica to reduce the swelling. It worked, and my 9lb 5oz baby was born a few hours later. That experience made me realize how many c-sections may *seem* necessary at the time but probably aren’t needed. It makes me really afraid for every woman. I hate to think of what the obstetric world will be like when my daughters give birth.
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I applaud you for being a doula, but in this situation I think you should have handled things differently. The client was contacting, she was making progress, and being discouraged by the medical staff. Asking for an explanation from the doctor, and a few minutes to talk to the client in private may have given her time to dilate more to prove the doctor wrong. Multiple c-sections are terrible for a woman’s self esteem where birthing is concerned.
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Jessica Reply:
January 19th, 2013 at 11:40 am (Quote)
Ultimately, it is the mom’s decision. When being presented with the “facts” by an OB, or even several doctors who are coming and going it can be overwhelming for the mother. It’s also assumed to be safer to go with what the doctor is saying than to trust your own instincts in that place and time because that’s what we have been taught our whole lives. Doulas are great. They’re not there to make decisions for the mom or stand up to the doctors who are bullying her. Her job is to support the mother in her decisions, even if it goes against what the doula wants for her.
As for what happened, shame on those doctors.
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ash Reply:
January 19th, 2013 at 11:52 am (Quote)
But I see no harm in asking the docs for a few minutes to let the mother think it over. As soon as they stop bullying the mother so she can make her OWN decision instead of letting docs make it for her then I would be at peace with what happened. Something as simple as asking for a few minutes to think then asking for a re-check could have changed this entire situation.
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Amy Reply:
January 20th, 2013 at 5:37 am (Quote)
It could also have led to the doula being asked to leave. If the doc feels the doula is “meddling”, they can just have her removed.
Being a doula is very delicate work. Many hospitals do not like us and will take every opportunity to get rid of us.
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Emily D. Reply:
January 21st, 2013 at 9:27 pm (Quote)
We also don’t know that the doula wasn’t doing this. No time frame was provided – yes, she ended up with a c-section, but it can be exhausting to go back and forth because every time the staff comes in they talk about a c-section, and every time they leave you have to build the energy back up for a vaginal birth.
I had a client recently who received an epidural largely because the nurse kept taking her husband out into the hallway for a private discussion and telling him that his wife was suffering more than she’d ever seen (total BS, the mom was coping great but was being very vocal and entering transition). Once my client’s husband lost faith in her ability to birth their baby without medication, she just couldn’t cope with it anymore.
As a doula, I won’t tell a couple that their nurse is flat-out lying to them, or that she’s completely ignorant, since their relationship with her is absolutely critical to their birth experience. In the end, they were both grateful for the support I gave them, and they had very positive feelings about their birth team, which helps them remember their birth with happiness, despite the epidural and the resulting breastfeeding difficulties. Should I have put my foot down? Maybe. But my goal for a client is NOT that she have an unmedicated birth. My goal for her is that she feel empowered and positive about her birth. Sometimes getting her the birth she planned for will require a level of antagonism with the staff – whom SHE chose when she decided on her doctor – that will diminish her birth much more than an unwanted intervention.
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Mama Wrench Reply:
January 22nd, 2013 at 3:46 am (Quote)
Then I kind of feel like hiring a doula is money down the drain. No offense, but it’s one thing to talk about preferences in the comfort of a well-layed-out office or living room; quite another to actually need help in the throes of labor and be told, “It’s your decision to make; this is what you said last week, but I can’t contradict your doctors or make any suggestions to him regarding your preferences because I’m scared I might not be able to ‘help’ the next customer.”
If you have to base your attention to one mother against your ability to be hired again — I’m really not trying to be snarky — I have to wonder exactly what the benefit is? The doulas I interviewed were asking quite a substantial sum of money for my income (some wanted upwards of $500!); if they’re taking that much to just stand there and tell me what I’ve already said without actually advocating, I’d be pissed. I’d be better off just having my sister-in-law there; at least she’s not shy about sticking up for people against the medical staff.
