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Advocate S/O, can DPs "advocate"?  

post #1 of 28
6/5/08 at 2:42pm
Thread Starter 
In a hospital birth, is it okay for the partner(s) of a laboring mother to do stuff like tell the hospital staff "don't offer her the epidural, she told you not to"? Is there anything that can be done to make sure s/he has the power to do so?
post #2 of 28
6/5/08 at 2:57pm
My husband will. I told him he's going to be the one telling the nurses if she wants anythign she'll ask so please leave her alone.
post #3 of 28
6/5/08 at 3:41pm
as long as the staff know that DP is who you want speaking for you, I don't see a problem. Make sure you tell your nurse and practicioner that what DP says is the same as you saying it.
post #4 of 28
6/5/08 at 3:49pm
Your partner definitely can and should advocate for you. But the best situation is if s/he doesn't have to: you should discuss your wishes regarding interventions with your midwife/OB in advance, and make sure you're on the same page about them. Your midwife/OB will have the most pull with the staff. If s/he says "Don't offer the lady in room 5 any drugs, she's having a natural birth," it's going to carry a lot more weight than anything a patient says.

Regarding offers of epidurals or other pain relief, I've heard that some people print out signs for the door that say "Drug-free labor in progress! PLEASE RESPECT OUR WISHES and do not offer medical pain relief."
post #5 of 28
6/5/08 at 3:49pm
I think this is ideal, actually. I think it carries more weight than when a doula does so. I think a partner would have to go a lot farther to get thrown out of a hospital than a doula would, kwim? A doula might get asked to leave for speaking rudely. A partner would pretty much have to get to physical violence.

Unfortunately, partners are often too uninformed or too overwhelmed themselves to do this. What's the use in having a husband who could clean up the floor with all those people single-handedly if he just sits there and lets them hurt you and your child?
post #6 of 28
6/6/08 at 12:45am
Thread Starter 
Quote:
Originally Posted by paquerette View Post
A partner would pretty much have to get to physical violence.
Thank goodness.
post #7 of 28
6/6/08 at 3:09am
I imagine it depends on the birth place. My DH was an awesome advocate for me both times- he knew more what I wanted & needed from my reactions to the situation then I did (if that makes sense- he just knows me that well). He told the doctor to shut it while I was pushing and coached me after he saw that a better way would work for me... he also handled the doc apts in the hosptial after birth refusing entry while the children and I were sleeping b/c he knew I needed it. Both my first two were born at a military hospital though and I believe that is much more accepting of spousal wishes than a private hospital. I imagine though you can write it into your birth plan and carry it with you at all times (I'd probably even go so far as to sign it).
post #8 of 28
6/6/08 at 9:46am
Quote:
Originally Posted by paquerette View Post
I think this is ideal, actually. I think it carries more weight than when a doula does so. I think a partner would have to go a lot farther to get thrown out of a hospital than a doula would, kwim? A doula might get asked to leave for speaking rudely. A partner would pretty much have to get to physical violence.
I agree with this.

Dad can push it and forceful but the doula needs to temper communications and anticipate issues to help circumvent them. My experience has been that hospitals automatically defer to the dad upon arrival when mom is busy in active labor. And as the doula, I have to earn the staff's "ear". When doula and dad are a unified front, the staff is more inclined to back off.
post #9 of 28
6/6/08 at 9:50am
Dads CAN advocate but IME they rarely do, even when they plan to going in. Hospital staff, OBs, even CNMs, can be masters of manipulation when it comes to getting their way, and once your partner turns on you there's really nothing left but taking what they're pushing in most cases. There's no way to predict how it will go though choosing an NCB-friendly hospital and 100% supportive birth attendant is the best way to get as close as possible to the birth you want.
post #10 of 28
6/6/08 at 11:04am
absolutely. my husband made sure all our wishes regarding labor, delivery and the baby were known to the doctors/nurses during our recent UC transfer.
post #11 of 28
6/6/08 at 11:43am
I think it is possible for them to do so, and they will carry more weight than a doula, however, I think it really depends on the partners and the situation. I think many partners, especially if it is their fist child, are just overwhelmed by the experience. In my case, my dh and I never expected to have to advocate. Like people in this thread are saying, we picked the perfect hospital and providers that were supposedly NCB friendly. We walked in with our guard down, and when I was pressured and mistreated, dh got nervous and he would stop the provider and then loudly ask me what I wanted, which I perceived as him yelling at me to make a decision. He knew what I wanted, but he was afraid something was seriously wrong and he didn't know how to handle it or make decisions without my input. He also confessed to me later that he really thought something was wrong with the baby and at times he was getting irritated that I was saying no to things.
post #12 of 28
6/6/08 at 12:03pm
Thread Starter 
To spin off a bit from this spin off, can doulas do "in progress" education of dps? Like "The doctor said she's not progressing quickly enough, if we supported her in a different position that could help." or something?
post #13 of 28
6/6/08 at 12:26pm
Quote:
Originally Posted by sapphire_chan View Post
To spin off a bit from this spin off, can doulas do "in progress" education of dps? Like "The doctor said she's not progressing quickly enough, if we supported her in a different position that could help." or something?
Absolutely

That is a very good example of "combination advocacy". When a client's labor pattern started to get erratic, the OB said "let's start pit". The client was in laborland and had no response, the dad said "let's wait a while and try other things", and I said "we'll try these positions/exercises for 30 minutes to try to shift the baby" (I suspected OP).

