Doulas: advocate or educate mother to advocate for herself?

Some of us mothers cannot advocate for ourselves during labor. It's not the pain, it's the hormones and laborland. See recent research that has been well circulated on oxytocin and trust.

Women have a right to be able to trust the people around them when they are laboring. Without this, women's short and long term health and happiness (and that of the families relying on them) is in jeopardy. It's all too clear that most women in the hospital environment should not trust the people around them.

If hospital doulas cannot advocate for the mother during the birth (I do understand the problems with that scenario), then the doula might focus on empowering both the mother and another trusted person such as the FOB.

*HOWEVER* if a woman is about to be assaulted and battered (e.g., unconsented to episiotomy for provider convenience), I see no problem with preventing such assault with force if necessary. A crime is a crime is a crime, and as a person if I fully comprehended what was about to happen and could stop it without being in physical danger myself, I would do so. I'm not sure how we can rationalize things otherwise. Actually, the way this is usually rationalized is a blame the victim thing where it is argued that the woman chose genital mutilation because she birthed in the hospital -- like saying someone deserved to be raped because she wore a short skirt.

There's a lot to talk about in this thread.

I agree with you Claudia. I am not there to override anything that the doctor does. I am there to help the mother, educate her, provide support and information. There have been Doula's locally that have been removed for overstepping their bounds. Portland has so many doulas, and they attend so many of the births that we are on tenderhooks. There is a movement in one of the large hospitals here to "outlaw" any doulas in the birthingroom UNLESS that have been "preapproved" by the staff. (this was started by the nursing staff). We walk a very fine line indeed.

For example if I saw the doctor going for an amni-hook I would say loudly "Jane Doe, the doctor is planning to break your water, do you have any questions about that?" If the doctor was going to cut an epis. I would say "Jane/John the doctor is going to cut an epis., didn't you want to avoid that." I would NOT however touch the doctor or take something from them. I also talk to my clients before hand about a *signal* to use. For example most of my clients are not christian. When they want more information about something they say "can we have a moment to pray about it?" Then when we are all alone, we talk about all the options.

Although a woman NEVER choses to be hurt by her care provider, she does have the resposibility to choose them wisely and ask questions prenatally. She also has to educate herself. I see that some mothers hire an interventive OB to save them from birth and then hire a doula to save them from the OB thinking that they will get the best of both worlds and by a miracle have a homebirth at the hospital. It doesn't work that way.

Claudia - I am always willing to talk to you and give you a shoulder if you need to talk about a certain situation. I have been *warned* by a doctor and by a CNM at the early parts of birth to watch it or leave Before I even said anything but that I am a doula. I have also have some amazingly wonderful doctors/midwives attend my clients births.

Victorian

Quote:
I agree, if you touch the dr/nurse or take anything out of their hands then you are just as bad as they are. Assaulting a dr so they don't assault the client does not make it right.

I try to educate a client during prenatals, during an interview I tell them there is only so far I can go or the staff does have the right to remove me(or anyone). My last client I only met once before she had the baby so I was not able to educate her as well as i would have liked.

Doula's have only been here for 3-4 years, in the last year there has been a surge of us but still not attending as many births as any of us would like. There is 1 Doula who has given the entire medical staff a bad idea of Doula's so the rest of us have been playing nice to show them we're not all like her.

I get so much conflicting information on how far to push the medical staff. I come to Mothering and I want to stand up to the nurses and say, "look she told you she did not want an epidural/pain meds stop telling her she needs one/asking if she'd like something". On the other hand are the Doula's who actually work here who are telling me not to because the nurses will kick you out. The first way feels right to me and it is what I want to do but if I get kicked out I'm no good to my client. The doula who has ticked off the staff was pulled out once because she was trying to get her client to go against hospital policy. I need to get my hands on the hospital policies which isn't the easiest thing to do.

Quote:
That makes me sick. I know you as doulas have to abide by the hospital rules so you don't get kicked out. But, it makes me sick that it could happen. If I'm in labour, I'm really not up to fighting with someone who keeps insisting on procedures that I don't need or want. I definitely don't want to find myself with a freaking epidural just because the nurses won't let anyone stick up for me!!! (I don't have a doula, but I have a dh...good luck to them in kicking him out...unless they're sending me with him.) I had an epidural with my second c-section, and while it's definitely preferable to general anesthetic, I won't put up with one for anything short of being cut open...I hated the thing!

