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Morra Aarons Mele is the founder of Women Online, a consulting firm for companies, not for profits and political campaigns seeking to mobilize women...
 
 
 
 

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Stuck between a doula and a hard place

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I’m not going to watch the Ricki Lake video. I'm not giving birth at home. But nor am I comfortable with a purely medical birth. In an ideal world, I think, I would have my baby in a birthing clinic, with a midwife. With yogic breathing and candles, maybe water. And definitely no drugs. But as a first-timer with a high anxiety level, that doesn't feel like an option. I am with one of the best practices in my city, and will give birth at one of the best maternity hospitals in the world. I’m blessed, but increasingly alienated from my birth practice. I like my doctor but the whole experience is entirely medical. I have a hard time standing up for myself, feel too rushed to ask the questions I need to. The other day I got a bill for a $352 test I didn’t even know I had had. And when I have minor pains or mysterious ailments I face a stark choice when considering whether to call my doctor: they will either tell me everything’s fine, and to take some Tylenol. Or, I’ll come in, and more big-budget tests will ensue. Neither is a very comforting choice. Often, the whole experience of doctor visits leaves me a little empty inside.

So, I decided to look into doulas. I have followed, and been grateful for, the work of Katharine Stone and her writing on Postpartum Progress. I take very seriously the threat of postpartum depression and I want to prepare against it. The BirthWithConfidence blog (written by Lamaze) cites a recent study:

Related to the findings on the mental health of new mothers, what struck me most was that at the time of the survey 63% of mothers were likely to be experiencing some degree of depressive symptoms and 18% appeared to be experiencing symptoms of post traumatic stress related to their birth experience.

The writer continues,

Childbirth educators and doulas have noted for years now the increased incidence of PTSD and have shared with each other women’s stories that seemed to describe a relationship with both the escalating rate of medical intervention..nearly routine induction, unnecessary and frequent internal examinations..and impersonal, routine, and, sometimes abusive treatment of women in labor. It’s not just the stuff that gets done to women…routinely, abruptly, and uncaringly. It’s the powerlessness that women feel in an environment that is inherently frightening at a time when they are vulnerable and literally at the mercy of the system. Gone are the days of kind words and encouragement and loving touch. Now it’s get the job done fast or you’re on the cesarean fast track.

A doula seems like a great compromise between the reassurance of a high tech hospital birth and a more human experience. The statistics of doula-assisted births are quite stunning and very heartening. I’ve met with a few, and really enjoyed it. Although you hear a lot of backtalk about “touchy-feely” doulas fighting with doctors at the birthing bedside and trying to deny screaming women painkillers, I haven’t yet seen any evidence of this. The women I’ve spoken to have been professional, knowledgeable, and surprisingly pro-doctor.

My favorite new birthing blog, “At Your Cervix,” written by a labor nurse who is becoming a midwife, writes this cautionary post about a recent worried first time mom and dad at the hospital:

“…Of course, when the doc made his (minimal) appearance, early on in the observation period of time, he was quite negative with her and her husband, regarding what to expect in labor. He came across as very pro-epidural, and pro-interventions, when she and her husband were adamant about being low key, low intervention. They expressed their frustration with me, regarding the doctor, after the doc left the room. I told them, basically, that I respect (and agree!) with their low intervention wishes, but that the doctor was just trying to encourage them to keep an open mind about their options in labor/birth. I apologized for his behavior to them, to help them feel a little better about the situation, even though I was irritated with the doc's attitude. At the same time, I could see where the doc was coming from - keep your options open! Don't shut off completely to options available! Be flexible in your game plan/birth plan.

Basically, I’m torn. I love the idea of a doula to help advocate for me, and coach me to follow my birth

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redesignedmom 5 pts

I have had two completely different birthing experiences, one with a doula and one without.  

The birth of my daughter was one of the most tramatic experiences of my life.  For my entire prenatal period, I had a doctor that I loved and we had a very detailed plan that we had worked out together for months.  Unfortunately, nothing would go as planned.

This is a good lesson in itself.  No matter how well you plan, be just as prepared for nothing to go the way you think it will.  

The thing is, when you go to a doctor that is part of a group, the chances that that doctor will deliver your baby is very low, unless you go into labor during office hours.  I'm sure this has worked out fine for many women but for me, it was the middle of the night both times.

The doctor that was on call when I went into labor with my daughter was really unfortunate.  My water had broke and labor was slow to start.  I had had my appendix out six weeks earlier (yeah, 34 weeks pregnant and a totally different story) and she basically told me that I was high risk and would be treated as such, even though my doctor had told me as long as I had gone six weeks past surgery, I would be considered normal.

