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| 01/11/2006 9:13 PM |
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B"H
Dear Henci,
It's me again-- with a second question:
Some of my doula friends and I find ourselves in a predicament. That is-- our clients often hire us to offset the effects of their own care providers-- some of whom they feel stuck with due to insurance, to lack of convenience or knowing who to trust to go elsewhere (and often the "good" providers are taken and will not accept our women transferring to them in second or third trimester)-- in short, for all kinds of reasons women are choosing to birth with practitioners who are not all they would like them to be. However, they expect us, the doulas, to know what "to do" well enough to protect them from a negative experience. As one woman asked me in an interview, "Would you know to tell me whether or not a c-section was necessary?" I told her she should be able to trust her doctor to make the call, but it was clear that she was not sure that she could.
On one hand it is wonderful to have our clients' faith; however, there they are removing somewhat the mantle of responsibility onto us to "make sure they have the best possible birth." IN our attempts to please, what we have decided to do is to keep our women out of the hospital for as LONG AS POSSIBLE. We have gotten quite good at showing up at 8-10 centimeters and often the women don't even get an IV because by the time she gets in the room and gets undressed, she climbs up on the bed and is ready to push. HOwever, they are still subject to the doc's 2nd stage protocols-- whether they be episitiomy, directed pushing, etc....
This is the question, though: Is it safe or correct to deliberately delay going to the hospital and in the meantime having NO FETAL MONITORING WHATSOEVER up until the birth is imminent--in order to "protect" women from the system they have chosen? I am not a clinician, but do read quite a bit about midwifery, birth, etc. and, when I think about why babies die and when they get into trouble-- is it not during the 1st stage of labor, and not necessarily during the 2nd stage or the birth? I am not sure about this, but I would think that most babies get into trouble during the most intense part of labor, an hour or so before birth, as they are descending into the pelvis very deeply-- and may have at that time cord impingements or other cord issues, or meconium that we would not know about at home if the membranes are intact. To me it seems funny that a lot of the people we serve would consider out of hospital birth scandalously dangerous, yet show up at the hospital 5 minutes before their baby is born because they don't like hospitals. I know people should not be at the hospital before active labor hits, but should they be doing most of active labor their in order to be monitored if hospital birth is what they have chosen? Bottom line-- should we be practicing the way we are practicing? If not, is there any happy medium? Would appreciate your advice.
Thanks,
Shayna By: shayna |
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Archived User
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| 01/14/2006 10:17 AM |
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I know you are caught between a rock and a hard place, but when you start doing things such as advising clients to stay home longer, you are exceeding your scope of practice and crossing the line into giving medical advice. The best thing you can do is help your clients make informed choices, which is your clients' right. ICEA sells business-sized cards with these questions. Here is the page they are on. Scroll down to "Key Questions About Your Care." I recommend handing them out to clients and students. (They will, by the way, come in handy for any medical encounter.) Or you can get them from a number of sources, including my book or off the Maternity Center Association site Making Informed Decisions and make your own list. I also recommend telling your clients that barring an emergency, they should ask their questions and then request time alone to consider what they have heard before making any decision. This will prevent them from being railroaded into a hasty decision. I would also emphasize that they have the right to give an informed refusal as well as an informed consent.
-- Henci By: Henci Goer |
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maria (guest)
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| 02/03/2007 3:38 PM |
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I just found this :-) Great to know, and have. I am becoming a doula and it is very clear to me that my 'job' happens mostly before labor even starts. Once in labor, at a hospital, there is nothing I can do to go around what the doctor is saying. It is not my place. I can only advocate her birh plan in a normal situation if it is breached.
maria.
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