Turning down a client for philosophical/ethical reasons?

[sheilige]

I am fairly new to doula work so I haven't worked out a lot of these type of scenarios. If someone approaches you and plans to do something you are philosophically against because research shows it is dangerous or unneccesary do you choose not to work with that client and if so how do you tell them that you don't want to work with them?

I am torn because as a doula I don't make decisions for my clients, but in this case this potential client would like her water broken at 38 weeks so her baby doesn't get too big. This was how her previous baby was born. Or am I being too picky and need to get my opinions/judgements out of the way?

How do others deal with this? Thanks!

[Jane]

I think you can make that choice - some doulas don't work with clients that circumsize, for instance. Some only do midwife births. It's important to protect your soul when you put yourself out there.

That particular issue doesn't bug me too much, so I'd take them, but I support your right to make another decision!

I think she needs a doula, but it doesn't have to be you.

[memiles]

I reserve the right to not take on a client that isn't a good fit. If she's saying something now that you know you can't support, you owe it to her and yourself to encourage (and possibly help) her to find a doula that can be supportive.

My mantra is "it's not my birth", but I'm not going to willingly attend a birth that I know will tear me up. That happens enough as clients get sucked into their doctor's scare tactics, so if I can avoid it at the beginning I will.

[MsBlack]

I definitely feel this is within my rights as a care provider. I think all a person has to say is "I'm sorry, but I don't feel that we are a good match...I can't work with you, but I can give you the names of other doulas".

good luck!

[onlyboys]

:

I haven't ever refused anyone, and I've supported women who I differed from philosophically, but there are some issues that I feel strongly about.

[1stimestar]

Some doulas do put restrictions on which clients they will take. When a potential client says they want something like that, I take it that they really NEED the education I can give them. Most of my clients tell me they plan on leaving the option for an epidural open as they "may" want one. But most of my clients birth without one. By the time they get to birth, they have learned all about the pros and cons of interventions, about normal birthing, WHY routine hospital procedures are routine and how they are not necessarily based on evidence and how they can be affected by hospital politics, etc. As a newer doula you may not feel up to the challenge or you may just not care to take on clients like this ever. But I love taking clients from where they are to where they can be. It's a wonderful journey to witness, a woman becoming strong and powerful.

[Rockies5]

If her choice makes you that uncomfortable, you are not the doula for her.

Do your best to bow out gracefully, without placing blame on her choices.

I do want to gently ask how you thought being a doula would be like?

I'm not saying we are to stand by closed-mouthed while a mom is spoon fed myths about oversized babies from her OB or social group but neither are we to fire every women who knows up front she'd like pain medication (or an early induction).

Is there a way in your situation to non-judgementally share information on safety of inducing or growing healthy sized babies without fear? At least share resources with the new doula.

You learn how to seperate their best birth from your best birth as time goes on.

[mwherbs]

humm- you don't have to work with anyone you feel uncomfortable working with, I don't think that it has to be so high minded as ethics or philosophy- if you feel strongly enough about the choices a birthing family is making that it would actually impair your ability to serve them then why stick it out- she would be better served by someone else- giver her a list of other doulas also expect to give a refund-- realistically you cannot take care of everyone who comes your way---

[fairydoula]

Originally Posted by sheilige

I am fairly new to doula work so I haven't worked out a lot of these type of scenarios. If someone approaches you and plans to do something you are philosophically against because research shows it is dangerous or unneccesary do you choose not to work with that client and if so how do you tell them that you don't want to work with them?

I am torn because as a doula I don't make decisions for my clients, but in this case this potential client would like her water broken at 38 weeks so her baby doesn't get too big. This was how her previous baby was born. Or am I being too picky and need to get my opinions/judgements out of the way?

How do others deal with this? Thanks!

