Do I need an attitude adjustment?

[holly6737]

I"m a doula. I volunteer in a great program in a local hospital that provides doulas to women who can't afford (or don't feel like paying) doulas or who didn't even know about doulas until they get to the hospital. We do either shifts or take on prenatal clients. I told my "supervisor" that I would be a primary for this particular woman who is expecting twins. I agreed because I had never seen twins born vaginally before and I thought this would be an interesting birth. I figured any woman who hadn't given in to the idea that twins ALWAYS HAD to be born by c/s must be educated and making informed choices. I really expected her to be planning a NCB without a lot of intervention. So supervisor sent me her birth plan. After I read the birth plan, it was obvious that I was NOT the doula for this woman. First, she is planning on getting an epidural. Second, she is perfectly fine with a very medicalized birth and her overall attitude was complete trust in her care providers and their decisions about her care. She stated that she only wanted to know what was going on before it happened. (WTF? Just let me know what's going on and that's it?!)

OK- first, I've supported women who have gotten epidurals. However, most of the women I support initially plan on NCB and later, after insistence from their care providers and difficult labors (hey, it hurts!), end up getting an epidural. That's fine with me. I support them. At the heart of it, I believe in a woman's right to make an informed choice to accept pain medication. However, it's always sort of awkward during that time between getting the epidural and pushing. I just sit there in the chair. I feel obsolete. The almighty epidural completely replaces the doula. I know this shouldn't be true in theory, but IME it has been. They sleep, I go get some dinner. It's frustrating and I"ll admit, disappointing sometimes. So, If she ends up getting an epidural, fine. But if the woman is planning on getting an epidural, what is the point of having a doula? If I were being paid, I think I would be more okay with it. But since I"m a volunteer, I almost feel like I"m wasting my time.

Then there's the medicalized childbirth part. I dont' believe that NCB is right for every woman, but I really believe in NCB. I respect women who make informed choices, and if they make an informed choice to allow intervention X, then that's fine. But just blind faith in the medical professionals? I don't respect that. The bottom line is, I emailed the supervisor back telling her that I can't attend this woman's birth. It would just end up making me angry and frustrated and no doubt it will end up in a c/s, especially since it's twins. She might not even make it to labor. I realize that my attitude sort of sounds snobby, like I'm some kind of NCB elitist, but I don't think I am. I support informed choice. I dont' think that always means NCB for every woman. But this woman's birth plan seriously bugged me. I really WANT to be supportive of this woman, I am just finding it very, very, very difficult. I haven't heard back from my supervisor, but no doubt she will be pissed. The whole premise of the program is that every woman deserves a doula, even women who plan on getting epidurals. But why should I give up time with my family just to sit and stare at someone watch TV? Do you get what I"m saying? I dread checking my email. She hasn't emailed me back yet.

[mamallama]

Honestly, and I mean this in the nicest way possible, I do think you need an attitude adjustment.

Doula work isn't about the doula. It isn't about witnessing the miracle (though that's a nice perk,) it's about providing support as the family defines it.

For some women, that means rubbing her back and suggesting position changes. I love giving that kind of support, and I bet you do too.

For other women, support means you witness how hard it is and hold her hand while she gets that blessed relief from the pain. Then you help her remember she's in labor for the next 8 hours If that's what she wants, she deserves to get it! She's only going to birth that baby one time--let's make it a good memory.

I prefer to support women who have unmedicated birth as a goal. There's nothing wrong with having a personal preference.

The thing that's wrong is being judgmental or withdrawing support when women make choices you disagree with.

[holly6737]

Even if you're a volunteer and have never met the woman before? Is that really withdrawing support?

My point is- can't her partner rub her back, etc. if she's planning on getting an epidural? I would never leave a birth if a woman decided to get an epi. I'm talking about refusing a client before you've even met her. Should and can doulas be picky about their clients?

[mamallama]

I think you have every right to choose who you attend (before the fact,) especially when you're a volunteer. I have refused clients who wanted to pay me!

I think doulas should be as picky as they need to be--otherwise they'll burn out pretty quick.

I don't think it does any good for anyone, though, to speak disparagingly of women who desire an interventive birth.

[Rockies5]

Originally Posted by holly6737

My point is- can't her partner rub her back, etc. if she's planning on getting an epidural? I would never leave a birth if a woman decided to get an epi. I'm talking about refusing a client before you've even met her. Should and can doulas be picky about their clients?

Maybe she doesn't want her partner to rub her back?

And, yes doulas should be picky and work with people they like and wish to support.

It sounds like when you are volunteering, you'd like to screen clients.

I don't know if this is possible in your situation, and if not, then yu DO need an adjustment if you plan to stay in the volunteer position.

