Doulas--are there places where you won't attend births?

[ajmckay36]

I'm really struggling with this question of late.

We have several hospitals in our area...NONE are natural birth friendly. I have accompanied clients to natural births in these hospitals on several occasions but I've also had my share of births gone down the drain because of hostile nurses, OB's who insist on doing *something* and so on. As a doula I've been treated disrespectfully by the nursing staff on several occasions at one of the hospitals. Said hospital has an induction rate of 90 percent (yes, you read that right)...only 2% of births are unmedicated, no nurse midwives...sigh....it's really sad.

On a positive note we do have a hospital across the river in Indiana where we have a VERY progressive OB (homebirthed her children & is a friend of mine from our local birthnetwork) and two nurse midwives. This hospital is very natural birth friendly...very low c/s rate, most of the nursing staff has delivered naturally...wonderful environment to work in. We also have two very lovely DEMs in our area and I love to attend births with them.

My dilemma is this--I'm considering limiting my practice to births at home or births in the Indiana hospital. I feel slightly guilty about this...but at the same time, I have come away from births at our area hospitals feeling defeated & discouraged. I know I need to work for change, but I just don't know if I want to put myself "out there," if you know what I mean. I get tons of business (I'm also a Bradley teacher) so I can pick and choose...but I just don't know.

Any insights? Am I being too hard on myself for NOT wanting to work in an unsupportive environment??? Or do those women need my help the most if they choose to birth there (even if they know how toxic of a place it is...???)

[courtenay_e]

You know, I am struggling with this very same issue myself right now. I'm sick of being treated like a zealot who is keeping the client from having pain relief by the staff, and sick to death of poor outcomes because couples are choosing to put themself in a place with high epidural rates, high induction rates, and high cesarean rates, even though they've been given the information about those rates. I believe that this is simply a symptom of "oh that won't happen to me"-ism that so many americans have.

I am thinking that I WILL attend the births at the icky hospitals, but with the personal understanding that I have to put up more of an attitudinal and psychic barrier around myself. I need to better understand that this birth place is a CONSCIOUS CHOICE for this couple, and that whether or not they have an outcome with which I am comfortable, it is that with which they are comfortable, because they knowingly chose it. I support their birth plan to the best of my ability with the tools I have been given, in that environment...and that that is allll I can do. I think that they deserve to have the support that I am able to give, considering the environment...but I will no longer stress about offering more than I can give.

[Kirsten]

Hmmm... I'm not a birth professional (just saw under new posts) and haven't used a doula - but did take Bradley and have incredible births using that method!

I understand why you are considering working places that have a higher liklihood of successful natural births. It would really make a bold statement to have prospective clients tell you they are birthing at X hospital, and to hear that you don't attend births there because the chance of a natural birth is just too low. As a pregnant woman, that would really make me stop and think - this doula won't even attend births there! Might worry me into looking at other options.

So it could affect change in a way different than you'd originally thought.

Is choice of hospital something that you discuss with prospective clients now - in regards to their chance of natural birth at different options? My midwives told us they transfer to a Seattle hospital, instead of the one a block away, for non-emergency transfers because the Seattle hospital is more natural birth friendly. Being that they work in the birth system every day, I took that recommendation very seriously, and would choose the hospital they recommend if I ever found myself needing one for pregnancy/birth reasons.

[tlcdoula]

I think each of us needs to decide what is right for us. I will attend births at any hospital within my area because the way I see it - this is about the mother and not about me and how I might be treated. In most cases (from what I have seen) if a mother is looking to hire a doula she will do so but in most cases will not switch hospitals or doctors. So the way I see my role is making the birth the best that I can. Yes, I do talk with moms prenatally and I have had a few switch doctors or birth places, but no matter what I think all women deserve a doula. We do not know what the reason is that these mothers are choosing these doctors or these horrible hospitals.

