Doulas who attend trainings with a doula organization are taught to not speak against medical provider advice. We are told that we aren’t to get between the clients and the medical providers. Yet, it happens. Usually it’s a very subtle thing, like our client calling us first to ask what to do if her water is broken. The proper response would be to ask their provider, of course, but perhaps we first offer some helpful tips like putting a pad on and seeing if it’s urine or letting them know the smell and color of amniotic fluid. Perhaps their provider suggests a procedure and they call us to get more information about the procedure such as what it is for or if there is an alternative. I like to think that these conversations are about helping the client educate themselves and get evidence based information so as to go back and have an empowering discussion and decision with their provider. What I would choose to do is not relevant and not only do I say that but I encourage the woman to listen to her gut feelings and ask for as much information and clarification as she needs.
Have I seen things that have given me pause? Of course. Have I felt like I would make a different choice at times? Yes. But none of that matters — it is not my birth. I am there to support decisions and facilitate the birth process no matter the circumstances. Now I will tell you about a recent scenario, with some details changed and names left out. Even after 15 years of being a doula, I am always learning.
One morning I receive a text from the client’s husband saying the amniotic fluid is very low and baby needs to be born and an induction is going to happen immediately. I text back and say ok, let me grab my stuff, call me when you can and give me details and how low is the fluid. I am told the level of fluid is an 11. I won’t go into great detail over what is considered low and the fact that many providers perhaps are a bit overzealous with inductions for low fluid. In my head I thought the level is an 11? That’s not that low — but I correctly assumed that I was missing vital pieces of information. After a little while another text comes that the OB is recommending a cesarean. This really made me pause — why not an induction and trial of labor first? Again, I remind myself that I must be missing information as I know this provider and truly do trust his opinion and judgment and the fact he is called the male midwife in our area. I receive a phone call from the clients and get a little more information as I am driving to the hospital. The fluid was so alarmingly low that the ultrasound technician said there was none and as the OB explained to them that with there being no dilation or effacement of the cervix even past the edd that he was leaning towards a cesarean to safely deliver baby, but it was their choice.
I am confused, I admit it, but I keep it to myself. My client is being sent straight to the hospital for monitoring and to make her decision about induction or a cesarean that afternoon. I assure them I am on my way and we will sit and discuss all the details so she can make a decision. When I arrive we sit and talk extensively. I ask the client what her gut feeling is. She says to do a cesarean, for a variety of reasons. She cries, we hug, we grieve a bit. Then we sit and discuss what she can expect for a cesarean. She is concerned that she has to wait a few hours but I assure her she is being monitored and if anything adverse happens that she and baby will be well taken care of. We spend the next few hours making sure the father gets all their stuff from home and gets something to eat and just going over things.
When it is time for the cesarean we are all prepped. This OB happily allows doulas or birth photographers in the OR. I have never been in the OR at this hospital with this OB — this is how rarely one of my client’s under his care gets a cesarean. I talk to the father while we are not allowed in for those few moments and keep him company and give him some advice for post cesarean care. We go in and the cesarean begins and I snap photos. Mama looks gorgeous despite the circumstances and I take some photos of her and speak reassuringly to them.
Beautiful baby girl is born in minutes, quickly taken to the warmer, and then given to Daddy for skin to skin. In moments we discover why the cesarean was an excellent decision. The placenta has already previously torn away in a partial abruption. There is virtually no amniotic fluid. An infection is suspected. The OB graciously shows this to me and we nod at each other over our masks. The surgery goes well and baby is given to mama on the way back to the room and we almost immediately initiate breastfeeding.
I stay for a few hours and we discuss what a good decision was made. I know that it’s a whirlwind of activity at this time and I offer to come back the next day to help process and give cesarean care tips. Unfortunately we had a huge snowstorm that night so I speak to them on the phone and come the following day. All is going well. We discuss the partial abruption and later we find out that the amniotic fluid level was not an 11 but instead was declared a 0.
Would it have been possible to have a successful induction? Maybe. Maybe not. No one is concerned about that any more because the decision has been made and it was an empowering and successful birth even if it wasn’t an unmedicated vaginal birth.
I am reminded yet again why we don’t give advice counter to medical advice. Doulas are not OB’s or midwives. We are not even labor and delivery nurses. There had been no symptoms of a partial abruption — no bleeding, no pain, no contractions. There was no fever to indicate an infection. Baby’s heart rate was good on the monitors. The week before the amniotic fluid had been at over a 20 level, then went to virtually none. Sometimes you take the signs, symptoms, and trends and have to make a tough decision.
I am reminded yet again why it’s important to have a birth team that you trust and also for my clients to trust their intuition. As we discussed while she was making the decision — no one could give her a guarantee either way of the best call. You make the best decision you can with the information you have at the time. Hopefully you have an OB like hers who doesn’t unnecessarily frighten or make you feel you don’t have a choice. She had a choice and the risks and benefits of both were clearly outlined. Yes, mother and baby were both fine and healthy but the bonus was that my clients felt empowered in their decision and were supported all the way and their emotional health was considered and supported.
Being a doula is a precious role and one that should stay within the proper scope of practice of non medical advice while offering emotional and physical support.
All Rights Reserved, 2015, Kimberly Sebeck, Knoxville Doula