"I don't believe in doulas"

[Stacymom]

I am a brand new, still in the process of certifying doula, and I was able to be at my sister's birth this weekend. (It was the second birth I have done as a doula.) I flew to Virginia, and was lucky because her contractions started as soon as they picked me up for the airport! I encountered something there that I never thought would happen, and wanted to see if all of you had encountered this, or if it was just this particular Dr.

My sister saw a rotating practice of Ob's, and when she was almost ready to push, the Doctor on call came in. The Doctor looked at me asked me who I was. When I told her that I was the sister and also a doula, the doc said to me, "In this room, you're the sister. I don't have doulas in my rooms." I knew right then that we were in trouble.

My sis had a hard time pushing. (They wouldn't let her push in any position besides lithomy, despite my sister's begging. But that's a whole 'nother rant.) I was encouraging her through it, and giving her progress reports- telling her how close the head was, etc. When the baby's head was out, the Doctor turned to me and said "I don't want to hear anything from you." What? I hadn't even said a word to the Doctor, and all I had done was encourage my sister through the whole process.

I should have known it wasn't going to turn out pretty, but after the birth, I approached her to fill out one of my evaluations sheets that I need to use the birth for certification purposes. I was polite, and asked her if she could spare a minute to fillout an evaluation for me. She looked right at me and said "No" and walked out of the room. Then, she turned around, came back in and said "I don't do doulas. I don't believe in doulas." Yes, she doesn't believe in doulas, like I'm the tooth fairy or something. I was completely shocked. The Doctor hadn't been in the room more than 20 minutes total, and she literally never said a word to my sister and brother in law during the whole time she was in there, not even a hello, or an encouraging word. I didn't know that I even had time to offend her!

Maybe its just that I'm new, but I've had a really hard time just shrugging this off. Is this attitude typical for OB's? I don't understand why a doctor would be so hostile to someone there to help the mother. I have another client who's doing a hospital birth that's due soon, and I'm worried that I'm going to run into this again, and I don't know how to react. I've played it over and over in my mind, and I really don't see that I could have said or done anything offensive to that doctor! Please, ladies, just tell me that this attitude isn't typical for Ob's! I'm just feeling a little shell shocked, and hoping that this was an out of the ordinary experience, and not something that is common to doula work in hospitals.

What is validating though, is that my sister and bil were grateful that I was there, and weren't happy with the Doc either. They thought she was rude, and weren't thrilled with the way they were treated. They were glad that I was there, and my sister had the guts to refuse an episiotomy, even when the nurse was pushing her to agree to one, and then talking to the Doctor about how much easier her birth would be if she got one. : Mayeb I've just been hanging out in the natural birth arena for too long- I didn't know that stuff like this still went on!

[arwenevenstar]

I have only been a doula for a couple of years, but haven't run into this kind of attitude. I think this is awful:
I have met one OB who wouldn't really speak to me or acknowledge me, but not blatently rude like that.

Don't let it put you off. you are working for the clients NOT the OB, cling onto that!!

[Dabble]

That would be extremely frustrating. It is sad that people with those attitudes are still around.

But I think what you need to focus on though, is that you did your job. You were there for the "client", your sister and BIL, and that's what matters. You supported them through the birth process, and you would have done the same with a great doctor/midwife/baby catcher, as you did with this crappy OB.

You had to work a little harder to operate within the ridiculous constraints that the OB placed upon you and the mother (lithotomy position? how about that dr needs to fast forward a few decades), and you managed just fine.

Good practice for the crap you might encounter in the future, although I hope that never happens again.

Is your sister planning on a different sort of birth for her next child, after that disappointing experience?

[tlcdoula]

Yes, I definitely have seen attitudes like this and unfortunately it is usually because there was a doula that came before me that gave all doulas a bad name!!!

When I was at my sister's birth the doctor was pretty much the same way - he never said anything to me, but when asked if he would fill out my paperwork he wouldn't. My sister also asked him at her postpartum visit and he flat out refused. I was frustrated and angry with him because this is the same man that delivered my first three children back in 1988, 1990, and 1991!!! In fact I was so frustrated that I sat down and constructed a really nice letter letting him know exactly how I benefited his patient, and added somewhere in there that I would appreciate it if he could fill out my paperwork so that I could learn from this experience. I included a self addressed stamped envelope and I actually got it back!!! I couldn't believe it. I honestly just assumed that he would toss it, but felt I had to try.

