Tuesday, August 26, 2014

"No really, you do not need a doula" A Kind Birth review and editorial


Catchy title, at first I was profoundly offended.  I guess that's the way we get people to click through and I'm glad I did.  This article is 100% true...but I do have a few little side notes.

Go ahead and read the above article, then please come back for my take on it all.

Alrighy, here we go.

There are a few different breeds of Doula's out there, just like there are OB's, Nurses, Midwives, CBE's etc.

A Doula who will tell you that she can "protect you" from the intervention of hospital medical staff without challenging your reasoning for being there is not doing her job.  Her job is not to placate you.  Even if it's an awkward conversation, her job is to tell you that the OB/Hospital that you have chosen to give birth in has a standard of care that promotes intervention.  Even if you have been with the same OB since you got your period, even if it's the closest hospital, even if all your girlfriends went to the same OB.  It is her job to challenge you because most people do not realize how powerful the intervention machine is. It is very hard to walk into a hospital and successfully find a way to say, "So yeah, I see that your rate of epidural anesthesia is 95% and that your rate of cesarean is 40%, I want to deliver here, because it's pretty/it's close to my house/it's where my Ob/Gyn has privileges, but I don't want you to do anything you normally do because I think it's unethical and disgusting after watching the business of being born, so please change everything about policy, procedure, and your standard of care for me, thanks."
Your doc may tell you that even though the hospitals cesarean rate is 35-40% (criminal) that his/her personal rate is lower than the hospitals.  He/she may tell you that your birth plan will be respected.  Please believe me when I tell you that the numbers don't lie.  Your care provider is a representative of the hospital that he/she works for, can not guarantee that he/she will be on call for you, is certainly a member of an obstetric group that has a range of styles and beliefs surrounding intervention, some of whom you may never meet.  If your hospital has a high rate of intervention and you desire a low-no intervention birth whenever that is the healthiest option, then you must align yourself with a provider that is in your corner and can demonstrate that by choosing to work at a facility that is aligned with those values.  They are out there. Know that if you have a high intervention provider/hospital and a low-no intervention birth plan, and a doula you interview doesn't challenge you, then you have one of the following breeds of doula: A. Not enough experience B. Not big enough balls to stand up to medical staff if she/he can't challenge you about this decision C. Just wants the job/experience/income and is willing to hold your hand and placate you for whatever the fee is.

I can not protect you.  I can not directly challenge you doctor.  I can do my best to guide you to ask important questions so that you are giving informed consent whenever possible, but even as a veteran doula of 16 years, I have been caught off guard by a doc that demoralizes a woman by speaking in negative hypotheticals, "If you don't dilate in the next (insert arbitrary number of hours here), we'll have to (insert arbitrary intervention here), causing her to question whether or not she can actually do this and planting a seed of doubt that (without a lot of support) can cause stress, have an effect of her labor hormones creating a self fulfilling prophecy.  I've been surprised by a doc who cuts the cord without saying a word, or giving an explanation, against the expressed written requests of the patient, stating after the fact that the cord was done pulsing....really?  Hmmm, please explain how the cord stopped pulsing 2 seconds after the birth of the baby and the full blueish purple cord blood still thick in the cord as we waited for the placenta.  NOT COOL.  It was too late, I couldn't protect her from that, never even saw it coming, the baby was fine, Mom was fine, there was no reason to expect him to do that because he had been supportive of many other "alternative birthing practices" up to that point, like laboring in the water, not offering medications, etc.  There are plenty of stories like this to go around.  Stories that would honestly make your head spin.  I don't want to frighten you, but take my work and my word for it, if you want to have a chance at a low-no intervention birth, find a doula who will challenge you, find a care provider who doesn't have a problem with a doula, who also works at a hospital that has numbers that support the goal.

Now, my only criticism of this post.  I would actually set up an initial (in person) interview before challenging a woman on these topics for a variety of reasons.  In an initial phone interview, I might not want to go balls to the wall about a big topic like this.  She has never met me before and I could come off: bossy, fanatical, or downright bitchy.   I will let her see me clearly and honestly at the interview prior to any deposit changing hands, because I want her doula to be the right person for her and these things tend to shake themselves out organically.  It may come to pass that she is not as committed to a low intervention birth as she originally believed, or it may emerge that she has fears that are unresolved.  It may be that she is simply early in the pregnancy and is just uninformed or has been decidedly misinformed, she may be placing blind faith in her doc, or it may be that she secretly wants the "out" if she decides in the moment that she needs medication. . These are not things that I'm going to bring up on the phone during an initial phone consultation unless she does, this is much, much deeper, more appropriate for the first time we meet to make sure that we are a good match.  My willingness to challenge and be honest about the hospital or care provider they have chosen, at the opportune time, may cost me the job.  That's alright because if I'm not the right fit, then I'm not.  None of these are necessarily deal breakers if she decides that she wants my services knowing that my expertise is in supporting women who are seeking a low-no intervention birth.  I want her to have the right person for her, but I need to sleep at night and therefore will not mis-represent myself or placate.

I will also take this opportunity to say that hospitals that have a list of "doula's" that they call in while women are in labor, and don't offer any alternatives, (I tried to deliver business cards to a local L&D a couple weeks ago and was turned away because of this list) are doing a massive disservice to their clients.  Without having met a person prior to labor, knowing their preferences, knowing what comforts them, knowing their personality, imagery they prefer, music they like, words that trigger stress, words that trigger relaxation, their dog or cat's name, their pet peeves, their food allergies, their other children's names, the relationship between mom and partner, spouse, boyfriend, baby-daddy, etc, without knowing a woman outside of labor and walking in thinking you are going to provide the same care that we do is profoundly offensive to those of us that spend time and energy creating a relationship.  The professional Doula is meant to be a part of the modern answer to the village of FAMILIAR and COMFORTING female elders that would have surrounded a woman  from ancient times up to about 100 years ago.  Not another stranger in her face during birth. It is a strategic move on a hospitals part to provide "free doula care" which is simply designed to be a hand to hold and not much more. Not challenging, not educating, not advocating, not supporting.  It's doesn't scratch the surface of what a real, strong, doula with integrity will do for you. It's a placating service. That does not mean that you have to spend a fortune, there are some independent free doula's out there who also have integrity, there are some who are paid fairly for their level of experience, and there are those who charge more than their services are really worth.
Need help navigating?
Call me.
I don't charge for a phone consultation if you are considering me for your Doula position.
For general consulting, I will accept a donation in whatever amount you feel I've earned.

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