GOODLUCK. I'm interested to see what happens.

[holly6737]

No, I don't mean to speak disparagingly of her. If she is making an informed choice to have a very medicalized birth, I would respect that choice. I don't believe NCB is right for every woman and I stated that above. Her body, her birth, that's fine. I just don't want to be there if I can help it. That's all I'm saying.


And I don't think she's making an informed choice. She was pretty upfront that she's going to agree to whatever they recommend regardless. Her exact words were she just wants to know what is going on before the procedure is done. IMO that's a recipe for disaster.


ETA: Supervisor emailed me back and *very surprisingly* said she totally understands. So crisis over. For the future, though, it is nice to know that doulas for hire do screen their clients. I do think that every woman who wants a doula deserves to have one, I just don't think every doula and every client make a good team, kwim?

[happydoulamama]

I find it's very helpful for me to understand the reason that women who expect an interventive birth also want a doula.

If I understand their reason for wanting a doula, I am more apt to feel good about providing service to them.

IME, the women who expect epidurals and hire me are doing so in hopes of avoiding a c-section. I am there simply so they don't get railroaded. If I agree to be with them in labor, it means that I help them find their voice, help them avoid unneccessary interventions (for instance vacuum/c-section after 1 hour of pushing).

I also find that it's true that doulas help mothers to become good mothers. Because of our mothering, the birthing mother better understands patience and other virtues neccessary to be a good mother. Partners also benefit in that way.

There is no telling what a positive birth influence could do for a new family. I am trying really really hard in my practice to let go of being a birth snob and remember these ideals instead.

Good luck.

[holly6737]

Originally Posted by happydoulamama

I also find that it's true that doulas help mothers to become good mothers. Because of our mothering, the birthing mother better understands patience and other virtues neccessary to be a good mother. Partners also benefit in that way.

There is no telling what a positive birth influence could do for a new family. I am trying really really hard in my practice to let go of being a birth snob and remember these ideals instead.

Good luck.

I needed to be reminded of this. Thank you!

[mamallama]

I'm glad the crisis was averted.

I'm also glad to hear of the volunteer program at your local hospital--while I think doulas should be compensated for the valuable work they do, a volunteer program is a good start toward making doulas universally available.

Thank you for donating your time and skills to new families.

[shellwalsh1]

Interested

I just recently found out I was pregnant and am looking for a doula/midwife. I am a little taken back by your reaction to the woman whom you were to be supportive of. If I understand correctly all your assumptions of this woman were only from reading her birth plan. I wondered if you had taken the time to meet this woman and gently educate/guide/support/doula her that you would be better off to make an informed decision on whether you wanted to work with her or not. Is it not possible that you could have eased some of her fears and perhaps help to educate/inform her more on her options and choices?

I am on my second pregnancy and I want a doula, I also want an epidural. Why? Because I am scared as heck not to. Does that mean I don't deserve any support from a doula? Does that mean I am less of a mother? I am totally shocked. I was worried about looking for a doula/midwife support for this exact reason, that I would be judged. I am a little disheartened.

[mamallama]

welcome to MDC, shelwalsh.

I won't presume to speak for holly, but I will say that this issue is a real and legitimate concern among birth professionals. Holly has asked for guidance in the birth professionals forum, and she got what she asked for. Birth professionals need support too.

As a mom, you have your own concerns. My advice to you is to figure out what you want from your doula, and then when you're talking to your local doulas, figure out whether or not they'll be a good match for you.

If someone seems like they might be judgmental, thank them for their time and move on down the list. Some doulas are happy to assist at a birth when the mom knows ahead of time she'll want an epidural. As I'm sure you know, the later in labor you get that epidural, the less likely you'll be to need additional intervention. Many doulas (myself included) are happy to help you stave it off for as long as possible. Or maybe you want relief as soon as possible. There are loving, caring doulas who will support that option too.

Best wishes to you for a beautiful and peaceful birth.

[Meche]

Even though I strongly believe in the benefits of natural childbirth, I have chosen to support women in their variety of choices, including epidural and scheduled c-section. I find that each person's needs are different... for an epidural client, I might be using reflexology and pressure points to stimulate contractions ("Can I give you a foot massage? It might help the labor") or aromatherapy in the OR (to help relax the couple and cover some odors). There is always an opportunity for me to help.

I also look at what I get from each client, especially when I spent the night sitting with them as they watch tv or sleep through contrax and missed a homebirth of another client because I was already involved in an epidural labor. If I hadn't stayed with the epi client, I wouldn't have seen how the big toe pressure point could increase contrax. If I had signed off the client who decided on a scheduled C, I wouldn't have placed a positive image of doulas in her mind for supporting her. Sometimes, the learning curve for us is hidden, but worth looking for. Plus, after all the fast labors I've been lucky to attend, it balances out in the end.