Also the way I see it is that I can make a difference. I can make a difference for the mother whose situation would most likely be worse if I wasn't there and I might just be able to make a difference with the staff. It might not be something that happens instantly, but I can tell you that there is a local hospital that I have gone to a few times. The first couple of times I was looked at like I had a disease. The staff wasn't particularly nice, but that was okay with me. I wasn't looking for them to be nice to me or for their approval, but after going there a few times it was nice to see them changing their tune towards me. By the time my niece had her baby at this particular hospital the nursing staff was amazed at what a beautiful birth my niece was having and how fantastic myself, her mother and the mother worked together. Our nurse even had other nurses pop in to see how fantastic I was with the mother and how doulas weren't all horrible or bad.

Like I said - we each need to decide what is right for us. As of right now I will not limit where I go because regardless of whether I like that birth facility or not I believe that the mother deserves a doula and one who will care about her and help her wholeheartedly. I do work with them prenatally and like I said there are mothers who will change doctors but then there are mothers that won't. I don't feel that it is my job to "save" them, but instead am there to help them find information and made educated decisions that are right for them.

[Kitten]

You might consider that some people have NO CHOICE about where they can birth. My insurance will only cover one area hospital. If I were too high-risk for a homebirth, I would have to go to that hospital. I don't think this hospital is as birth-friendly as the other hospital in town. I would be completely crushed if I had to give birth there and no doula would attend me there. It's the women stuck at the crummy hospitals that need the tigers the most IYKWIM.

I'm sorry it stinks so much for you. I used to work in similar circumstances (as an advocate and assistant, just not in the birth field) and it could be really exhausting sometimes.

[Shazer]

I'm considering becoming a doula and the local hospital has two doctors who deliver. When I went in after problems with a homebirth, the doctor on-call did a very short exam before he declared that he would only proceed with a c-section for me. Therefore, I have no desire to face him ever again. If I become a doula, I don't know how I could do it. It is such a tough thing to deal with people in such opposition to your beliefs. Whatever decision you make, it has to be with what makes you feel comfortable and in what situations you believe you can help. Best of luck!

[DoomaYula]

I'd LOVE not to ever attend a birth at Yuma Regional Medical Center; however it's the only hospital for over 50 miles and we don't have any homebirth midwives. So then I wouldn't be a doula really.

Personally, I think where there's a will, there's a way. If a client wants a homebirth or a birth center birth -- or a birth in a hospital that's farther away -- she'll find a way.

[Stephanie L.]

I feel we each must do what's right for ourselves, of course. But the more I hear of these desperate situations (like excessive epi/intervention rates) the MORE I think doulas are necessary. Sooooooo many women don't have any idea about their choices in birth~~thank goodness you/we are here to help!!

When I first started looking into being a doula it was for homebirths. But the more I learned, I discovered how much more doulas are NEEDED in hospitals. I certainly don't LIKE working there, but mamas need help!!

[Jilian]

Originally Posted by Stephanie L.

I feel we each must do what's right for ourselves, of course. But the more I hear of these desperate situations (like excessive epi/intervention rates) the MORE I think doulas are necessary. Sooooooo many women don't have any idea about their choices in birth~~thank goodness you/we are here to help!!

When I first started looking into being a doula it was for homebirths. But the more I learned, I discovered how much more doulas are NEEDED in hospitals. I certainly don't LIKE working there, but mamas need help!!

I agree, but there still is one OB in particular that I will ABSOLUTELY not work with. He induces 48 hours after EDD no questions asked, he's c-section happy, and he kicked me out of the hospital (for no reason other than being pissy) when my client (not even his patient, a hb transfer) would not consent to a cesarean. I don't want to work with him and more importantly I don't want to risk being kicked out of a client's birth and leave her unsupported with this bully OB.

[courtenay_e]

For me, I don't even think that in the end it's how I'm treated, though this last birth I attended, the treatment I got at the very end really made me sad...for me it's the picture of birth that these women have in their heads. What they want is SUCH a different experience than they WILL get (and they all say, "Oh, my doctor is so nice, and was VERY agreeable when s/he saw my birth plan, I am not worried at ALL"), that really, I can do my job (and according to every review I've gotten, I do it well...), and do it to the best of my ability, and yes, they'll overall be more satisfied with their birth experience...but they will NOT have the experience that they knew was available to them. Not the birth I know they could have had. The birth THEY know that they could have had. It's not my choice to decide what they should want or need or have supported in their labor/birth. They choose, I support. But it is frustrating to me to see them choose what they want, despite the fact that they know full well that it is highly unlikely that they will get THAT birth plan in their hospital of choice. And no, in our area, we are so inundated with hospitals that almost every woman has at least a couple of hospitals from which to choose...even medicaid patients have a few choices (not that any of them are great, but at least they have a choice).

