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This is reprinted with permission from a friend and fellow doula on the Yahoo! doula group:

DEEP DOULA THOUGHTS
(or ‘Things that make you go “HUH”?’)
By Stephanie Soderblom CD CLD CCCE CBC


I am a doula. What this means is that I have spent the last 10 years helping moms and dads BECOME moms and dads. I like to call doulas, “People helping people out of people”. However, over the years I’ve seen many practices that are “standard” and “routine” that I have found just doesn’t make sense at best, and appear dangerous at worst.

The following are some of my thoughts on some of the routine procedures that have left me wondering “Is anyone thinking about this??”

1. Oxygen in Labor:

We’ve all seen it…mom is laboring and baby has some funky/questionable heart tones. First thing they do, of course, is change moms position. The next thing they always do...is slap oxygen on moms face. Look over at the pulse oximeter and it shows mom's O2 level as being 100%...before we added oxygen. Ok..if mom's oxygen saturation is already at 100%....what do they think having her breathe more oxygen is going to do other than freak her out?? In what way can it possibly benefit her?


2. Scheduled Inductions:

Parents are told that they will be inducing next week...for [fill in any reason].

This is an elective induction, not a medically necessary one. That’s a pretty bold statement...how do I know this without further information? Because if they were REALLY worried about mom or the baby, would they really send her home and wait 4 days before inducing her? And if they aren't worried...then couldn't they recheck on them in 4 days and THEN decide a course of action?


3. Baby is getting too big:

Parents are told that they need to induce at 39 weeks because the baby's getting "too big".

Ok...so...how much do they think the baby's head/shoulders will grow in that extra week or two weeks? They talk about baby's weight...but what about baby's head and shoulders? Babies don't get stuck at their chubby little thighs, hung up by their adorably dimpled butts ....

What we have to work hard to birth are heads and shoulders, not their chub. To help with the delivery the baby’s head is made to mold, the pelvis will expand and open up…

What growth do they think will occur those last 1-3 weeks that will change the outcome of the delivery? What really is the difference in head size between an 8 pound baby and a 10 pound baby? (double chins don’t count!)


4. “We don’t know how long baby will continue to tolerate...”:

Parents are told that they need to give her Pitocin because, although baby "looks good now, we don't know how long baby is going to tolerate this..." Isn't that true from the moment of conception? We never know how long baby is going to be happy.....all we can go off of is NOW..and right NOW baby is happy and everything is fine. If everything is fine...why are we in a hurry? Why rush it? If mom and baby are fine with the way things are right now – then it must not be because of mom and baby that we need to speed things up, right?

Then who is it for? To this I have an answer, but would prefer that each reader is able to answer this question themselves. If it’s not for mom and baby, then for whom are we wanting to hurry things up for?


5. Diet and drugs during pregnancy:

Women are told to fanatically watch what they eat or drink....watch out for tuna because of mercury, deli meats could have listeria, don't walk into a restaurant that has smoking because you might inhale second hand smoke, no sushi, no alcohol whatsoever, no caffeine. When you are pregnant you are making decisions for two and should be meticulous about what you put into your body.

When a baby is getting ready to be born, aren’t you still pregnant? Do the rules stop applying? Yet on the day that the baby is to be born, the most important day that this child will have, much more important than the day she was 20 weeks 6 days pregnant…much more transformation than on the day she was 32 weeks 4 days pregnant…an even more dramatic day than the day she was 8 weeks 1 day pregnant. On THAT day we will encourage mom to take an average of 7 – 9 different pharmaceuticals (including things such as Stadol, Demerol, Fentenyl (“100 times more potent than morphine”), bupivicaine) and prevent her from eating anything at all, and we will call that “normal” and “safe”.


6. It’s TOO RISKY:

We will routinely take women and artificially rupture their water, introduce catheters and monitors to the inside of the uterus, add Pitocin into a woman, give her anesthesia, induce her if she gets too uncomfortable, give an elective cesarean if she just strongly requests it.....

But then we will say that a VBAC is too risky and shouldn't be done. After all the risk of a baby dying during any type of delivery is 0.12%...the risk of a baby dying during a VBAC is .20%. Not a huge difference. Risk of dying from a uterine rupture is .0095%, risk of dying from a repeat cesarean is .0184%. But a VBAC is too risky.

