Do you ever feel like we might be doing things all wrong? - Mothering Forums
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#1 of 14 Old 06-01-2008, 06:37 PM - Thread Starter
 
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Sometimes I'm : by birth.

We've had so many clients in the last 6 months with all kinds of complications. Postpartum hemorrhage, late post partum hemorrhage due to retained placenta (even though we checked and KNOW that the placenta looked complete), transfer/c-section of a mom who's baby just wouldn't come down, broken clavicles, all kinds of things.

All of these moms who put so much time and effort into taking care of themselves and taking responsibility for their pregnancy and not seeing any benefit!

And then all the women I know who are going in for the inductions at 38 weeks or having their planned c/s are birthing without any complications or hardship. It just feels maddening some times!

It's like the twighlight zone. Sometimes I think, "Did I miss something?" I'm hoping it's just a bad run and we've filled our quota for a lifetime but sheesh.

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#2 of 14 Old 06-01-2008, 08:15 PM
 
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Whatever is true, whatever is right, whatever is pure, whatever is lovely, dwell on these things. Phil 4:8

Let me take a moment and remind you of your own quote on here. Yes it is easy to dwell on the bad and focus on what you did wrong, but don't forget to take time to focus on what what you did right and the women you helped.

At times we are all tested, stay strong and think of what you can do to improve the care you give in the future.

Good Luck,
Annie
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#3 of 14 Old 06-01-2008, 10:56 PM
 
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I find it most common for my clients who did not have their perfectly planned birth, that they are not unsatisfied. If the mom feels like she had the information to make her OWN choices and was supported in those choices they can still have a good birth feeling. They know that sometimes things happen. They control the things they can and let go of the things they can not.
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#4 of 14 Old 06-01-2008, 11:25 PM
 
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Boy, I really needed those words of wisdom right now! THANKS
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#5 of 14 Old 06-01-2008, 11:56 PM
 
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I would like to comment, even though I am not a birth professional, if that's OK. My first birth ended up in a transfer for an epi and shot of pitocin after many hours of labour. I don't know if I could have kept going and birthed at home - I'll always wonder if I should have tried to keep going at home, but the birth itself, even though in hospital was beautiful. My midwife ran the show completely and it was as calm and serene as I could have hoped for. My choices were respected and we made a break for it as soon as I was cleaned up and had a pee pee. It was not the homebirth I'd wanted, but it was still wonderful.

My second experience was a perfect waterbirth at home. I laboured well and pushed for about 20 minutes. My son was perfect and I will always cherish the memories of this peaceful, quiet birth. However, I ended up with a retained placenta and (surprisingly) a velementous insertion which became detached when my midwife attempted gentle traction. PPH of about 2 litres. I had an emergency transfer for a manual extraction, but luckily avoided the OR. Not an entirely pleasant experience, but better than a d&c after a glorious birth.

I do not regret for a minute the choices I made. I have managed to separate the birth memories from the events that came after. I also don't think I would have homebirthed if I hadn't been so close to a hospital. I knew the risks as they had been very clearly explained to me by a midwifery student during one of my appointments. I understood the protocol for dealing with excessive bleeding and never felt that my life was in danger or that my care was anything other than exceptional.

I know that if you asked the same question of the medical community you would likely get a much different answer, but from my perspective, you are NOT doing anything wrong. You allow informed decision making and that's always a good thing.

Diane, SAHM to DD (June 05) and DS (April 07).
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#6 of 14 Old 06-02-2008, 01:28 PM
 
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I know a student doula who attended her first 8 births, 7 of them were caesareans.
After the last caesarean she just broke down into tears, and the attending physician(an EXCELLENT) family doctor, ran into her in the hall and asked her what was wrong. She told the doctor, and the doc gave her a hug, and the doula said 'What am I doing wrong?" and the doc said 'F*** off, dear. Do you think that kind of power? do you think you can cause caesarean sections?'

We all have bad streaks and good streaks as birth professionals. It may be luck. I'd like to think of it as a lesson. Not a lesson like we are a bad doctor/doula/midwife/dentist/whatever' but some sort of lesson. Something we need to go through to help us be better practioners (and our clients need to go through, each baby has its path). As much as we'd like to think that if we do everything right everything will happen right, everyone has their path and its just not like that, we dont know what kinds of forces are at work. Maybe your lesson needs to be that sometimes interventions are necessary and that doctors care just as much for their patients as we do for our clients, or that a client can have a caesarean and still have a good birth experience, or sometimes just to know that western medicine is not evil.

When things arent going well, I like to look for the lesson. And no matter what happens it's our job to make our clients feel safe and loved throughout the experience.