[MsBlack]

I'm going to disagree with some of you on this one. Any birth worker, but perhaps most especially a volunteer, has the right to values and prefs, and to make choices about who she is happiest to work with. Guarding ourselves against experiences which we are pretty sure will be disappointing/disagreeable to ourselves, is an important part of continiuing to feed our joy in this work and avoiding burnout. Yes, the goal is to serve the client--but I just don't believe that it is healthy or any sort of 'normal obligation' of providing service, to expect to entirely sacrifice one's own enjoyment and values!

Sure, perhaps without meeting the mom first, a judgement is being made too fast...but then again, if you decide to meet the mama, it could be all that harder to back out gracefully, for a variety of reasons. Under the circumstances of the birth plan described, I'm not so sure I'd want to meet the mom either. Yes, MAYBE her attitude can be shifted through 'good doula-ing'....but are we supposed to go into these situations with the attitude that we should be imposing (or even hoping for) changes on moms? To me, THAT is an attitude that needs adjusting, because it is not too respectful of the pregnant woman!

Yes, every woman who wants a doula oughta be able to get one. And every doula, by the same token, oughta be able to choose which clients she is most comfortable with--for ANY reason! Some of you, IMO, are judging this doula (OP) in the same sentences through which you are telling her not to judge this mama--for one thing. Doesn't seem quite fair.

ANd by the way....you are a volunteer. Your supervisor really has no right to give you any sort of flack about this! I hope you don't allow that.

[holly6737]

Thanks, Ms. Black. It would be difficult to back out after I already met her. Then I would really feel like I was withdrawing support. As it is, she is open to the rest of the volunteers for them to decide if they want to work with her. Hopefully someone will step in my place and support her.

shelwalsh, I hope I don't discourage you from hiring a doula. I do believe that every woman deserves a doula and I hope you find one that is supportive and encouraging of your choices. To try and explain myself I will say that as a doula I've seen several births. I know what can go down during a very interventive birth and I have had to take several months off from 'doula-ing' before for a violent birth. I end up getting angry, frustrated and questioning whether or not I will ever step foot in a hospital L/D again. That's not a good place to be. You leave wanting to bang your head against something extremely hard. I've left before feeling like I"ve witnessed an assault. I'd like to avoid those kinds of situations. It can be disturbing. Of course the woman deserves support, but at what cost to the doula? If the doula were being paid, this cost would be obvious, but as a volunteer, it just ends up draining me and making me unable to provide support for other women who also need it. I hope you can understand where I'm coming from.

[3daughters]

Do you volunteer for PALS?

I was a volunteer doula at a twin birth. Mom was induced at 38 weeks and had the epidural placed before the pitocin was even started. She trusted her caregiver implicitly but still needed emotional support that only someone trained in birth could provide. She was nervous about the well being of the babies and the comfort that I gave her was so important!

None of these were choices that I would have made (including her choice of caregiver) but she was in need of support and I was there to provide it. It was a magical experience for me to see twins born vaginally and to help them nurse shortly after birth. The appreciation that couple expressed made it so worth it!

[Malga]

Yes, every woman who wants a doula oughta be able to get one. And every doula, by the same token, oughta be able to choose which clients she is most comfortable with--for ANY reason! Some of you, IMO, are judging this doula (OP) in the same sentences through which you are telling her not to judge this mama--for one thing. Doesn't seem quite fair.

:

Holly6737 I totally feel your frustration and I empathize with you completely. I come across very similar situations being a nurse in a birth unit and it can be so hard to deal with sometimes. Don't have any great advice-- it is tough and there is not a lot you can do so late in the pregnancy and after people have made there choices.

[shanesmama]

I know this is a couple days old but I still wanted to respond.

First I do believe that we as doulas need to accept the clients that we feel comfortable w/, just like they are picking the doulas that they feel comfortable with. We do have that right.

As for why do women who are getting epi. need doulas. Well there could be lots of reasons.

Some women have there own goals. They know they want an epi, but say want to try to get to 5cm, or so before they get one, and they want that support to get to there goals.

Perhaps this is women knows that epi sometimes don't work all the way or had a previous birth and the epi didn't take all the way, and she didn't handle it that well, and she wants support in case of that same situation.

Maybe her husband keeps telling her that he thinks he is going to pass out (jokingly or not) and that is in the back of her mind, or she knows no matter how much she loves him, that he isn't a very emotional type of guy, or just has that type of personality, and she is uncomfortable w/ anybody else in the room, so she needs a doula for more of an emotional type of support person instead of a knowledgeable physical support person.

Women need doulas for different reasons. I would never just deny a client on the basis of she wants an epi, without talking and or meeting w/ her to discuss these things.

