Visited hospital client will use.

[CMcC]

What a nightmare! I knew it was a bad hospital (first baby born there before I knew better), but I had no idea it was really that bad. Things that bothered me the most:

1) Separation of HEALTHY newborn and mother for approx 2 hours regardless of vaginal or cesarean birth!
(I thought they only did this because I had a cesarean and was developing an infection.)

2) Super small hospital with 6 rooms and 2 nurses! Whichever nurses are on staff....that's who she gets...no requesting a better nurse.

3) The nurse behind the postpartum desk doesn't know what a doula is! : I even had to tell her I wasn't a midwife after I already told her I was a student doula! I was too irratated to explain to her what my job is.

Anyway, I've got 2 articles I am thinking about printing out for nurses/doctors that give us any trouble keeping the baby after birth. Look at Implications for Clinical Practice and Kangaroo Care. I'm going to talk to my client and have her talk to her dr about keeping the baby after the birth. Do you think it would be to aggressive if I gave a copy of those articles to the heads of the hospital in hopes they'll make some changes? I really don't like doctors who don't practice evidence based medicine!

[SublimeBirthGirl]

Are there OBs who practice evidence-based medicine?

Any chance this mom will switch? I'd share these policies with her, for sure.

[courtenay_e]

I know of a COUPLE in our area, but they are CERTAINLY too few and far between! I'd certainly give the client the information to share with her doctor, and have her say something along the lines of "I understand that this is protocol, however, I am aware that immediate and constant skin to skin contact is what is best for the mother and baby immediately after birth. THerefore, that is what I will choose to do when my child is born." That doesn't leave much room for arguement, and lets them know that she understands that she's the one paying the bill. NOW, how hard she's going to have to fight for that at the birth?...Let's just say that that won't be your most relaxed birth support experience. I'm going to do two of those myself in the coming month, and I'm NOT looking forward to it. In fact, I'm seriously considering just not taking clients who have chosen to birth at this particular hospital. It goes against my principals...but at some point I need to protect my own emotional/psychic health, you know? And these places are BAD karma! At this point, though, usually what I'll do to try to effect change is when I go, point by point, through the interventions and the pros and cons, I'll say, at ROB, you'll expect THIS to be common practice, whereas, say at PABC or TB, you'd receive THIS as the standard of care. Sometimes, they just didn't know that there was any difference in practice from place to place, and the practice of ROB just doesn't fit what they want for their birth experience, so they'll switch. SOmetimes, they just say, "Oh, well, that won't happen to US." *sigh* and it invariably does. But, one can only do her best to educate...

I might also be willing to speak to the staff on the L&D and post partum units about what a doula is, how and why they are beneficial, etc. It might just make your job easier. Or not. Doesn't sound as if they're going to be exceptionally eager to change their practices...that list of protocol WORKS for them, you know? But it never hurts to try!

[CMcC]

Originally Posted by SublimeBirthGirl

Are there OBs who practice evidence-based medicine?

Any chance this mom will switch? I'd share these policies with her, for sure.

Okay, so true about OBs....

We've gone over switching doctors and hospitals several times. She keeps flip flopping. Since her due date is soon, I think I'm just gonna have to grin and bear this one.

I do plan on talking to my client about it, but I've been working with her since Febuary, and she is still very timid. This birth is not one I'm especially looking forward too. (There are other factors that complicates things.) I don't think she has ever stood up for herself.... so if this is what she wants for the birth, it's going to be more less my job to voice her preferences.

We'll see how this birth goes, I don't want to completly write off going to this hospital yet. Women who go to this hospital REALLY need a doula. Maybe I can be of some small difference that gets the ball rolling to new and better practices....

[BetsyS]

As a midwife, I worked in a practice that was the epitome of MEDwifery. We served a low income population, provided a needed service, and to really get through the job, you had to keep in mind that you were providing care to women who otherwise would not receive care. It was not the picture of true midwifery care. We also had a small "private" patient load of women who had insurance. In Atlanta, women choose midwifery care for many reasons, but honestly, not really for a true midwifery care experience.

