When clients receive misinformation

[earthgirl]

What do you do? How do we make sure a client is truly giving 'informed consent'?
Do you give her 'evidenced based' information to bring to her care provider?
Do you list possible questions that she should ask her cp?
How do you handle it when doctor's play the 'dead baby' card?
How do you know your information is current?

As doulas we should challenge ourselves as professionals, while upholding a code of conduct, and staying within our scope of practice. Where is that fine line of supporting a client with information, and stepping on toes of the medical community by seeming antagonistic?

I want certain topics to get the discussion it needs, keeping in mind the Community Guidelines.

[doula Michele]

This is a great topic an done that everyone is passionate about, yet it also depends on the individual doulas comfort level.

Personally I am not an advocate really. I figure everyone will learn what they want to learn. Sometimes our experiences force us to dig deeper for info.

If my client is comfortable with what their dr is telling them, and they choose to believe and not do their own research then I leave it at that. I give them websites to help them get started 'if they want to". If they don't then I fully support them in the birth that they have.

Lots of my clients hire me because they want the support in having their birth their way... and in that case I still give them research and websites that I have. Then I work really hard to support their choice.

If we are at the hospital, and they are using intervention, I may ask questions myself of staff. I find that when I do not come across as a 'know it all', and more that I am trying to learn from them, I get much more co-operation and honest answers and good discussion amongst nurses and the client.

BUT that is just me. I am quiet by nature, I am not very one to try and prove that I know more, or that I even know better. Because honestly I do not. I am mild mannered, and pretty passive.

[DoulaCBE]

Quote:

Originally Posted by earthgirl Where is that fine line of supporting a client with information, and stepping on toes of the medical communtiy by seeming antagonistic?

I just read a quote that deeply resonates with me on this topic:
We must relearn to trust the feminine, to trust women and their bodies as authoritative regarding the children they carry and the way they must birth them. When women and their families make their own decisions during pregnancy, when they realize their own wisdom regarding birth and its place in their lives, they have a foundation of confidence and sensitivity that will not desert them as parents.
There is an inverse relationship between the amount of technology used in a woman's birth and her subsequent self-esteem: The greater the number of interventions, the less well she regards herself postpartum. On the other hand, women happy with themselves in birth eagerly go on to embrace the responsibilities of mothering. The triumph of birthing on their own terms leads to new depths of self-love and self-respect, emotions readily translated to their babies.
— Elizabeth Davis


The bolded and underlined part above is what resonates most deeply with me. As a doula, helping parents make informed choices about their care is one of my top priorities. It's also one of the main reasons I'm hired.

If I don't correct misinformation, then I'm not delivering the services I've been hired to provide. To go back to the quote above, it's really hard to lay that foundation of confidence when you don't have accurate information or even the "other side" of the story when it comes to choices that need to be made. It can deeply shake the faith of parents to learn that they've been duped for months by their provider and I remained silent because I was afraid of the repercussions to me. Often I find that couples in this position aren't quite comfortable with their provider anyway, and just need a little morsel to validate that little niggle in the back of their head that this isn't the right provider for them to switch. Also, I can provide them with the correct information, or the "other side" of the coin and they can then take it back to their provider and discover on their own by the provider's reaction and participation or lack there of in a discussion about the information the client has discovered just where that provider stands. Often clients will see where the true nature or practice style of this provider lays.

If a client is with a provider I know lies, or I know promises one thing during pregnancy but delivers another entirely during birth I either give them leading questions to ask their provider that will begin to peel back the layers and reveal the true nature of the provider, or I will outright state "In my experience, you're not going to get the type of birth you are hoping for with this provider." Sometimes I'll just ask how they feel about this provider in their heart of hearts and when they indicate that they're not completely trusting, I'll simply reply "Trust your gut, it's leading you in the right direction."

We have a brand new labor and delivery unit in town. I'm told it's quite beautiful and everyone is wanting to birth there because of the big rooms, jacuzzi tubs, etc. In speaking with prospective clients or fielding calls from people looking for a good birth location I have to be honest and tell them:
"Yes, it's a brand new building and it's very pretty, but a new and pretty building isn't going to get you the type of birth you just described as your desire. This hospital requires continuous monitoring for all patients. Since they have the new telemetry units, they feel there's no reason for a woman to NOT be continuously monitored. And yes, they have these beautiful and what appear to be super comfy tubs, but you can't use them. There's no policy to clean them, so even though they opened in April, no one has been able to use them as they have no policy as to how they should be cleaned."

[doula Michele]

I guess I really believe in informed choice as well.
But I want it to be informed choice on the clients part. I want them to find their own info. I help them, but I want them to dig and find what reasonates with them.
Because we all feel differently about things....no matter what the evidence says. Sometimes I personally know what the evidence says about lots of things...and If it doesn't make me feel right then I do my own thing anyway.

