Wednesday, August 19, 2009

Have you ever thought about being a doula?

A friend asked me this, via text message, this morning. I was going to write her a big, long email back about my experience in doula-dom, but realized what good blog fodder it is! So here I am.

Yep, I thought about about being a doula. In fact, a little over six years ago, I set out to be a doula. Seeking a better birth experience with Joey than I had with Kevin, I hired a doula, and it was a very positive experience, and it kind of became the impetus for me to try to satisfy my fixation on pregnancy and birth by endeavoring to become a doula myself. What could be more fulfilling, I wondered, than being in a line of work that allowed me to support women during pregnancy and birth, and to witness the miracle of birth over and over?

I completed all of the study requirements set forth by DONA at the time, and underwent their weekend-long training workshop. The only other requirement to gain certification was to attend three births as a primary support person (and obtain written evaluations from the mothers, attending physicians, and nurses at those births).

In a nutshell, I was never able to follow through on the whole thing because I didn't have round-the-clock childcare available (which is necessary when you're going to be summoned by women in labor at all hours needing support) . . . plus, I kept having more babies myself ;)

I did attend two of the three required births, however. Well, actually, one and a half. And both of those experiences, along with my own hospital birth experiences, left me with the definite conclusion that I'm just not cut out to be a doula. I get too fired up about this stuff, too emotionally involved.

The first "client" I had (I use that term loosely since I offered my services for free, as most aspiring doulas do for those required certification births) was a young woman having her second baby. She was a single mom; her boyfriend had dumped her shortly after she got pregnant the second time. Her name was Melissa. I still remember the day she went into labor. I had met with her a few times during her pregnancy in order to establish a rapport with her. On the day she went into labor, we went to the park and walked around the lake together. Her contractions were sporadic but increasingly uncomfortable. She thought she might be leaking amniotic fluid but she wasn't sure. Towards evening we decided that she should call her doctor. She was told to go straight to the hospital. She called me from the hospital and told me she had been admitted. I can't remember how far she was dilated, but they determined that she was definitely in labor and that she was in fact leaking amniotic fluid, and since they didn't know how long she had been leaking, they were treating it as PROM (prolonged rupture of membranes) and so they hooked her up to an IV of antibiotics for the duration of her labor (don't even get me started on that). By the time I got to the hospital, her mom was there with her and she was confined to the hospital bed and writhing in pain. She wasn't progressing as quickly as they wanted, so they kept threatening Pitocin to augment her labor. She kept declining, and we tried some natural measures to get her contractions into a more active pattern. She labored for hours, mostly confined to the bed (because of the IV and fetal monitor they insisted on), which probably slowed her labor down. Anyway, finally she requested an epidural, which was given to her when she was 8 cm dilated. After laboring pretty much all day, the girl was exhausted and she finally fell asleep. It was the middle of the night by now, and her mom and I both dozed off too. At one point, a nurse came into the darkened room and checked Melissa's cervix. She whispered, "You're complete now. We can get things set up now and you can push, or you can sleep for a while longer, it's up to you." Melissa opted to rest a while longer. A little while later, the doctor came storming into the room. This wasn't even Melissa's regular OB, it was just the OB who happened to be on call, and he had come in briefly to meet Melissa once shortly after she was admitted, and that was the extent of his involvement with her to this point. He roughly checked her and told her point blank, "You need a c-section. The nurse tells me that you've been complete for a while, and yet the baby hasn't been born yet. It's too big for you to deliver vaginally." I was stunned, absolutely stunned. So was Melissa. WTF?! I knew this doctor was full of shit, I just knew it with every cell of my body. He was telling her that her baby was too big before she had even tried to push him out. We reminded him that she had given birth to her first baby vaginally with no problem. He said, "Second babies are always bigger than first babies. This baby is too big." I was terrified that Melissa was just going to go along with it, but it wasn't my place to make her decisions for her. I was only there to support her and help her reach informed decisions. Fortunately, she asked the doctor for a few minutes of privacy to think it over. He was a complete asshole. He actually said to her, "If you choose not to do what I am recommending, I will not be responsible for whatever happens to your baby." I swear to god, he said that.

As soon as he left the room, I went into a tirade. I told her that CPD (cephalopelvic disproportion - or in lay terms, a baby whose head and body are too large to fit through a mother's pelvis and/or a mother whose pelvis is too small to accommodate her baby) is impossible to accurately diagnose when a mother hasn't even attempted to push her baby out, that it's horribly over-diagnosed, that the doctor is full of shit insisting that second babies are "always" bigger (my second baby was exactly the same weight and an inch shorter than my first), and that she had every right to insist on an opportunity to try to push her baby out.

Melissa told the nurse that she wanted to try to push. So the nurse went and got the doctor and they broke down the bed and got everything ready. The doctor wouldn't even look Melissa in the eye. He had her lie back and put her feet in the stirrups and . . . sliced a nice big episiotomy with a pair of surgical scissors. I will never forget that as long as I live. I swear to god it was an assault. It was like he was punishing her for having a mind of her own and deciding to reject his recommendation of a c-section. I'm pretty sure I started crying then.