My sister later told me that he commented on how professional my letter was and that was why he filled out the form. Unfortunately I never did get her to leave his practice, but that is another story and he is now retired

[mendomidwife]

I don't know what state you reside in, but in California complaints can be made to the State Medical Board. I would also suggest both you and your sister write a letter to the Chief of the Medical Staff at the hospital, cc a copy to the CEO and Director of Nursing at the hospital. I would attach an evidence based article on the benefits of Doula care. This is a great opportunity for you to do some outreach/teaching. If you don't do it - his behavior willl continue.
Most hopsitals frown on this type of behavior, and believe me - if you write a letter it would be put in his personnel file. Some hospitals also have a patient advocate that you can sit down and talk to - explain his actions and how they offended you.
Unfortunately - most families that have just given birth are so involved in their new baby that often don't follow through with a letter - which just perpetuates the behavior.

Carla

[SublimeBirthGirl]

One of the things I hate about DONA is that you have to get reviewed by the medical staff, who are often hostile towards natural birth, doulas, strong women who know what they want, etc. Anyway, I would encourage your sister to file a complaint against this doctor. Her behavior was inexcusable. I would blog about it, with the doctor's name, wherever possible. Let people know what she's like.

[Stacymom]

I'm in Virginia- I don't live here, but was lucky enough to fly out for the birth. I already thought about posting in FYT here. I don't know how open to the idea of filing a formal complaint my sis and bil would be. They are pretty accepting of their experience- I don't think they realize that ther were treated badly, and I don't want to paint their birth experience in a bad way just because I was frustrated.

Carla, I will definitely think about what you said. I'm not generally a rock the boat type of gal, and I was feeling shell shocked and intimidated. I'm afraid that without my sister's input, the letter would come across as "just another pushy doula" with a chip on my shoulder instead of making a positive impact. I did get a good evaluation and some very positive feedback from one of the nurses, though, and she gave me some good constructive criticisms so I know that there are nurses there with a more positive attitude toward doulas.

I so think its rather silly of DONA to ask for evals from Drs who are only there for the very last part of labor. How are they supposed to know how effective you were as a doula when they weren't there?

[Noah's mommy]

Originally Posted by Stacymom

I'm in Virginia- I don't live here, but was lucky enough to fly out for the birth. I already thought about posting in FYT here. I don't know how open to the idea of filing a formal complaint my sis and bil would be. They are pretty accepting of their experience- I don't think they realize that ther were treated badly, and I don't want to paint their birth experience in a bad way just because I was frustrated.

Carla, I will definitely think about what you said. I'm not generally a rock the boat type of gal, and I was feeling shell shocked and intimidated. I'm afraid that without my sister's input, the letter would come across as "just another pushy doula" with a chip on my shoulder instead of making a positive impact. I did get a good evaluation and some very positive feedback from one of the nurses, though, and she gave me some good constructive criticisms so I know that there are nurses there with a more positive attitude toward doulas.

I so think its rather silly of DONA to ask for evals from Drs who are only there for the very last part of labor. How are they supposed to know how effective you were as a doula when they weren't there?

That's really frightening and discouraging to hear as I live and work in Virginia. Yikes!

[hipmummy]

I am so sorry that you had such an awful experience. I have been fortunate to have had multiple OB's refer me to their patients. ButI have run into other OB's who have been turned off by some douls'a no specifics they just did not like them. Some hopsitals just are not doula friendly. I think they are scared that their patient may actually be able to think for herself.

[holly6737]

WOW! Yes, I've heard of OBs with this kind of attitude before. On the other hand, I'm a volunteer doula at a local hospital and some nurses and OBs regularly call our "on-call doula service" to request doulas, so at least some recognize how useful and vital we are to the birthing process. I had one OB that left messages on my cell and home phone, and two other doulas phones in one night practically begging someone to come in for a birth he was attending. I kind of felt like I was being stalked! (In a good way...) One family practice doctor thanked me *repeatedly* for the "wonderful work" the volunteer doulas do at that hospital and wrote me this glowing evalution (Of course he was also the kind of doc that sat in the room for over an hour telling the birthing woman how important it is to listen to her body). There are bad OBs and there are good OBs. I'm really sorry you had that experience. That OB was a real UAV. Just know that you will have good experiences too. They're not all evil.

[Contented73]

What hospital in VA? Is it Reston Hospital here that has "banned" doulas? I can't remember exactly, but anyway there is a hospital here in VA that refuses to acknowledge doulas. Perhaps that's where you were? If that's the case, it's not surprising that the doc would behave that way. And, unfortunately, she'd got the hospital's backing! Awful!