I know that I am not coming across clearly.

[Wendy79]

About hospitals, I will sometimes say "that hasn't always been my experience at that hospital, so you may need to work hard to make your wishes known". For instance, in a local parenting magazine, I recently saw a graphic table that laid out the options and hospital policies for labor and delivery units in the area. It was put together by a local doula and was a great idea... but one of the hospitals stated that babies are not taken to the nursery as a matter of routine, when I know for a fact that they ARE--they go to the nursery to receive their first baths, get assessed, etc, and the parents ARE NOT ALLOWED IN THE NURSERY. I did my student nursing clinical practicum in L&D there, and saw it happen every single time, even when the parents asked to accompany the baby for the bath. I'm sure with a strong advocate it can be handled differently, but this is definitely routine--and they tell people it's not.

Michele comments that people will learn what they want to learn, and I too have found this to be true. I feel like if I contradict the doctor and the parents are not interested in hearing about it, it won't make them change their minds--instead, they might think "this lady thinks she knows more than a doctor".

Angie, will you share more about how you give information to clients? Do you use handouts, or can you give us a sample "script" of how you might cover an issue with parents?

[DoulaCBE]

Quote:

Originally Posted by doula Michele I guess I really believe in informed choice as well. But I want it to be informed choice on the clients part. I want them to find their own info. I help them, but I want them to dig and find what reasonates with them.

I want them to do their own work too, and I encourage them to research their options on their own and not just take my word or that of their DR, mother, brother, etc. But what do you do when you know they've been given misinformation and they clearly don't know that it's wrong, outdated, etc? Do you just let it lay and hope they'll do their own research. Do you open a conversation about what you know?

One of the difficulties I see is that many of us have been encultured that Dr knows best and that we don't question them. It's accepted that you do your own research when buying a car, crib, carseat, etc, but it's historically been discouraged to question a DR who is seen as an authority figure.

Quote:

Originally Posted by doula Michele Sometimes I personally know what the evidence says about lots of things...and If it doesn't make me feel right then I do my own thing anyway. I know that I am not coming across clearly.

I understand. When I had my last baby my blood pressure and labs were so bad that they wanted to give me mag sulfate. I know the research on it, I know the medical benefits, and I disagreed. I knew if I took mag that I wouldn't be able to cope and if I couldn't cope I'd get an epidural and increase my chances of having a cesarean and avoiding that was my ultimate goal. So I made my own choice.

[DoulaCBE]

Quote:

Originally Posted by Wendy79 Angie, will you share more about how you give information to clients? Do you use handouts, or can you give us a sample "script" of how you might cover an issue with parents?

I have a comprehensive prenatal binder that I loan to all clients. I use the Lamaze Care Practices that Support Normal Birth, I use the CIMS handout on Induction, I try to use a lot of current research based articles. I also have a suggested reading list that is supportive of my goals for informed consent. Now if they read any of those books is anyone's guess. I do point out 1-2 that I'd recommend strongly if they didn't want to read a bunch of books.

I also give out a handout at our first visit that lists common birth interventions and the alternatives. I ask them to check off their preference and put a ? by the ones they aren't familiar and then we discuss this handout point by point at our next prenatal visit. This also opens up the floor to present current research/best evidence.

In addition to those I do a values clarification exercise with clients about their ideal births and then ask them to give up 3 things until we narrow it down to their top three priorities. During this exercise the discussion on interventions, medications, risk vs benefit etc is once again opened for discussion. We talk through each step/card and when we get to the final three we discuss those in depth as well. We look for any contradictions, example "I want unlimited mobility/I want an epidural as soon as possible" to clarify what it is they want for their birth.

If other things come up I take them as they come. I've had 1 or 2 clients in my career who simply weren't interested in information and while they were a personal challenge for me, I respected that and just gave emotional and physical support.

[Bex]

My big fear is giving out misinformation--I do not think it's just dr's that do this. I have found SO many studies that contradict each other. I have no idea any more what is true and what is not. I tend to be skeptical of info coming from certain websites. As michele has said before, there seems to be a study to proove or disproove EVERYTHING, and I am very worried about giving wrong information to a client, and having an ob become angry with me. So, I'm not sure what to do lately. But I do not see myself as an activist.


edited for ACTIVIST

[doula Michele]

In our first prenatal visits I tell them to research induction, pain meds and c-sections.
I am like Becky, I do not want to give wrong info. Alot of things very depending on the situation of each individual woman.
I would definatly have to admit that my personality does not really make me an advocate. I help women find info, I am a sounding board, reminding them of all their options. But beyond that, I support them through their choices. That would be why women hire me. They want support, they want their mom and she can not be there, they are just plain scared and want someone to guide them through the experience.
Alot of my clients have already researched there choices, and thats how they come across doulas.