I would deal with it like this - If I felt that this was one of several issues or "red flags" I would probably decline to be her doula and provide her with references of others who might fit better. If I felt that this was due to a lack of information or MISinformation, I would first try to provide her with information on why breaking waters at 38 weeks might be a detrimental thing for her and her baby. Books, articles, websites, etc. would all be resources for that type of information. Information on how often EDD's are wrong and you could be starting labor at 36 weeks without knowing, or the risks of breaking waters and NOT having labor start, the cascade of interventions, PIT, IV Pain meds, epidurals, c-sect. etc. I like Henci Goer's book "The thinking woman's guide to a better birth" for fast and hard stats on particular interventions.... I think you could start with INFORMATION and see how you feel and see how she recieves the info.
Why does she want to break waters at 38 weeks? Maybe it's a big baby concern, maybe she's just darn tired of being pregnant?? In that case, sometimes just having someone knowledgeable to talk to can make all the difference.
Best of luck in whatever you decide.
- Jen

[sheilige]

Wow this is great information and great help, I truly appreciate all the responses. I really liked the idea of a client like this really needing a doula. And I should know that I need to start where the client is, not expect them to all be at a certain point when they choose to hire a doula.

I really appreciate the help, there is so much that experience teaches you that training doesn't so being a new doula, I have a lot to learn!

[Marisa-Bradley]

I would be very suprized if she had an OB or Midwife that would agree to this!

[Reha]

This is exactly the sort of thing that happens in my city.

[lorijds]

I would be surprised if they did this without certain parameters--cervix has to have some dilation, and baby has to be engaged. So it is not a guarantee that it will happen.

I had a client once who was adament that if she ended up in the hospital, she wanted an epidural. I am not an epidural girl, but I still had her. Then, when she went into labor and chose to transfer to the hospital after a long labor, her white blood cell count was too high, and they wouldn't do the epidural.

Sometimes things don't turn out as planned, and having a doula there is very helpful (though that goes without saying, doesn't it?!)

[mwherbs]

yes ROM occurs quite a bit here - 3 cm is the minimum dilation -- but they will have a mom come in and apply cytotec or prosta gel the night before hoping to get them to the 3 cm --- the doctors drive me nuts here--
probably your best "in" is that she wants to hire you- I don't see this being a meet the gal one or 2 times and then show up when called - much more of a time investment and probably a candidate for birth classes or a mini set --
ROM- takes you down a timed road, induction is one thing and can take how ever many hours but rupturing membranes creates a real risk of infection

[CarolynnMarilynn]

I basically will care for anyone who hasn't proven themselves to be racist, homophobic, or dangerous, or living with same. The only clients I have asked to leave care were ones who make racist comments (1), homophobic comments (1) and whose partner threatened my student at a home visit (1). Philosophical differences are mediate-able, provide the fodder for really interesting discussions at prenatal visits, and if they end up coming around to a more natural, non-interventive approach are often the best advocates for that kind of care when they are on the other side of their birth. (Along those lines, I find the papa bear-types that initially dismiss midwifery care as witchy-hippy-feelgooders are the ones who stand from the mountaintops and shout its praises after the birth as the newly converted- giggle).

[SublimeBirthGirl]

I wouldn't take a client who I knew was going to circ. That said, I'm not sure this is really an ethical dilemma. Or rather, for me it wouldn't be. I'd make sure she was giving truly informed consent (though information will rarely negate experience in most people), but if she does have all the relevant info, this is really "her body, her choice." I realize the baby is involved as well, but for me it's a different scenario when there is still body-sharing involved (ie pregnancy).

[mwherbs]

Originally Posted by CarolynnMarilynn

I basically will care for anyone who hasn't proven themselves to be racist, homophobic, or dangerous, or living with same. The only clients I have asked to leave care were ones who make racist comments (1), homophobic comments (1) and whose partner threatened my student at a home visit (1). Philosophical differences are mediate-able, provide the fodder for really interesting discussions at prenatal visits, and if they end up coming around to a more natural, non-interventive approach are often the best advocates for that kind of care when they are on the other side of their birth. (Along those lines, I find the papa bear-types that initially dismiss midwifery care as witchy-hippy-feelgooders are the ones who stand from the mountaintops and shout its praises after the birth as the newly converted- giggle).

yep but I also have another sub-set of people who I just don't like on a gut level and I don't always have a reason that I could list off, to tell the truth often it is clear they don't like me either.
I could name off some- particular very controlling sexist husbands , most of the time they edge on violent behavior and are at at a minimum verbally abusive -- yep I think that these gals need to be supported in birth but someone else needs to be their provider-- that doesn't mean I haven't served and can't serve women in bad relationships just that some of the partners push too many of my own buttons and they need a different midwife -- and I say I just don't think this is going to work out, I am sure that she is a good candidate and will have a good birth here is a list of some other local midwives I would recommend. I just really have found I can't serve everyone.

