Doulas + Doctors = Disaster in the Delivery Room?

By Mandy Schutt 

I recently heard someone say that they didn’t hire a doula because they’d been told that doulas and a doctors don't mesh in the delivery room.

 

Oh dear... 

 

I shudder to think about the mothers who have hesitated to hire a doula because their ears fell privy to the same untruth. Call it a rumor, a stereotype, a gossip topic, or an over generalized statement, but please don’t call off hiring a doula because of it!

 

I would like to publicly proclaim that I have never- not once- had any problem with any doctor that I have worked with; same goes with nurses. I have however, had many a friendly chat with nurses in the hospital’s “Nutrition Room”, exchanged laughs with hospital staff, and had several doctors throw a, “thank you, great job!” my way as they left the room.

 

I think that somewhere along the way, a few lousy doulas with overbearing personalities made a lot of noise and muddied the path for other doulas and expectant mamas who want (and might need) a doula. I don’t doubt that there have been instances where doulas and docs have butt heads, and a doula has overstepped her boundaries. Isn’t this how it always is though? In every profession, there are a few loudmouths who get a little too big for their britches, and then, BAM! your reputation has been damaged!

In truth, doulas are a pretty polite bunch. We don’t want any sort of tension in the delivery room- much less tension that we create! We know that when a birthing woman is put in an emotionally uncomfortable place, her labor can slow drastically and anxiety can make her feel unsafe. This is the last thing a doula wishes for her client. The stereotypical image of a doula and doctor battling it out over a hospital bed occupied by a helpless doe-eyed laboring woman, just doesn’t ring true to my own experiences, or that of countless doula colleagues of mine.

 

So, how do I avoid labor room conflict?

First and foremost, I keep in mind that each labor belongs to the respective birthing woman. I do not take ownership of the labors that I attend. I will never tell a client what I would do “in their shoes”. I will provide them with pros and cons, and simplified explanations of procedures, but I will never, ever say, “Well, if I were you…” because, quite frankly, I am not. Every woman is different, we all carry our personal luggage into our births…some of the luggage is Prada, filled with the finest of pretty things, and other luggage is in the form of torn plastic grocery bags, overstuffed with dirty laundry. Most of us take a bit of both into our birthing experiences, but most assuredly, my luggage is quite different than yours. So if we all enter our labors as different humans, why would we all make the same decisions in labor?

Here are some things that I do as a doula to avoid tension in the labor room, advocate for my clients, and steer clear of any possible conflict at the hospital.

 

I review hospital procedures in my prenatal sessions with clients. Prenatal meetings with my clients are good jam sessions to begin working as a team. These sessions also allow my clients to pick my brain as far as standard hospital procedures are concerned. As I learn more about a client’s birth preferences, I run though possible scenarios that could come in conflict with their wishes. This allows the client time to address these topics privately with their care provider before she ever enters the hospital to have her baby.

Here’s an example; a client plans to use a birthing ball during labor. If I know that this particular hospital doesn’t allow birthing balls in the room, I would recommend that the client speak to their doctor about it.

In some cases, a client’s doctor might be able to make special exceptions and will let the nurses know that you are approved to take this action. (Though in the case of a birth ball, the usual reason they are not allowed is simply lack of space, so this might be one that your doctor has no pull with.) Other times a doctor may provide the client with alternative methods to accomplish a similar result. Still on other occasions a doctor or hospital may simply not allow it.

In any case, finding out ahead of time that there is a conflict is much better than having this discovery in the delivery room! When a client knows these things ahead of time, they have more choices such as changing doctors or birthing locations. However, a client may decide that they like their provider and birth place so much that a sacrifice in her birth preferences is worth making. Either way, the decision is hers, not her doula's to make, and while the initial prenatal session between the client and doula may have prompted her down this path, it is the client that has ownership of the final decision.

 

I use careful language and encourage clients to “claim” their birthing choices.

As I mentioned above, I want every mother to be able to fully embrace her birthing choices. Some say that doctors have been labeled as, “dominating” and have become too much of an authority figure in the birthing room, telling a woman how she should birth instead of taking the cues from her. This same dominating title could label any person assisting a mother during birthing; even a doula. This is exactly why doulas should not make decisions on behalf of a client. If a doula were to do this, they ultimately become the same dominating figure that they so adamantly oppose.

 

 

I don’t speak for a client if they are able to speak for themselves. Additionally, when I speak with my clients, I make every attempt to keep my language as neutral as possible. For example, if I wanted to know about a couples decision to bank cord blood, I would not say, “You’ve decided to bank the cord blood, right?” or “I’m assuming you won’t be banking cord blood?” Instead I would say something like, “What have you decided to do about cord blood banking?”