What this meant is that I was monitored the whole time and she only gave me a short period for labor to begin before she gave me pitocin.  I just felt rushed and unsupported by her for my entire labor.  I felt like she was just chomping at the bit to cut me open, not the most nurturing birthing environment.

My doula was very good at keeping me as calm as possible through this whole thing and keeping me informed of what was going on and why certain decisions were being made, but my anxiety level was very high and the pitocin contractions were extremely painful.  

The short version of the story is that eventually, during pushing, my daughter started to dcell and then they lost her heartbeat.  Then there was panic and rushing around and throwing of scrubs and I was screaming, it was terrible.  When we got to the operating room, they hooked her up to the monitor and she was totally fine, but the doctor insisted on continuing with the c-section.  While they were upping my epidural to the correct levels, I continued to push (as you can't stop), with the help of my nurse and eventually, I took control and demanded that she let me try to push her out before she proceeds with the c-section as she was fully crowning and her heartrate was fine.  She gave me three pushes and I was luckily able to push her out.  The whole operating room broke out in cheers.

Although having a doula was a nice additive to my experience, she was not allowed in the operating room and was able to do little to prevent my bad experience.  I am in no way saying that doulas can't be a great help and I felt like my doula did a great job given the circumstances, but when it comes down to it, it is all about your own sense of power and peace and the relationship with your doctor.

I also give a ton of credit to my nurse.  She was amazing and stayed with me through the end, even though her shift had ended.  She empowered me and from working with that doctor (who it was pretty clear that most of the nurses didn't like working with) many times before, she was knowledgable about how to deal with this doctor and helped me to get what I needed in spite of her.

In the end, my daughters birth was very empowering and she was healthy and beautiful and that is all the really matters.  

When I got pregnant with my son, I took a totally different approach.  I was determined that if I had anything to say about it, that doctor was never going to come anywhere near me again.  Unfortunately, this meant that I had to leave my doctor, who I totally loved.

Having several experiences in the maternity ward at my hospital (my daughter's birth and I spent a week there after my apendix operation), I was confident with the nursing care and quality of the facility.

For me, it really came down to finding the right practice.  All the doctors in the practice must be on the same page as you when it comes to your needs during labor.  With a group of doctors who share on call duties, you will never be sure of what doctor will be there to deliver your baby.  

I was fortunate that I found a doctor I trusted and who would for sure deliver my baby the second time around.  He has an individual practice and delivers 97% of his own babies.  He goes on vacation once a year and as long as you aren't due during that time, you can almost be certain he will be there with you.

My first birth was so dramatic and stressful that the second time, I just wanted calm. I wanted to enjoy the birthing experience and embrace motherhood in a way that I was denied the last time.  I did end up choosing an epidural, but was not pressured or deterred in any way.  This time around the decisions were mine, with the understanding that if things got really bad, he would have to take over.  That I could live with.

I am very narrow through my pelvis and my babies are big and therefore, they have a little trauma coming through the birth canal.  My son's birth was no different in this matter, but I didn't even really know anything was wrong.  My doctor was calm and cool through the whole thing and found the perfect balance of telling me this was serious and I had to push with no resting, without making me feel scared at all.

My son was born healthy, happy, huge and in a hurry.  

I am so glad that I have that experience as the freshest and most prominent in my mind.

I agree that birth done the wrong way can be increadibly tramatic and with lasting effects.  I was so jumpy and scared going into it the second time.  

But, I am glad that I took charge of my pregnancy and birthing experience and did what I needed to make sure I wasn't in the same situation again.

My advice,  find a doctor you trust in a practice that as a whole gels with your belief system and what you desire from your delivery.  Take every opportunity you can to meet with as many of the doctors in the practice as you can and also make sure that the hospital you are going to has practices and rules that you agree with and a top notch nursing staff.  If having your plan followed through on and your doctor there with you, then do your best to choose someone who delivers a very high percentage of their babies.

Ask questions, be up front with what you need and don't be afraid to change course if necessary. 

As far as doula's go,  after having one with me the first time, I didn't feel it was necessary the second time.  But,  my husband was amazing during labor and I was confident enough the second time to be my own advocate and I trusted my doctor implicitly.

I think every birth and every individual is completely unique and doula's can be an excellent resourse and a great help.

The Redesigned Mom ( http://redesignedmom.com )

A Stay at Home Mom's Journey to Self Fulfillment

katstone 5 pts

First, thanks for the shout out!

Second, this is such an interesting discussion.  I think many of the commenters are right that one needs to take charge, as much as possible, and make their feelings known.  We all have the responsibility to speak up for ourselves.  

