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Laboring woman changes minds about drugs- what does a doula do?

916 views 5 replies 5 participants last post by  sevenkids 
#1 ·
I need some suggestions from experienced doulas here. I am wanting to train to be a doula when my in-utero-baby is about a year old. In the meantime I have a few pg friends who want me to be their support person.

I've been reading and studying up and have helped two women so far. One had a hospital epidural birth which is what she wanted. That was pretty easy. The other one just had her baby earlier this week. She was a VBAC and had a totally drug free labor but her labor was very fast and intense. I had the same kidn of labor and understood how painful it was. She said later it was worse that her previous pitocin-induced labor!

Anyway it got me thinking because I have another natural childbirth coming up in October and that friend has never had a baby before. She is adamant about not wanting drugs but what if she changes her mind halfway through? I know that with my own labor I was happy to get the epidural because I felt like I was going to die- and I'm a former long-distance runner so I know how to handle pain!

She will most likely be in the birth center but may have to give birth at the hosp. I'm not sure if they give narcotics at the birth center or not but they don't give the epidural. So what if she starts begging for drugs? How do I know it's her speaking and not the transition "I can't do this anymore" speaking? I don't want to sound bossy and say no you can't have them, you didn't want them, if she really did change her mind and needs them to cope.

I have a feeling at that stage she may not be able to think rationally so it won't do me any good to list all the reasons she didn't want drugs. All she will know is that she is hurting and wants it to stop. I've thought about doing the following:

1) give her a code word to use if she *really* has changed her mind
2) keep her busy with changing positions so she won't think about it. Like say, okay but let's try leaning over this chair first to see if that makes you feel better.
3) Say let's get through 5 more cx first and then we'll see.
4) Tell her no she can't have them, as she asked me to do, but I feel funny doing it because what if she really does want them?

Any other suggestions? Thanks!

Darshani
 
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#2 ·
As a doula, I have my moms look at the pain chart in Penny Simkin's Pregnancy, Childbirth and the Newborn (also in many lamaze handouts) which has moms rate their philosophy for pain relief from one end of the scale (epidural in parking lot) to the other (no pain relief, even for surgery) and offers 5 steps in between. This gives me a sense of where they really do stand on pain relief.

For a mom who absolutely, positively wants a drug-free birth, I will sometimes bargain with her during transition. I sometimes try to save a comfort measure (like getting in the shower) for transition, or will try and get her to delay the pain meds for a certain number of contractions. So, for a mom who says, I can't do this anymore, I say, "Well, let's try getting into the shower and see if that helps (or bath, if you have access). For moms who aren't up for that (or if that has been tried already), I say, "I know this is a lot harder than you had expected, but that getting through this without drugs was important to you. Do you want to see if you can handle 5 (or three or ten) more contractions, then I will call the nurse?" After the five contractions, I will usually say, "Well, you fulfilled your part of the bargain, I will keep mine and get the nurse if you want, or we can try and make it another five." A lot of times, if a mom really is in transition, five or 10 contractions is all that it takes to get to the point where mom feels pushy. Being able to focus on a small number of contractions seems to help moms feel like their pain isn't going to go on forever.

Hope this helps.
 
#3 ·
Not a doula, but interested in becoming one. . .

I had a doula for my birth though - and though I was dead set against an epidural, I had one during my birth.

My doula handled my begging for pain meds in the following ways:

1) redirection "Lets try X position for awhile"
2) putting it off "I'll go get the nurse in a minute"
3) having a conversation about it BETWEEN contractions, when I had limited access to my rational self
4) deep focus - she'd ignore my pleas for meds and ask me to open my eyes and look at her so I could concentrate and center myself.

When I finally had the epidural it was after the doctor prescribed pitocin. I said no pitocin and my doula and I discussed the possibilities that I was too tight (mentally and physically) to have the baby without some intervention. My least feared intervention was the epidural. Within an hour I dialated from 4 to 10 on the epi.

Honestly - we discussed and plan on all of these things before the birth. In your position, I'd have a good open discussion with the mom as to what she wants when and make strategies for things like labor stalling, pitocin happy docs, etc..
 
#4 ·
Thanks so much for your answers! I'm learning a lot here just by lurking. I hope her birth goes well and hope I'm able to help her and her dh through it.

Darshani
 
#5 ·
I didn't have a doula but my midwife reacted beautifuly to my begging for the epidural. first she took her nice sweet time
then she checked me before committing to the epidural (I believe this has to be done anyway) and said "Tell y ou what. You will be holding your baby in 30 minutes. can you hold on for just 30 minutes more?" "yes" "if you don't have the baby by then we will give you an epidural and let you sleep (they were trying to prolong labor for 5 days - long story)" I had Madeline 40 minutes later. The check was all I needed to confirm that this pain wouldn't last forever and that I oculd make it just a few more minutes. it was nice to know I was getting somewhere and only had to hold out a few more minutes. Also since there was no hope of stalling labor I was allowed to change positions and the pain lessened incredibly.
 
#6 ·
I used to get disappointed when my clients decided on pain meds after everything we discussed, but I realized that no matter what my feelings on the subject, it's their birth and they have the right to choose whatever they want. If after you know you have done your best to educate and inform your client about the pros and cons of routine pain meds, they still decide to use them, then it's their choice, and they have to deal with the consequences.
I can usually get a good feel as to how committed they are to a unmedicated birth long before labor begins, and if I have a strong feeling about their desire to remain med free, I do every diversionary tactic in the book. If they seem wishy-washy about it and come up with a hundred and one possible scenarios for why they might need one, I,(and more importantly, they) feel great if they held out until 7 cm instead of accepting at 4.
If a woman is adament about not wanting pain meds, she usually will not ask for them until transition, when she's being physically tested the most. If she can understand that this is the hardest (and blessedly shortest) part of labor, and she will have that baby very soon, she will find inner strength and continue. If she was open to the possibity of having pain meds, she will be more ready to accept them when offered.
It really has to do with the mother and not so much your skill as a doula. We are here to help the mother achieve the birth experience she wants, which may include pain meds. Not to say you give up at the first sign of difficulty, but remember not to take it personally if they decide they want/need pain meds.
That said, I find that using and emphasizing the term "your baby" a lot during labor and transition helps remimd them of why they are feeling all these sensations. ("breathe deep, send all that good oxygen down to YOUR BABY", "YOUR BABY is really low in your pelvis, that's why you feel all that pressure", "Your going to be meeting YOUR BABY real soon!" "Make room for YOUR BABY") When you are overwhelmed with discomfort, it's easy to forget this pain has a purpose.
 
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