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Mama Wrench Reply:
January 22nd, 2013 at 3:53 am (Quote)
To be clear: When I say “advocating,” I do not mean making medical decisions, but only creating space between the mother and staff. Even asking, “Client, would you like some time alone to consider your options? I know you told me last week that you wanted XYZ, maybe a few moments alone will help” in front of the doctor, to reinforce that you’re talking for Mama and not yourself, is better than just throwing your hands up and saying “Nothing I can do about it! Don’t want to get kicked out! Don’t want to get banned!”
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Carolyn Reply:
January 22nd, 2013 at 10:16 am (Quote)
I have to agree with you. I have often found myself wishing that I’d hired a doula (there are 2 CPMs in my area that will act as a doula in hospital for $800), thinking that would have prevented the horrible care the baby and I received and the injuries that I still live with. I thought a doula was someone knowledgeable about birth that could speak up for me when I couldn’t, and if that were the case it would have been worth it at any price. However, this thread is shining a new light on what a doula actually does. Am I wrong in thinking that a doula would not/could not have helped me overcome or prevent any of the following problems from the first time around that I’d like to prevent the second time around?
*an unmediated episiotomy that I was not given the opportunity to decline, or even warned first about which was not documented in my medical records
*Immediate cord clamping that resulted in low blood volume for the baby even though I was assured that they don’t clamp immediately at a prenatal appointment
*Not being asked about any new born procedures; not even given the opportunity to witness them.
*Pushed onto my back and held down to “get ready for the OB” even though I said I didn’t want to move
* IV fluids and Pitocin (the nurse told me I wasn’t allowed to decline)
*constant vaginal exams, and the 1cm per hour time clock
*not being allowed to eat or drink
*being separated from the baby immediately after birth for more than 24 hours
*not being given the option to attend the newborn exam
*Being told repeatedly by the nurse that moaning through contractions was annoying and that I should stop
*having a nurse that refused to page the anesthesiologist because she didn’t believe me when I said my epidural wasn’t working
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Mama Wrench Reply:
January 23rd, 2013 at 3:53 am (Quote)
It sounds like, for mothers whose doctors are verbal and actively engage mothers in their health care options and procedures, doulas would be wonderful. But here in the real world, mothers don’t only need someone to rub our feet and tell us how beautiful we look. I have my husband for that, and he’s free.
If hospitals and physicians were actually upfront and asked mothers before doing anything, then of course doula “support” would be ideal, by reinforcing the mothers’ wishes and reminding her of her original intentions. But mothers can’t see everything going on behind the scenes (unwanted, unconsented procedures happen all the time, often with mom only being informed after it’s done); how can she possibly be “empowered” to make a decision when the choice is never offered? Doulas advertise as though they protect mothers’ wishes in the often hostile hospital setting. If that’s not the case, then — like Jane said — some other level of support, with legal backing, is necessary.
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Emily D. Reply:
January 22nd, 2013 at 7:30 am (Quote)
It just depends on why you’re hiring a doula, I suppose. I’ve hired a doula for my upcoming homebirth, but her purpose isn’t to fight, it’s to be physical and emotional support for me and my husband. My husband is terrible at massage, and he’s stressed out enough at just starting a new job right before our first baby arrives that he will need someone else there to tell him, hey, this is normal, it’s okay, here’s how you can help. That’s what my doula is for. If my midwife suggests something that I don’t want, I’ll tell my husband and he can argue with her while my doula continues to focus on me and my needs.
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Jane Reply:
January 22nd, 2013 at 9:01 am (Quote)
I think what a laboring woman needs is a labor lawyer. A paid advocate who will come into the labor room and do nothing but argue and document and ensure the mother’s wishes are respected.
Doulas weren’t supposed to be doing that job. Their job was to do the job originally slated for L&D nurses, to comfort and suggest and ease. What most of us are looking for when we’re thinking “doula” is “bulldog advocate who will stand up for me when I can’t do this for myself.”