But I did see a study once (maybe quoted here, maybe in doula training, don't remember), that said that it is emotionally more difficult for a woman to break up with her OB (even if she pointedly doesn't like him/her) than it is her first boyfriend. Scary, but I've seen it to be true. I've had a couple of clients switch (and I rarely come out and say, "Boy that's just a really BAD hospital!" Usually I'll look at their wants and needs in a birth and if they are at one or two particular hospitals, I'll strongly suggest that they will most likely not get what they are looking for in a birth at those hosptials if they are looking at a midwifery style birth), but usually they duck their heads and say, "Oh, WE'LL be fine!" and off we go.

Then again, I DO do a prenatal "class" that talks about interventions, and because I have worked at most of the hospitals in the area, I'm comfortable saying, "Where you'll be birthing, THIS is standard procedure, you may get away with THIS, it's going to be hard to get THIS, but if you're knowledgeable and vocal, you might have a chance..." Sometimes when we're done with the interventions class, it will make the clients think twice about their practitioner or place of birth. Most of the times not. Whatever. It's always harder for me coming directly off of a rough birth to think about the next birth at the same hospital. THe thing is, each birth is different, so I can't begin to expect to know what the next birth will bring.

Seems that my last birth just a couple of days ago was a brow presentation (ended in cesarean), which explains a lot about the way the labor unfolded...though I'm still fairly convinced that if they had just stayed home the baby would have been born vaginally in a much shorter timeframe...but that wasn't their choice. And they're actually very comfortable with their choices and the way the birth unfolded. So who am "I" to say that they should have chosen differently? They are happy with the outcome, and I couldn't have done more for them if I'd tried.

[bryonyvaughn]

Originally Posted by Stephanie L.

...But the more I hear of these desperate situations (like excessive epi/intervention rates) the MORE I think doulas are necessary... When I first started looking into being a doula it was for homebirths. But the more I learned, I discovered how much more doulas are NEEDED in hospitals. I certainly don't LIKE working there, but mamas need help!!

While I appreciate the benefit those women who are aware of and choose birth doula services, IMO what is NEEDED is for women to be able to birth in a non-adversarial system.

When I started UPing/UCing, I was the only person I knew doing it. Eight years later I know two women who UBAC as their only means to avoid a repeat Cesarean, one who UCed as her only means to avoid a Cesarean for having twins, and one "low-risk" mom who UCed as her only chance at a non-managed birth. I've been at home with several hospital birthing moms who've chosen to wait until their 8 or 9 cm to head to the hospital to avoid interventions and repeat Cesareans.

While there will always be moms needing birth doula services at home and in the hospital, until the adversarial attitudes and actions of hospitals, staff, and birth attendants vanish, more and more moms will vote with their feet.

~BV

[Rockies5]

Originally Posted by Stephanie L.

I feel we each must do what's right for ourselves, of course. But the more I hear of these desperate situations (like excessive epi/intervention rates) the MORE I think doulas are necessary.

Absolutley. The "awful" intervention full births in desperate situations are WHY I became a doula. The hardest births are also the most satifying that I could be there to at least be a small voice in a sea of adversity. I particularly go for the 15yo single moms, who are told by week 20 that they will "need" a cesarian to which their main support (their mom) agrees. These girls are the strongest, and they have to be. I think it's workthwhile even if I feel afterward like I just crawled off a battlefield, and typically it costs me to attend them. These are tomorrows mothers, (and voters) and they NEED to be empowered in their births and feel strong and capable as women and mothers.

