Doula questions.

816 Views 10 Replies 6 Participants Last post by mjg013, Apr 24, 2009

mjg013

Discussion Starter · Apr 22, 2009

I am working on my doula certification through DONA. I have done all my reading, I haven't taken the workshop yet because I'm waiting for another one in my area to attend. I was recently offered the opportunity to attend a birth. A woman I used to attend church with is expecting her first baby. She was telling me the other day that things aren't going well. She is 32 weeks and has gestational diabetes and the baby is breech and measuring big. He's been measuring big the entire pregnancy. She really wants to avoid a c-section but hadn't really planned a natural birth because some other friends told her it was not possible to have a natural birth at the hospital she's delivering at. I know that isn't true. I had 7 of my 8 children at that hospital. I told her that if she wanted a natural birth she needed to be discussing it with her doctor since he/she is the one who gives the orders while she's in labor. Well, her dh isn't comfortable with labor at all. He wants her to just have the c-section so that they can show up, nice, neat surgery, baby comes home. He's just freaked about the entire process. So I suggested she get a doula. I told her that I was training and needed to attend births to earn my certification and would love to be there to support her during her birth. I suggested she see a chiropractor about the Webster technique to work on getting the baby to turn and shower her how to do pelvic tilts. I also discussed the importance of being able to push in other positions since her baby is measuring big. She is around 5'2" and her dh is over 6' tall so it's very likely. I told her having an epidural would interfere with pushing in other positions so it's something she should take into consideration but that she should do what she is most comfortable with. The good thing is that the hospital has an anesthesiologist on the floor at all times so she can decide to get an epidural anytime she wants. She was never keen on getting an epidural to begin with. Again, that was her dh's suggestion because he doesn't want her to be in any pain. I really feel like having a doula is going to be a huge help to both of them. They're both really excited now that I'm going to be there with them. She has talked more about natural birth with her dh and he is more receptive now that I'm going to be there. Anyway, there is a point to this. She asked me to come to her ob appt Friday with her. She has injured herself and needs the physical help but she is also going to discuss her desire for a natural birth with her doctor. I'm trying to help her with questions she needs to ask. We live in a very non-birth friendly state so it's imperative to make sure the doctor is on board ahead of time. What does she need to ask? So far I've told her she needs to find out what the doctor's procedures are for a laboring patient? What does the hospital expect and what policies do they have in place? Which policies are they more lenient about? What are her options for fetal monitoring? Will the doctor support moving around and walking during labor? Will the doctor support pushing in alternative positions especially since the baby may be big? Does the doctor routinely do episiotomies? What point do they begin to discuss augmenting labor? What point do they offer epidurals? What else does she need to ask? Also, I am aware that these are things she should have asked at the beginning. Thanks for any help you can give me.

See less See more

Save

1 - 11 of 11 Posts

TzippityDoulah

· #2 · Apr 22, 2009

it sounds to me you have told her allthe right things and given her all the right tools.

The only thing I would caution *you* on is not getting your hopes to high. what I mean is if this is your first (or one of your first births) it's so easy to get your hopes high that you can really change this woman's life and see her obtain a wonderful birth experience. and that is good!! but keep in mind she is 32 weeks... and she had made a lot of her choices. she's picked her hospital and her OB and well... even her husband

it's a lot to expect things to do a 180 in the last couple of weeks of pregnancy. if her husband is all about section b/c it's less messy - well it shows he really doesn't understand birth AT ALL. (nor how incredibly messy surgery and after care actually is!!) which might be somethign good to point - maybe find a c/s video?

I would try to "tackle" a few things at a time... just don't be too dissapointed if they don't see it all your way. remember, this is their brth and their choices and you can only do so much to help.

maybe referencing a few good websites would be a good place to start. since you attended church with them I assume they are Christian? if so this is a good website for natural birth (but it's also not too overboard as to scare off newbies!)

http://christian.birthingnaturally.net/

this gives your client/friend a chance to be her own advocate and learn some things for herself. if you try to spoon feed a client too much it never goes well. but if you give the the tools to research for themselves it can REALLY empower them. (you know that whole "teach a man to fish" idea? heh)

good luck with everything! and congrats on becoming a doula!!

See less See more

Save

doulanichole

· #3 · Apr 22, 2009

If she doesn't like her ob's recommendations she could always switch to a less c/s-happy provider. And there are some.