And the first thing that Labor Lawyer would do would be to walk in with a copy of every legal right the laboring mother has, and when the doctor says, “I don’t work with labor lawyers,” the labor lawyer replies with every legal statute that allows him or her to be right there, documenting and advocating, and would the doctor care to put his or her objections in writing?
This is unnecessarily adversarial. But many of us have felt we needed that, or wished we had that, when the hospital itself became unnecessarily adversarial.
It isn’t the stated job of a doula, though. Doulas should be there to support the mother’s emotions and physical needs during labor.
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Carolyn Reply:
January 22nd, 2013 at 10:21 am (Quote)
I understand, I was picturing a bulldog who would remind the OB what the mother has and has not consented to, but apparently that is not the case. And that is good to know.
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Michele Reply:
January 22nd, 2013 at 2:29 pm (Quote)
I totally agree. I am a lawyer, and actually had a list of legal rights printed out to bring with me to the hospital. I also had a colleague on speed dial, and my husband was instructed to call her immediately if any attempted forced action was tried. Thankfully, my birth went as well as I could have hoped, I got the CNM I loved from the beginning, and so it was all for naught. But just knowing that I had a legal retort for pretty much anything the staff could come up with was a great comfort to me. And I still had a doula, because she was there to help me make positional suggestions, massage, reassure me that wanting to give up at the end was normal, etc.
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Jan 19, 2013 @ 11:40 am (Quote)
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I have to agree with several other posters above me. I hope you didn’t charge this mother for your Doula serves because you didn’t do your job. There are several other things you could have done other that restrain yourself from leaving the room including taking the father aside and telling him that his wife was being railroaded. This OB was terrible, but you weren’t much better. This woman pregressed 3 cm in 2 hours! That is 50% better than what doctor believe is “average.” And you sat silent and didn’t redirect the conversation by speaking directly to the doctor, directly to the mother, or directly to the father. You need more training in how to handle people during stressful situations.
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I don’t think it’s fair to blame the doula for this. Ultimately it ended up being the mothers decision. It says that the client couldn’t handle the back and forth emotions being told she was having a VBAC and a c-section. That alone implies that someone was telling her she could still have her VBAC. It sounds like the mother just gave up on fighting for a VBAC as she was emotionally exhausted.
A doula is there to support you emotionally and inform you of your options. They are not there to pick a fight with the dr on your behalf. Only the mother can speak on her behalf and make medical decisions. Not the doulas fault if the mother consents to something she really doesn’t want.
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ash Reply:
January 19th, 2013 at 1:07 pm (Quote)
There are simply too many ways the doula could have changed the situation. As details pointed out , something as small as telling the husband the woman was being railroaded or asking the mother for few minutes to think it over then asking for a re-check. Instead, she sat quietly “trying not to leave the room” rather than telling the mother that the doctor was spewing vs.
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Bonita Reply:
January 19th, 2013 at 2:07 pm (Quote)
This kind of attitude is very demeaning to mothers. We do not need someone standing over us making our decisions. In the end, it is our own responsibility to determine how much BS we are going to listen to. I was a “good patient” for my first birth and ended up with almost everything but a C-section. I took that experience and stiffened my spine. I am now extremely skeptical of everything that comes out of a Dr’s mouth unless they give me a reason to trust them (having a medical degree, or a good personality is not enough). As long as we act like women are not responsible for their own decisions, they will see themselves as victims and not as their own advocate.
Trust me, if the job title of “obstetric bouncer doula” existed I would be there with my BS flag and everything. But in the end the woman has to put some fight into her and take control of her own life. If she depends on others to always defend her or feed her decisions she will never be empowered. A doula is a part of a support system, which means that the woman is ultimately in control of her decisions and everyone else helps build her up.