They are where the change is going to happen in women's rights to their own bodies. Knowing that (maybe for the first time in their lives in most cases) they can say NO to someone trying to manipulate their body and then owning it all and reaching into strength they were told they didn't have to push that baby out is what it is all about and I am humbled by most of them. You can almost see the path of their lives changing right there. I haven't attended one yet that didn't rise to do what she had to and have the birth SHE wanted. Not all go natural, but everyone (so far) has done exactly as they planned and that's my goal.

You have to put your own needs for respect, importance and being right or even treated politley aside when you are doula-ing.

It means "servant" right? Needs to be remembered!

So I'll attended where ever I am called. Haven't attended a homebirth yet.

[ajmckay36]

Ladies, thank you so much for your thoughtful replies. As I said, I am struggling with this issue and you have given me some points to consider.

Originally Posted by courtenay_e

For me, I don't even think that in the end it's how I'm treated, though this last birth I attended, the treatment I got at the very end really made me sad...for me it's the picture of birth that these women have in their heads. What they want is SUCH a different experience than they WILL get (and they all say, "Oh, my doctor is so nice, and was VERY agreeable when s/he saw my birth plan, I am not worried at ALL"), that really, I can do my job (and according to every review I've gotten, I do it well...), and do it to the best of my ability, and yes, they'll overall be more satisfied with their birth experience...but they will NOT have the experience that they knew was available to them. Not the birth I know they could have had. The birth THEY know that they could have had. It's not my choice to decide what they should want or need or have supported in their labor/birth. They choose, I support. But it is frustrating to me to see them choose what they want, despite the fact that they know full well that it is highly unlikely that they will get THAT birth plan in their hospital of choice. And no, in our area, we are so inundated with hospitals that almost every woman has at least a couple of hospitals from which to choose...even medicaid patients have a few choices (not that any of them are great, but at least they have a choice).

You just summed up my experiences perfectly. Thank you so much for sharing that. It's exactly how I feel & exactly what happens with me & my clients/students...all the time!!!

I think for now I am going to have to stick with births at the progressive hospital or at home...I'm seriously on the brink of burnout. I have to look out for me right now & if I experience one more bad outcome I may burst into tears and just never go back again. Who knows though, by the time I start taking births again I may be ready to get back in the game full throttle and kick some booty. Time will tell.

Thanks again. :

[wumanh]

I think you have to go within and be honest about whether you really can wholeheartedly support a woman who is choosing to put herself in a situation where she is not respected or lied to, etc. Would we go along with that outside of the birthing arena? Would we participate in a rape? We would warn and educate and point out where it is safer but we usually wouldn't go with her to meet a man who would do her harm. I agree that you telling clients why you won't work in certain places could be powerful. Just like women voting with their feet where they will go to birth can have an effect.
I admire those who can go to these yucky hospitals and do their work. I am not one of them. Guess everyone has to make up their own heart and mind.
As for women not having a choice- perhaps it's not an easy choice to pay out of pocket or leave a doc or go to another hospital but where there's a will there's a way. Women have to want it. They can open their mouths and write their insurance companies or work out a deal with their midwife or cut down on other expenses, get creative to get what they want. They seem to do it in other areas of life. That being said, I do think all women deserve support for however far they can go in reclaiming their power. It's just the old- "there is no choice" doesn't cut it for me anymore.
Good luck with your decision

[Jane]

I think if I could offer a couple other doulas that do go to those hospitals, then I could feel alright about refusing to do that. Protect yourself. If you have to, don't say "I don't do births at that hospital", say "I'm not doing births there for 12 months".

[PapayaVagina]

When I was doula-ing I stopped attending births by the local Kaiser Permanente practice and then stopped at one of our local hospitals totally. It was such a battle from the second that we walked in the door and more often than not families wouldn't believe me when I told them the horrendous things that happened there until we got there and they saw them first hand. After births there I felt totally wrecked and in the weeks preparing for births there I was extremely stressed. I felt that I had to stop for my own sanity and that even when I was attending births there I wasn't able to do nearly as good of a job because I was so on guard and not able to have fun

[SublimeBirthGirl]

Yes, I will not attend births at the hospital. That's why I quit being a doula. Even good hospital births are ugly when you've attended homebirths. I can't handle feeling angry about how my clients are treated all the time. I'm not really cut out for doula work anyway, I'll stick to teaching.