When the doctor returned an hour later, baby had shifted, labor was back on track and the doc was amazed = "I don't know what you did, but it worked!" It was a perfect opportunity for educating the OB on the alternatives to pit, but she ran out again, and I was busy with the mama who was by then in transition.

I am thankful that this dad paid attention during our prenatal meetings, was able and willing to step up and push back to the doc's pit recommendation. Many dads are either mentally or physically absent during prenatals, so they don't "get" that sometimes they might have to step up. And many simply cannot, no matter how much they are prepped.

And yes, if the dad had not been the advocate, I would have done the back door" advocacy route: Talking to mom, "The doctor is recommending pitocin, due to blah blah. Is this something you want to do? Your birth plan says you want to avoid pit. There are a number of other things you can do first, and then make a decision. The baby is fine and you are fine" etc...

No, I cannot make decisions for the mama or directly challenge stupid recommendations. Yes, I can communicate her preferences and plans to the HCPs without overtly challenging their "authority". Yes, sometimes it sucks not to be able to be more direct.
post #14 of 28
6/6/08 at 12:30pm
Thread Starter 
Quote:
Originally Posted by sweeetpea View Post
No, I cannot make decisions for the mama or directly challenge stupid recommendations. Yes, I can communicate her preferences and plans to the HCPs without overtly challenging their "authority". Yes, sometimes it sucks not to be able to be more direct.
I was thinking more, since the dp CAN be direct if they know how, can you encourage the dp to say stuff like "my wife needs more time"? Obviously, as an arrangement worked out in advance, not just you directing the whole labor, but could a dp use a doula as a coach they can turn to anytime they aren't sure how to handle something?
post #15 of 28
6/6/08 at 12:41pm
Yes they can. It works with the ones that are paying attention to the whole process, not just the panic part. Sort of like baseball - when I scratch my nose, you need to say "please wait to take her blood pressure until after the contraction"

Yes, the docs are often more respectful of the dad's role in advocacy, BUT the dads are often very susceptible to the scare tactics employed by various HCPs to force interventions.
post #16 of 28
6/6/08 at 12:44pm
Thread Starter 
Quote:
Originally Posted by sweeetpea View Post
Yes, the docs are often more respectful of the dad's role in advocacy, BUT the dads are often very susceptible to the scare tactics employed by various HCPs to force interventions.
I'm now picturing a doula standing behind an HCP with a sign "S/he's trying to scare you, call for a time-out!"
post #17 of 28
6/6/08 at 12:46pm
Quote:
Originally Posted by sapphire_chan View Post
can doulas do "in progress" education?
I think this is my biggest reason for hiring a doula. My DH is a wonderful advocate but I can't expect him to remember everything or be able to foresee things a doula can.
post #18 of 28
6/6/08 at 2:03pm
Maybe if there's a pre-agreed upon code phrase that the mom or the doula can say to the dad that means "man up and get aggressive here!"
post #19 of 28
6/6/08 at 6:07pm
Quote:
Originally Posted by sapphire_chan View Post
I'm now picturing a doula standing behind an HCP with a sign "S/he's trying to scare you, call for a time-out!"


Slightly OT but just thought I'd share: my preceptor told me that when she has a hospital transfer (which is extremely rare in her practice), she always advises the dad to take a minute to put some nice clothes on. It doesn't have to be a suit & tie or anything like that (!) just something he would wear to an event like a dinner party with colleagues: perhaps a nice shirt, casual jacket, and pressed pants. She says she notices a HUGE difference in how the couple is treated and the staff tend to be much more respectful and really listen to what the dad says in that case. It makes sense to me.
post #20 of 28
6/6/08 at 6:47pm
Thread Starter 
Quote:
Originally Posted by Mama2Xander View Post


Slightly OT but just thought I'd share: my preceptor told me that when she has a hospital transfer (which is extremely rare in her practice), she always advises the dad to take a minute to put some nice clothes on. It doesn't have to be a suit & tie or anything like that (!) just something he would wear to an event like a dinner party with colleagues: perhaps a nice shirt, casual jacket, and pressed pants. She says she notices a HUGE difference in how the couple is treated and the staff tend to be much more respectful and really listen to what the dad says in that case. It makes sense to me.
: Set up "hospital outfit" for dh.
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