[Malga]

I don't know what state you reside in, but in California complaints can be made to the State Medical Board. I would also suggest both you and your sister write a letter to the Chief of the Medical Staff at the hospital, cc a copy to the CEO and Director of Nursing at the hospital

Excellent idea! This is how policies and attitudes change! It wouldn't take long to write a short and to the point letter and maybe throw in the latest research on doula's and patient satisfaction of women with doulas and then send copies to all. I would send to Medical Director of hospital (quick call to hospital to find out who that is) and cc to the OB and the nursing manager would suffice I think (all could be sent to the hospital with just Attention lines to each person). Letter like that have to be addressed. And it would have even more weight to it if the new mother wrote it or at least signed it because that shows how docs practice effects customer satisfaction.

[JunipersMom]

Write a letter - several letters.. anyone who is at a birth or who sees improper treatment of patients has a right (and as a doula a responsibility) to at least make the offense known. You do not need the parents support or involvement to let the hospital know about how their staff treats patients and their support people - sister or paid doula doesnt matter, still deserve the basic human respect of kindness and consideration. IMHO

[NavelgazingMidwife]

With respect to Carla, I would be REAL careful about writing letters. If that hospital doesn't already have serious issues with doulas, it might out and out ban them after a spate of nasty letters.

A hospital here in San Diego was about to ban doulas because two doulas got stupid and "fired" doctors (you read right) - they told their clients they needed to fire their doctors and get someone else in the middle of labor and nurses overheard them. So, in order to save the majority of doulas, a group of VERY professional doulas, including the DONA doula trainer, met with the Chief of OB, the Head OB Nurse and did a couple of In-Services to explain what REAL doulas do and they set up a contract that every doula entering that hospital is required to sign. Only support services now, thank you very much.

So, that doctor, quite obviously, equates the word doula with someone who was in his face at one time trying to tie his hands when he was working. It wasn't YOUR fault, that's for sure. And you are new, so how are you to know that? But, that's what he means by he doesn't believe in doulas. He doesn't believe in a lay person telling him how to do his job. Does that make sense?

So, instead of a nastygram, if *I* were to write a letter to the hospital, *I* might write something like this.

Dear kind ABC Labor & Delivery staff,

My sister, (insert name here) just had her baby on (insert date here) and while her experience was challenging, she is very much enjoying being a mother.

I was lucky enough to attend the birth with my sister and, interestingly, during that time, was beginning my training as a doula. Excited, I flew down from (insert state here) to be with her. The labor was great and I learned so much. The nurses she had were so wonderful and kind. I appreciate their help for my sister so much. Thank you!

I am confused, however, about what happened when Dr. X came in for the delivery. He expressed his disdain for doulas and my sister was very uncomfortable with his expressions of anger towards me - words said several times - and I really felt I was merely being supportive of my sister. My sister did not ask for anything out of the ordinary except for no episiotomy and she asked for that herself; I did not say anything about it at all, nor need to "remind" her of it. My job really was one of physical and emotional support.

If I did something to anger Dr. X, I want him to know I am so sorry! I cannot imagine what happened that made him so angry - although he seemed angry about me as a doula when he walked in (perhaps an issue with another doula at another time occurred?). I apologize for asking him to sign my papers... it was not the right time. I see that in retrospect.

Anyway, if you could pass the word on to Dr. X and also, once again, thank the wonderful, kind and educational nurses (all of you!) at your hospital, I would very much appreciate it. I know it helps moms so much to have doulas with them and, even though it can be challenging at times, I really look forward to helping many more moms that aren't my sister and working with nurses like you all.

(sign your name and address)

Now, I know this sounds all kiss-ass, but THIS is how you make changes in the hospital. THIS is how people hear you in the hospital. They wouldn't even read an angry letter, but a letter like this, they will read and share with others. I've been there. I've seen it happen.

I encourate you to shake off the doctor's crap. It's not the last time you are going to have a care provider treat you like caca. I've had nurses yell at me nearly at the top of their lungs (as a midwife, though). I've had docs do cruel, evil things to clients as punishment for wanting home and natural births and all I could do was stand there and hold my clients' hands and cry with them. You will see amazing things that stab you in the heart, but you will also see fabulously wonderful things that make your heart soar!

You canNOT take what they say so personally or you will sink in a pit of despair faster than you can get your certificate. When you read the good things they say personally, you will see they are canned, too, and you won't take those so personally, either. Just know that you are doing a great job - believe in your Self. And keep learning. Always.

I hope this helps.

