Childbirth Educator or Labor Support? What is Your Role?

I recently attended a birth where the caregivers were very reluctant to have me there. They encouraged the mother not to use my services as a labor support doula, and when they heard that I was an independent childbirth instructor, that fueled their fire even more.

The mother was insistent, and as her due date approached she held her ground and I was reluctantly accepted as part of the birth team. A week before her due date, at a regular office visit, a large polyp was discovered on her cervix; it bled profusely for several hours and gave everyone a good scare. She was sent home after the bleeding was under control and four days later returned for another visit. The cervix was looked at, and because the baby was estimated to be around nine pounds, it was decided that the following morning she would be induced.

I slept well that night, and the following morning met them at the hospital just as her membranes were artificially ruptured. The fluid was clear and profuse. The baby's heartbeat, from the electronic fetal monitor she had on, was loud and clear and nicely reactive. I stood against the wall with my hands folded behind my back. I listened to the conversation and since the mother seemed satisfied with all explanations, I added nothing. I watched as the IV was inserted and the pitocin drip was begun.

For the next several hours the monitor picked up contractions every two minutes, the mother felt nothing. She was happy to walk around, change position, and chat with the doctors, myself, and her husband. She was well rested, well hydrated, and not very hungry. We talked about philosophy and religion and the weather and sports. We discussed my work and her work and the joys of the birth ball. The doctor was lounging on the bed, the mom was in the recliner, the dad on the doctor's stool, and l on the birth ball. The atmosphere was festive, and comfortable. We were all amazed that the mom continued to feel nothing as the pitocin was consistently increased.

At three P.M. the doctor's partner came on call, I'll refer to her as Dr. K. This doctor was the one who had had the bad doula experience. I was out of the room when she arrived but was later informed that the word on me was that I was "okay." When il returned and we were introduced the mother asked her to tell me the "bad doula" story. So for the next forty-five minutes she proceeded to stand at the end of the bed, while the mother lay on her side in the bed and I stood on the side of the bed, telling the story.

The story involved a local childbirth educator who also attends births. I shall call her Denise. In the first story, Denise had taught a mother who had been in Dr. K's practice and had encouraged her to change doctors. The mother did change doctors, however she lives in the same apartment building as Dr. K. One morning the doorman of their building calls Dr. K and says there is a medical emergency in Apartment 5, please go up. Dr. K sends her husband, who is a cardiologist, and he returns saying the woman is in labor and he has told her to call 911. The doorman calls Dr. K again and says to please go to Apartment 5 as soon as possible. So she goes, and the baby is out, and Denise is standing there. Denise orders her to deliver the placenta and check the mom. Dr. K checks the mom's and babe's vital signs, says all is good, and to call 911. Denise becomes adamant and insists that Dr. K stay. Dr. K is not comfortable, mom and babe are fine, and again says to call 911. Denise refuses. Dr. K leaves and has the doorman call 911.

The second story involves Denise bringing a woman in labor into the hospital and again, Dr. K is on call. At each point in the process of admitting through delivery, Denise confronted her. She consistently questioned her and the hospital staff and advised the mother about the risks and dangers and alternatives to all procedures. Dr. K was very uncomfortable, the staff was becoming indignant, and the mother was extremely confused. Denise was adamant about her role as "the doula."

No wonder Dr. K doesn't like doulas or independent childbirth educators. Can you blame her? As you read through this how did you feel? Where did you feel that Denise or Dr. K or the mothers or I could have done things differently? Would you be comfortable standing with your hands behind your back and your mouth shut while all those procedures were being done to my client? Would you have called 911 rather than the doorman if you had been Denise? There are so many questions here to explore. So many feelings need to be examined.

When doulas have a "bad rap" in your local hospital, why is it? If it is because of doulas like Denise, then we have our work cut out for us. Because not only are we going to have to support the woman in labor, but we must also model the kind of behavior that we know is appropriate and hope that it is noticed. We have to undo the impression that other, not as sensitive doulas have left. Denise is not a certified doula. I believe that she was still wearing her childbirth educator hat at those births.

As a childbirth educator myself, I teach about the risks and benefits of many procedures. I teach about the domino theory that leads to cesareans and the class learns to be watchful of unnecessary procedures. Women learn to choose their caregivers thoughtfully, and to switch if they are unhappy or to make peace with where they are going. Pregnancy is the time to question and plan and explore. As childbirth educators we have the responsibility to inform and facilitate the exploration of feelings so that women can feel empowered when they do go into labor. We provide research studies, and alternatives so that women can make informed choices.

As a labor support provider, I support the woman's choices. Obviously, if I do my educating well, then her choices will feel good to her. If I don't do my job well, or if I am with a woman at her birth and she does not feel good about her choices, then I cannot step in and change her choices. Let me take a simple example: continuous electronic fetal monitoring. If I help her advocate for intermittent monitoring (assuming she wants it), then right then and there the first posts on the fence between the staff and "us" are set up. She has already chosen a hospital and a doctor that does continuous monitoring--she knows that. My job is not to all of a sudden change the hospital policy or to "sneak" around them and remove the monitor for a trip to the bathroom or shower.

My job is to figure out how to make her comfortable with those two belts. She can be sitting in a chair, lying on her side, standing by the bed, or leaning on the birth ball. All are possibilities that give her support, and continue to keep the support of the hospital staff and the doctor. By keeping confrontation out of the picture, on all levels, her comfort level is increased. When a woman feels like everyone is supporting her on the same level, then she can feel cared for. Then I can do my job, the staff and doctor can do theirs, and the mother, most importantly, can do hers.

As a postscript, both women who went to Denise for childbirth classes did not return to her. Both women went on to have subsequent pregnancies and both used Dr. K for their caregiver. Both women regretted ever having come into contact with Denise at all in the first place. They both had bad feelings about their experiences with her.

Just as Dr. K was finished telling this long story to us, my client felt her first contraction. We turned our attention to her, and two hours and twenty-four minutes later, after having powerful contractions every two minutes, she gave birth to a nine-pound two-ounce baby boy. It was a satisfying, joyous, and triumphant birth.