Monday, November 24, 2008

Why Can't We Be Friends? Doulas vs The Medical Community

NBC's Today Show segment (I apologize for the poor quality, but thank the person who put this on youtube for others to see.):

What a horrible story!  First of all, why interview a doctor?  Shouldn't they be interviewing a doula or someone from DONA international?  From my experience most physicians do not like people who encourage their patients to question their recommendations.  And I can certainly understand why they would feel that way.  After all, doulas are not trained to deliver or provide medical care for babies.  However, most physicians are also not trained for normal birth, they are skilled surgeons trained to look for reasons to intervene with a normal process.  The common thread here is that they both work for the expectant mother and along with the nurse they are part of a team whose goal is to give the mother and baby the best outcome possible.  

A doula sister of mine recently attended a hospital birth at supposedly "baby-friendly" hospital with a new maternity wing.  The first thing the OB did was to point at the doula and tell the laboring mother that she shouldn't influence her decisions.  After laboring for only six hours and getting clear to seven cenimeters open the doula was asked to step out while the medical staff spoke to the parents.  She was allowed back in and a short time later asked to step out again so that the staff could discuss with the parents their options.  My friend waited outside the room and the nurse came out with her things and told her it would be best if she went home.  My friend was shocked.  She left only to find out later that her client had an epidural, the baby's heart rate dropped, and her client ended up with a c-section.  It was the doctor's third c-section that day.  Later she found out that the nurse lied to the parents, telling them the doula had errands to run and that was why she left.  The nurse had simply come back in to get her belongings and bring them to her.

I have heard of doula horror stories, of course, where doulas pressure unwilling clients into natural birth when perhaps that wasn't what the mother wanted or it was a detriment to the outcome of the labor.  In any profession there are going to be those who need to find another line of work.  This would be an example of someone who has crossed the lines of doula support.

So what can doulas do to help build a sense of teamwork in the maternity ward of a hospital?

Before I walk into a hospital birth I encourage clients to inform their doctors that they will be hiring a doula.  That way they aren't surprised by my presence.  I come in with the mindset that the staff might have had bad experiences with other doulas.  I do my best to put them at ease by greeting them with respect and appreciation for being there.  I try to avoid interjecting while the staff is speaking and if I feel something needs to be addressed I will ask the mom if she wants to ask her doctor about the procedures discussed by using the B.R.A.I.N. acronym.  That empowers her to ask about the benefits, risks, and alternatives to any procedure.  Then we talk about what her intuition is telling her and ask if the intervention has to be done now.  Then she has the power to make an informed consent.  With this technique I avoid the temptation to tell her what I think she should do, which keeps me from crossing the line from empowering to pushing.  I do my very best to be the gentle voice in a roomful of people and while I am not hiding in the corner I am also not dominating the room and drawing negative attention.  If I want to suggest a change in position with the nurse in the room I will ask "I have a birth ball that I brought, do you think we would be able to use it?"  In my head I know that it is probably okay but in this manner I am respecting their "turf."  If they seem hesitant I try to find out what they are worried about, and we can often compromise "How about we keep it right by the bed so she can still be monitored?"  That way both parties get what they want.  I offer to do all of the running for the mom instead of asking the nurse for things I can easily get.  I am also sure to use the nurse's first name and always use a positive tone.  At the end of a birth I am sure to thank everyone involved.  If you think the nurse was great, praise her up and down!  Nurses sometimes work under crappy conditions and they experience burn-out pretty easily.  If the OB has an office I send a card thanking him/her for being great to work with and add a few business cards. 
Now I realize there will be situations like the one I mentioned above where the nurse was really out of line.  This sort of behavior needs to be brought to the attention of her supervisors.  Lying, manipulating, or removing a patient's right is never okay and should not be tolerated.  Just as we are advocates for our patients through labor we also have a greater responsibility to address issues that affect the well being of our clients. 

While our first priority is to our client we also have to realize that serving our client also means being respectful and fostering good relationships with the medical staff.  If we all get along and keep a peaceful and positive energy around the laboring mother can you imagine how much better the outcomes could be?    


Anjie said...

A very informative and well-written post. I wish I had never been deprived of my right to have a natural childbirth. I hope you never have an experience like your Doula friend. How awful! :(

DoulaMomma said...

Ugh - I agree that the piece was horrible.

Hey - just wanted to let you know that I linked to you/quoted you: