DONA Evaluation of Labor Services and caregivers who resent doulas

[herbanmama]

Hi all. I have been offline for a while to let my right arm heal, which is a little bit better, but I'm still not on much. Using a mouse is pretty painful.

Anyway, since my last posting in Birth Professionals, I have attended 2 births. The first was a quick labor, vaginal, no epidural, successful latch, and happy client. Client gave me all 5's (was a big help) on her evaluation of my services. The OB however, was against her having a doula from the start - made it clear that she thought doulas are useless. Client was afraid of her, she was rude to all staff involved in the birth (except for L & D nurse), and did all sorts of nasty things which my client had adamantly requested that she NOT do, like episiotomy (cut baby's scalp in the process!) for one example (not even going to go there). The whole family was appalled at the treatment.

So, the L&D nurse filled out my evaluation with lukewarm approval (three 3's and one 4), and the doctor left it blank. I mailed her a copy of the evaluation with stamped and addressed envelope and a polite request to fill it out, and just got it back - all 3's. A 3 indicates that my presence neither helped not harmed. I know for a fact that mother and her family were very pleased with my services, as mother's evaluation and personal comments indicated, and she wrote me a touching personal card thanking me - and the mother is not a touchy-feely type - so it means alot.

So what's the deal? What are 'good' evaluations? I had read somewhere on the alldoula's website that DONA accepts 4+ as 'good'. If that's the case, how does one work around caregivers and hospital staff who do not appreciate doulas? I would think that that's where our services are needed the most, and IMO, there are many caregivers like that. I could tell that the nurse in this situation did not want me there - like I was on her 'turf'. Honestly, neither were in the birthing room much at all, so how could they even know what coping techniques I suggested?

I think that it's pretty silly that we must get evaluations from caregivers, when so many hospitals do not like their 'authority' challenged, and a doula represents the philosophy of Mama's wishes being #1, which automatically challenges their authority. Do they weigh Mama vs. Caregiver? I should hope so.

Thanks for reading this long-winded rant. Any thoughts are appreciated.

[courtenay_e]

Sorry, I don't really have a lot of helpful words for you...just that this is just one of the reasons I went with ALACE rather than DONA to certify...

[DoomaYula]

Originally Posted by courtenay_e

this is just one of the reasons I went with ALACE rather than DONA to certify...

We're not medical providers, we don't do anything medical, I don't see why we should be evaluated by medical folk. It's the parents who are the most important.

OT: I've seen providers do nasty things to my clients and I've often wondered if it's because they're so anti-doula. I had a nurse whose eyes practically popped out of her head when a client presented a birth plan -- "Does the DOCTOR KNOW you have a birth plan?!?!?!?" -- the way she said it was like, Does the DOCTOR KNOW you have three heads?!?!!?!

[channelofpeace]

Originally Posted by courtenay_e

Sorry, I don't really have a lot of helpful words for you...just that this is just one of the reasons I went with ALACE rather than DONA to certify...

nak- me too

I work for my clients, not the hospital, not the doctor, not the midwife. My clients desires and needs come first and foremost and i am only working for them.

[redpajama]

I'm certifying with ALACE, too, so I don't know exactly how DONA works with regard to all this but, to me, those three evaluations totally tell their own story. If a client is so clearly pleased with your services, I don't know who would have the authority to contradict her.

That's frustrating, though.

[merrijayne]

Do you have to use all the evaluations from the same birth. i f i remember correctly i thought you could use a mix. As long as you have the required total. Just keep collecting the evals, Until you are satisfied.

[ldsapmom]

I am DONA certified and happy about my decision to become so. DONA is a good fit for me, and I like the idea about having recourse if a client is not happy with my performance; I also like the code of ethics and standards of practice.

I had one evaluation where the doctor filled in the blanks, but he did not circle ANY numbers; he wrote in the comments section, "I really didn't see her interactions with patient. Patient had epidural for pain control." I was upset initially, but he only wrote the truth. I was with this client for 12+ hours total -- guess how long he marked on his paperwork he was there? One hour total, off and on. The nurse, who was also there for 10 hours while I was there, gave me all 4's. She had a much better idea about the whole thing, which is why when there is a doctor, there must be a nurse's eval; if there is a midwife, that stands alone.

You can mix and match evals, like someone mentioned. That's why it can take more than three births to get all of this together.

[SublimeBirthGirl]

One of the many reasons I prefer ALACE as well. I think it's ridiculous to have to turn in evaluations by doctors. We work for the client, not the doctor.

The big question, of course, is why women so willingly give their hard earned money to doctors who scare them and treat their choices with disdain and disrespect.

[herbanmama]

^

Well, I am pretty sure that the client will never use that OB again. The treatment was really unacceptable, and they are now aware.

Yes, I considered ALACE, but chose to certify through DONA for practical reasons. I live in a conservative town where DONA seems accepted, and the DONA rep/trainer here seems to like my philosophy and is referring me to many couples through her Lamaze and CBE work, which is a plus.

I know I can mix and match evals, but I really disagree with the principle of having to get caregiver feedback for all reasons mentioned in the above responses. I work for the mother - her feedback should be the most important factor - in fact, the only factor aside from the birth partner's feelings and opinion of course - IMHO, much more important than the caregiver's opinion.

It's frustrating. I am going to submit the doctor and nurse's evals, with an explanation that the doctor was openly and verbally against a doula, and the nurse was ambivalent at best. If that is unacceptable to them, then I will reconsider who I certify through. I would think that they would look at the evals on a case-by-case basis and not by a stringent formula of numbers.

[1stimestar]

We might work FOR the mother but we have to work WITH the medical staff. So I think the evaluations are a good tool to be able to learn effective communication and coping skills. Because really, if you can't work effectively in THEIR environment, then you are limited to home birth clients only. Evaluations are not turned down simply because the doctor marks them as 3. I'm not sure where on alldoulas you heard that. This is one of the reason you get a chance to tell your "side of the story" with the birth essay. They take it ALL into consideration. Turn it in and show how happy the mom was and explain the atmosphere of the environment. Good luck.

[herbanmama]

Originally Posted by 1stimestar

We might work FOR the mother but we have to work WITH the medical staff. So I think the evaluations are a good tool to be able to learn effective communication and coping skills. Because really, if you can't work effectively in THEIR environment, then you are limited to home birth clients only.

True. I can totally see your point. And in my area, I will almost certainly be working with hospital births, so I do value establishing a good relationship with staff for my client's sake, and know that I am quite diplomatic when need be through my previous experience in Human Services. However, I fail to see how they can accurately assess your services when they are so rarely in the room, and may potentially have personal bias. I hear many stories of hospital staff who resent the presence of a doula, so it concerns me.

[tlcdoula]

Originally Posted by 1stimestar

We might work FOR the mother but we have to work WITH the medical staff. So I think the evaluations are a good tool to be able to learn effective communication and coping skills. Because really, if you can't work effectively in THEIR environment, then you are limited to home birth clients only. Evaluations are not turned down simply because the doctor marks them as 3. I'm not sure where on alldoulas you heard that. This is one of the reason you get a chance to tell your "side of the story" with the birth essay. They take it ALL into consideration. Turn it in and show how happy the mom was and explain the atmosphere of the environment. Good luck.

I totally agree!!! I am not 100% certain, but I believe that when I turned in my evals I think one of them from a doctor had all threes and I still was certified.

[tlcdoula]

Originally Posted by NadiaLadida

True. I can totally see your point. And in my area, I will almost certainly be working with hospital births, so I do value establishing a good relationship with staff for my client's sake, and know that I am quite diplomatic when need be through my previous experience in Human Services. However, I fail to see how they can accurately assess your services when they are so rarely in the room, and may potentially have personal bias. I hear many stories of hospital staff who resent the presence of a doula, so it concerns me.

I think a lot of "attitude" can be avoided if one stays professional. I have been in situations where staff have been very apprehensive of my presence based upon their past experiences with other (more aggressive and out of line) doulas. I stayed professional and never had a run in and never had someone say that they disliked my presence.

Even a client I had on Wednesday - she told me her doctor has never had a good experience with a doula. When I met her doctor the mother introduced me and I immediately got up and shook her hand and told her I was delighted to meet her. The experience was a really good one - she never felt threatened and I can guarantee her experience with me was not one that she has had. I was professional and so was she and all went very well!!!