I have definitely seen women end up with postpartum PTSD because their birth experience was very upsetting.  But what is also true is that what we imagine our birth should be like is not always achievable.  Some women have a plan and have support and everything works out as it was supposed to.  Sometimes they have a plan and good support and everything goes completely the opposite of the plan and women are traumatized by the fact that their plan didn't materialize.  I've seen women end up with postpartum PTSD because they were so wedded to what they planned to have happen and it didn't and they were heartbroken.  Those of us who like to keep tight control over our lives can feel very injured if our best-laid plans are thrown out the window. 

I think it's best to be somewhere in the middle, where you speak up for yourself but at the same time are flexible and realize that you can't always control the process as much as you'd like.  There are a lot more variables affecting the situation than just you.

I think every woman should be told that having a baby can be an unpredictable process.  Some have short labors, some labor forever.  Some get the baby out without any assistance, and some end up with forceps delivery (like my son, whose head was so big I just couldn't get him out after 4 FREAKIN' hours of pushing).  Some babies are born face down and some decide they want to come out sideways (like my daughter).  Some women go into the hospital when things are fairly quiet and get more attention and a more patient staff and some women go into the hospital on a day when every baby has decided to be born at the same time and it seems like you can't get anyone to pay attention. 

A great partner/husband or family member can go a long way in helping out, because they can advocate for you when you can't because you're tied to the bed by an IV.  They can march out to the nurse's desk and cause a scene to get help for you.  I think it's good to give husbands/partners that job.  My husband had no qualms about demanding assistance, God love him.  And there are lots of women who find doulas are helpful because, let's face it, there's a lot of time when you're in that labor room with just you and your family and nary a doctor or nurse in sight.  A doula who remains with you throughout, coaches you, answers questions and has a calm presence could be a welcome addition to the experience. 

For me, because I'm an introvert, I think a doula would more likely have made me uncomfortable.  It's hard for me to get to know people, and so having someone I'd only met once or twice in there with me during such a momentous occasion might have actually made me extremely nervous.  I'm not one of those people who likes parties and having lots and lots of friends.  I'm a homebody with a small inner circle.  So I'm glad it was just my husband and me. 

My point in sharing this is that what's most important is knowing yourself.  To know the kinds of things or people that provide you with comfort and the kinds that don't.  Have as many comforting things along as you can, keep out whatever stresses you out, and try to be open to and learn from whatever experience the universe brings you.

Katherine Stone Postpartum Progress

jenlemen 5 pts

that in my book, if your caregiver is not listening to you now, it's not a good sign and you are not crazy for thinking more attentive responses are in order.  even in cities where the birth center environment is not an option, you can still have a caregiver who is attentive and sees your feedback, concerns and perspective as important information to be taken seriously.

www.jenlemen.com ( http://www.jenlemen.com ) art, soul and stories for everyday

( http://www.jenlemen.com )

jenlemen 5 pts

morra, for what it's worth, as a doula i've been at the births on both ends of the spectrum--mother almost gets fired by her amazing, reasonable doctor for being totally uncooperative to doctor almost gets fired by her amazing, reasonable patient for being borderline abusive.  in both scenarios (and everything in between) it's my job as a doula to create a space where trust between all parties can bring about the best outcomes and happiest births.  i think a good doula knows how to do that and will leave her own opinions/agendas at home, so she can fully support her client and empower her to get the very best care she can receive from the caregiver she has chosen.  at this stage of your pregnancy, you still have options about who that caregiver should be and what kind of environment that caregiver tends to create when they assist you.  i've found that most women are hesitant to do that kind of processing in cities where their choices feel limited.  when they do, however, i feel like there's more peace at the birth because the woman understands the environment and caregiver was her choice, and she's more willing to accept the risks and/or limitations that that choice brings.

i don't know where you live, but i'd be happy to talk on the phone or work through my network of doulas i trust to help you find someone who will be savvy, realistic and also extremely helpful.  a good doula can make all the difference in your experience from these decisions until weeks after the birth.  in today's medical environment, i would not give birth without one--but i'd make sure that person came to me with good recommendations and that my intuition was telling me she's a good fit for your team.

 (and for what it's worth--both my worst case scenarios--uncooperative mother and borderline abusive doctor--ended up working out peacefully without any more unnecessary drama.  :)

www.jenlemen.com ( http://www.jenlemen.com ) art, soul and stories for everyday

( http://www.jenlemen.com )

jensta79 5 pts

I just wanted to wish you all the best of luck with your birth, and I hope it goes according to plan. However, no matter what happens, bear in mind that all that matters ultimately is that you deliver a lovely, healthy baby. If you have definite ideas about your birth make sure that they are written in your notes, but try to prepare yourself for the possibility that all may not go according to plan. I had a lovely relaxed labout set out for my first birth, with relaxing music for the first stage and invigorating music for the second stage (yeah, I know, I definitely had too much time back in those days!) but #1 ended up being born in two hours, start to finish so I didn't have time to follow my plan. I was a little wiser with my second and left it all to work itself out on the day, but even then I couldn't have expected fifty minutes from start to delivery!