[DoulaCBE]

RE: Giving out misinformation

Lamaze and CIMS are two wonderful resources for keeping current with newest/best research. They have tons of handouts that even a brand new doula can confidently give to her clients knowing that she's giving best/newest research.

The 6 Care Practices for Normal Birth makes a wonderful starting point for any doula. Once you become familiar with the 6 Practices you can build your information from there.

Our doula group just totally revamped our packets and we've used the 6 Care Practices as our foundation along with information from CIMS.

[melba]

I am not trying to be snarky, but I am hired by women precisely because they are looking for an advocate. I have never personally met a doula who is not an advocate...

I am honest with my clients. I will not participate in fear mongering or be silenced simply because I may make some OB or nurse angry. I am not hired by the OB or the nursing staff. I work for my client. Period. I will not perpetuate the culture of silence and fear that is common in Western Medicine. If my client has been given information that is not correct, I will find a way to let them know. I don't come out and say, Hey, Your OB is a jerk and that is wrong...BUT, I will find a way...Usually all it takes is saying that "some women find" or "evidence based research indicates"...

I am also very, very honest with my clients or perspective clients about what their experience may be like with a particular hospital or doc. I learned this the hard way and I will never forget it. My first hospital client: I was trying to maintain the joyous bubble of peaceful birth but at the same time prepare this couple for what they might encounter at the hospital. I didn't want them to approach their birth with tension or fear, so I tried to remain pretty neutral. I told them what hospital policy was but I didn't really convey how hard they would have to fight to get anything resembling a natural birth. It was my first hospital birth and I was also trying to maintain my reputation with the OB so I didn't come across as radical. Boy, did I do that couple a disservice. They got their unmedicated birth, but it was the fight of a lifetime in which the mother and father both told me afterward that in the future I owed it to local women to be as honest about the experience as possible so they could be better prepared for the fight. Just knowing that you can refuse any procedure is not enough...

Since then I have been honest...probably brutally so...I will tell moms flat out about the OB's who will promise one thing and then turn on them, the hospital policies that they will have to fight tooth and nail to get around, the OB's who brutalize women, like the one who insists on cramming her fingers up the anuses of laboring women in order to force the baby's head out sooner, often times tearing the skin inside the anus, the ones who don't refer to their clients by their names, the ones who section every single patient who labors past 7pm or on weekends...You get the picture.

I see my role as providing labor/prenatal support, but also as a sort of defender of women. It is probably the fierce feminist in me, but I just can't perpetuate a system that views women as submissive and their bodies as incompetent and powerless.

That being said, I have had many mamas who do not read the literature I give them or are really not interested in the alternative, but I support them fully. I just couldn't live with myself if I didn't at least try to give them accurate information. How would that make me any different than the OB's who are giving out the false information.

The activist in me needs to see a drastic change in our maternity care system and that ain't gonna change by being silent.

[DoulaCBE]

Quote:

Originally Posted by melba I just couldn't live with myself if I didn't at least try to give them accurate information. How would that make me any different than the OB's who are giving out the false information. The activist in me needs to see a drastic change in our maternity care system and that ain't gonna change by being silent.

[Wendy79]

I don't know whether any of the comments about "remaining silent" are aimed at anything I've said or anyone else has said, but I feel like there are assumptions and misunderstandings here--namely, I have not seen anyone in this discussion (or on the other thread) say that they remain silent in the face of misinformation. There are ways and ways of communicating.

Michele and Becky, personally I WOULD encourage you to think of yourselves as advocates--advocates for women and families. What I have read about your personal actions and philosophies puts you as squarely in the "advocate" category as Angie and Melba, though your advocacy might manifest differently. (Of course, if you don't want to embrace the term, that's up to you!)

I do NOT see myself as a "defender of women", but rather, as one who helps to empower women. (I am sure empowerment is important to you too, Melba.)

[Bex]

OOOOPSSSS--as I was sitting in line at the carwash, I realized I had said ADVOCATE, and I meant to type, ACTIVIST. So, I am changing it now, but to make myself clear so I don't get back into a corner and yelled at--ADVOCATE--yes ACTIVIST--not so much.

[Bex]

Ok, here's one thing--how do we know what ob's are giving out is always false? I again will say, it seems that you can find any study anywhere to support your position. An ob has one study, we have another. Or we give info, and it's out of date, it's old. There is newer info that the ob/midwife knows about, that contradicts what we say.

And, yes, I do worry about "getting in trouble" for giving out information. I'm not one who is willing to go to court if I give out info that could lead to a bad outcome. Kudos for those are brave to stand up and not worry about what an ob or dr. would do or say, but i am not that person. I am not yet willing to loose all that I have over a lawsuit.

which i guess is why I am not an activist, and fret so much over the info I give to clients. And perhaps this makes me a crappy doula