All that to say... We had a patient that had a doula. It seemed odd to us when she showed up with a doula, because she had never mentioned wanting a natural childbirth or anything of the like. The doula was just confusing to us as her providers. It turns out that she was very shy, her dh was absolutely, terribly not of any use at all (he kept telling her how "gross" everything was), and she just wanted to make sure she had a support person there. She honestly did not care about how things went, just that someone was by her side. If I remember correctly, she agreed to an induction (at 41 3/7 weeks; we weren't that much of medwives ), got an early epidural, and she ended up with a c-section. And was beautifully happy with this experience. She got the doula just because she couldn't trust her dh to be her support.

So, I guess what I'm saying is.... I guess you should feel out prenatally why someone wants a doula when they don't really want to question their providers, change hospitals, or seem to be able to stand up for themselves.

[DoomaYula]

I say just grin and bear it -- honestly I would NOT give them any paperwork about kangeroo care (or ANYTHING that is evidence-based, ha) until after the birth. Otherwise they may flag you as a troublemaker and give you or your client a difficult time. However, when you send your Thank-You notes to the doc and nurse, be sure to add that paperwork in!

I know we've discussed many times on this board that everyone who wants a doula and can pay should have one, blah blah blah, and sometimes we attend births that plain suck for us. Just try to make her experience a positive one, no matter how it works out.

[Stephanie L.]

In regards to baby separation: what about the whole being able to decline/refuse anything stuff? Is that only for Vit. K and the like?? I would think that a demand/requirement agreed upon (pre-birth...) would allow that baby immediately into mamas arms. Anyone know about this?

[CMcC]

Originally Posted by BetsyS

As a midwife, I worked in a practice that was the epitome of MEDwifery. We served a low income population, provided a needed service, and to really get through the job, you had to keep in mind that you were providing care to women who otherwise would not receive care. It was not the picture of true midwifery care. We also had a small "private" patient load of women who had insurance. In Atlanta, women choose midwifery care for many reasons, but honestly, not really for a true midwifery care experience.

All that to say... We had a patient that had a doula. It seemed odd to us when she showed up with a doula, because she had never mentioned wanting a natural childbirth or anything of the like. The doula was just confusing to us as her providers. It turns out that she was very shy, her dh was absolutely, terribly not of any use at all (he kept telling her how "gross" everything was), and she just wanted to make sure she had a support person there. She honestly did not care about how things went, just that someone was by her side. If I remember correctly, she agreed to an induction (at 41 3/7 weeks; we weren't that much of medwives ), got an early epidural, and she ended up with a c-section. And was beautifully happy with this experience. She got the doula just because she couldn't trust her dh to be her support.

So, I guess what I'm saying is.... I guess you should feel out prenatally why someone wants a doula when they don't really want to question their providers, change hospitals, or seem to be able to stand up for themselves.

Very well said. Gives me a lot to think about. Since my client is so timid, I wonder if she was pushed into getting a doula. Their good friend just had a homebirth a couple of months ago. And then the "sister-in-law" is pregnant with a due date a couple of weeks before hers.....she is also planning a homebirth. So maybe she was pushed into all this natural birthing stuff when all she really wants is an epidural...... Hmmmm, makes more sense when you look at it that way.

[CMcC]

Originally Posted by YumaDoula

I say just grin and bear it -- honestly I would NOT give them any paperwork about kangeroo care (or ANYTHING that is evidence-based, ha) until after the birth. Otherwise they may flag you as a troublemaker and give you or your client a difficult time. However, when you send your Thank-You notes to the doc and nurse, be sure to add that paperwork in!

I know we've discussed many times on this board that everyone who wants a doula and can pay should have one, blah blah blah, and sometimes we attend births that plain suck for us. Just try to make her experience a positive one, no matter how it works out.

Yeah, you're right, I SHOULD wait till after the birth! It's just so hard when I know what's going on and I can't "save" all those other babies the heartache.... But I will wait till after the birth to send those articles.

Well said, I'll try to make her experience as positive as possible.

[khaoskat]

I would make sure that someone goes with the baby to the nursery the whole time s/he is in there. This way there is nothing done to the baby that the parent's don't want done.

Melissa S.