If you think that you will need support to get what you want on the day, then a doula would be a good idea. However, my husband did pretty well for me in that area, so maybe your partner or a supportive friend could do that just as well, as long as they were completely clued up on what you want.

All the best,

 Jen 

Jennieworld Today - http://jenniepowell.wordpress.com

Csamuels 5 pts

Morra:

This is YOUR birth and YOUR baby and YOU are the boss.  That doesn't mean you are writing prescriptions but it does mean that you have every right to expect decent, respectful care.
Keep a note card with you - every time you think of a question - write it down.  When you get to your check up - pull out the card andask them, one at a time.  If your doctor doesn't see you in his/her office after your check up (I believe that should be SOP) - then ask them to stay in the examining room until you get through your list.
If you have a doc not answering your questions now, it's harder to trust him/her during delivery.
Talk to Jen Lemen, who is a doula and as far as I can tell, an angel on loan on this earth.  She will give the best counsel I can imagine.
If asking questions makes your doctor mad you need a new doctor.  This is a very important time, and even though the doc has done it many time, you haven't.  It's not just another birth to you - it's your baby.  That means you get to ask and he ought to answer.
It's so unfair that you are experiencing this; sounds to me like a doula might be a real help because it IS hard to stick up for yourself when you're nervous and dependent on the doctor, or at least it feels that way.  But consider this:  My favorite fact of everything I learned from having kids was the power of my own body; that this child and my body were busy with something that I had NO control over except to do lamaze breathing and be stunned at the power of what was happening.  That baby was going to be born, no matter what!
I'm sorry if I sound preachy - I just hate to hear that doctors are still acting like this.
Cynthia Samuels, Partner
Cobblestone Associates, LLP
Blog and Media Strategies and Content Development Online and on Television   

Don’t
Gel Too Soon ( http://dontgelyet.typepad.com/dontgeltoosoon )

amygeekgrl 5 pts

I think doulas provide an invaluable service to birthing women. I am rather fond of Leigh, a relatively new doula, who blogs at http://leighsteele.wordpress.com/. She writes about her experiences as a doula, among other things. It doesn't hurt that she's an amazing writer (and an amazing doula too!). :)

Btw, I took Hypnobirthing classes when I was pregnant with my first child too. They definitely helped me keep my focus. One thing I wish I would've done for my first birth is hire a doula.

Also, just curious, why don't you want to watch the Business of Being Born? I think all women, regardless of where they plan to give birth, should watch it for its educational value. But that's just my .02. ;)

Best wishes to you. I think you will know when you find the doula that's right for you. 

Amy
Crunchy Domestic Goddess ( http://crunchydomesticgoddess.com )
BlogHers Act contributing editor ( http://www.blogher.com/special-events/bloghers-act )

Morra Aarons Mele 5 pts

Thank you for your thoughtful comment. I'm starting a hypnobirthing class next week!

Thanks for the empowering words-  I agree every woman should aim to be her own advocate in birth just as we are in our lives and careers each day. But sometimes, a little extra support helps, too!

Morra Aarons-Mele
www.womenandwork.org

Dharma 5 pts

Hi Morra

Maria Niles sent me to your post.  I have been a doula (though semi retired the last few years) for, well as of this month, 12 years.  First, congradulations on your pregnancy, the first pregnancy is so exciting as well as overwhelming.

A doula cannot guarantee any outcome so while the statistics are wonderful I believe that some of the best results of having a doula at your labor is feeling supported, feeling heard, and having a shorter "I wish I had known/done" list when all is said and done.  Personally I don't believe a doula should advocate for you so much as aid in the providing skills that let you advocate for yourself.  

It is important to keep your mind flexible regarding what may happen but I also believe that finding your inner strength, knowing and standing up for what you want tend to give you a better birth outcome.  Not necessarily no inteventions, not necessarily no meds but a better outcome in terms of how you feel afterwards. 

In my experience learning relaxation techniques is key to having a great birth.  Having enough rest and sustanence are also key - so eat as you like during your labor.  Rest, even if it's not sleep as you get close and in early labor.  And of course, my bias is to hire a doula to help you remember that you are strong, capable, and loving as you birth and become a mother.

in peace

Dharma (aka Samantha)

kazari 5 pts

I don't think they'd recommend someone that annoyed them...

I think I have a recipe for that... ( http://krissyscookingblog.blogspot.com/ )