So i will repeat what the doctor said to my friend "You arent that powerful". Just look for the lessons, learn, and heal.
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#7 of 14 Old 06-02-2008, 02:58 PM
 
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I understand! I've said the same things to friends and family about my experience as a doula. More of my births have ended up "unnatural" than natural even though that is what Mom wanted. And not because she "gave in" to pitocin or pain relievers but because bad things happened, a few c-sections (breech) and one because a baby wouldn't descend because his head was sideways in the birth canal (40 hours of labor). Inductions because of broken waters or low amniotic fluid. Vacuum extractions for very low heart tones and muconium. C-sections for abnormal heart tones. PPH and transfer to hospital from home. I could go on and I've only been to about 15 births or so!

I am not so conflicted about what I did wrong. I do good and bad at every birth and learn from each experience. But I am a bit conflicted about the completely natural nature of birth. Don't get me wrong it IS natural. But naturally so it seems many more mothers and babies would not be here today if we didn't have wonderful home and hospital birth attendants.

We don't generally need attendents to watch us do other natural activities like poop or pee or have sex, right? :-)

Hoping for some smoother births down the road myself. I am optimistic though that the women I've served have done right most of the time and that they were all satisified after it was all said and done. And that is what is important.

Mother to FOUR BOYS!!  Austin (1997) Luke (2005) Mason (2007) and Judah (2010), wife to Joe, doula to many, and Birthing From Within Mentor in SE Michigan
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#8 of 14 Old 06-02-2008, 09:48 PM
 
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I think you were meant to be at these more difficult births to give what you could. There are so many factors involved with how a birth happens and we can never know them all. We can just do the best we can to inform and support women.
Watch some nice homebirth videos for some balance!
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#9 of 14 Old 06-03-2008, 05:14 PM
 
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Originally Posted by wumanh View Post
I think you were meant to be at these more difficult births to give what you could. There are so many factors involved with how a birth happens and we can never know them all. We can just do the best we can to inform and support women.
Watch some nice homebirth videos for some balance!
I wanted to add to this a bit, I don't know if this will make it better or worse, but one of the things I'm trying to keep in mind as I go into my first births (which all seem to be going medicalized rapidly) is this letter I read when I was in my doula training program. I'll link to it, just because it really is a 'rip the bandaid off the wound' kind of honesty, but I think it reminds me that maybe sometimes we have to see those bad births, and see things that go wrong, to remind us of what we're fighting for- to remind us not to be complacent and ok with the interventions.

A lot of the time we, as doulas, don't have the power to change things, as a PP mentioned- but I kind of look at these cases as a reminder to us of what we're fighting against- so that we *can* do the best job in the cases we can change. Like the PP said- we need to give what we can, and make each of these births special and wonderful for the woman too, even if on the surface they seem horrible to us. We give her what she needs to view it as wonderful, and then take the experience with us onto the next one...

Letter to my Doula

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#10 of 14 Old 06-03-2008, 07:25 PM
 
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Originally Posted by moodyred01 View Post
All of these moms who put so much time and effort into taking care of themselves and taking responsibility for their pregnancy and not seeing any benefit!
Ah, but you don't know that. Maybe they are seeing benefits. Maybe being cared for by the practitioner(s) of their choice, in the manner they desire, is a benefit, regardless of the outcome. Maybe those women learned something from the births that didn't go as planned that they couldn't have learned any other way. Some probably did, some probably didn't. But I believe there ARE benefits.

Here as mama to W (2/04), R (5/06), D (7/09), and J (12/9/12!), co-parenting with my DH

I WOH part-time, am a doula & childbirth educator, home/unschool, and hope we are nearing the center of chaos


 
  

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#11 of 14 Old 06-05-2008, 01:24 PM
 
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I dont see how that letter can be any sort of inspiration. Its tragic that this writer had a traumatising Caesarean and thought that her doula could have prevented it, however it is most certainly not something I would include in a doula training package and I dont think its a great reminder of anything. I dont think any doula lacks sympathy for their caesarean clients and will do anything they can to prevent an unneccessary ceasarean.
This letter comes from a place of birth trauma, fear and horror, and it seems as though this woman feels her doula let her get wheeled away to the OR for no reason. No one knows why this woman feels this way. What is the context? Is the woman suffering from PPD? Did the doula do a lousy job? What is the emotional state of the woman and relationship between woman and doula?
I do not think this is a reasonable representation of a normal post caesarean reaction to a doula's role in the whole thing.