Melissa pushed her baby boy out in less than ten minutes (I'm getting the chills just typing this . . . all the images are coming back to me). And he weighed several ounces less than his big brother had weighed at birth.

I have no doubt that Melissa having a doula present saved her from a completely unnecessary c-section, and it was a great feeling to know that I was able to play a part in making such a life-altering difference to someone. It was also absolutely indescribable to witness the birth of a baby from that perspective - from the perspective of a witness and not the person giving birth (although it goes without saying that there is nothing more miraculous than being the one giving birth). It was an honor and utterly humbling.

But. The whole experience sent me into a sort of tail spin. I cried for days over that, over how that doctor treated her, how he lied to her and assaulted her. I went into a sort of depression over the whole thing. See, I couldn't distance myself. And it hurt. A lot.

The second opportunity I had went like this: it was a mom having her first baby and she was about a week past her due date and both she and her doctor were ready to have this baby out. There were no problems - the baby was doing fine in utero still, the mother was doing fine, but she was sick of being pregnant and the arbitrary 40-week mark had come and gone and her doctor was more than ready to put an end to the pregnancy. I actually inherited this client at the last minute from the doula I had used with Joey - she had a family emergency come up and knew I was trying to get my certification births done, so she called me and asked if I could take this client for her. So I didn't have an established rapport with this mom and her husband. I met them at the hospital and sat there twiddling my thumbs for about 12 hours while they induced her with cervadil and then Pitocin. Despite those measures, she still wasn't progressing, and they finally decided to stop the induction and let her sleep for the night and then try again in the morning. I went home at that point, telling them to call me the next morning and I would come back. They didn't call me back until after the baby was born, though, and she had ended up with a c-section. Totally not surprised. But very disappointed and disillusioned.

And again I went into that whole crying jag thing over it.

I hate the maternity system here in the US. I hate how women and babies are treated, and I hate that women just accept it for the most part. I hate that women fear birth. I hate that doctors lie to women. My own birth experience with the twins was horrible, and just completely confirmed my distaste for the hospital birthing industry. And that's what it is - an industry. I would love to see the US adopt a midwifery model of maternity care (as supported by WHO), but it's never going to happen. Obstetrics is big business. Huge. And women are all too willing to hand over responsibility for their birthing experiences to doctors who supposedly know what's best for them. Doctors who have discovered better ways to bring their babies into the world than Mother Nature has provided. Because women are defective, you know. Didn't you know that?

See how I get all revved up about this stuff? This is why I can't be a doula. It all just hurts too much.


Jen said...

Damn, Lisa. That doctor! That's one of the most horrible things I've ever heard.

I can totally understand why you couldn't do it; I know I couldn't. But still, I bet you'd be great at it.

This is definitely food for thought. Thanks for sharing.

Anonymous said...

It's Anonymous again...:) I have to agree with you in that it is somewhat of an industry. I worked with OBs as a medical representative and a lot of times/most of the time it is "one glove fits all". I do, however, think that some OBs do a wonderful job and can guide the woman in the right direction. I chose to deliver my twins via a c-section even though both babies were head down and we knew that they were not more than 5lb each even at 36 weeks..For me, it was the best decision and I would do it the same way again. Super easy, no pain, etc..but I tell you, my doc tried to talk to me into a vaginal delivery up until I told him my final decision when my water broke. So it goes both ways, I think and I do believe that there are great doctors out there. But you are right, there are some bad ones and some women can benefit from a person like a doula to help them through the process...

Lisa said...

Ahhh, Anonymous. We meet again ;) Are we destined to be adversaries?

I gotta be honest: I do NOT understand the whole elective c-section thing. In fact, it bothers me. While I do believe in freedom of choice, I also believe that this huge rise in elective c-sections is changing the landscape of maternity care and birthing in the US. The more c-section is accepted as normal and mainstream and routine, the harder it is for women who want natural, intervention-free births to have them. And while I am most likely done having babies, this bothers me for my daughters. And for all women.

And really - 'Super easy, pain free" . . . ??? Really?? So recovering from major abdominal surgery was a piece of cake? On top of taking care of TWO newborns? Huh. I fought tooth and nail to NOT have a c-section with my twins for those very reasons. Maybe you avoided the pain of labor, but nobody gets their gut sliced open, their internal organs rearranged, and then everything sewn and stapled shut without pain. Plus all the risks associated with surgery . . . sigh. Yeah, I just don't get it.

But if you were happy with the experience, well, good for you I guess.

Anonymous said...

I've was a doula, for three years. I've seen doctors rape women with very long hemostats because they were pissed. Yes HORRIBLE! I've also seen women do the impossible and come out of it with such amazing personal growth that it's permanently changed them.