To me a doula is more of an in-the-background person who might bring up questions or remind about something mentioned on the birth plan to support the laboring mom in advocating for herself. Not only for legal reasons, but I think this is ultimately more supportive and empowering. I think being up-front about the doula role/how you see the doula role is important when first meeting with prospective clients. I don't think you need to spend a huge amount of time on this, but if they have the idea that you can be their intermediary and take away all the hassle of interacting with the hospital staff, you need to clarify your role imo. Obviously, doulas still help alot in working with hospital staff.

With my first birth I think I thought that my doula could speak for me at the birth in the hospital. Then as the pregnancy progressed I grew into myself more and got to a place where I didn't want someone else speaking for me (I also didn't want someone who went overboard with trying to educate me--which my doula did a little bit--it was more important to me that my doula listen to what I wanted whether or not she agreed with it). My doula was helpful in the way I mentioned above though.

When I went to DONA doula training I felt that they/my instructor conceived of doulas more as a support to advocacy rather than being an advocate directly (which is still advocacy imo).

I think its important to draw up a birthplan with your client. Provide her with facts and figures and testimonials, whatever she needs to make an informed decision about the aspects of her birth.

I like to suggest that she takes her birth plan to her primary caregiver beforehand if possible, so they have an idea before labour what this mama wants and doesnt want.

When the nurses offered one of my mama's morphine, I simply said, "would you mind explaining what the effects are exactly, how long they will last and what the side effects/risks are?" Even though I knew the answers to the question already, it put the message across that:

1. We want to know the facts
2. Im not here to override your authority
3. Im here for the mother

The nurse looked a bit surprised and said something about not having anyone ask that before ( ) and proceeded to explain. After that she gave us all the info about whatever she was offering or doing.

I like to think that we are here to educate the staff at the hospital too. Most of these people have no concept of gentle or empowered birth - until they see it in front of them.

We need to work with the staff in order to create harmony and make room for change and progress. Say what you need to say to advocate for the mother, but remain calm and respectful. Behind these uniforms are real people and more often than not they respond positively to decency and respect.

I do beleive that as Doula's our roles are very shaky when it comes to hospital protocol but I also believe that the only way things will ever change is if it happens from the inside. We need to build bridges and work alongside the staff. We need to provide the woman with enough information for her to make an informed decision about how/where she wants to birth. Then we need to ensure her wishes are met while she cannot properly defend herself.

Just my humble opinion

Quote:
Me, too. I totally agree. I teach the mom to advocate for herself, and I also advocate for her, gently, if needed.

I attended a birth with another doula last week and this doula, when the nurse came in asking about pain and telling our client to "think about what you will want when you pain gets to 10," said, "She is doing just fine right now." Then the husband picked up on that and he would be the one to say it when the nurse came in. I might not have been so bold, but the other doula had experience with this particular nurse before. I would have asked the client, "How are you doing right now? DO you want to discuss this right now or take time to think about it?"

But overall, once a practitioner and a client have made up their mind about something, it's none of my nevermind at that point. Prenatally we talk and figure out where we are. I am not going to beat a dead horse. Many realize when they step off their birth path -- a gentle reminder is okay, but more than that, not my job but to support.

Quote:
I see the challenge and admire those of you who are willing to work within the confines of the role of "doula." I am very, very uncomfortable with some of the things I've seen in a hospital room, and really need to work on my body language if I am to be a good doula.

I totally, completely agree with the PP who said that she needs someone to advocate for her while she's laboring. I feel the exact same way. For me, I am totally incapable of making a good decision at that moment. Not because I am uneducated, ignorant, or passive; because I am using all of my "mama-monkiness" to get through this birth. Perhaps labor is not like this for everyone. I know for a fact it's not, actually. (I had a client who was totally in control mentally of everything all the time she was laboring.) But, I needed my husband (who acted as my doula) to protect me.

I repeatedly told my last client, "I'm not a very obedient doula." And, it's true. In some ways, I suspect that doulas who really feel the call to be midwives might overstep their boundaries in the quest to help a mama have a safer birth. I've read the DONA regulations and find them really constraining. I don't want to check my client's dialation or prescribe herbs or meds for induction, I just want to be able to "protect" her birthing space in a way that is simply not possible in someone else's space.

