a rough birth for me...

[Gunter]

i have only been doing doula work since january. i have been to a mere 5 births. the last one i went to was really tough for me to be a part of as it went on. i will spare you all the details but have some questions.

in general, how do you handle it when everything is "going wrong" in the hospital setting?

and, how do you decompress after or process it while maintaining confidentiality and such?

i feel that i let the parents-to-be down b/c of how traumatic the birth of their first born was. i have apologized to them and will, again. but i don't know what else i could have done to prevent so many of the things that happened. i do know that i could have been more tolerable of the doc and nurses and other staff. it was so hard to watch my client being lied to and manipulated. it was really hard to keep a straight face or not respond as they conjoled her into one intervention after another.

additionally, i spent some time watching the nursery room through a window for the first time. it made me weep when i got home. all those babies crying while separated from their parents and being further ignored by the people walking by. all that attention given to bathing babies, etc...could have been spent encouraging bonding or breastfeeding IMHO. so much of what was being done seemed unnecessary to me. It made my head spin. i have been to two other hospital births and they were so much better in terms of keeping the mom and parents together.

would love to hear your advice. thank you.

[pamamidwife]

I think it's important to remember that you cannot prevent many things that are done in the hospital. First off, it's not your job. Let that go - it takes off alot of stress in this situation.

A doula's job is to provide information, not to keep a provider away from the patient or to protect them from their provider. If your clients want a protector, they're birthing in the wrong place.

Women choose their providers for a reason. She chose this provider and place of birth for a reason. If she wanted you to "protect" her, you took on a virtually unattainable job that is bound to end in disappointment - for all of you. As a doula, you cannot possibly change the course of institutional birth. There are too many variables - and like I said before, it's not your job!

Process it with the parents and talk about your feelings, but do it in a way that doesn't diminish their feelings. If they're happy about the experience, let them have that. Your view of the birth and dissatisfaction with it may not be their reality - don't bring that into their babymoon if it isn't. Perhaps just a discussion about how you interacted with staff is all that is necessary. That's all you had control over.

Much love to you. Attending hospital births is very hard. I don't know how you women do it.

[Finch]

ITA with everything the pp said. Bad births happen. For a supportive, caring doula to be present at a bad birth is more of a blessing than you know. You made a difference, a positive one, even if you don't feel like it.

[SublimeBirthGirl]

What, exactly, are you feeling the need to apologize for? What do you think you did wrong?

One reason I threw in the towel on doula work is I don't have the stomach for attending hospital births.

[1stimestar]

All you can do is offer information. The parents are the ones who have to say no. For debriefing, I normally go to alldoulas.com where I am a member. You can just use "mom" and "dad" instead of names. *hugs*

[DoomaYula]

I agree with Pama.

A lot of times as doulas, our hands are really tied. Which makes me wonder why you're apologizing -- did you "do" something?

I did recently apologize when I was helping a client take off her tshirt and I accidentally caught it on her IV and yanked the IV out! OMG, I felt awful.

[Gunter]

thanks for the support.

mostly, i want to (and have already) apologize about correcting the doctor when he said things that were not true about the length of labor/breast feeding/rooming in/epidurals/why to have a inter-uterine pressure catheter thing and being so upset that i could not look anyone in the eye b/c of the lies and manipulation that was happening. i took things on too personally and had a difficult time disassociating myself from everything that was happening. the nurse was giving details about what would happen in a c-section birth and i said to the mama with a smile, "well, we are not going to worry about that b/c you don't need one." and the nurse turned to me for the first and only time and said, "would you let me finish?"

mostly, i am second guessing myself. was i so horrible that they needed to talk to me like that? did i not do my job as a doula?

and then just the aftershock of seeing such things happen as a birth experience and seeing the nursery where screaming babies are ignored. those things are really hard for me to take in.

[Finch]

Originally Posted by Gunter

thanks for the support.

mostly, i want to (and have already) apologize about correcting the doctor when he said things that were not true about the length of labor/breast feeding/rooming in/epidurals/why to have a inter-uterine pressure catheter thing and being so upset that i could not look anyone in the eye b/c of the lies and manipulation that was happening. i took things on too personally and had a difficult time disassociating myself from everything that was happening. the nurse was giving details about what would happen in a c-section birth and i said to the mama with a smile, "well, we are not going to worry about that b/c you don't need one." and the nurse turned to me for the first and only time and said, "would you let me finish?"

mostly, i am second guessing myself. was i so horrible that they needed to talk to me like that? did i not do my job as a doula?

and then just the aftershock of seeing such things happen as a birth experience and seeing the nursery where screaming babies are ignored. those things are really hard for me to take in.

Okay, you must tell me which hospital. I have a guess which nurse it was.