I can tell you are very angry, I get angry too. I get angry when I think of how mistreated I was during my first birth. I used to get angry at my husband for not telling me no when I asked for an epidural after 12 hours on Pitocin. I eventually had to own my own failures and weaknesses that led me to the point that I actually accepted the Pitocin (when everything went downhill). I, and only I, am responsible for the mess that happened when my daughter was born. I took that and have now had two homebirths because I knew that going back to a hospital would do nothing for me. I made different decisions, I didn’t through myself back into the fray that a hospital birth was and hope for a different outcome. I would have had a C-section with my second birth had I just gone along and chosen the same path but hope that it would have a different outcome.
The doula cannot stop a trainwreck if the mother has put the train on that course.
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Emily D. Reply:
January 22nd, 2013 at 7:31 am (Quote)
We also don’t know that the doula wasn’t doing this. No time frame was provided – yes, she ended up with a c-section, but it can be exhausting to go back and forth because every time the staff comes in they talk about a c-section, and every time they leave you have to build the energy back up for a vaginal birth.
I had a client recently who received an epidural largely because the nurse kept taking her husband out into the hallway for a private discussion and telling him that his wife was suffering more than she’d ever seen (total BS, the mom was coping great but was being very vocal and entering transition). Once my client’s husband lost faith in her ability to birth their baby without medication, she just couldn’t cope with it anymore.
As a doula, I won’t tell a couple that their nurse is flat-out lying to them, or that she’s completely ignorant, since their relationship with her is absolutely critical to their birth experience. In the end, they were both grateful for the support I gave them, and they had very positive feelings about their birth team, which helps them remember their birth with happiness, despite the epidural and the resulting breastfeeding difficulties. Should I have put my foot down? Maybe. But my goal for a client is NOT that she have an unmedicated birth. My goal for her is that she feel empowered and positive about her birth. Sometimes getting her the birth she planned for will require a level of antagonism with the staff – whom SHE chose when she decided on her doctor – that will diminish her birth experience much more than an unwanted intervention.
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Carolyn Reply:
January 22nd, 2013 at 12:58 pm (Quote)
“Sometimes getting her the birth she planned for will require a level of antagonism with the staff – whom SHE chose when she decided on her doctor”
The mother does not choose the staff, it is a consequence of her decision to hire that physician, but not something she has any control over. It isn’t like a doctor warns their patients that the hospital they practice in has employed some god awful people and that anyone birthing there is likely to be abused. I’ve also never heard of an OB who says to a patient, “Really, I’ve been stringing you along all this time; I’m not going to do any of the things I’ve agreed to. In fact the care I provide will be not only detrimental to your emotional health, but your physical health as well.” or “I’m great, but the other doctors in my practice are jackasses.” Until medical personal are under the same truth spell Jim Carry was in the movie “liar, liar” it is very unfair to put that much responsibility on the mother’s choice of physician.
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Emily D. Reply:
January 22nd, 2013 at 3:10 pm (Quote)
That is an excellent point, Carolyn. I know that hiring a midwife – in whatever birth setting – is not feasible for every woman, and I do think that hospitals should be more focused on customer service and facilitating women’s needs and desires. But a doula cannot give birth for a woman, and like I was taught in my doula training, you can’t work harder than the mother is. Birth is emotionally, physically, and spiritually demanding. If she doesn’t want an intervention, she has to say no. I will tell my clients over and over again, “I think you can do this,” but when they decide they can’t, that’s it. I can’t reboot their desire for a natural birth once they decide not to have one. And I SHOULDN’T, because as a doula, my job is to support the mother’s decisions and help empower her to make those decisions in a way that she will be proud of later on. I don’t know every woman’s pain tolerance level, and every woman copes differently. If she is asking for an epidural, not just during contractions but between them, despite everything that I am doing, I don’t believe I should tell the staff that she doesn’t mean it. I also believe that I’m still doing my job, and doing it well.
I wasn’t there for this particular MOBSW gem, but I think that doula-blaming is just as hurtful and useless as mother-blaming. Why is the doula being attacked more than the OB who decided that a mother who dilated 3cm in 2 hours wasn’t going to progress any further?
