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I feel you, this is the reason I decided against becoming a birth doula.
 
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I am sorry.
 

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What would you do if there was a transfer? Abandon your homebirthing family? I think that perhaps you are not cut out for this line of work. You are there to support the mother, whatever interventions may or may not be needed or requested. If you cannot do that, then don't become a doula or midwife.
 

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I am sorry this experience was triggering for you. Birth is unpredictable - even midwife attended home births. Moms receiving interventions, including epidurals, often have as much need of support as moms who are delivering without medication. I agree with amma_mama. You should really consider if this line of work is for you. It's not acceptable to abandon clients. You owe this family an apology. (edit - probably a partial refund)
 

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I agree with cyclamen and amma-mama. This is what it's like to be a birth professional. Unpredictable, bad hours, and uncertain outcomes. Don't be a doula so you can be a birth activist- that makes it about you. Being a doula is about helping your client no matter what. It's not about you.

And you owe your client a refund. I don't care how "low cost" this birth was..she doesn't deserve less because you agreed to accept less money. Either give everyone the same care regardless of payment, or don't accept discounted services.
 

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In the future, you need a plan for what you will do if a birth goes longer than expected. If you are only attending home births, you need a plan for accompanying your clients to the hospital in the event of a transfer, because if you do enough home births, eventually you will have some transfers. You should probably have a back up doula that you work with.

You should probably also develop your refund policy to include a variety of scenarios so that you have a clear cut boundaries to refer back to.

You can use this experience to develop your professionalism. Do you have a more experienced doula who is your mentor?
 

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What's your plan if your home birth/birthing centre patient ends up being transferred to a hospital? Last minute transfer to another doula?
Being a doula isn't about you, it's about your clients and their needs/wishes/wants.
I highly suggest taking some time off, and doing some serious introspection about your person biases, judgments and preconceptions. That family deserved better.
 

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Discussion Starter #9
I don't see why a refund would be called for because the family a) sent me home and b) didn't request me back after I offered to come back in the morning when she was pushing ?? I wouldn't call it "abandoning" either, and I would never intentionally do that-again- the DAD sent me home!

I'm fine with homebirth transfers.... it's just that I can't do these births that are planned to be at the hospital knowing all the interventions and standards that they follow. I would be very motivated to attend a woman transferring from home because I transferred from home and I have personal experience with that.

also- I do have an experienced doula (and a midwife) who are my mentors... as well as a peer review group. I do need to put situations like long induction/long labor into my contract so it's clear. What do other doulas do? I've heard of clauses in contracts that say anything over 18 hours reserves the right to call in backup for a break. The first birth I attended as a doula was at home and I was there 22 out of 27 hours and I managed just fine- being at someone's home makes it a lot easier to take breaks and nap than being at the hospital where there is literally nowhere!! WHAT do doulas do at loooooooonnnggg hospital births where the labor goes overnight and mom has an epidural and mom and dad are sleeping?? In this case they went to bed at 12:30 or so and didn't wake up til 8- so what was I expected to do in that situation professionally? sleep in my car? sleep in a chair in the waiting room? drive home and come back in the morning (hospital was hour and a half, longer with traffic, away). I was exhausted and had no idea what to do in the situation- so when he told me to go home- I did. WHAT would YOU have done??

I KNOW that women deserve support regardless of what kind of birth they are having, I wholeheartedly agree with that AND I Know that I am not the doula to give support in planned hospital births with interventions after this experience. I know birth can't be planned and things happen, but I know I can provide more "present" support to a mama laboring at home or in a birth center because the presence of interventions and the very environment is more conducive to natural birth. That said... the first birth I attended where the mama got an epidural was great- I supported her through 15 hours of natural labor and the 3 hours after she got the epidural and 2 after she had the baby and she says she loved her birth experience and felt very supported. The triggering part of that birth was how they handled the baby after it was born- a perfectly healthy baby being separated from mom and put on a warmer for an exam and a bath and all that crap... ugh. Very hard to watch.
 

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I don't see why a refund would be called for because the family a) sent me home and b) didn't request me back after I offered to come back in the morning when she was pushing ?? I wouldn't call it "abandoning" either, and I would never intentionally do that-again- the DAD sent me home!

I'm fine with homebirth transfers.... it's just that I can't do these births that are planned to be at the hospital knowing all the interventions and standards that they follow. I would be very motivated to attend a woman transferring from home because I transferred from home and I have personal experience with that.

also- I do have an experienced doula (and a midwife) who are my mentors... as well as a peer review group. I do need to put situations like long induction/long labor into my contract so it's clear. What do other doulas do? I've heard of clauses in contracts that say anything over 18 hours reserves the right to call in backup for a break. The first birth I attended as a doula was at home and I was there 22 out of 27 hours and I managed just fine- being at someone's home makes it a lot easier to take breaks and nap than being at the hospital where there is literally nowhere!! WHAT do doulas do at loooooooonnnggg hospital births where the labor goes overnight and mom has an epidural and mom and dad are sleeping?? In this case they went to bed at 12:30 or so and didn't wake up til 8- so what was I expected to do in that situation professionally? sleep in my car? sleep in a chair in the waiting room? drive home and come back in the morning (hospital was hour and a half, longer with traffic, away). I was exhausted and had no idea what to do in the situation- so when he told me to go home- I did. WHAT would YOU have done??