Let's take this over to a homebirth. We will do all of the interventions listed in the first paragraph (things we KNOW dramatically increase the risk to mom and baby) but say that homebirths are SCARY! After all – what if something goes wrong! We forget how very often things went wrong BECAUSE we were messing around with things – how often things go wrong in a hospital that wouldn’t have gone wrong at home because we wouldn’t have been inducing her, wouldn’t be giving her those pharmaceuticals, wouldn’t be restricting her eating, wouldn’t be breaking her water…


7. “Take a big deep breath like you’re going under water, chin to your chest, curl around your baby, and push down – 1, 2, 3, 4, NO NOISE, 6, 7, 8, 9, 10…good pushing, now deep breaths, breathe for your baby…”:

Women are told to hold their breath for 3 counts of 10 while pushing, not to make any noise or let any air out.... then are told they need to "breathe for their baby!" between contractions...between....when there is no pressure on the baby. But they don't need to breathe for their baby during the contractions?? I ask every pregnant woman right now to get a watch or timer with a second hand – and hold your breath 3 times for 10 seconds IN A ROW and see how it feels. Now do it again…after walking for 10 minutes on a treadmill. How does it feel?

As for the no noise thing - I've heard them say, "your voice is your power...if you are making noise you are letting your power out..." Here are some mental images for you - Think 'karate'...think 'Olympic weight lifters'...think 'US Open tennis players'. You'd think if your voice was your power then karate instructors would be saying "SSHHHhhhh!" and the karate studio would be absolutely silent. Wouldn’t Olympic coaches have discovered that fact that you can lift more or gleam more power from being silent?


8. Premature urge to push:

Women are told that they MUST not push before they are fully dilated....the pressure down on the cervix could make the cervix swell. Not even little grunts! No no, breathe, don’t push!

But then, an hour later, she is given Pitocin to strength then contractions, they never worry that it will make the contractions so strong that it will swell the cervix. She feels nauseated and is throwing up, and they don't worry that THAT will swell the cervix. Isn’t the point to have good strong pressure down on the cervix?

I’ve heard some women be told that they might TEAR the cervix! YIKES!! That would stop me from wanting to push, too! But if that was the case then wouldn’t it hurt MORE to push not less? Most women who are pushing are doing so because it feels BETTER to push…wouldn’t think that tearing your cervix would feel better than not, do you?


9. Internal examinations prior to labor:

Why are we checking you? What is the point?

Oh yes, I hear you answering now…it’s to see if you’re going to have the baby soon.

First off, if you’re full term (which I HOPE you are if you are having internals!) then the answer is a resounding YES! You will be having your baby soon! (and I don’t have to stick my hands inside of you)

Next, an internal examination prior to the onset of labor gives NO information that is beneficial or useful.

Wow…pretty bold statement, yet true. You are checked and found to be ZERO dilated and ZERO effaced. You could have your baby that night. (that was my third child) Or you could be found 3cm dilated and 75% effaced and it could be WEEKS! (that was my second and fourth children) So if dilation and effacement aren’t going to tell us when we are going to go into labor, why are we checking?

Wait, not fair…that was MY question!


10. You need an IV in labor…just in case something goes wrong, we MUST have access to your vein!

Rather than question this statement, I’m simply going to relay what happened with some students I taught a childbirth series to many years ago. He (the expectant father) happened to be an EMT-Paramedic. This couple was doing a hospital tour so that they could become familiar with the hospital they intended to have their baby in. The nurse showed them the triage area, then showed them the labor and delivery rooms, explained that this is when they would get their IV…

The EMT dad said, “Umm, what if we don’t want an IV?”

Nurse replied, “It’s standard…what if something goes wrong? We must have access to your vein and what if it takes a while to get the IV started? It can be difficult sometimes to get it started…what if we can’t get it started and we’re trying to get an IV in while your baby is having problems??”

The EMT dad looked her straight in the eye and said, “Are you telling me that I can start an IV in the field, at night, in the rain, inside a vehicle that has been flipped over on a patient who is critical and bleeding out…and you are concerned about starting an IV on my healthy wife in your brightly lit hospital??? That frightens me.”