So, I've reached the conclusion that I cannot be an obedient doula and still feel good about what I am doing. If I would continue to practice, I would be dangerous to the profession. It's clearly not where I need to be.

As far as assault goes, I would not ever touch a doc who is unnecessarily about to make a cut, but I sure would protect the mama. If that means placing my body in the way of the scissors, I would. I was frank with my client about this as well. I will not allow assault to happen in front of me to someone I am in the role of helping.

For the record, we discussed this exact thing in my doula training. "What would happen if you saw the OB reaching for the scissors for a episiotomy that the mother did not want?" The trainer's reply? "No one can cut a woman unless she consents to it." : This was in a room full of women who were studying to be midwives. The discussion that ensued was not, ahem, pretty.

I don't take a lot of doula clients because I'm a midwife at heart, but at times I have needed the cash and I want to get my foot in with the hospital staffs around here (I'm training in a different area than where I live). I tell my potential clients that a doula is only as good as the doctor and the nursing staff. There are some hospitals I won't work at, and a lot of times when someone comes to me and says "my doctor says X, so I want a doula," I just flat refuse to take them.

Still, the other day we had a nurse (a NURSE!) saying as mom was pushing "Are you totally opposed to an episitomy? I haven't read your birth plan b/c I just came on." My client looked at me with pleading eyes and I said nothing. The nurse let it go with no answer. The next time it came up, she looked at me again, and I looked at her husband. I said, "her birth plan says that she would prefer to tear," and at the same time both my client and her husband said, "NO!"

I still haven't figured out why the nurse was trying to push the episitomy when the doctor was right there, leaning against the wall, watching her push very effectively on her own. My client is really upset that he didn't step in and say "I really don't think that's necessary right now," but I'm wondering if he was hoping the nurse could get her to conscent? I just don't get it!

It is a very fine line. I usually just say, "I know my client has said she would prefer X," and then turn to the clients and say "do you still feel that way?" We're in the stage, though, where the doctors and nurses still like us, for the most part, so that works okay. But, it has worked well for me even with transports where we aren't as appreciated.

Most of my doula experience is actually with transports. I've never had a mom treated badly or "punished." I always prepare them for what's coming (ie...we're transporting b/c she's got a persistent posterior baby and has been stuck at 8 for 6 hours...I'll tell her that she can expect an IV for hydration, some pitocin to intensify her contractions, and possibly an epidural to help her relax...all of these are things that will be "offered," so I go over them with her before we get there, letting her know what might or might not be helpful). When we get there, I introduce myself to the nurses as the "midwife turned doula," and make a point of saying that we're there because we NEED THEIR HELP. I stay with my client as much as is humanly possible and always give my opinion on things once the doctor or nurse has left the room. In the face of something I know they don't want, I say, "I know part of the reason she chose a homebirth is because she was hoping to avoid that." I may ask the client if she still feels that way, or if the doctor seems to be okay with my relationship with the client, I will striaght up ask him if there's another possibility. Fact is, with a transport, you're going there for a reason, so there will always be more intervention than anyone originally wanted, but I have yet to see anything happen that the client flat-out didn't need or want.

Quote:
the problem here though is that in a court of law a Dr. giving an Epi is NOT considered genital mutilation. (Yes it should be) so I as a doula am not LEGALLY defending another person.

As a doula I think my job is a little of both. I try to educate parents on how to advocate for themselves, ask for the package insert on any medication, ask for second opinions, always ask WHY, HOW, WHEN, and WHAT.
But then I also know that parents when faced with a Dr. who is telling them someone is going to die, aren't always thinking straight, so even though I know the answers I may ask the questions they aren't... Like if a Dr. is saying that the heart tones are irradict so we need to think c-section. If the parents are stunned and not asking questions I might say something like "are there things we can try before we do the c-section?" "what would cause the baby's heart to do that"? etc... I always try to maintain an air of innocence and politeness.
as for nurses pushing drugs, I have followed a nurse out to the station and very kindly, with a huge smile say "Jane has asked that she not be asked about pain medication. She really wants to try to have a med free birth, and is doing well but she's worried she may cave if it's offered again."
I think the key is attitude. Unfortunately Dr.s and most nurses feel they are far superior to us... currently it is in our best intrest to allow them to think that..