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Crazy question for doulas

628 Views 10 Replies 7 Participants Last post by  mamato3cherubs
I have a client of my own who has recently started to attend some births as a sort of doula herself. The clients she supports are all residents of a home for women with crisis pregnancies. Many are young, most are planning to parent their babies, some are planning to place their babies for adoption. My own client is often the only support these young women have. She herself does not have formal training, but did take a Bradley class herself during her first pregnancy (which was a cesarean birth for breech) and then had a lovely unmedicated VBAC with me a year ago. There are no formally trained doulas around here, so she and her mom both attend births out of the goodness of their hearts.
Now for the actual question. My client asked me recently how she can help a woman for whom cervical exams are very painful and traumatizing cope with said exams.
Now my obvious answer was to refuse them all - but this is difficult in the hospital setting she is in. It frankly makes me ill to think about a young, frightened woman being forced into an exam that they don't want.
My other suggestions were for my client - functioning as a doula - to insist on knowing the exact reason for the exam, and what the information will be used for, with the thought that some exams at least could be deferred or refused.
I also mentioned that when I have a client where I actually really need to know dilation, or position - or something urgent like is there a cord in front of the head, and that client doesn't tolerate being examined well, that I have found that doing the exam in side-lying is sometimes easier on the client.
After those two suggestions, I'm fresh out of ideas. The town where the home is has just one OB, and he is not real open to changing his ways.
How do you doulas help women avoid unwanted exams?
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Just want you to know that I saw your note and will get to it, just fighting off sickness at the moment.
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I like to talk with women before they ever get to the hospital about vag checks if I can. I ask how they think this will make them feel, things of that nature. Some people, I do not talk with, I just have to feel out the conversation. at a birth, I encourage moms to ask why is anything being done to or for them, VEs included. I help them prepare by breathing deeply and focusing on my voiceand speaking calmly to them. I let them know it is okay to tell the person doing it to stop if it is hurting or frightening them. I've had moms say later that they appreciated knowing they could stop a vag exam and appreciated my reminding them so. I encourage moms to ask the nurse/doc/midwife to go slowly and be gentle and if itlooks like she really can't cope, I will speak up for her, saying something liek "the last exam she had was really uncomfortable for her....". Of course, beforehand I always tell women they can refuse anything but if they chose to go ahead with things, that is okay. Someting else with vag checks is that I ask women "Do you want to know what numbers you are or do yhou just want to know if you have made progress or not" (if they've had one previously) I've found that most women don't want to hear numbers because it bums them out and makes it even harder next time they have one done. I always offer to hold their hands during them or let them hug me or whateverthey need and I never leave them alone during a vag exam. I can't think of anything else at the time but please send my love to your client who is doing this. My dream is to work with "at-risk" women (young mothers, pregnant from abuse, abused women, etc etc) so I really give her lots of thumbs up and amj sending lots oflove and light her way.

Namaste, Tara
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Thanks, Tara, that is helpful. I'm used to being the provider myself, so it's hard for me to figure out how to cope with a different provider! Would love any other ideas.
you used the word traumatizing. I would first figure out the reason this is so bothersome for her, if it is mental or emotional this could very well be contributing to the physical pain. If she can figure out what has prompted the reaction (besides the obvious basic invation of the body that everyone goes through) then she may be able to know how to better help her.

There are books out there that she could read if she is interested in helping out women who are survivors of abuse or trama. that may be a good resource for her.

It doesnt take formal training to make a good doula, just a kind heat, open mind, and desire to help. Well a basic knowledge of how it all works is good too, LOL, but reading and reading can really help. Along with learning from every experience.

and of course your thoughts seem right on too.
"When Survivors Give Birth" by Penny Simkin is a must read for all doulas, especially those dealing with at risk populations.

Originally Posted by Amydoula
"When Survivors Give Birth" by Penny Simkin is a must read for all doulas, especially those dealing with at risk populations.
yeah, thats the one I was thinking of. Alot of resources on line as well. I just havnt gotten to that one yet. On my list though, if I can find my list that is
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Jen -
I would only add to what other have said that something to consider is relaxation, visualization, self-hynopsis teachniques, etc. Don't know how much time she has to prep with these moms before hands. But even on the spot, a simple exercise of imagining a favorite beautiful place, floating in water, deeply loosening all the muscles etc, can be helpful.
If I've practiced these for labor with a client, we use them in VEs as well as contractions. There are some in the back of The Doula Book by Kennell & Klauss.

Obviously better if they don't happen much/at all as you say!

I second reading up on abuse survivors for the work she is doing, too.
I always suggest that my clients ask for the same person to do the exams each time, which generally means the nurses wait for doc. to get there before doing an exam. This means, with a lot of docs, that exams are only happening every 3-4 hours, which is much better than can happen in hospitals. It also eliminates the chance of variation because of different hands/fingers checking, which can be a big problem for moms (speaking from personal experience there). I also advise them to include a section on vaginal exams in their birth plan and encourage them to think about how often they want them, to remind the provider to ASK them about an exam rather than TELL them it's time for one. Some have put in the birth plan that they understand an initial exam is necessary, as well as an exam before second stage, but that they prefer no other exams unless they ask to be checked.
The problem with putting anything in a birth plan is that this provider refuses to accept them. He says that he won't put them in a client's chart because then if he didn't follow, the patient could sue him. (So, therefore, it is apparently better to tell them up front you won't do what they ask, I guess.)
The rule in my own practice is no exams unless the client requests - or I feel I need the info for decision making purposes, in which case the client is asked for permission. Generally this ends up meaning an exam on admission, if pain medicine is requested, or if we are considering an intervention of some type (add pitocin, do an instrumented delivery, etc.) I don't routinely do exams prior to second stage, unless requested, except for in moms with really dense epidural anesthesia who can't feel anything and need guidance.
I can't really wrap my brain around routine, every 2 hours or what have you, exams - especially if the mama doesn't want them or finds them uncomfortable, frightening, or traumatic. I do think at least requesting that the same examiner, and making sure the exam is being done for a particular reason (and a reason other than wanting to be able to plot labor on a Friedman curve!) is a step in the right direction and should be hard to argue with.
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I am sure you have heard this a hundred times, esspecially around here, but I have to say it again, the world would be a better place if there were more Doctors and OBs out there like you!
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