I KNOW that women deserve support regardless of what kind of birth they are having, I wholeheartedly agree with that AND I Know that I am not the doula to give support in planned hospital births with interventions after this experience. I know birth can't be planned and things happen, but I know I can provide more "present" support to a mama laboring at home or in a birth center because the presence of interventions and the very environment is more conducive to natural birth. That said... the first birth I attended where the mama got an epidural was great- I supported her through 15 hours of natural labor and the 3 hours after she got the epidural and 2 after she had the baby and she says she loved her birth experience and felt very supported. The triggering part of that birth was how they handled the baby after it was born- a perfectly healthy baby being separated from mom and put on a warmer for an exam and a bath and all that crap... ugh. Very hard to watch.
Well, the average first labor is 24 hours. That's an average. its not unusual for labor to be longer.

You haven't told us the reasons for this induction - and you shouldn't, that private information. But you should reflect on it. What led this mom to consent to an induction that didn't take for four days? Why didn't her doctor wait to induce until it looked more likely to be productive? Seeing how long this was taking, why didn't they move to a section? I'm guessing, from the In-hospital vaginal birth after four days of labor, that mom and baby tolerated labor very well, and the family was able to advocate for the birth they wanted. So the person who struggled here was you.

I think that may be hard for you to hear. But I think it's important for professionals who provide care to others to acknowledge when they themselves are struggling. And I can tell, from this post and your other posts, that you are struggling. when we are struggling, it often seems like the answer is to fix other people's lives. But you can't just decide that you will be at peace with your own life and your own experiences if you can exercise power over other people's experiences instead. That will not work.

If you are going to do birth work, you will need to adapt to the way that birth controls your life. That means interrupted sleep, long nights, and getting back in the car. You should ask your mentors how they do it. While you are considering that, you should also reflect on what you need in your own life, and how you can take care of your own needs.
 

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It sounds like they sent you home because there was no place for you to sleep, and then when they would have had you come back, you were two hours away. Those are details mom/family shouldn't have to worry about while mom is in labor. Those were your details to plan for. Your refund policy should be clearly defined to cover a variety of scenarios, but as an outsider to this situation, it doesn't sound like they sent you home because they decided that after all, they didn't really want/need a doula. Did you know the hospital was two hours away when you accepted this job? What was your plan?

Options - warm gear in your car (if sleeping in your car was always the plan), extra cot in the hospital room, arrange ahead of time to stay with a nearby friend, or get a motel room. Yes, you do need to sleep.

A back up doula is always a good idea. You have to plan for things to go wrong, go long, and go sideways.

You have a lot of passion and it sounds like you have been a wonderful support to some moms. But passion is only part of it. Having professionalism will allow moms to be able to count on you in a variety of scenarios and will allow you to be reliable and consistent. Do you have a counselor to process some of the trauma you find triggered around births? I think you need to get that sorted out. I wouldn't assume that you won't be triggered when supporting a home to hospital transfer... so you need a plan for that. It's a natural response to trauma, and exhaustion is a natural response to sleeplessness, but being a helping professional means knowing how to take care of yourself so that when you are working, it can be all about the family you are caring for.
 

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So you had a triggering moment when a mom who stated her birth was excellent? I would expect that you will also have triggers with a transfer, having read your birth story
 

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Any mother or doula whose client is considering an induction should know what their Bishop's score is. I suggest a score of 11 or more.

http://www.amazingpregnancy.com/pregnancy-articles/173-html.html
http://www.givingbirthwithconfidence.org/p/bl/et/blogid=16&blogaid=683
http://babyandbump.momtastic.com/pregnancy-third-trimester/329466-induction-bishops-score.html
http://wellroundedmama.blogspot.com/2012/02/induction-math-importance-of-bishop.html
http://en.wikipedia.org/wiki/Bishop_score

I am sorry that you feel this way, but I agree with you about inductions and other interventions when birth takes place in a hospital setting. Many years ago, I was on a consumers' committee to put an ABC in the local and largest medical center in the area, and the staff ob/gyns always found a way to risk prospective parents out of using this ABC. So I too gave up trying to change things. I understand your frustration.
 

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Yes, you do owe her a refund. You were there for 5 hours. It's not their problem that you didn't plan ahead. You never should have left the hospital. She was a 4 cm and got an epidural. As expected, she was ready to push about 8 hours later. This is not out of the ordinary for a birth. It's not the mom and dad's job to know how labor progresses...that's your job and what they are paying you for.