Hee hee. I’ll just let that story sit with you for a while.

Maybe I’m too logical…or maybe there will be ONE person who reads this and starts to THINK about this thing we call ‘childbirth’.

See…I’m not just logical…I’m a dreamer, too.

Tags:

Comments

( 23 comments — Leave a comment )
(Deleted comment)
ahavah
Mar. 26th, 2006 11:43 pm (UTC)
My pleasure! I only wish I'd written this myself. :P
cheekymama
Mar. 26th, 2006 11:42 pm (UTC)
These thoughts are exactly why I will not do hospital births anymore. I will only do homebirths, because I am sick to death of routine bullshit, and mothers giving their rights away the minute they walk in the door.:)
ahavah
Mar. 26th, 2006 11:45 pm (UTC)
Ah, but that's one of the reasons why I became a doula! Hospital births don't have to be like that if women are educated.

Still, I wish I had enough clients that I could pick and choose. :P
nedia782
Mar. 27th, 2006 01:10 am (UTC)
Who else just grinned from ear to ear while reading that? ;) I am with you cheekymama. I hate the routine B.S thats shoved down a mothers throat as soon as she walks in. I also continue to do hospital births though. I believe in the power of education, but, when a woman is in labor land, and is so engossed in the process of birth, how is she to be expected to devote her strength to fighting the hospital staff? Not to mention once she does stand up, the staff is going to contine to treat her like shit. Im usually the one who gets treated like shit for making the "suggestion" that the mother do something different, which I can handle, but again what happens after I leave? Blahh I dont know the answer, all I know is its frustrating as hell and makes me want to quit hospital births, but then who's losing out?... LOVED the post, made me smile :)
ahavah
Mar. 27th, 2006 01:13 am (UTC)
If you loved the post, you should check out her website...
browneyed_whore
Mar. 27th, 2006 09:05 am (UTC)
This reply is so freakishly true. I especially worry about women who are young (as I was; 18) and don't have someone there to be her 'voice' when she can't be due to labor. It's sad how in any form of hospital care they get offended if you don't think they're right or want to try something other than what they say you 'need'.
nedia782
Mar. 27th, 2006 03:21 pm (UTC)
I know, sometimes its not even mentioned as an option "We are going to break your water now" or others like "Nows a good time for your epidural" its just disrespectful and its gone unchallanged for so long that its just the norm, and is expected of women to comply....yuckie yuckie yuckie!!
ahavah
Mar. 27th, 2006 04:05 pm (UTC)
Grrrr - our local hospital is one of those "Are you ready for your epidural now?" Like it's a given. Even Josh gets pissed off about that. I was lucky that my midwife really supported my choice for a natural birth. But the nurses...different story.

/pet peeve :P

They seriously just say they're breaking the water without INFORMED CONSENT? Gah. Just...gah.

And I realize how lucky I was with my births. With Eden, the only thing I came away pissed about was they talked me into an IV. That was before my education as a doula, but I still read EVERY good pregnancy & birth book out there.

And don't you know I have to fight not to have a hep-lock with Ivy. Grrrr.....

Damn, I need to hurry and get my birth stories finished.
nedia782
Mar. 27th, 2006 04:13 pm (UTC)
lol I hear ya. Even with my second I knew what I wanted, and I had read all the required reading for DONA, but, I am so internal with my labor that I got an IV, just because they gave me one, and they broke my water, just because they said they were going too. I was/am so angry with myself for that, and I HAD A DOULA WITH ME, but, I was her first birth, so she wasnt sure of how to assert herself to me or the staff, which is fine I didnt he same thing at my first birth. These are just some of the reasons I chose to stay AWAY from the hospital this time, that and I think he most influencial and misinformed people in L&D are the nurses, and they REALLY dont like when a younger WOMAN thinks differently than them...grrr... I feel you, its so so so so annoying and enraging!
ahavah
Mar. 27th, 2006 04:18 pm (UTC)
so she wasnt sure of how to assert herself to me or the staff

I'm sorry, but it's another peeve of mine to see statements like this. Part of the problem with people NOT understanding the role of a doula is that they think the doula must speak up for the woman, or that she will fight with the staff.