[CarolynnMarilynn]

Originally Posted by mwherbs

yep but I also have another sub-set of people who I just don't like on a gut level and I don't always have a reason that I could list off, to tell the truth often it is clear they don't like me either.
I could name off some- particular very controlling sexist husbands , most of the time they edge on violent behavior and are at at a minimum verbally abusive -- yep I think that these gals need to be supported in birth but someone else needs to be their provider-- that doesn't mean I haven't served and can't serve women in bad relationships just that some of the partners push too many of my own buttons and they need a different midwife -- and I say I just don't think this is going to work out, I am sure that she is a good candidate and will have a good birth here is a list of some other local midwives I would recommend. I just really have found I can't serve everyone.

I get that. I give myself permission to make that same choice - luckily I just haven't had to (yet). I wouldn't care for someone with whom I was really uncomfortable. I have been challenged in caring for people who really challenged me (like one brilliantly intelligent woman who intimidated me intellectually) and some whose social needs really intimidated me. But on a personal level I felt like I could facilitate an environment of trust. I guess that's what it is about - could I facilitate an environment of trust with that person that goes both ways? It's not so much about philosophical beliefs for me - except of course with racism/homophobia etc which is an absolute for me.

Interestingly our practice encompasses women who are using (usually crack), may have an apprehension order in place for the baby after birth, who are street-affected, who are sex-trade workers, all the way to the evangelistically religious (complete with signboard car!) and the vegan-homebirthin'-peasant skirt-types, and almost always we can find enough common ground to provide a basis of trust. So few times I ave felt unable to care for women. It's kinda cool that humans can be so diverse, yet find common ground, huh? And honestly, the women that I have asked to leave care have not been in any of these extreme groups mentioned above. I just think that is interesting!

[CarolynnMarilynn]

Originally Posted by SublimeBirthGirl

I wouldn't take a client who I knew was going to circ. That said, I'm not sure this is really an ethical dilemma. Or rather, for me it wouldn't be. I'd make sure she was giving truly informed consent (though information will rarely negate experience in most people), but if she does have all the relevant info, this is really "her body, her choice." I realize the baby is involved as well, but for me it's a different scenario when there is still body-sharing involved (ie pregnancy).

Unfortunately for me that would mean I wasn't able to care (for the most part anyhow) for a very large part of my community: muslim women. Although I find the practice abhorrant (sp?) and actively educate against the practice, I accept that some families will still choose it and will provide care to women who will choose that. Sigh.

I am struggling with providing care around genetic screening options, as is routinely offered to all women in Ontario. I find it hard (but I think I succeed) to keep my feelings about genetic screening to myself, especially when termination is chosen for a genetic disability. I would like to opt out of this kind of care and discussion of it. I haven't quite figured it out yet.

Carolynn

[homewithtwinsmama]

Originally Posted by mwherbs

yep but I also have another sub-set of people who I just don't like on a gut level and I don't always have a reason that I could list off, to tell the truth often it is clear they don't like me either.
I could name off some- particular very controlling sexist husbands , most of the time they edge on violent behavior and are at at a minimum verbally abusive -- yep I think that these gals need to be supported in birth but someone else needs to be their provider-- that doesn't mean I haven't served and can't serve women in bad relationships just that some of the partners push too many of my own buttons and they need a different midwife -- and I say I just don't think this is going to work out, I am sure that she is a good candidate and will have a good birth here is a list of some other local midwives I would recommend. I just really have found I can't serve everyone.

It is really a good idea not to serve someone with a husband as you described above. I have twice and in both cases it turned out to be a big mistake and I learned my lesson forever. In one case the guy ended up threatening to turn in the midwife and I (we work in an illegal state) because he didn't want to pay his bill. And the midwife did walk away and we did not get paid and had put in a lot of time with this mama (because he disappeared right before birth and showed up again 6 weeks later we did a ton of postpartum help way beyond what we normally do with a couple or mother whose partner hadn't driven all their family support away). In the other case dad was a drug addict, violent abuser. Wasn't there for the birth, but was very threatening later to me personally. I feel sorry for women like that, but in terms of serving them in a homebirth--no thanks--I won't take that risk because my family needs me safe and sound. They will need to find someone else or birth where hospital security is just a call away.