I am a Lamaze educator in training, hoping to sit for the exam in October.  I am also a DONA birth doula and a peer breastfeeding counselor in an international non-profit organization -- I will hit my 2000 hour mark in May . 

I have a doula client who is 37 weeks, 4 days.  Yesterday at her OB visit, her OB asked, "Do you want me to massage your cervix?"  She was a bit perplexed, and luckily we had met the day before and discussed the advantages of allowing labor to begin on its own.  We used the terminology "stripping membranes," but this massage thing made her ears perk up.  She told him she was okay with vag exams (although we covered the "necessity" of that as well the day before), but she did not want anything else -- she wanted labot to begin on its own.

He also mentioned "labor is hard on babies -- during contractions their blood supply is shut off."  I wrote that down word for word as what my client ssaid.  She was very confused by this.  He said between now and her due date, he wants to her walk, have sex, and allow him to massage her cervix.  She was a bit confused, and said, "Now?  Even though I am only 37 weeks?"  He confirmed, yes, now.

Any ideas what he was talking about with the "labor is hard on babies."  We know vag births are better for babies.  He also mentioned the squeezing  and pressure on a baby's head as he or she passes through the birth canal.

I know from past experience he is not an egotistical doc, he is more the faulty emotional appeal doc.  He is the one who says, "Since you had a cesarean, if you were my wife or daughter, I would not take the risk to have a VBAC."  He constantly says, "If you/she were my wife or daughter..."

What are some good sources of info I can give to her so she can feel empowered about these topics?  I was going to give her the CIMS Rights of Childbearing Women-thing.  I know he likes evideance, and I have a feeling he misconstrues things (I heard him talking once about how much pelvic floor damage vag births cause versus cesarean). 

Thanks 

This is a hard one for a woman as far along in her pregnancy as your client is. If she were early in her pregnancy, I would recommend the Childbirth Connection website, www.childbirthconnection.org for info on choosing a care provider or send her to www.motherfriendly.org/resources to download "Having a baby? Ten questions to ask," but she's past the point of choosing someone who practices evidence-based care. Hmm. One option on the Childbirth Connection website is the section on what questions to ask in order to make an informed decision. That can be found at http://www.childbirthconnection.org/article.asp?ck=10081. I don't usually toot my own horn, but I think that my book, The Thinking Woman's Guide to a Better Birth, might be a good answer because it has all the research. The bookstore chainstores often have a copy on the shelf or can get one in pretty quickly. Another option would be to suggest that your client ask this ob to provide her with the research that supports his recommendations. I can tell you that the research consistently finds that inducing labor roughly doubles the odds of a first-time mother having a cesarean and that inducing labor before 39 completed weeks increases the likelihood of the baby ending up in an intensive care unit with respiratory difficulties. Early delivery also adversely affects breastfeeding, as does cesarean delivery. I think the best way to counter the "labor and birth are damaging" theme is to have her read the Giving Birth With Confidence blog at http://birthwithconfidence.blogs.lamaze.org/. Finally, his desire to "massage her cervix" sounds weird enough to raise concerns about this man of an entirely different kind, if you know what I mean.

-- Henci 

I was going to say the same thing - "massaging the cervix" sounds really creepy to me!  I hope it's just a ploy to sound friendlier than "strip membranes"??? (which now that I think of it has it's own creepy sound to it.)  But it really raises questions about how this doctor views his job and the women he cares for. 

I prefer "sweep membranes."  Really though, keep your hands out of there and let labor begin on its own! 

-Donna

Thanks.  I never really thought about the massaging part.  What's unfortunate is this woman is paying out of pocket for her OB expenses.  She would have loved a midwife, but she went to the office that could see her first, and that happened to be his.  Again, I don't know why it never occurred to us:  What business does he have massaging ANYTHING up there? 

I don't know why I didn't think of just letting her know she can ask for his supporting evidence as to why this is a good idea...that helps in almost any situation surrounding pregnancy/birth.

Henci, I have both of your books.  This is a mom that needs to come to things on her own, AND, she has dyslexia, so I don't get the feeling she reads much because of that.  But, there is no reason she can't ask the doc to show her his proof this is a good idea.

If this baby is still there in a week, I will ask if she would like me to come with her to an appointment -- the doc already asked her if she wanted me to meet him.  I don't ordinarily do that, because I am not his patient, but I can see how it might help her remember what he said, etc. (and he did already throw the idea out there).  He actually approached a midwifery practice for the doula list, when his patient asked him about doulas.  Maybe there is some hope!  Wish this mama and baby luck!

I've had some further thoughts about how to help your client make informed decisions in labor or if induction is suggested. In order to make an informed decision, your client has the right to know:

• what is being recommended and what that will involve explained to her in language she can understand, not medical jargon,
• why it is being recommended, that is, the benefits,
• the potential harms--there always are some--and how likely they are to occur,
• the alternatives,
• the benefits and harms of the alternatives, including doing nothing.

If there is an urgent situation in labor, then this decision-making process may need to be shortened, or, at the very least, someone should explain what they are doing and why. Very few situations are emergencies, however, and it will be obvious when this is the case.

When I worked as a doula, I used to recommend that when a decision needed to be made, that my client and her partner ask their questions and then ask for time alone to consider. This helped prevent them being railroaded. It's hard to evaluate the situation and have a discussion with medical staff present. Once alone, I could suggest other questions they might wish to ask or alternatives they might wish to discuss or clarifications they might want. This avoided the "And who are you?" attitude I tended to get from medical staff if I put in an oar however diplomatically. Then I too would leave so the couple wouldn't feel any pressure from me either.

I certainly do wish you both luck! Keep us posted.

-- Henci