Some nurses are not doula friendly. They hate doulas. Why, I don't know. Anyway, most of the time when a patient comes in with a doula, this is communicated in report, and anti-doula nurses usually choose not to take this patient. However sometimes meconium happens and the anti-doula nurse ends up taking the doula patient, and shows her butt in return. It ain't right, it ain't fair, but it's the truth.

As for the doctor, what exactly was he saying?

[DoomaYula]

Originally Posted by Finch

Some nurses are not doula friendly. They hate doulas. Why, I don't know.

: unfortunately. I try to go out of my way to be EXTRA friendly to nurses, but I still get the cold (and snarky) shoulder from nurses.

I sometimes have to repeat a mantra, "Not.My.Birth.Not.My.Birth." And I go home and shower and try to relax and spend some time with the kids to "get over" a birth.

[courtenay_e]

To decompress, I usually call my partner, or a couple of other friends who are in birthwork or breastfeeding support (depending on what it is I need to rant about).

To get one step ahead of the game, I actually take the time to do my own version of a childbirth education class with my clients. We go, intervention by intervention, through the list of every single one I've been able to think of, and we talk about what the parents KNOW about the pros and cons. And then I give them resources to read/hear the actual medical evidence about those interventions. Generally by the end, the partner/husband asks me for my outline so they can study it. It takes about two and a half or three hours to get through it...sometimes we do a "crash" course, and sometimes we do it in two meetings, depending on time restraints, and the attention spans of the clients. Because I've heard most of the "reasoning" the docs and staff use to get clients to do what THEY want them to do, I will ususally USE those "catch" phrases during the talk...so that it's not something new and terrifying when they hear it in labor. So, for instance, I'll say that, if they hit a labor plateau, some medical staff will come in and say something along the lines of "Well, your body just doesn't know how to have this baby. I can LET you keep doing this for another three hours, and do an EMERGENCY cesarean, or, we can just cut our losses and do it now, when everybody is healthy!" Having already heard this before, my clients are much more likely to say, then, back to said staff, "How is the baby reacting now? How am I reacting now? What would happen if we did nothing now? What would happen if we changed up what we're doing now (ie: walked, used nipple stim, took a shower/bath), but didn't have a cesarean right away?" Having our clients educated BEFOREHAND can make it MUCH easier on US. We don't have to be the one taking the flack from the nurses, because the mother and her partner are the ones "making waves"...

though every now and then, when a resident comes in and wants to do yet another vaginal exam on a mom whose water is broken (just for personal experience, not really to benefit the mom in any way)and the parents look to me for an opinion...I won't give an opinion. I give them the stats. I'll say to the PARENTS, "Well, we know that you've had four vaginal exams since your water broke. We also know that, once you've hit three exams with broken water, the chance of infection goes up exponentially. What is it you want to gain from this exam? If the benefits of the exam outweigh the risks for you, that is definately a choice that you can make!"

THere have DEFINATELY been times when I've been at work at a hospital where I've had to bite my cheek and look away. Oftentimes, it's better to look at the mom and dad and suggest that perhaps they take a few minutes to talk it over in private before they make a decision, and then when the doctor leaves, go over the things that we know to be true about that particular intervention...if that time is available to us. Or, sometimes, I'll suggest that, while they're thinking it over, I help her to the bathroom, because she hasn't gone in a while. Then, when she's in the privacy of the potty, I'll talk to her about what her take on what the doc/staff just suggested might be. Sometimes, we don't HAVE to correct the doc...the parents KNOW that they're full of baloney...because we went over it all beforehand, or the parents just know. MOst of the time it's not really worth correcting the doc to their face, because it's not like 1) it'll make our job any easier at that given point, and 2) it's not like we're TEACHING them anything or keeping them from saying it five minutes later to the laboring woman down the hall. We won't change the individual doctors by correcting them in front of patients. We will benefit the laboring mothers by giving them information with which to arm themselves beforehand.

Too, when you talk to the family about the birth...NEVER apologize for a given situation unless they bring it up. THey may be overjoyed at how things turned out! If you bring it up in a negative light and apologize for the way things turned out, you may turn what they have as a GREAT memory into a sadness that they just can't quite put their finger on. I like to ask them what they liked about what I did, and then I like to ask them how I could improve what I do. That way, if I did something they didn't like, they can tell me in a constructive manner. If they were happy with everything, I'm not "tainting" memories. And, perhaps they were HAPPY that you "defended" them when the docs were bullying...perhaps they don't think you have anything to apologize for. Maybe they do...but let them make that choice as they're digesting what happened.

Lastly, yes I agree w/pp. Most clients clearly understand that what was marginally bad could have been nightmarish, had they not had their own knowledgeable, caring support system there with them. Too, they DID put themselves in the situation of birthing where they did, with the practitioners they did. Not that ANYBODY deserves poor treatment, per se, but they made that choice for a reason, and perhaps next time, if they weren't happy, they'll make a different choice. And maybe, just maybe, they WERE happy or even expected that kind of birth...because that's what you get from that kind of place...