I do everything I can to prevent unneccesary caesarean, but I realize that what I can do is limited. What I will not do: "you will throw yourself bodily in front of the train to save her" because guess what, that is not going to "save her".
I am not fighting either. I dont need to be reminded what I am 'fighting for' because I dont fight. I am not combative with doctors, nurses, or clients. I consider that I effect positive change through information and demonstration, but there is no way I am going to go off on a doctor for me thinking a section isnt neccessary, or that he caused it because 1) I am not a doctor, even if I were a midwife I am not a doctor, and 2) because fighting is definitely not the solution to repairing the wounds in maternity care.
I want to have a good relationship with doctors even if I dont agree with their practice all the time. I want to be respected in the hospitals and have nurses and docs happy to see me when I enter the room, because a combatative doula is not doing their job to help the woman because tension and anger has no positive effect on birth.

The next thing to consider is that there are risks involved in everything, and whether the options are vast or not, each woman is making a choice, on some level, about what risks she is willing to make.
She is choosing to give birth in the hospital which carries the risk of unneccesary or increased medical intervention, which may inevidably lead to caesarean section.
She is choosing not to give birth at home. Even if access to midwifery care is limited or non existant there is a choice with risks. The risks being that it could be illegal, or more expensive that she could afford.
She could UC but find that too risky in that there is no medical support, or whatever.
They may not be informed decisions, they may not be decisions out of a wide array of delightful options, however they are her choices. you are not responsible for them. She chose to get a doula, which is great but she needs to recognize what that means and doesn't mean, and to realize that because she is giving birth in a hospital there is a risk of intervention, which she may decline if she so chooses and at no point may/will her doula, make decisions for her, nor is a doula her doctor, therefore the doula is NOT responsible for the resulting caesarean or fourth degree tear, or whatever it may be.

A bit of a rant because that letter kind of got under my skin. We cannot take on the tragedies of our clients in an unhealthy way. We can mourn for them, we can be sad, or feel bad, but we are not to feel guilty or responsible for the choices of our clients.
I know the idea of choice will really make people mad because I know women have so few options, especially where I am from but inevidably they are decisions with risks. Each decision. If a woman is not willing to take any chance of unneccessary caesarean she should UC.
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#12 of 14 Old 06-05-2008, 07:57 PM
 
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Originally Posted by Sage.Naissance View Post
I do not think this is a reasonable representation of a normal post caesarean reaction to a doula's role in the whole thing.

They may not be informed decisions, they may not be decisions out of a wide array of delightful options, however they are her choices. you are not responsible for them. She chose to get a doula, which is great but she needs to recognize what that means and doesn't mean, and to realize that because she is giving birth in a hospital there is a risk of intervention, which she may decline if she so chooses and at no point may/will her doula, make decisions for her, nor is a doula her doctor, therefore the doula is NOT responsible for the resulting caesarean or fourth degree tear, or whatever it may be.
I know the letter was very blunt and honest, that's why I chose to link it instead or repost it- I wanted people to be warned that it isn't a sunshine and rainbows letter. And no- it's not a representation of an average c-section- but it is a representation of what they can be like, and what we want to avoid.

I think you're taking the letter a lot more literally than I've had it presented to me and explored it. I don't think anyone literally expects you to throw yourself in front of a doctor as he weilds his scalpel. But too often we as doulas stand back when our clients make a decision, or are told they must do something, instead of letting her know the information, the unbiased facts and other options. We don't say anything because we don't want them to look at their doctors in a poor light, or we don't want the doctor to be mad at us when the client questions a procedure. Women choose to have a doula because they are advocates and will support a woman in childbirth. Yes our advocacy is changing in light of the current client, but we have an obligation to let a woman know when there are other choices, better options.

If I know of a better option and don't tell her, then yes, I somewhat AM responsible.

I presented the letter and my comments because I think the "bad births" do serve to bring us back down, and to remind us why we are at a birth- to do wha we can to make that mother's birth the best it can be for her. Sometimes- that surgery is the best it gets, and our job is t comfort and support her, but these 'bad births' can also remind us for next time what we're trying to avoid, and why we do what we do.

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#13 of 14 Old 06-05-2008, 07:58 PM
 
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I think the letter is also a very good reminder of discussing prenatally what a doula CAN and CAN NOT do for you so your client doesn't have unrealistic expectations about your scope of practice.

Wife of one and mom of five, including my HBAC twins!
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#14 of 14 Old 06-05-2008, 09:18 PM
 
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I think the letter is also a very good reminder of discussing prenatally what a doula CAN and CAN NOT do for you so your client doesn't have unrealistic expectations about your scope of practice.
That's very true. Good point!

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