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details Reply:
January 22nd, 2013 at 4:22 pm (Quote)
So what you are saying is once she has drunk the Kool-Aid that it is best not to point out to her that she has drunk the Kool-Aid because that might spoil her happy memorizes? Yes, let’s please throw out the concept that when we know better we do better and all live in ignorance!
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Anon Reply:
January 22nd, 2013 at 5:16 pm (Quote)
I think it’s more a matter of not shaming or blaming the mom and making her feel like a failure. What you want to do and what you, yourself capable of doing are two separate things. The pain and physical factors of giving birth are not something you can really prepare yourself or know how you will cope with beforehand.
I would like to be able to run a marathon, but reasonably I would be lucky if I make it a mile even with someone encouraging me and telling me that I can do it. I think labor and a race are similar in many ways. You can have all the trainers as support you want, but at the end of the day, it’s you (the mother) who decides when you’ve had too much and you can’t take anymore. We don’t blame the trainers when the runner gives up. We also don’t blame or shame the people who do end up dropping out of the race.
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Details Reply:
January 22nd, 2013 at 7:12 pm (Quote)
My point was that I would have to tell the couple that their nurse was lying to them and that Dad should stopped allowing himself to be removed from his wife’s side. I would also have to point out that they could request a more supportive nurse without telling her why. Being nice and keeping one’s mouth shut doesn’t always serve well. Not that being a b*tch to the nurse would be a good idea either. Of course sometimes you don’t find out what the nurse was doing in the hall with dad until it is too late. But if the mom says I’d like to birth again what could I do to have a more natural birth next time, you tell her the truth.
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Details Reply:
January 22nd, 2013 at 7:14 pm (Quote)
It’s that one of our big complaints witht he doctor’s that they don’t tell us the truth. They should tell us the truth we can handle it. Well same thing with your doula. She should tell you the truth in a respectful way and assume you can handle it.
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I understand You ladies wondering what the heck I was doing. We did talk and had the doctor leave the room. I encouraged her and told her how wonderful she was doing! She was just in tears. What you have to understand if you are not a doula is that the doctor will almost always trump the doula in a mother’s mind during the midst of labor. So if the doctor says this and the doula says that, 99% of the time the mom will do what the doctor suggests. It is against the code of ethics from an organization I’m a part of to confront or question a doctors opinion while they are present. I did try to help her understand that I thought she was progressing beautifully. I honestly care for all my moms and it broke my heart to know that I tried my best and it wasn’t enough to reverse the damage the doctor’s words caused.
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Bonita Reply:
January 19th, 2013 at 2:33 pm (Quote)
I am one of the rare women who would listen to a doula more than a Dr (while using my common sense) thanks to how mistreated I was during my first birth. It makes me sad when people blindly trust medical “professionals”. I don’t blame you at all, because in the end the woman is going to feel violated whether it was the Dr or her doula telling her what to do. True empowerment happens when the woman makes the right choices on her own to prevent a trainwreck. A doula is just a facilitator.
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I agree, which is why I always make sure they understand that they always have the right to refute or question anything the doctor says. It’s always their own choice. I’m sorry you had such a rough experience. In end she was the one that chose the section, although it really made me sad.
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What I think the posters who are blaming Doula D don’t understand is that the doula does not have any medical decision-making power over or for her clients. That is only up to her, her spouse or her medical proxy/power of attorney. I *always* tell my clients, long before their birth, that I am not there to “save” them from the doctors or nurses and it is not my job to tell the staff what her choices are. I WILL:
-offer leading questions to my client to help her verbalize her choices (i.e. in front of the nurse or HCP, “Doula Client, remind me, were you planning for your baby to have the Vitamin K shot?”)
-do my utmost to make sure she has both sides of the information in the situation
-do my very best to make sure she is aware before a procedure, etc it about to if the medical staff has not said anything (i.e. “Doula Client, Dr.Your OB would like to use a vacuum to help your pushing efforts. Are you OK with that??”) so she or her partner have time to consent or refuse.