IT'S NOT THE DOULA'S ROLE TO SPEAK ON BEHALF OF THE PATIENT!

A good doula might have said, to YOU, not the staff, "They're planning on breaking your water for XYZ reason. I know you mentioned that this was something you wanted to avoid. Do you feel ok with this?"

But NO doula should assert herself to the staff. NOT the role of a doula. A doula is there to support the mother and help HER stick up for HERSELF.

BTW, I just posted another article I think you'll enjoy.
nedia782
Mar. 27th, 2006 04:22 pm (UTC)

sweet :) I agree with you and I also think thats a HUGE oversight on the part of most women and the staff. I have never directly confronted the staff at any of my births. I HAVE however talked about the proceedure and its "use" in front of the staff. There is one nurse that has attended 3 of the births Ive been at...wooo girl do we HATE each other. Shes a crusty old bitch who tells women they dont need a squat bar, its easier to lay on their backs and push the baby towards the ceiling, LMFAO Im not kidding, exact words!
ahavah
Mar. 27th, 2006 04:30 pm (UTC)
It's so sad when 'professionals' let their personal opinions get in the way. That's where preemptive measures work really great.

For instance, in my prenatals, I make sure to tell all my clients that go to a certain hospital that their 'policy' includes 'purple pushing'. I explain the possible harm this can cause (I don't believe I know of *any* benefits), the various positions a woman can choose to birth in if she wants, and let her know up front that she will HAVE to decline if she wants to birth any other way. I also encourage her to talk to her CP and tell them if she wishes to birth more naturally (and I use that word, too!)
ahavah
Mar. 27th, 2006 04:31 pm (UTC)
PS:
You should print out that article I just posted and leave it for your nurse friend (maybe without her knowing who left it, if there's any hope of her taking heed - mail it in and sign it 'A disappointed patient' LOL)
nedia782
Mar. 27th, 2006 04:37 pm (UTC)
Re: PS:
Seriously!! Anda s far as picking a hospital, the women I work with are all low-income, so they get their DR assigned tot hem, and I know how that feels. When you dont have money you dont feel like you have power. Its not the Dr.s I ve had a problem with, they have all been really nice and really gotten into showing my how to stitch up a woman, or even asking my opinion on things, its the GD nurses!!!! Good idea about the bitch whore nurse though, lol
ahavah
Mar. 27th, 2006 04:41 pm (UTC)
Re: PS:
Remind them that even low-income women have the right to refuse anything they don't feel comfortable with!

God, I guess I just don't understand the area you live in. I fall in the 'low income' territory, and I had pregnancy medicaid. I was able to choose from a variety of CPs who accepted Medicaid, which is why I was very lucky and pleased to have the only midwives in town who 'do' waterbirths.

With my first baby, they had a 3 or 400 dollar 'doula fee' - yes, they call it that because they stay with mom for the whole time! - that is not covered by Medicaid. I actually was only able to pay half - my mom was going to pay the other half as a baby gift, but I had such a fast labor that they waived it for me! (And I was literally handing them mom's check while I was in labor; I believe I was yelling all sorts of things like, "This baby will not be born into debt, dammit, take the check!" LOL They didn't, and I was happy with the way they handled it. 3.5 hrs of labor)
nedia782
Mar. 27th, 2006 06:39 pm (UTC)
Re: PS:
Yes I dont live in a good area for birthing women in general, and if your poor, which just about everyone is, then you are treated like your retarded. Thats why I do the volunteer work that I do. I am poor, I know how it feels to be treated like that, and I know its NOT ok. The only midwives in this area who accept medicaid are hospital midwives, and they have to follow hospital "policy" just like the ob's. Which areound here means if you water is broken or leaking you CANNOT be in water to birth (rolls eyes)...Thats why its so hard for me to go to hospital births around here, to see the women being treated like shit, and seeing them taking it because it IS the normal way for them to be treated, not the right way of course, but the "norm"...
ahavah
Mar. 27th, 2006 04:01 pm (UTC)
The thing is - even a doula can't be a woman's Voice in labor. She can encourage you to be your own voice, but only the momma can stick up for herself.

