Reply turned post, what a doula can do

Well, Rixa wrote an entire post about the physician who trashed birth plans and doulas on her blog. I tried to write a reply to it, but I was got an error message that said it was too long. So, I have published it here. I guess that’s how the reply – turned – post was born.

Aha! Here it is. Well, I answered this travesty of a comment on my blog.

I have a few other things to add. The grammar and spelling are irritating to me, but irrelevant. Don’t even bother expecting good grammar. I see spelling errors everywhere in the hospital where I am training right now. Worst of all, I see meds misspelled in charts! If there’s anything you want to spell right, it should be the name of a med! I see right and left mixed up all the time also. I am doing a tumor board presentation tomorrow, and the pathology report mixed up the right and the left. Scary.

I also wanted to add that one major purpose of a doula attending a hospital birth, at least when I am a doula, is to inform the woman what to expect when she is traiged and admitted to the hospital. Also, to give informed consent, hopefully prior to labor, on typical labor interventions, and to help the woman decide where her priorities are before she is in labor, and what she may want to discuss with her practitioner. If the practitioner doesn’t show up until the end of the labor, how is she supposed to discuss an order given over the phone to break her water and give her pitocin when she’s at 4 cm? I was clueless about what would happen to me, and most women are not informed at all about what it is really like.

Many women don’t know that your doctor most likely won’t be there until you are completely dilated (that is the standard of care in my area – not sure if it is in all areas, but it is something the woman can ask her practitioner about once the doula brings it up.)

Many women don’t know that they will need to have labs drawn when they show up – they think they are “preadmitted”. They will be asked the same questions about their history over and over again by multiple hospital employees. They will be asked invasive questions about their sexual histories, drugs, smoking, prior abortions, including exact dates. In front of their partner, mother, doula, whoever is there. Even women who want an epidural immediately will not be able to get one (see below), and will be asked these questions during contractions, regardless of if there is an issue that is concerning her about the way her labor is progressing (such as the baby being premature, there being blood, her blood pressure being high, etc.) No one will reassure her or care that she was just asked all the same questions, or that she is scared, or in the middle of a contraction, or doesn’t want to answer a question about an abortion in front of her mother. It may be a good idea to inform her doula or partner the answer to some of these questions, such as if she has ever had a reaction to anesthesia, or if she has false teeth, etc.

Nurses may be brusque and insist that she removes all of her jewelry and not wear any of her own clothing, and tell her it will risk her and her baby’s life if she doesn’t remove them. (Seen it).

If they are planning on an epidural, they WILL NOT GET IT RIGHT AWAY. This is a HUGE issue. Many women seem to think the anesthesiologist will meet them in the parking lot. My cousin Susan was told by her obstetrician that she “didn’t deserve to feel any pain.” Well, she needed to have labs drawn, and run, and then needed to have 2 liters of IV fluid infused before they would even consider giving her an epidural. Considering her entire labor was 4 hours long, she felt the pain for half of it the first time. The second time, the epidural only took on one side. Was she only half as deserving? Did she even know that epidurals don’t always “take”?

I have seen epidural informed consent that consisted of “it won’t effect your baby”, and then the baby crashed immediately after, since the woman already had low blood pressure and was flat on her back. I got the honor of explaining to them what happened. I have seen an anesthesiologist storm off angrily when another couple asked about the blood pressure drops associated with epidural and spinal anesthesia (she was there on a birth center transfer and was most likely getting a spinal and a cesarean) – again, I was left to reassure them.

I have seen women told that stadol will “take the edge of and help you relax a little” as the entire informed consent. This poor women effectively missed her delivery because she was too busy hallucinating, moaning, and drooling on herself. The baby was born depressed and had to be given narcan to cancel out the effects of the drug. I have learned from these experiences to inform all women, regardless of their professed desire to avoid meds, what the pros, cons and side effects are BEFORE we are there and someone tries to talk her into it.

Also, I didn’t know, and many women don’t know, that their baby is likely to be whisked away immediately following the birth, and most likely will not be returned to her until after a four hour “observation”. I was simply devastated when that happened, and cried until they returned the baby. Even women I have warned about that have cried with me while the baby is gone.

Anyway, this went on longer than I planned, but needless to say, doulas can provide information in a way that tends to be seriously lacking in standard hospital labor and delivery.


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6 responses to “Reply turned post, what a doula can do

  1. Luckily, my neonatologist dad was on hand both times to make sure my babies weren’t whisked away. That was the blessing.

    The curse was (and I am mixing up both delivery stories here) an unwanted episiotomy (girl), pit nightmares, and yes, the blood pressure drop/massive nausea from the additional epi meds that were given to me because I was being “whiny” about the pain – flat on my back (boy). He was crowning, and no one had bothered to check in an hour or so.

    I had two healthy babies and my dad fought neonatologists and pediatricians to keep the preemie, my son, by my side nursing. He even fudged a little to get me home early and smuggled home a bili light so J wouldn’t be admitted for breast-milk jaundice. I shunned all the narcotics they tried to give me post-op – the pediatrician looked on in horror while I tore up his scripts. “You must have an incredible pain tolerance.” No, I just wanted to nurse drug-free. My chiropractor spent months fixing what a one week hospital stay on my back did to me.

    Wish I had a doula. Would do it differently, with additional knowledge. Keep passing good info – you will be such and effective OB.

  2. How about fundal massage and/or reaching into the vagina to extract clots… women are yelling “ouch!” and the provider just distractedly says “sorry, sweetheart” without an explanation for what they’re doing or why they’re doing it. Ouch indeed.

    • MomTFH

      I saw an OB attempt a manual placenta extraction on a woman with no anesthesia and no warning. Talk about your chandelier sign!

      • I admit I had to google “chandelier sign” and when I read it I was all “oh HELL yes”. I saw something very similar to what you did (although mom had an epidural, at that point it wasn’t super heavy) and the resident JAMMED her hand up into the vagina with no warning. Mom screamed and arched off the bed… “Oh sorry sweetheart, I have to do this”. This was after a very painful and frightening delivery with a dystocia. The (great) attending came in a few minutes later to talk to mom about watching for signs of PTSD after a traumatic birth, and I still regret that I didn’t pull her aside to talk to her about how the resident wasn’t helping any. I am obviously still processing the whole experience myself…

  3. Dawn

    I think it’d be great if a woman didn’t have to tell all her history out loud (what about privacy issues). Can she just give the nurse a form that’s already filled out? I don’t understand why we do preadmit stuff (I’ve had meetings with an RN weeks before my births) and still have to answer questions and sign things while in labor. I considered bringing a piece of paper with the answers, let the nurse just look at the paper and leave me alone!

    As to baby being wisked away, yes, it’s terrible not to know this ahead of time AND is not always needed. I think it’s important to let the woman keep baby if she wants to and baby is not in need of seperation care…

  4. Tamara

    I’m a first time reader and your blog is fantastic. Good luck with your training, you’re going to be an amazing doctor. I live and New Zealand and have had 2 babies here. Our maternal care system is soooo different to yours and these stories make me so sad. I had midwife care throughout my 2 pregnancies (paid for by the state) and delivered my second baby with my midwife at a birthing centre with family present only. My second baby was delivered at a hospital again by my midwife with an anaesthetist giving me an epidural. (Not perfect but he was really good). No forms to fill in on the day, no strangers, no observers. My babies (after a quick check) were given to me to feed rightaway (and they both did) and after that never left my sight (unless I requested it). Here it is considered best practice in normal births for mother and baby to nurse rightaway to promote successful breastfeeding. Anyway, I hope that doctors like you will have a positive effect on the system you will work in.

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