Remember, doulas are about empowering women and families to take back THEIR births. A good doula shouldn’t have a savior complex any more than a good doctor or midwife should!
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Doula D, I bet you did a fabulous job supporting this mom! I have been in many similar situations in my doula years and I imagine the situation went something like this:
Mom has already been in labor for well over 24 hours and is fed up with everything. She just wants to be done and wants to be done. She might have even been medically managed through her pregnancy and is tired of hearing all these things, sorting out the BS, advocating for herself on every little dang thing and so forth (even in my own pregnancy I got that way and consented to some things I didn’t think I would because I was so tired of having each thing be an issue on some level).
Doctor comes and gives her crappy news after amazing progress and doctor leaves the room. She is already upset and near to giving up with the doctor’s words, but you soothe her and tell her how great she has been doing. You cheerlead, you praise, you remind her of what she learned prenatally. You talk about the options and tell her how things will move faster now that she is seven and is in or approaching transition. She smiles and says thanks and hems and haws but keeps having that voice of the doctor in her head say she isn’t going to dilate any more. Sure, you say it might only be another hour…and then she could push (which she remembers may take a while). But of course it might be more than an hour, no one can say for sure. What if she does wait three more hours and doesn’t actually make progress like the “amazing” doctor said? And then she’s worked so hard and waited longer and still doesn’t have her baby.
Back and forth you go, with lots of encouragement and reminders and praise. But she is exhausted. And has to wonder if there’s at least some truth to the doctor’s words and says that, no, she has worked so very hard and is so tired and knows that if she consents to a cesarean that she’ll be done and have her baby and the rest of labor, or lack thereof, will be “easy.” It doesn’t matter about recovery or risks or anything like that. Right now, in this exhausted mom’s world, despite all your efforts and reminders, she is done and sees only the immediate “relief” of a cesarean birth.
I’ve had a couple moms go there over the years. And like I said, I gave way on a couple things I never thought I would (small things that didn’t really matter, but still…) when I was just plain exhausted with advocating for myself.
I have a feeling you did an amazing job and that mom in the end did what you taught her to do: to get the information, think it over, ask questions/advocate for herself and then gave informed(ish) consent. And as her doula, I bet you were there with information every minute of the journey and stayed by her side with all the more support and encouragement even when she chose something you felt would have been the wrong decision for you.
I’m sorry that both you and mom/family had to go through that and deal with doctor’s BS. But I’m glad she had you there with her to keep her options as open as she would have them be.
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Doula D, I’m sorry people are blaming you here. People are being extremely quick to judge. You “almost had to leave the room, listening to all the BS this ob had to say.” You didn’t; you “almost” had to. We’ve all been there, so infuriated at some nonsense someone is spewing, but it’s not our place to argue with them.
A doula is NOT there to make decisions on the mother’s behalf. If only it were the case that all patients with doulas had perfect care, in L&D and otherwise. A doula can only help a woman. She can remind her of her plans, remind her to ask questions, suggest changes of position, relaxation techniques, etc. She can’t, and definitely shouldn’t, take over the role of making decisions for the woman just because she “knows better” any more than a doctor should do that.
Doula D – I wasn’t there, I don’t know anywhere near enough facts to know whether you did or didn’t perform the role you told your client you would perform, so I wouldn’t presume to judge. I am very thankful for the existence of doulas, though, particularly mine.
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Something similar happened to me, although the message was delivered much more nicely and with more medical info. I stopped progressing around 6cm even though I was having super-intense close contractions. Midwife suggested we try Pitocin (and epidural so I could rest and handle the contractions). I was GBS positive and water had broken, so there was a bit of a time limit involved. But it was up to me to make the decision and since she wasn’t med or C-section happy I trusted her judgment. The Pit worked, and turns out that my son had his arm up by his head…definitely a bit more work to get that through!
It would be interesting to see the pink link to see what led up to this point. I do have my suspicions, though…
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