When a client understands that they have the ability and freedom to make their own birthing choices, using their doula as a resource, birth can be an extremely empowering experience. So, it’s important that my clients know ahead of time that I am there as a resource, and I will give 110% to make their birth as comfortable as possible, but I will not make their decisions for them; a doula should be an advocate, not a proxy.

 

I mentor my clients on how to speak for themselves in a medical setting.

This is not as difficult as it might seem. While a hospital setting can be intimidating, any expecting couple or mother is able to advocate for themselves if they are equipped with the right questions. These simple questions will work in 99% of hospital scenarios, with the exception of extreme emergencies.

 

Imagine you are a doula in this instance:

A laboring mother has expressed a desire to be mobile and unattached to any cords as she labors. After a few hours in the hospital, the nurse comes into her room and says, “OK, it looks like we are going to need to hook you up to some fluids. I’m going to get the I.V. started for you.” 

As the client’s doula you know that there is a conflict between what the nurse wants to do and what your client has made clear in her birth preferences. Should you speak up or stay silent? Confront the nurse or bow under the pressure?

 

I believe in my clients and in their ability to speak for themselves, so in the above scenario, I would personally have no dialogue with the nurse. I’d know that the client, her birth partner, and I have worked together during prenatal meetings and have discussed the possibility of being faced with an unexpected choice that conflicts with their birth plan.

Because of this preparation, I know that my client will either, a) allow the nurse to start the I.V. if she is comfortable with that change in her birth preferences, or b) will advocate for herself using the three NAP Questions:

1. Necessity: Is this absolutely necessary; are my baby and my body safe?

• If “yes”, then the mother has two options. Accept the procedure or sign a hospital waiver stating that she has officially refused the medical advice that she received.
• If no, then move on the next question:

2. Alternatives: Are there alternative ways to achieve a similar outcome?

• If “yes”, then ask for the alternative options. (In the above scenario, a care providers might offer the option to labor for another hour as the client drinks a lot of water, or might offer only half the bag of fluids, so that the mother is attached to the I.V. for less time.)
• If no, then accept the procedure or sign a hospital waiver stating that she has officially refused the medical advice that she received.

3. Privacy: Can I have a few minutes to think about it privately?

• If yes, then the mother has time to discuss the procedure with her partner and consult with her doula if she wishes. This allows the mother a moment to collect her thoughts, gather information, and not feel that she is making an impulsive decision under pressure.
• If no, then accept the procedure or sign a hospital waiver stating that she has officially refused the medical advice that she received.

No matter what choices my client makes, I know that they are her choices and not mine. I support my clients in all of their decisions, even when their plans change.

 

I stay within the doula’s scope of practice.

To make things extremely clear, it is out of a doula’s scope of practice to speak or make decisions for their client.

 

DONA, the nation’s largest doula certifying program, has written this in their training texts:

“The doula advocates for the client's wishes as expressed in her birth plan, in prenatal conversations, and intrapartum discussion, by encouraging her client to ask questions of her caregiver and to express her concerns.  The doula helps the mother to incorporate changes in plans if and when the need arises, and enhances communication between client and caregiver.  Clients and doulas MUST recognize that the advocacy role DOES NOT INCLUDE THE DOULA SPEAKING INSTEAD OF THE CLIENT OR MAKING ANY DECISIONS FOR THE CLIENT.”

 

Here is another excerpt from CBI, an international doula certification program:

“Our philosophy is very much one of a labor supporter or childbirth educator being a provider of information. You enable your client to make informed choices by providing them with information on what is happening and what options they have available to them, based on what they want to know.”

 

If you are concerned about conflict in the delivery room, be sure to voice your concerns with your doula, or better yet, address the issue while you are interviewing your doula. If you happen to be interviewing one of the few and far between “dud doulas” whose attitude towards doctor-doula communication is out of their professional scope, simply do not hire them.

 

A birth is the experience of another woman, and as a doula I am there to enhance that experience, not claim it. While it might be a difficult task for one to let go of personal opinions about birth, it is absolutely necessary in the doula profession to do just this. There is an abundance of wonderful doulas out there that would be willing to work alongside you without the delivery room drama! Done properly, doula support and advocacy for a client can be done successfully without a clash between doctor and doula.

 

 

 

Comments

[doula los angeles]

I can imagine there are some doulas out there who do overstep their boundaries. Giving us a such bad reputation!

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