I can see the whole elective cesarean thing for SOME women. I have met some that were so spooked about their bodies and had such bad sexual history that dealing with anyone near their vaginas was too much.

However it has to be a leveled choice based on honesty of what is involved with both. THAT is what is missing in maternity care today. The risks are presented with such "spin" it's not a fair choice when you don't have the facts. Doctors attend 98 % of the births and they have a definite preference for cesarean. They don't even know all the risks of cesarean or the benefits of vaginal birth, let alone share them with women. It's up to women in the U.S. to tell each other!

Anonymous said...

Lisa, I elected the c-section because it was twins. I would not have with one child. To me, a c-section in a controlled environment with a doctor that I absolutely trusted was safer than Baby A coming out OK and risking the chance for Baby B. Perhaps not true, but I often heard that it's about Baby B and I did not want them to use extraction stuff to get him out. It was a safer choice.
And I am being very honest with you, the whole surgery was a piece of cake for me. Truly. I was up standing and walking very shortly after the surgery and visiting the babies. I was discharged normally and by the 3rd day I was off pain medication. I climbed stairs right away, etc. And yes, took care of two infants all by myself with my husband's help. There was no pain.

Not trying to "kidnap" your blog as I have my own, but I simply made a comment and since you wrote back, I did, too. But I feel that you always have to have people agree with you..if not, you really do not like that. I sometimes feel like you are "bitter" against the whole world and people that do not share your thoughts...Not everyone is going to have issues with a c-section and not everyone is going to do great with a vaginal birth. Especially with multiples involved.


Megan said...

Just out of curiosity: what's the basis for the thought that a c-section is safer for twins? Are there studies or statistical data to back that up? Is that something they show to moms of multiples? It seems to me that if OBs are asserting that c-sections are safer for multiples, they should have some data comparing vaginal births (and, ideally, before c-sections were the norm) and c-sections with multiple births. Women need to be getting actual facts, not just what an OB thinks, in order to form their own opinions. My issue is I doubt (from my own personal, albiet non-twin, experience) that OBs are providing that information to their clients because I believe that mom and baby safety is secondary to what they feel is easier and less issue for them.

Lisa said...

Megan, no, a c-section is not the safer way to deliver twins, anymore than it is the safer way to deliver a singleton - absent a true medical need. There are instances when a c-section is appropriate - if the baby(s) is severely premature, for instance, it may not be able to withstand labor and a vaginal birth. The necessity of delivering twins by c-section is no different than the necessity of delivering a singleton by c-section. Unfortunately, it's become the accepted way to deliver twins because it's easier for the OB and can be scheduled conveniently and take place under extremely controlled circumstances. With higher order multiples (triplets and so forth), it's pretty much unheard of anymore to have a vaginal birth, at least here in the US. I'm sure part of this is that higher order multiples usually are very premature, but I don't think that's the only factor.

Even if someone has a good experience with a c-section, like any other major surgery, there are risks: infection, injury to internal organs, blood clots, hemmorhage, all the risks associated with anesthesia . . . plus there are risks to the baby(s). Any baby that is born by c-section is at higher risk for breathing difficulties, as the contractions of labor and being squeezed through the birth canal actually prepare the lungs for breathing on the "outside."

One of these days I'll post my twins' birth story (I'm actually waiting for their birthday next month ;) I had to spend a good part of my labor fighting with the docs not to do a c-section on me. I still look back on that experience with a lot of sadness, even though I was able to give birth vaginally. But one of the postpartum nurses told me that there had been several twin births that week at the hospital, and I was the only one that wasn't a c-section. Very sad.

Larry said...

It is too bad that c-section has become such an easy option for women to have foisted on them - I totally agree that there are circumstances that warrant it medically but it seems most of the time c-sections happen for doctor convenience and/or mother convenience - look at Cedars Sinai in LA - they schedule people just for the lame reason that the parents want to pick their kid's birthdate - jeez! And having had a surgery in the tummy I can say it was NOT at all an easy recoup for me and I was only 19 and in good health - I think Kelly/Anonymous was lucky to have no pain and that probably speaks more to her threshold for pain than to the surgery, which means labor would have been a piece of cake for her too - the fact that so many women miss the experience of labor and pushing their child into this world is sad to least there are still some docs out there that like to do it the good old fashion way - my OB delivered my friend who had twins at age 35 vaginally and never once broached the idea of a c-section and when she had a small hemmorage she just shoved her arm up there and massaged her uterus until it clamped down and stopped the bleed on itself - no fuss no muss. I think women really ahve to support each other and educate each other so they can choose in an informed manner and hold their ground for what they want. L

Michelle said...

Okay, that doctor story was a nightmare. How awful!! And really? who attacks people in their own blog, when they share personal stories about their life? Ridiculous.

I fought having a c-section my whole pregnancy with the twins, and at the last ultrasound, when we knew Lydia was gone, I panicked and asked for one. My doctor was surprised, but did exactly as I wished.

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