You took your childbirth classes. You read books and websites. You created a beautifully printed birth plan. You envisioned a birth full of candles and flowers and looking like a birth goddess, or perhaps you envisioned getting pain medication and watching movies and visiting with your friends and family. And then..
Circumstances changed. Maybe you had a transfer from a freestanding birth center and went to an unfamiliar-to-you hospital. Maybe your baby stopped growing optimally and a medical induction became a reality. Maybe your no intervention birth plan is toppling so far from your preferred choices that it becomes bewildering and frightening to you.
As an ICAN leader and experienced doula, I sometimes receive phone calls from women in these situations even though they are not my client. I had one this week. Without giving too many personal details, her situation was such that it seemed a medical induction was best for the safety of the baby. She was transferred to a high risk group. Upon arriving at the hospital she was told that the induction would be slow and could take days and there was no time clock. And then..
Multiple residents came in with different suggestions for getting the baby out now. She had researched a good deal and asked wonderful informed consent questions. Is this an emergency? Am I or the baby in danger to proceed slowly? The answer was no. Still, she called me crying at the pressure of having one doctor after another file into her room with dire warnings of distress to the baby (and worse) and predictions of a cesarean if she didn’t allow them to perform all of the interventions they were recommending, even if she was not comfortable proceeding that quickly versus giving her body a chance to swing into active labor on its own.
I listened to her cry. I listened to her fears and her disappointment that things were not proceeding as she had imagined. Then I reminded her that informed consent is actually informed consent and refusal. We went over the informed consent questions again. What are the benefits and risks of doing a certain procedure? Why is it being suggested? Were there any alternatives to what they were recommending? What happens if we employ expectant management and give things more time to progress? Would you give me a few minutes to discuss with my partner and make a decision I feel good about?
Disclaimer: I wasn’t there. I’m also not a medical provider and do not give medical advice. I am not the one responsible for the safety of that mother and baby. I am unaware if there was information that made her medical providers feel one course was the best. I am a doula. I am used to listening to women who are frightened, disappointed, and unsure of the right choice to make. I am interested not only in physical safety of mother and baby but an empowering birth experience — no matter how it plays out. I am interested in her looking back and feeling that she made the best decisions with the information available at the time. I am interested in the birth team cohesively working together to ensure a safe AND empowering experience.
She focused on finding some inner peace and asking these questions. Unfortunately, it did not go well and the pressure became strong and some not nice words, phrases, and tactics were used, per her. Her providers agreed there was no emergent reason (as in safety of mom or baby) to pile on the interventions but told her they were certain she would end up with a cesarean if she didn’t comply.
That is an awful, if not impossible, way to try to labor and open your cervix. So as I have mulled this scenario over in my mind I decided to come up with a few tips in case something similar happens to you.
- Ask your informed consent questions. If there is an emergency, not only will they tell you but your medical providers will already be swiftly acting. When you sign in as a patient you are giving them an agreement to save you and your baby’s life. We are not talking about clear indications for life saving measures but more those gray areas of trying to decide which path to take.
- Engage your nurses, if possible. In this case the charge nurse came in to speak with her and reminded her that these were the suggestions but that the mother is the one driving the decisions and that it is informed consent and refusal, should that be her choice.
- Follow evidence based medicine. While it should not be the case that each laboring mother has to know facts, studies, and regular or alternative standards of care and treatment, it might be in your best interest to quote recommendations given by pregnancy organizations such as ACOG.
- Should there be a complete personality clash between you and the provider caring for you, consider asking for a different doctor or waiting for the on call schedule to change. Again, this is obviously not always possible when there is a serious or emergent situation happening. In this case, the on call doctor changed in 3 hours and she decided to wait until she could speak to that doctor.
- The vast majority of providers are not there to make your experience terrible — or to get to their golf game. They really are interested in your physical safety and that of your baby. However, they may not realize how important certain decisions are to you. Talk to them. Convey not only how important certain things are but why they are. Suggest or ask if there are alternative methods to what they are suggesting. (examples would be: instead of starting Pitocin using a breast pump, instead of rupturing your membranes, sitting on a birth ball, etc.). Maybe their answer will be one of excited acceptance or perhaps they know something about your personal situation that is causing them to recommend something else.
- Find a place of calm. When a situation becomes tense there can be certain phrases and tactics that are used that are triggering. Stick to the facts and if there is a doomsayer in your room or someone who constantly promises you will end up with a cesarean, let those words and phrases bounce off of you in the emotional sense. Conversely you can request your provider to stop using those phrases unless it an absolute certainty that is the correct path to take. Having a baby is an emotionally charged experience! Hear the words but do not attach emotions to them. If you find yourself overwhelmed, go in the bathroom and take a nice soothing and dark shower, or walk in the halls for a change of scenery. If you are confined to the bed for actual medical reasons, play soothing music or listen to music through ear phones. Ask your partner for hugs and massage. Clear the room and ask for a set amount of time to get yourself emotionally back on track.
These are just a few suggestions I can think of. I would be remiss if I did not mention that having a doula is an evidence based way to ensure emotional support for you and your partner and to help you try alternative methods to keep you and baby safe but also stick as closely as possible to your desires and wishes for birth. No, doulas will not speak for you or argue with your medical providers. We will remind you to breathe, to take a shower, to relax, to ask appropriate questions, and do all we can to use our tricks and tools to help your labor progress even if it has veered off course.
What happened with the mother who called me? She texted me a photo of her beautiful baby and said the atmosphere completely changed for the better when the on call doctor changed to one more emotionally understanding of her. Just by making the decision to wait those couple of hours enabled her to relax and to make more progress and to feel good about her decisions.
Do you have any tips for dealing with tense medical situations?
All Rights Reserved, Kimberly Sebeck AKA Knoxville Doula 2016