I was (still am) young when I had both of my kids, but I embraced my power and wouldn't allow anyone to do otherwise. It's a conscious choice. But still, I did have to 'fight' for what I wanted when I was in labor, and that's just not right. I was very blessed that I had a partner who respected my wishes and helped back me up. Sadly, not every woman has that.

And THAT is why I became a doula.
browneyed_whore
Mar. 27th, 2006 09:02 am (UTC)
I have no idea where to start with this...I had so many problems with my first child heh.

I remember them putting the O2 mask on me and telling me to lie on my left, the baby's heart was funky. Now, I had no amniotic Fluid and he came out dehydrated and all sorts of things because the Doctors didn't bother giving me an ultrasound the week I was due (lovely clinics) and I still wasn't effaced or dialated. So I agree, with my limited knowledge, in the fact I needed to be induced.

The oxygen thing though..it freaked me out. I couldn't breathe right. I felt like I wasn't getting any air and lying on my left was extremely painful. I wanted to lie on my right. I kept thinking "I don't need this fucking mask" and taking it off once they'd leave the room.

The whole drug thing confuses me as well, because like the post said we aren't supposed to do them at all, and always eat when we're hungry. But They wouldn't let me eat for an entire day and I had gone to the hospital without breakfast, since it was supposed to just be a check up.

I thought it was just the hospital I went to, and the fact that I had to go to a clinic and didn't have insurance. And though I know they majorly messed up, this makes me wonder about other hospitals as well. And though I'll most likely have to go to one when I deliver, I'll be damned if I'm going to be a scared 18 year old not knowing what to expect or voice what I want and letting them push me around.

Thank you for sharing. I love the Doula posts. :)
ahavah
Mar. 27th, 2006 03:58 pm (UTC)
Glad you love them!

Inductions definitely have their place, but they're just Waaaay too rampant these days. Inductions can cause their own sets of problems, which lead to a slippery slope of interventions.

I hate to hear a momma say the doc 'won't let' them. So often people forget that they're consumers. We hire the care providers to work for us, not the other way around. The hospital policy where I gave birth didn't want to 'let' me eat in labor, either, but we took our own snacks and I was fully prepared to use them. Lucky for me, I had my babies quick and didn't need the extra boost of energy. But it's true when they say labor (ie:work) is like running a marathon - how do they expect mommas to do that without food or drink??? It's ridiculous.

There's so much to be said for being educated about your choices. One more reason why everyone should have doulas! LOL I'm sorry that you had problems with your first birth. Should you choose to have another, I hope that you have a sacred and empowering experience.
(Anonymous)
Mar. 29th, 2006 03:22 am (UTC)
True, true
I hear ya sister. My favorite quote when it comes to questions like these is..."Midwives see birth as a miracle, and only mess with it if there's trouble; Obstetricians see birth as trouble, and if they don't mess with it its a miracle!"

-blair
ahavah
Mar. 29th, 2006 03:25 am (UTC)
Re: True, true
I love that! Thanks for stopping by!
(Anonymous)
Jun. 5th, 2006 11:39 pm (UTC)
Inducing for size
Ooooh, I'm sorry, but I do have to quibble over the size inductions. I had a *lot* of big babies, 9-10 pounds. After #3 separated my pubic bone slightly during delivery, the OB offered to start inducing me two weeks early. I blithely declined... #5 weighed in at 11'03" and didn't just separate my pubis slightly, but massively. I couldn't walk for 36 hours because I couldn't put any weight on the joint at all.

Not to sound melodramatic, but it still causes me pain until this day. My pubic joint pain is now my early pregnancy test, because the relaxin production begins before my period is even due. I can keep it under control with my physical therapy routine, and it hasn't been bad enough to keep me from having more kids, but it is a bloody, ruddy nuisance. If I could go back now and induce at 38 weeks, I sure as heck would.
ahavah
Jun. 6th, 2006 03:59 am (UTC)
Re: Inducing for size
Thanks for sharing! Wow, I'm so sorry that happened to you. I can't take credit for writing these, and I haven't done nearly as many births as the author. What I've heard supports women going to full term, because lung maturity can vary depending on size. Of course, every woman is different, and some are probably able to accomodate larger babies better. 11.3 is a big baby, if I read that right as pounds. I wouldn't blame you for that decision.
( 23 comments — Leave a comment )

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