Wednesday, October 13, 2010

Musings of a Doula/Midwife and a Birth Story

Sorry for the lack of posts. It's been a bit hectic around here. Between weddings, births, home visits, childbirth classes, etc. I miscarried what I believe was a blighted ovum. Holding that little, Oreo cookie-sized placenta in my hands was, and still is, heart-breaking and somehow awe-inspiring at the same time. Despite all the running around, I have had time to do a few things such as grieving the loss (mercifully), bathing (thankfully) and checking up on my family on FB (this is what the world has come to, people). Recently, I also had the opportunity to be the doula for a woman who was having a planned hospital birth. This isn't normally the kind of doula work I do. Most of my clients are planned home births. Being a doula (or a midwife) in a hospital setting can be difficult. Being both can be very, very uncomfortable. So here's the story...

This mother was in great health and having an uncomplicated pregnancy. However, she was going to an OB practice that specialized in high-risk pregnancies because she had developed a good rapport with one of the OBs there after suffering a traumatic loss a year ago. The OB and parents decided to undergo a medical induction at 41 weeks. We had already discussed the pros and cons of medical induction and all the likely scenarios. The mother decided that she was okay with receiving Cervadil but did not want Pitocin. I was feeling like the champion of informed consent before we went into the hospital. Then things began to change.

First, they couldn't give her the Cervadil because of an allergy issue. After much debate and confusion on the part of the parents as well as the medical staff, she was sent home to "wait it out" for the night with instructions to return in the morning. This left the mother feeling frustrated because she was ready to be in labor and tired of being pregnant. However, she decided to go home and wait. Two days later, on the morning that she was to return for another shot at medical induction, her water broke. When she called to tell me this, I asked how she felt about forgoing the induction since it seemed like she was beginning labor on her own. She informed me that she was just at a point where she was "over it" and just wanted the baby out. So, we went to the hospital.

I'm sure you know how things progressed from that point but for those who may not have guessed, let me re-cap: Pitocin started and doubled every 20 min --> Mom in unbearable pain --> Vaginal Exams every 2 - 3 hrs --> Epidural --> More Pitocin --> Failure to wait and fear of "big" baby --> C-section --> Mom distraught over how everything played out.

So...I left that birth feeling like I had done all I could do barring locking the doors or throwing myself prostrate over this woman's burgeoning belly. I gave her the information and allowed her to make her decisions free of judgement on my part. But when her choices led to the unwanted scenarios that we had repeatedly discussed for months, I felt like she was upset with me for not protecting her from those choices. I felt I had let her down. Maybe my mistake was in assuming that informed consent meant informed responsibility. Maybe it was that, in an effort to not make it seem as if her trusted provider was setting her up, I wasn't blunt enough with her about the writing I had already seen on the wall. How does one balance tactfulness and brazen defiance? After her doctor did the final vaginal exam and declared that she had made NEGATIVE progress (even after making positive progress all along) and gave her the c-section talk, I could've opted to check her with the mother's consent. But what would I have done if I had discovered that the doctor's exam was "inaccurate" and the mother was actually further along? At best, it would've seriously broken the trust this woman had in her doctor. At worst, it would've done that and possibly seen me arrested for practicing medicine without a license.

What would you have done?


  1. I'm not a doula but it seems and sounds like you did the right thing. You gave mom the info and she made the decision. Everyone wants someone to blame when things don't go well. Easier to blame you than herself.

  2. Hi Milk Chocolate,
    I like your comment informed consent is not informed responsibility, nor do many women choose informed dissent.
    I've been in this situation a few times and its never easy. Birthing women often do seem to cope by submitting to the will of the person they put "in power" for their birth. That's a social support twist from the doula point-of-view. Sometimes women want both, to let the doctor decide, but also the support of a woman during their birth. Sometimes we can just be there to celebrate her journey however she chooses to ride it out.