Save

turtlewomyn

· #4 · Apr 23, 2009

I would recommend that she has the ACOG recommendations for fetal macrosomia in hand. They do not recommend induction or c-section for babies that have a fetal weight estimate of less than 5000g (or around 11 pounds) in women without GD (or 4500g, 9lb14oz for women with GD).

The breech situation is another story, and I would not recommend a vaginal breech birth with a care provider who is not trained in vaginal breech birth. But you have already worked with her on any ideas to get that baby to turn turn turn (has she seen spinningbabies.com yet??)

Save

MG01

· #5 · Apr 23, 2009

Hi there,

I am also in the process of doula certification.. have done the readings and am doing the workshop next month. Congrats on the chance to attend your first birth!

I had a breech in my pregnancy (turned spontaneously at 39 1/2 weeks!) but tried everything else to get the little guy to turn. I made up a breech resource list based on what I learned during my pregnancy to provide to future doula clients that I can send you if you want, so that you can edit it to fit your needs and provide it to this woman and/or future clients?

I think it's always nice to have something written up; I know for myself it helps a lot since trying to remember/learn just by hearing something, it goes in one ear and out the other, I guess it's just a different learning style..

Anyway, let me know, and keep us posted

See less See more

Save

mjg013

Discussion Starter · #6 · Apr 23, 2009

Thanks for all the support and suggestions. She researched natural birth to start with but then a lot of her friends told her it wouldn't be possible. She just didn't pursue it after that. I delivered at the same hospital with all but one of mine so I know the atmosphere and I know she can get the things she's wanting. She told me that she already knew she wanted to labor at home as long as possible and wait as long as possible before getting an epidural. She said her dh is just so terrified because he has no idea what to expect. She said he feels a lot more relaxed about it knowing I'll be there.

I have a lot of info on turning breech babies because my twins were breech. But I would love the resource list too. You can never have too much info. I had 2 c-sections one with breech twins and then with my last one because my uterus just wasn't contracting effectively. It's a crazy long story. My doctor and I fought hard for a VBAC but it just wasn't happening. So I have explained to her what a c-section is like and the difference in recovery.

I talked to a friend of mine yesterday who uses the same practice this lady is using and she said they're very laid back. I'm pretty familiar with them as well. I know one of their nurses really well. So I'm confident that the doctor will be supportive. And I have already told her that she has the control over her choices but that she shouldn't just go with an epidural because her husband is afraid. The ob she is using has not started suggesting a c-section yet. They told her the baby still has time to turn and if he hasn't in another couple weeks they are going to talk to her about a version. I've already given her info regarding that as well.

See less See more

Save

mjg013

Discussion Starter · #7 · Apr 23, 2009

Quote:

Originally Posted by turtlewomyn

I would recommend that she has the ACOG recommendations for fetal macrosomia in hand. They do not recommend induction or c-section for babies that have a fetal weight estimate of less than 5000g (or around 11 pounds) in women without GD (or 4500g, 9lb14oz for women with GD).

The breech situation is another story, and I would not recommend a vaginal breech birth with a care provider who is not trained in vaginal breech birth. But you have already worked with her on any ideas to get that baby to turn turn turn (has she seen spinningbabies.com yet??)

That isn't an option here. It's strictly against hospital policy. My ob/gyn lost his privileges at one hospital for doing a vaginal breech delivery. He offered to deliver my 2nd twin breech as long as the first was vertex. He warned me though that the hospital staff would be freaking out. As it went they were both breech. They just will not do them here. I'll always regret not calling The Farm when I was pregnant with my twins. So we already know that breech delivery isn't an option. He has to turn for her to even have a chance at a vaginal delivery.

See less See more

Save

MG01

· #8 · Apr 24, 2009

Quote:

Originally Posted by mjg013

Really!? That is messed up! I am kinda confused though.. when I was researching breech options with my pregnancy, my understanding was that it was always an option, simply because one is never obligated to consent to cesarean. Now, of course, I would not have gone ahead with that since having an untrained or fearful attendant who is not on board would have hindered my birthing and creating an unsafe situation (I wound up lining up three physicians who would indeed do vaginal breech, in my city and surrounding areas, and planned to go to whoever was on call when I went into labor, but the little trickster turned at the last minute

so I did get to proceed with my midwives as planned).. but, maybe the difference is hospital policy says no breech, and he explicitly agreed to do such beforehand (rather than it happening- or being portrayed- as the patient simply refusing to consent despite his urging a cesarean) I can't imagine a doc could get fired for something he has no control over, but we do live in a crazy world, and I know there is a ton of fear-mongering over vaginal breech birth and issues with liability, so it does create a tricky situation.

