Are We Shooting Ourselves in The Foot?

Recently I had a prenatal massage therapy client come in for an appointment; we’ll call her “Client A”.  On my prenatal massage client form, I have a spot for the client to request information about my birth doula service.  If she requests that information, I take a few moments to discuss what her desires for birth are and explain how my support can help enhance her birth experience and help her have a positive memory of how her baby was born.  I did this with Client A.

Allow me a moment to briefly share my background:  I have 2 boys who were born vaginally, but with medical interventions.  I have personally experienced induction, episiotomies, use of vacuum extraction, narcotics in labor, epidural, spontaneous water breaking, and AROM.  I know how some of these interventions were beneficial to me or my baby and some were harmful.  Fortunately, my children are healthy, happy, and show no signs of birth trauma.

Knowing what I know now about these interventions, I am sure that I would have made some different choices if faced with the same circumstances today.  I have provided support to 16 sets of parents and 17 babies as they entered the world, some in hospital settings and others in our local birth center.  I am neither pro-intervention nor am I against intervention.  I am, however, pro-knowledge.  I believe that if a woman is fully informed of both the risks and the benefits of an intervention, she can in good conscience make the best decision for her and her baby; this is her birth after all.  As her doula, I support her in any well-informed decision that she makes. 

I carry with me The Thinking Woman’s Guide to a Better Birth by Henci Goer along with OB/Peds Women’s Health Notes to help my clients if they are faced with an intervention decision during labor.  I show them the information, which includes the pros and cons and allows them to make the decision with which they are most comfortable.  I feel that this is the best way I can serve the birthing women who have invited & honored me to join their birth team.

Now, back to Client A.  She has indicated to me on several occasions during prenatal massage appointments that she would like to have a doula-supported birth.  This is her first child and she is apprehensive about how labor will go.  She has indicated that she is not opposed to interventions, although she would prefer to be able to do things such as walk and be in a tub (which is not available at the hospital she toured).  She spoke with her OB who told her that the hospital is a teaching hospital and therefore, she would be subject to the presence of and examinations by various residents and other staff.  She also was told during her tour that the hospital protocol is that everyone is hooked up to a fetal monitor.  While her OB is not opposed to doula support, she made sure to tell my client that the doulas that she has worked with have stepped over the line and tried to tell her how to do her job as the doctor.  This caused my client to express a wish to not do anything that may cause any kind of drama or confrontation during her labor and birth.

Here’s my question:  In our efforts as doulas to support women and advocate for gentle births, are we shooting ourselves in the foot? While being zealous about birth and wanting to help as many women as possible to become educated about their choices, are some of us going beyond our scope of practice and code of ethics and actually  REDUCING the choices to women because we are creating battle lines with their medical providers?

As Doulas, we are not supposed to perform clinical tasks, nor are we supposed to speak for our clients or make their decisions for them.

I have no illusions about the world, myself, or birth.  I know that we are in an uphill battle against insurance companies, OBs with “God-complexes”, and women who question their abilities or rights to decide how their babies are born.  I know that I am not the end-all, be-all of birth professionals.  I am, however, a mom who has had interventions because I didn’t know any better.  I am a doula who just wants my clients to feel empowered and informed enough to own the decisions that lead to how their births evolve.  And I am frustrated when a client decides to not have a doula because she is paying the price for another patient whose doula was a little over-zealous and put her OB on the defensive.