Communicating with Doctors.

"You're stretching beautifully! Listen to the doctor as he guides your breathing and eases the baby out. The doctor will tell you when to push hard and when to ease up. Allow yourself to feel the burning as the baby moves down and out. You are opening like a flower, so perfectly, just like you knew you would. Easy, easy, that's it! Your tissue is so supple, the doctor is supporting your tissue by holding the compress so he can feel how much pressure the baby is putting on your perineum. Listen carefully to him so he can help you guide this baby out gently and easily."

And the baby is born over an intact perineum. You congratulate the doctor for the great work he did on easing that baby out. You know, and the doctor knows, that he has never ever done that before. And he silently acknowledges that yes, it can be done, but doesn't let you know that this was his first time. A triumph for the doctor, a triumph for the mother. A validation of the miracle of birth.

As a labor support doula I teach doctors all the time how to do this. They simply don't know how. Do they know I am teaching them? Do they feel threatened? I think not. They don't even know that I am talking to them. It's the mother I am speaking to. So what if they just happen to hear what I am saying? It is an extremely easy and non-confrontational way of advocating the episiotomy issue for a mother who feels very strongly about it.

When labor assistants and birth doulas speak to doctors directly about the quality of their care, it sets up a potentially dangerous situation. Doctors do not like to be challenged, especially while they are doing their jobs. Mothers do not like confrontational situations during labor. No matter how gently, sweetly or professionally you remind the doctor or staff of a mother's wishes, it is heard as confrontational. The staff and doctors feel that they can be the mother's and the baby's advocate, and in fact, probably went into their professions to do just that! So advocating for her has to be done very subtly in order for it to work.

Most labor support doulas know a great deal about natural childbirth. And most of us trust it. Most doctors know a great deal about managed childbirth and trust it. I think that if we trust their judgment in medically indicated situations, they will trust ours when a normal spontaneous vaginal delivery is indicated. Try it, you just might find that it works.

--Ilana Stein, CCE, CLA, lives in Flushing, NY, and is a Training Instructor for the ALACE Labor Assistant workshop.