I am hoping the little one turns though, it definitely can and does happen more often than not so hopefully it will not come to cesarean for her (although if it does, I think it will be ideal that she still has the support of a doula)

Also- The resource list is a Word document so if you'd like to pm me an email I can send it to you?

See less See more

Save

mjg013

Discussion Starter · #9 · Apr 24, 2009

Quote:

Originally Posted by Mama_Gaia

I think that it was because he knew the baby was breech and agreed to attend the delivery anyway. You'd be hard-pressed to find a doctor willing to attend a breech delivery at all. I'm assuming if it was an "emergency situation" where they didn't realize the baby was presenting breech until pushing began then they would go through with it but I have heard stories of doctors rushing women in for emergency c-sections at the first sign of a breech presentation. I certainly wouldn't want to go into that sort of situation with that attitude. There is a single doctor in the area that will consent to breech deliveries. He's obsessive about it and has had some very bad outcomes as a result. I guess the more accurate thing to say is that safe breech deliveries are impossible in this state in a hospital. And there are only 2 birthing centers in the entire state that I'm aware of and none near me. I checked when I was pregnant with the twins. Our birth options are very limited. UC is the only way to have a legal homebirth. It all makes me so angry I can't see straight. Too many generations of complacent uninformed women has done so much damage. It's why I want to become a childbirth educator and doula. Knowledge is power.

And I'm sure my ob/gyn didn't lose his privileges over that one incident just that was a last straw. He kind of bucks the system. He is a dedicated speaker for patient rights and informed consent. He used to teach childbirth education classes with his wife. He delivered 2 of my babies during office hours because the hospital along with his partner weren't giving me the support I needed so he came to the hospital on his lunch break and after work to help me and catch my babies. He even came in from being on vacation to do my c-section with the twins. He also fought really hard for me to have a VBAC with my 8th in spite of a lot of hostility from the hospital and the fact that I had had a low vertical incision. He even supported my plan for a UC with my 6th pregnancy until we ended up with twins, breech presentation, preterm labor, etc. He's just not the typical ob and believes strongly in patient-led childbirth. Not exactly what the hospitals encourage. I think the hospital put out the policy against breech deliveries and he refused to schedule c-sections on that basis alone and when his breech deliveries didn't start decreasing he became too big of a risk. He also refuses to do elective c-sections without medical indications.

See less See more

Save

mamallama

· #10 · Apr 24, 2009

A big issue I see is that if/when the baby turns, when will they pressure her for induction? A diagnosis of GD puts her on the first stop of the induction railroad--I doubt they will be supportive of her going much past 40wks.

And for you, I agree about not becoming overly invested in her birth going one way or another. As she's a friend, I understand being invested in her well-being, but getting bogged down in the politics/culture of birth seems like a real possibility here. It might be good to take a step back and look at what it means to be supportive in the context of the big picture.

Best wishes as you start down this path!

Save

mjg013

Discussion Starter · #11 · Apr 24, 2009

So the appointment went well today. The baby is still breech. Her fluid was very low last time which was a concern but it has doubled in two weeks which is really good. She didn't like the dr we saw today. She said this doctor is the only one in the practice that she isn't crazy about and ime that will probably be who delivers her. The doctor seemed a little flaky and not really willing to give any real answers. The good news is that they seem open to natural birthing. They won't even discuss the possibility of induction or c-section until after 39 weeks which is encouraging in this area. They said they would only discuss it if there was a real reason too but that there was no reason they saw for her to not go to term. They were watching her sugar of course. She was measuring exactly right for gestation which seems like a good sign. I measured 44 weeks at 37 weeks gestation with my last baby. And she thinks she may be a week or more farther along than they think because she was doing fertility treatments and her cycle was longer than average. So we have that working in our favor. Now we just try to get this baby to turn. Thanks everyone for their help.

See less See more

Save

1 - 11 of 11 Posts

This is an older thread, you may not receive a response, and could be reviving an old thread. Please consider creating a new thread.

Top Contributors this Month