[Zoo Loo Naturals]

Is it possible for doulas to suffer PTSD (post-traumatic stress disorder)? Do they need support groups?

I'll give you a hug, because I have been there.

It's an interesting role to be in. Not working for the hospital, sometimes it's threatening for the staff.

[Alison Cole]

FWIW, my first doula client endured days of painful prodromal labor, and ended up having a c-sec (where she lost anesthesia mid-section and had to have general) for malposition/possible HELLP syndrome after laboring for days. I was devastated. I was sure I had failed them. Two years later they asked me to attend their second birth. Mom said, "When we talked about it, dad couldn't imagine us birthing without you there."

Of course, we want to protect our clients, and we want them to have beautiful, satisfying, low-intervetion births. But even when that doesn't happen, we offer them something so valuable: comfort, care, support. And really that's why we're there. You don't need to apologize. It sounds like you did right by this family.

[mm72873]

I just sort of ran into this thread, and as a 9 month pregnant vbac woman with a doula, a mw delivering at a hospital, I think you are underestimating your role. When I met my doula she did go over a lot of interventions I might face at the hospital and what may or may not be safer for a healthy natural birth. Yet, I feel it's important to separate two things though. I will highlight a situation in order to make my point clear.

I recently contacted my doula about possibly getting labor started through either using cohoshes, or acupuncture. Last birth, I was over 42 weeks and had to go in to get pic.....and ended up with a c-section. Through our conversation it became clear that she felt any sort of intervention on the birth's process was unnatural and made statements that made me see that she thought I should believe the same thing. My husband and I on the other hand do not feel these methods to be detrimental, especially if started at 41 weeks. I have decided to do my interventions to get labor , although I'm sure my doula feels they are not kosher. I think it's important in situations like these to check yourself and no matter what your personal idea of a perfect birth might be, to be most effective, you must feel out what these parent's idea of a perfect birth to be. I can't help to think now, even though I'm going through the inteventions (cohosh and acupuncture) that I am doing something wrong, whereas before I spoke to her, I did not feel that way.

As a doula in a hospital your help is even more needed and more important I feel. I am depending on my doula more than even my midwife for I know she will be there for me alone. Please count your successes and not the small battles lost.....see your role as one of great strength, clarity at a time of chaos and beauty....when you get too caught up in the politics of it all, you are no longer connecting with the parents.....they themselves might not ever even blink an eye at having baby in nursery for a quick shut-eye.....in the end....a loved child, is a loved child, is a loved child.......the only thing that in the end makes it a less perfect birth is a "perspective" and not a real thing.


Blessings...and wish me a happy, easy vbac birth.....soon!!!

[Finch]

Originally Posted by Alison Cole

Of course, we want to protect our clients, and we want them to have beautiful, satisfying, low-intervetion births. But even when that doesn't happen, we offer them something so valuable: comfort, care, support. And really that's why we're there. You don't need to apologize. It sounds like you did right by this family.

Exactly.

[AmieV]

courtenay, the prep work you do sounds SO AWESOME. If you feel comfortable sharing, would you mind pm'ing me just a teensy outline? I would love to put something like that together once I start working since I will be doing primarily hospital births at least in the beginning. I don't expect you to want to give up the whole thing, that sounds like a lot of work, but just an idea of where to start would be really, really cool. I personally have never had a hospital birth so it makes me a little nervous to not know exactly what goes on. thanks! if you don't want to, I totally understand too.

[DoulaClara]

Gunter,

Doulas do need to decompress and mother themselves after births. Some births more than others.

I find self-reflection in the form of a journal really helpful, too. Maybe writing down (or typing out on a Word document) the entire birth from start to finish as you remember it, and then going through and thinking, "Why does this trigger this emotion? What could I do differently another time? What could be a positive from this situation?"

As we all know, some hospitals are more doula friendly than others. Some are more heavily interventionist, and some are just plain butcher shops, especially when lower-income mothers are involved. I hesitate saying that, but after a few experiences, seeing things with my own eyeballs has altered my mindset. I am in the process of re-evaluating my own approach to prenatals, for when I resume doula work. While I will obviously take hospital births (as I feel women birthing in a hospital setting need doulas more than anyone!) I need to rethink my own mindset going in. Depending on the hospital, it often feels like going to the hospital for a desired birth experience is equivalent to going to a fast food joint for Thai food.

I agree with a PP that tells you to stop apologizing. Be there for the family, with the family. It sounds like they need some support. again- be gentle with yourself.

Clara

[birthdancedoula]

Originally Posted by Finch

However sometimes meconium happens

Finch, I just gotta say...I love ya, girl!!

S, you and I have already talked about this situation but you always know you can come over to mi casa for a little decompression, right?!?