[hipmummy]

I found it was helpful to get to know the OB before the birth. Even if you can;t do this have your client put the buzz in their ears. I have yet to complete my DONA certification due to the 4cm(what about the 18++ hours after that!!!!) rule which is absolutely ridiculous, plus my ds is 10 months so I feel because of those obstacles and the above mentioned it is hard to become and stay certified. When I trained with DONA a group of six of us, who lived in a 15 mile radius would meet every month or bimonthly to discuss our progress and share tips with one another. We were a great support system for one another. The other five are certified and I am the only one left to complete my packet. Don't give up, they all had the same challenges that you had. Some OB"s do not return them, but others have sent in glowing recommendations. I had attended on birth (a planned CS with a Mom with malignant thyroid cancer) who said if the anesthesiologist did not let me into the birth (along with Dad) he would request someone else. This OB had a staff meeting and suggested they should let all CS moms have a trained Doula and their partner!!Not all OB"s are out to get us. they just want to see a little magic first. Also you could call the OB's office sometimes the admin person can look in the chart and help you out. Just have the client go through the proper HIPA channels. Good Luck!!!!

[Midwife Kris]

I would dare say that the review from the doctors/nurses are personal meaning you neither hurt nor help them And that they are not really giving much notice of you being there. They can't comment because they don't pay attention to you.

[1stimestar]

Originally Posted by NadiaLadida

I fail to see how they can accurately assess your services when they are so rarely in the room, and may potentially have personal bias.

Heeheee do you think the members of the certification committee doesn't also know this? I believe they know what weight to put on each evaluation. Write your paper and send it in!

[SublimeBirthGirl]

Some doctors and midwives don't like doulas, and you could be Doula Goddess Supreme and not get a good rating from them. An OB might be around you for 15 minutes out of a 30 hour labor, so why does his/her evaluation matter? Sure, doulas have to get along with hospital staff. It's not that hard if you have a little diplomacy (I was even nice to a doctor who was the only person in my life I've ever come close to punching, literally). If a doula wants to work, she learns to get along with hospital staff. I still don't see why a doctor's opinion on the quality of my doula services matters.

I did both the DONA and ALACE training. In the end, I certified with neither but one reason I did the ALACE training (after the DONA one) was because I didn't like DONA's policies. I may go back to it someday, and that's another nice thing about ALACE: you can certify any time, no time limits.

[herbanmama]

Originally Posted by hipmummy

I have yet to complete my DONA certification due to the 4cm(what about the 18++ hours after that!!!!) rule which is absolutely ridiculous,

Oh, THAT too. Client was already 7 cm when she went in for labor, I am turning it in anyway. She has walking around like that for about a month. I'm hoping that doesn't count against me.

My second birth was a VBAC gone scheduled C-section after client failed to go into labor (we later found that the condition of uterus from previous C-section would not have allowed her to go into labor, so it was a good call), and the staff were WONDERFUL and the docs were awesome, allowed me to wear the oh-so-stylish suit, mask, and booties, and accompany into surgery. Not even an issue, it was an automatic 'yes'. So, I know that not all hospitals, docs, and nurses have issues with doulas. In fact, the one I will probably end up working in 75% of the time is very doula-friendly.

My third client is due next week, is also a VBAC at the above mentioned doula-friendly hospital, so I'm crossing my fingers for client that we'll have a nice smooth vaginal birth. Wish us luck!

[SublimeBirthGirl]

we later found that the condition of uterus from previous C-section would not have allowed her to go into labor

What does this mean exactly? Sorry to go OT but I'm curious

[herbanmama]

Oh cool. My username change took!

What does this mean exactly? Sorry to go OT but I'm curious

Well, she had a prior C-section, had no contractions, was not dilated or effaced, and twelve days after her due date, she reluctantly agreed to a repeat C-section. Actually, we both thought that OB had been pretty unusual (in a good way) in waiting that long for a VBAC without making a fuss...

Anyway, during the surgery, it was discovered that she had a large 'window' into the uterus at the previous C-section site. According to the doc, her uterus was so thin in a large area, that it would have not have been productive in labor for the lack of uterine muscle - never mind the risk of rupture. Whether that is absolutely the case or not, I do not know, but client and I felt pretty good about her, so I tend to believe her.