Barbara E. Herrera, LM, CPM
San Diego, CA

[doulanichole]

On another note, I also think it's important that we not too quickly jump to conclusions about what a nameless "bad doula" may or may not have done at a birth. I am not going to post the whole long, drawn out saga, but I will tell you that often doulas become the scapegoat and certainly an easy target to blame when hospital staff do not feel they can adequately "control" the birth room and their patients. Some doulas can even be reprimanded by hospital staff and banned for simply supporting their clients, within their Scope of Practice. Sadly, the OP's story could just as easily turn into a whole other sequence of events when reported by the OB and nursing staff. Things that are very far from the truth can easily become gospel and then it will be because of one "bad doula."

I think things can often be location specific and while some things may work in some places and with some people (depending on their mindset), in other places it will likely have a very different outcome. While nice letters and sit downs with hospitals would work well with some, there are others that have not taken well to these requests either. I am not even sure how a doula bannign would work honestly. Do you ID everyone who comes through the door and make sure they are genetically related to the person birthing before allowing admittance? As long as women can have friends and family for support, I'm not sure how that would work. And if they couldn't, well I would hope that anyone looking at hiring a doula would have enough sense to take their birthing dollars elsewhere.

I am sure it is hard for you to deal with being treated this way, especially being so new and it being your sister. I wish I had some words of wisdom for you, but I am still healing from a horrible birth I witnessed almost a year ago. On the flip side it is what finally caused me to realize it was time to explore a different path. I think the biggest thing you can do is talk about it with other birth profs and write about it as much as you need to until you feel like you can't possibly tell the story again. Hopefully healing will come with time and more births with better attendants.

[BirthFree]

And really, in the end, does it MATTER what she thinks re: doulas? It's like someone telling me they don't think the world is round. Fine by me, but that doesn't change the truth .

I think I'd pass it along as "whatever" and have my SISTER (the consumer that paid the hospital) write the letter re: the rude treatment. But that's me. A doula doing it vs. the 'patient' doing it is pretty different in the hospitals' eyes.

[momileigh]

One of the best doulas I know got doulas banned from a hospital. She was just doing what she felt was the right thing to do at the time. People could have scapegoated her and pointed fingers, but when it comes right down to it, doulas are people, and when their greatest crime is going too far in caring for their clients, well, I have a hard time passing judgment. Doulas are angels and if you can be a good doula in a typical hospital you have all my respect. I went to midwifery school because I don't have what it takes to be a doula.

[Stacymom]

I really do appreciate all these replies, and its been very useful for me to read your responses as I'm processing waht happened.

I don't know for sure what I'm going to do, or how to handle it from here. My sister brought it up today, and as she thinks and talks about her birth experience more, she is getting more angry about how she was treated by this ob. I'm trying not to egg her on or to make it worse, but I will certainly encourage her if she decides to write a letter.

She called her ob's office today to make a six week appointment, and was told that she had to see the same doc that was there for the delivery. My poor sister, two days post partum, was a wreck. We talked about it, and she's going to call back tomorrow and insist that she see someone else, and if they refuse, she will be finding a new ob/gyn practice.

And like someone said, this has certainly been a learning experience for me, if nothing else!

[homemademomma]

Originally Posted by NavelgazingMidwife

With respect to Carla, I would be REAL careful about writing letters. If that hospital doesn't already have serious issues with doulas, it might out and out ban them after a spate of nasty letters.

i LOVE your blog! i didnt know you posted over here.

[bionicsquirrel]

Originally Posted by doulanichole

On another note, I also think it's important that we not too quickly jump to conclusions about what a nameless "bad doula" may or may not have done at a birth. I am not going to post the whole long, drawn out saga, but I will tell you that often doulas become the scapegoat and certainly an easy target to blame when hospital staff do not feel they can adequately "control" the birth room and their patients. Some doulas can even be reprimanded by hospital staff and banned for simply supporting their clients, within their Scope of Practice.

I am sorry you had this experience, but really, I think it is on the extreme side of things. Once you attend more births you will see there is a huge variation to how doctors respond to you and treat you, but most are favorable.

On a related side note, I was just reprimanded by a nurse who accused me of doing a cervical check on a mom who was very calmly at 10 cm. The nurse said there was no way I could have known that a mom so composed was already 10. I just stated the facts about why I suspected she was 10 (feeling pushy, already past transition, had rested for a good amount of time between contractions after transition etc.) and shrugged off the accusation. Not all doctors, but some, have very little respect for the intuitive aspect of being a good doula.