[gemasita]

THere have DEFINATELY been times when I've been at work at a hospital where I've had to bite my cheek and look away. Oftentimes, it's better to look at the mom and dad and suggest that perhaps they take a few minutes to talk it over in private before they make a decision, and then when the doctor leaves, go over the things that we know to be true about that particular intervention...if that time is available to us.

This is what I do...a lot of cheek-biting and then trying to get a moment alone with my clients. I even tell them beforehand that if I hear something that does not sound right, I might have a chance to give them a look but I might not so they need to ask for some time to think if they want me to go over what I have learned, read, and researched.

I have heard some outright, horrible, wrong, dramatic lies! It's a hard thing to be a witness to. Especially since hearing those lies will impact some clients no matter what we do to counteract the misinformation. It's sometimes already made an impact on them.

I just tell myself that they CHOSE their care provider and they CHOSE their birth location and if I am truly about choice, then I know that what is right for me is not what is right for everyone. They get everything that comes along with their choice - good or bad. A doula's role is to enhance the relationship between a couple and their care provider, not come between them.

Hospital births can suck. The hardest part for me is watching those poor, innocent babies cry and scream without knowing where they are, where their mother is or what is happening to them. Their parents got to choose where they were born but the babies didn't.

I have been to so many traumatic births but I am always glad that the parents had SOMEONE there with them and that's what keeps me going (and getting to see that AWESOME births that come along every now and then).

It's so hard sometimes and sometimes I do feel completely traumatized. I usually debrief with another doula (without idenitifying the parents) or go to a board and write out the story. It does help.

[PapayaVagina]

Originally Posted by pamamidwife

I think it's important to remember that you cannot prevent many things that are done in the hospital. First off, it's not your job. Let that go - it takes off alot of stress in this situation.

A doula's job is to provide information, not to keep a provider away from the patient or to protect them from their provider. If your clients want a protector, they're birthing in the wrong place.

Women choose their providers for a reason. She chose this provider and place of birth for a reason. If she wanted you to "protect" her, you took on a virtually unattainable job that is bound to end in disappointment - for all of you. As a doula, you cannot possibly change the course of institutional birth. There are too many variables - and like I said before, it's not your job!

Process it with the parents and talk about your feelings, but do it in a way that doesn't diminish their feelings. If they're happy about the experience, let them have that. Your view of the birth and dissatisfaction with it may not be their reality - don't bring that into their babymoon if it isn't. Perhaps just a discussion about how you interacted with staff is all that is necessary. That's all you had control over.

Much love to you. Attending hospital births is very hard. I don't know how you women do it.

I completely, completely agree and couldn't have said it better myself.

I think that a lot of books and doula training does a huge disservice in pumping doulas up to believe that they can make such a huge different in such a crappy system.

When I first started doula-ing it was very difficult when I'd have births where there were nasty interventions and I thought I could've stopped them but there was no way I could have. I think some families also later blamed me for not protecting them as well. It later became more important to me to make sure that communication with staff was kept open and friendly so that parents could have the greatest amount of flexibility as possible and that their birth space didn't become hostile because of me.

[jlpetitte]

Wow, I could write a very, very long response to this . Gunter, I feel like you do completely. I have seen birth from different positions (but, have not had a baby myself yet). I worked in homebirth as an apprentice to start, then worked in a birth center setting, as a doula, and now I have completed my BSN and have spent 2 weeks in my new job in labor and "delivery" in a very interventive small hospital. So, I have to bite my cheek as I am DOING the terrible interventions : : , boy is that crazy!

Its just amazing to me. You meet nurses and doctors with very different backgrounds, beliefs and training. And I have to tell you that as a nurse now I realize how much my hands are tied according to the OBs you are forced to work under and hospital policy. My goal is to make some changes by becoming involved in new evidenced-based practice group, but the culture resists change. It is almost impossible to have a normal birth in a hospital and that is not your fault as a doula. Families have to be very outspoken to stand up to authoratative OBs or they really should choose a different provider and/or different setting for birth (and that is something I would tell my doula clients and so do other doulas I know). That is just the reality now.

I completely agree with what Pam and courtney_e and other PPs said.

The other really sad thing I see that many are fortunate not to see in birth center and homebirth settings-- people that don't care. Moms that don't even want this babe really and moms that really don't want to be involved in the process at all (they want to be induced ASAP, epidural ASAP, they want to watch TV and they want the baby in the nursery). So, as a nurse you see that-- not really as a doula or midwife (because generally speaking those people don't choose doulas or midwives).

All I can say is that you can't take it on yourself. Sometimes I have to remind myself that people have their own ideas and minds and they need to figure out their path on their own KWIM? I can't be responsible for other peoples choices and births, etc.



I think it will get easier for you when you can not take on that energy and just do the best you can with the situation as its presented.