[Sage.Naissance]

I am totally pro natural Childbirth and I think it would be amazing if everyone was aware of how fantastic our bodies are and what we can really do as women. However, this is not always the case. As doulas we could choose just to work with the homebirthey, breastfeedy, cloth diapery granola types. Real easy, no conflicts of interest, women who know what they want. We'll see a lot of great births, support women who are strong and wise and in tune with their bodies. But are these empowered women the ones who really NEED doulas?
For real Natural birthers Doulas are a great asset but a lot less neccessary than the women who dont see themselves as powerful strong women who can birth naturally. They might need supportive women around them to show them how well they can do.
Probably all of this woman's friends took epidurals, their mom took an epidural, they read books like the girlfriends guide to childbirth. Its a paradigm. But they are still a woman who is becoming a mother, she needs support, and more than ever she needs to feel empowered.
I take a lot of clients who want Epidurals, and I inform them that the longer they wait the faster the labour will go, teach them about endorphins and the way doulas are able to treat pain, etc. I always let them know that I will do my best to get them as far as I can in labour before getting them the Epi, but if they do feel that they need it they will get it. Often when given this kind of support these women end up with Natural childbirths and they will go on to change the perceptions of all of those around them! This happened to me just last week! These women feel more empowered and strong than you can imagine!
A lot of women who have been victims of sexual abuse also choose to have epidurals so that they can disassociate. This is an extremely important consideration and these women diserve to give birth with epidurals WITHOUT judgement.
Who we doula is our choice. We choose what we are comfortable, but we also learn an emmense amount from our clients, we expand ourselves and who we will work with, we learn to see things from perspectives we were never familiar with. I encourage you to try to work with these clients and you will learn something about these women, and indeed, a lot about yourself. I know I have.

[Free Thinker]

Trying not to feel offended... maybe I can explain the mama's viewpoint?

WHen I first found out I was having twins I still insisted on a natural birth. My OB was okay w/ that, but he highly recommended an epidural and wanted me to think long and hard about it, and also to do the paperwork ahead of time incase an epidural or spinal block was needed (read that as emergency c-sec). FOr months I went round and round the epidural decision. I read as many stories as I could, some were good, other's ended in c-sections even though the twin mamas really wanted vaginal births. At 20 weeks they were both head down! Yay! I was so happy, then twin B flipped to a frank breech position, and he stayed that way the rest of my pregnancy. My OB was still wanting me to have an epidural, and said he would probably deliver in the OR instead of hte regular delivery room, but he was okay w/ Baby B coming out breech. The reason he recommended the epi was incase he had to do a version after twin A came out. He explained how he'd have to turn the baby if he didn't line up right, and it sounded like it would HURT! If twin B was still unable to come out and got distressed, it would be an emergency c-sec, which could end in my being put completely out (in a real emergency) and missing the birth completely. I weighed my options and made an informed decision. How do you know this mama has not done that? To make a really long story short I labored in teh regular delivery room with the epidural, after twin A was out twin b turned sideways and tried to stick his arm out, so I had to have a version. That is honestly the strangest experience ever. His HR was also decelling and I was afraid I'd have to have a c-sec. Even w hen they got him head down, I couldn't push him past my pubic bone for a while and it DID scare me. They used the vaccuum several times to get him down, finally I was able to push him out! I think I made the right call. I also think I had a great Dr. who realized and respected my wish for my birth to be as natural as possible. If I had a doula, I do think it would have helped. The time when teh Dr. was working trying to get the baby in the right position was scary for both me and my husband. Having someone else there that knew what was going on and was reassuring us would have been wonderful. That also broke my concentration and made it hard to focus on pushing, a doula could have helped there, too. My boys were healthy at 6-11 and 6-15 and got to come home in 24 hours, I had no tears either, and while recovery wasn't easy, I didn't ahve to deal w/ a c-section. Another mama from another board was due the same time as me and did a homebirth. She ended up not being able to get her twin B out either, and had to go in and get a c-section the next day for twin B. SHe IS a doula and has had several other children as well. Twins are just different.

Not trying to make you feel bad, Holly, just trying to maybe answer the question as to why a twin mama chooses to get an epidural before labor and puts it in her birth plan. I hope I also showed how I could have benifited from a doula, even though I had an epidural. BTW, for times I got the epidural around 4:30-5ish (6cm) and had baby A at 6:40, B at 7:07, so getting an epidural doesn't really mean you will be there for hours with nothing going on. I got to the hospital somewhere between 2 and 3 and was monitored for an hour (cx just 10 minutes apart but hurting), then they decided to keep me (5cm) and did the IV and called ansth to do the epi., it all went very fast IMO.