You never should have left the hospital. Give them back their money.
 

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Any mother or doula whose client is considering an induction should know what their Bishop's score is. I suggest a score of 11 or more.

http://www.amazingpregnancy.com/pregnancy-articles/173-html.html
http://www.givingbirthwithconfidence.org/p/bl/et/blogid=16&blogaid=683
http://babyandbump.momtastic.com/pregnancy-third-trimester/329466-induction-bishops-score.html
http://wellroundedmama.blogspot.com/2012/02/induction-math-importance-of-bishop.html
http://en.wikipedia.org/wiki/Bishop_score

I am sorry that you feel this way, but I agree with you about inductions and other interventions when birth takes place in a hospital setting. Many years ago, I was on a consumers' committee to put an ABC in the local and largest medical center in the area, and the staff ob/gyns always found a way to risk prospective parents out of using this ABC. So I too gave up trying to change things. I understand your frustration.
I love knowing a Bishop score, and if I was a doula whose client was considering induction I would definitely want that information. But doulas don't decide when to induce. Moms and doctors make that decision. Evidently, this woman and her doctor had a reason to induce. maybe they were concerned about IUGR. Maybe she was quite a bit post-dates. maybe her Bishop score was actually great, but the induction didn't really take anyway. Regardless, this mom and her partner are ROCK STARS. I think it's really important to keep that in mind. They did four days of labor, without the support they had been counting on, and wound up with a vaginal delivery. If I was a doula, I would want to know what they did. I mean, wow. Plus, how exhausting!

My personal opinion is that the family is owed. You can call and ask if they would like some post-partum services or if they would prefer the cash. Or, if your assumptions about what happened at the birth are too triggering, you can just pay them back.

You're projecting your own experience on to what happened to this mom. That's not helpful. Not to you and not to your clients.
 

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Discussion Starter #17
edit - the bishop's score was 2 going into the induction. NOT favorable... thus why it took 4 days, started on Wednesday afternoon, baby was born Saturday afternoon. She was not post-dates, it was 4 days before her due date. They said they were happy to be staying in the hospital because they had just moved Monday and their new house was completely unpacked, something else I think influenced the induction.



the family called me and thanked me for my support and help. They recognize that they didn't need me in person the entire 72 hours leading up to when she finally got into semi-active labor (at 3cm). I was in phone contact with them throughout the days and ready to go the entire 3 days leading up to when I got there. I did 2 prenatal visits and a free interview and gave them tons of resources and information. I drove an hour each way each time I met them. I provided 5 hours of labor support and then was told to go home. They haven't said ANYTHING about a refund or expressed that they are unhappy with their birth and the services I provided, rather I AM UPSET and disappointed in myself for leaving and not being there. YES, I knew the hospital was that far away but unfortunately I am NEW and NAIVE and didn't anticipate the situation where I'd be left alone at midnight while everyone else is sleeping til the morning. What am I supposed to do get a hotel? too expensive-- i did look though! I called friends in the area- no one picked up, I considered my car- but not safe and too cold. There was really no option.

so yeah..... HUGE mistake on my part thinking that I could go into birth work working in the hospitals after my experience... but now I know.

and-- there isn't a midwife/doula out there who doesn't have bias and her own issues around birth and her personal experiences. From what I've been told it's a continual process of dropping your shit at the door and doing the inner work. It's only been a year for me and i know it takes time... EMDR is helping a lot but there's obviously still more work to be done. Professionalism is something that I DO take seriously, which is why I feel so guilty and like absolute shit about the way this birth went. Unfortunately a refund is not possible- I don't have the money or any more coming in any time soon, and they have not asked for it. I do intend on having a conversation with the mama in a couple days once she is settled in back at home and apologize for leaving even though she says now that it is fine.

I'm just going to start my midwifery academics for now and keep being a stay at home mom I guess.... births later. I don't have any more scheduled after this next one due next week.
 

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You are upset and disappointed in yourself because you know you behaved unprofessionally. Do the right thing. You need to find the money to offer it back and if you can't do that, then you need to offer services in kind.

Your lack of planning is not the family's responsibility. Just because they haven't complained doesn't mean you did the right thing. As a professional, you are responsible for evaluating your actions and figuring out how to do better. If you are sincere about being a midwife and investing all this time and money into your education, you also need to be sincere about developing your character and ethics.
 

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Discussion Starter #19 (Edited)
thank you for your perspective. I can neither refund the money nor offer services in kind, I would be able to but they have moved 2 hours away now. When I started working with them they were only 1 hour away. I have a small child and can't do it. So I guess this will just be a very unprofessional mistake and I'll apologize profusely. I could offer placenta encapsulation, but they've already said they don't want it. PP doula work is also off the table because they live so far away now, so i don't have anything to offer.
 

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You are right, every health care professional has biases, and it's an on going process to recognize and process them. You have been given the opportunity to analyse this situation and look at how your biases affected the outcome.
 
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