Wednesday, June 1, 2011

About Doulas Behaving Badly

I was thrilled to see this resurface from Mother Wit Doula Lesley Everest. I, too, have been told by nursing and OB staff that I'm one of the only doulas they like -- those "other ones" have hidden agendas, or think their wishes are more important than the mother's, or are argumentative. 

In my professional support network, I don't have colleagues who see their role as agitator. And most of us have a preference for what  the mother in the room is showing us, so much so that we don't use information from the fetal monitor, let alone tinker with the machinery.  Do those doulas really exist? Who knows?  Everywhere, but particularly at the larger hospitals where I work and may not be a familiar face to the enormous staff, I mind my place within the hierarchy of hospital culture, and exercise my greatest skills in grace and diplomacy while still meeting the emotional and physical needs of my client. In the eyes of hospital staff, I am only as good as the doula they met before me, whether she is real or a stereotype, and so I am careful. Not only do I love my job, I also care deeply about my profession and the visibility of my professional community, and I envision a day when doulas are a valued, readily accepted part of maternity care

But sometimes it is tricky. As a doula, I have the benefit of a prenatal relationship with my clients, whereas the nurses and OB/midwives don't. There's a lot that I know about what sorts of meanings a woman has associated with her pregnancy, labor, birth, and post-partum. A few weeks ago, my client gave birth to her beautiful baby girl. My client had had a breast reduction some 15 years prior, and it was a goal for her to have as much of a breastfeeding relationship with her baby as she possibly could. She'd done so much reading about Breastfeeding After Reduction, perhaps even more than she'd read about birth.

She knew about the benefits of immediate, uninterrupted skin-to-skin, and it's correlation with higher breastfeeding rates. She reviewed it with her OB, who assured her that skin-to-skin was preferable also from the hospital's point of view, and that as long as there was no need for the baby to go to a warmer or be evaluated by pediatricians, skin-to-skin was the plan. And it did happen. Immediately after the baby emerged, she was placed right on her mother's naked, warm, receptive chest.

For seven minutes.

At seven minutes of life, definitely not an hour, and certainly not before the OB was done even repairing the perineum, the nurse said "Let's weigh her. Of course you want to know what the baby weighs, right?"

A doula's best advocacy tool is to remind her client about choices. If it isn't feasible for the mother to absorb that in any moment, then the next best person is her partner. My client's partner, her husband, was within my reach at that moment. I tapped him on the back and whispered in his ear -- "Do you want to know what the baby weighs, or do you think they'd like more skin-to-skin time?"  He moved quickly from behind his camera and asked the nurse, very politely, for more time, since mom and baby seemed so cozy,  and the nurse agreed.

At 20 minutes of life, so 13 minutes later, the nurse indicated that she needed to weigh the baby  in case she was over 9 lbs and needed blood sugars tested. Baby weighed in at 8.13, and the nurse began to diaper the baby, cover her sweet head with a hat, and then laid out swaddling blankets.

This time the dad was out of my reach, so I couldn't whisper a reminder of all that the mother had read and wanted. It is usually my last option, but I had to exercise it -- and I asked my client in my normal voice, "You can hold her again. Do you want her swaddled, or do you want her naked on your skin?"

The mother's eyes lit up with excitement. "Oh, naked for sure!"

The nurse's jaw stiffenened tight as she began to undo the swaddle. She was definitely displeased and looked at me sternly as she said, "Just be sure the baby is warm enough."

So is that the equivalent of taking a patient off a monitor? Is that the same as undoing an IV? Am I a doula behaving badly? That nurse probably thinks so, and I don't think I've done much to advance my field in her eyes.

But I can live with that.



Cynthia said...

Your work with these clients is, to me, doulas behaving goodly! You advocated for your clients by helping them to remember what to ask for in those critical moments when they are fuzzy, or tired, or taking photographs, or otherwise occupied AND at the same time wish for certain things to happen, such as having as much skin-to-skin time with baby as possible. I had a very similar situation recently where the baby went to be weighed and was then left on the warmer... really, just left there. No one was doing anything with the babe, and neither mom nor dad realized this, so I gently asked mom if she would like to have her baby with her. She said, "oh yes, please" and asked for her baby. I truly think this is good doula behavior - so long as we're being polite, kind, diplomatic, and mostly, speaking WITH rather than FOR our clients. Nothing like pulling on machinery, in my view. Thank you for a wonderful post.

Meredith said...

It is so infuriating to read about policies and events like this - while speaking out of one side of the mouth they of course advocate for something like skin-to-skin while out of the other side of the mouth it's "we need to weigh the baby, and the baby needs to be swaddled to stay warm." Where is the evidence? Oh right, the evidence shows that baby warms up best when naked against mom.

Both of my doulas were quite respectful and never contradicted hospital staff. But I can see how even respectful conversation to remind the parents of their rights or options can be interpreted as going against the hospital, and it's so sad.