Thursday, May 13, 2010

What's a Good Doula to Do?

Recently, one of my clients went in for a c-section after a trial of labor. The nurses could see how much support I was providing my client, who was definitely more than panicked by labor. I'd say she was bordering on hysteria at times, but with guided visualization and breathing exercises led by me, she would calm down.

When the nurses brought scrubs for the husband to wear into the OR, they gave me a set, too. "She needs you in there," they said.

I went into the bathroom to change, and I could hear the anesthesiologist saying no. Rather than put the scrubs on, I came back out. I asked the nurse "No go?"

The anesthesiologist looked at me directly -- and not unkindly -- said no, I could not go in. She even said she was sorry, then explained to my client "There's just so little space in the OR, and with both your husband there and your doula, it will be too crowded."

I have to admit that I was disappointed, having never been in the OR yet, but I readily accepted her decision. Doulas almost never go into the OR. More importantly, I felt like my client had no expectation for me to be there, and she was fine with it. I told her I'd wait in her room, that I'd be there as soon as they brought her back in, and that I couldn't wait for her to introduce me to her baby.

Soon it was just me in the room, and I was tidying up my client's belongings. Another nurse came in. "Do you still have the scrubs?" she asked. "Put them on, because I think you should go in there."

I told her that the anesthesiologist had already refused me (what I learned in training was that it was the anesthesiologist's call, since doulas and partners would need to share the same space with that doc).

She shook her head. "I'm the OR charge nurse" (or whatever her title was...), "and it's no one's decision but mine, and your patient needs you."

"Is she having another panic attack?" I asked.

"No," said the nurse, "but if she does, you're the one she responds to."

Truly, I felt that my client and her husband were fine, even relieved to choose a c-section (and they did choose it). I said to the nurse, "The anesthesiologist looked right at me and told me no."

"But it's my call," she insisted. "They won't give you a hard time, they'll give me a hard time."

Had my client been unravelling, perhaps I would have reconsidered -- perhaps. But doulas walk such a tough line in the hospital; I'm only as good as the doula the staff has dealt with just prior to me, and whatever I do sets the mood for the doula they encounter after me. And doulas have to work hard to earn the respect of OB's, more often than not. Ultimately, I decided not to go.

What would you have done?



Kimberly said...

thank you for sharing this experience with us! I think you made the right call. I too was in a similar situation but was permitted in the scrub room to watch the procedure and be on hand should my client panic or decide she needed me. My clients mother was in there with her and was more than willing to switch places with me should the need arise. It is a very tough line to walk, but a doula's relationship with the hospital staff is a very important one. We must set an example and show the hospital staff that we respect them and appreciate their respect in return. You did the right thing and I am sure that doula's that come after you will appreciate the wonderful example you have set and the respect you have earned for you and all of us! Have a wonderful day!

yogabec said...

I'll second the thanks for bringing this up. It is such a fine line. I think you definitely made the right decision once the procedure had already started. I also know that I might have chosen differently. I think the main question I would have asked was if my client was asking for me. If she wanted me to be there, then I would have gone; but if she wasn't asking, and it was just the nurse thinking I should be there, then maybe I would have asked if I could be on-hand, but not actually in the room unless my client panicked. I feel I should mention that I have sat in on 3 of the 5 c-sections clients of mine have had, and everyone was always pleased I was there (hospital and parents).
I suspect this is a line we all will have to walk but I always try to err on the side of giving mom the support to trust the choices she made, and sometimes that means staying with her, and sometimes it means letting her do something alone.

Erin said...

Thanks you for sharing. I myself have never been in this situation, however my first thought was did the mom and dad want you there if you could have been there? If so then I would have taken the opportunity to be there or at least let her know that you were near by and could be there if she felt she needed you there. The women who told you to go there obviously had the final say and felt that it was right for you to be there. It must vary from one hospital to the next because I was told at one birth that turned into a c-section, that I could go in if I wanted to, by her midwife who was assisting the surgery.

Joyce said...

Thanks for sharing. I would have gone in. I've attended around 30 c-sections and have been in the OR for probably 75% of them. I have felt how beneficial it is to have a doula in the OR. I would have let the OR charge nurse and the anesthesiolgist talk about it and suited up and been available to go in. Mom doesn't have to be freaking out or asking for you to have you be present, in the OR nor not. It was wonderful that the nurses recognized your valuable support. I'm concerned how the nurses interpreted your decline to go to the OR at their request for the support of the client. hmmm. I'd encourage you to suit up even if the anesthesiologist initially says no so that you can be available if they change their mind and say yes. It has happened more than once to me. Thanks for the discussion.

Amy said...

A doula in the OR can make a *huge* difference in the parents' experience. The continuity of care from the doula can be a big thing for them! I'm sorry you missed out on being there for the actual birth. How confusing to have two different messages from the hospital staff. :-(

motherwitdoula said...

I fully honour your decision, and this is a hard one to have made. I can understand your not wanting to have created tension in the OR and have someone get annoyed with you.

I've been to hundreds of births, and let's say maybe about 40 C-sections...I've only been in the OR a couple of times, as where I live it is actually anesthesia who has the final say, and they only let one other person in to unless I'm with a single mom, it's only the partner in there.

I personally would have gone in. You may be worried about not making waves with anesthesia, but by refusing a request from a nurse who is showing a lot of trust in you and your doula abilities, it's possible that's creating waves too. I would go into the OR, behave myself immensely so anesthesia also saw what a great thing it was to have a doula in the room, and pave the way for future happier C-sections. But if the anesthetist got mad and it affecting the environment, I would respectfully leave. But if the head nurse is the boss and the parents want you there and you're behaving beautifully, then if he acts up, it sheds a bad light ultimately on him...he sounded kind, though, in your estimation.
If the mother were having freakouts during labour and was responding to you, it's doubtful she'd have a problem with you being there. Another option would be to go in the OR and check in with them...hey, how are you guys, and gage whether or not it feels appropriate to them for you to be there. If not, you leave, but at least you give them an opportunity to choose. If you don't go in, you don't give them the choice...what if they nurse told them, "I told her to come in, but she wouldn't"? They might feel miffed that you had the opportunity to calm them down, but didn't.
A lot of things to consider. That's why doulas are so amazing..we are diplomats extraorinaire.

Maria @ A Mom Is Born said...

Thanks so much for all the comments! It is hard to question yourself, even harder when you can't go back and change things! It is also truly hard to be caught in the middle.

sharidoula said...

Already familiar with the OR from previous educational experience, I would have been in there!