Labor sitting and Doula-ing

[DL]

I've heard the term "Labor sitting" used by some midwives. Is it the same thing as labor support as we doulas know it? It might seem like a silly question, but I just wanted to know that I know. Thanks!

[tlcdoula]

Labor sitting as I know it means staying with the mom until the other doula can arrive. For example, I had a client once who went into labor a few weeks early and it turned out to be the same day as my training, so I was with the mom as long as I could stay and then my back up doula can in and "labor sat" while I taught my class. When I was done teaching the class I came back (unfortunately the mom had her baby while my back up labor sat LOL)

[DL]

Oh, ok.....that makes sense!

Michelle!

[Kim Trower]

Midwives use the term because they are not actively managing the labor such as an OB or nurse might, so they are literally sitting at a labor, or sleeping, etc until they are actively needed.

[DL]

Quote:

Originally Posted by Kim Trower Midwives use the term because they are not actively managing the labor such as an OB or nurse might, so they are literally sitting at a labor, or sleeping, etc until they are actively needed.

Ok.....so in general, "labor sitting" is often more passive than doula support (which may or may not be really physically active, depending on what mom wants, of course). So birth doulas can "labor sit", but often do much more than just "labor sit". I think I got it!! Kim!

[motherwise]

I haven't ever heard this term used for doulas. In my experience it is used mainly for apprentice midwifes who can come at mom's first call and stay untill labor picks up enough to call the midwife. They either check moms cervix or just watch her behavior to gauge labor progression. It would be a bad idea for any doula to labor-sit because it could put the doula in the position of delivering baby which is fun but clearly out of our scope of practise. Also complications could arise even during early labor that a Doula could not or should not manage. For instance, think of this scenario: You (the Doula) arrive at moms house (homebirth)to find her breathing easily through contractions and, being the experienced, knowledgeable doula you are, judge her to be about 3 cms. You call the midwife to let her know that it will probably be awhile since mom is a primip and still talking through cx. Midwife is at a family reunion and is leaving right then, but is about 2hrs away counting traffic...so all is well for the moment. Just then as mom stands up, you hear a POP and a yelp and realize without even looking that her water has broken, you immediately see that there is pretty thick mec so you pick up the phone to call mw, but it goes straight to voicemail...What do you do? The scent of liability is heavy in the air.

Of course, I genuinly belive that birth is normal, and this situation would be rare, but you have to protect yourself too

[DL]

I realize what you are saying, motherwise. I don't expect to "labor sit" as you've described it, but I did want to know what the difference was between "doula-ing" and "labor-sitting" in general. I've heard midwives use the term, and not doulas, so that's why I was wondering if there was technically a difference or not. Based on the replys I've gotten, I'm realizing that there is a difference. Thanks for your insight!

[Kim Trower]

Quote:

Originally Posted by motherwise I haven't ever heard this term used for doulas. In my experience it is used mainly for apprentice midwifes who can come at mom's first call and stay untill labor picks up enough to call the midwife. They either check moms cervix or just watch her behavior to gauge labor progression. It would be a bad idea for any doula to labor-sit because it could put the doula in the position of delivering baby which is fun but clearly out of our scope of practise. Also complications could arise even during early labor that a Doula could not or should not manage. For instance, think of this scenario: You (the Doula) arrive at moms house (homebirth)to find her breathing easily through contractions and, being the experienced, knowledgeable doula you are, judge her to be about 3 cms. You call the midwife to let her know that it will probably be awhile since mom is a primip and still talking through cx. Midwife is at a family reunion and is leaving right then, but is about 2hrs away counting traffic...so all is well for the moment. Just then as mom stands up, you hear a POP and a yelp and realize without even looking that her water has broken, you immediately see that there is pretty thick mec so you pick up the phone to call mw, but it goes straight to voicemail...What do you do? The scent of liability is heavy in the air. Of course, I genuinly belive that birth is normal, and this situation would be rare, but you have to protect yourself too

I don't see how liability is involved at all. Whether you (the doula) was at the home or not, or hospital for that matter...you explain what is happening and let the parents make the decision. For example, in the situation above I would explain the baby has pooped, this does not always mean something bad is going to happen but that it can mean distress or just that the baby is big and is ready to be born, or simply that the baby pooped. I would then give them choices such as staying home until hearing back from midwife, going to the hospital, or if it was really me in this situation. I would just call another midwife and ask them to come check (if parents were okay with this). I would talk with them about their feelings...is baby moving, what does their instinct tell them, etc. Again nothing clinical is happening, the doula is not liable for anything as I see it.

[DL]

Ok.....I'm still thinking on this one.......

Actually, I sometimes do labor support at home before the couple decides to head for the hospital, just like most other labor/birth doulas (labor support at home is not just for home births). As I'm understanding it, I wouldn't call that "labor sitting", as I do nothing clinical, and I'm not the one making a decision on when the midwife should be directly involved. I do, however, gauge progress according to mom's behavior the best that I can (who wouldn't be doing this, at least in her own thoughts? ). I have talked to CNMs on the phone before, and frequently they have asked me how mom seems to be doing to me. In these instances, I factually tell them what I see (not think), but always make sure the midwife speaks with the mom in order for any decisions to be between the parents and the midwife. Like Kim, I make sure the parents know their options and the possible consequences (good and bad) and have the parents make the choice of their next move to make. These actions keep me within my scope of practice as a doula, and I believe very different from that of a midwive's assistant who is "labor sitting". Just my ....someone please correct me if I'm wrong.

I do appreciate everyone's input on this topic; ladies! It's clear to me that there are some differing views on what the term "labor sitting" actually means among doulas. IMO, it would be interesting to get a midwife's explanation of what she expects from someone who is "labor sitting" for her and how it differs from her view of what a doula should or should not be doing during labor support and if it coincides at all. Not saying that you, I, we, should agree or disagree on the midwive's explanation, but it would be enlightening I think. ....Interesting!

[motherwise]

Let me clarify a bit...first of all I am strictly speaking of a home birth where the midwife or mom specifically asked you to labor sit and you agreed. The reason I am saying homebirth is that if you were with a mom who was planning a hospital birth and you noted thick meconium present, you might go ahead to the hospital instead of staying much longer at home. Note also that I am speaking of thick mec. Very different from light mec in many cases. If midwife is not there and you AGREED ahead of time to labor-sit, than mom and dad may begin to look to you as the one with the most medical knowledge there. Even though you are not a medical professional, they may feel that you at least know a bit more than they do. Okay, so lets say you tell them the facts and options and let them make the decision...if they decide to stay at home and there is a problem (lets just say very hypothetically mw doesn't get there in time or early enough to prevent any complication) the parents may blame you for not advising them strongly to go to the hospital. If the parents do decide to go to the hospital, how will you be recieved by the staff? Obviously this is a very hypothetical situation...my one and only point is that it could be a bad idea to agree to 'labor-sit' depending on the situation. I just mean we need to be careful about any 'fine lines', y'know? The truth is that we are not medical professionals and thankfully, liability is not usually an issue. However, doulas have been sued before so it's good to always be careful. I agree that is would be interesting to get a mw perspective. I am a student mw who is not yet an apprentice, so i still have much to learn.

Anyway, I really didn't mean to say this to ruffle any feathers or anything, and I guess my analogy leaves a little to be desired .

[Kim Trower]

ahh...there in lies the problem....don't agree to labor sit and always make your knowledge and your responsiblities known. No feathers ruffled at all...you'd have to do alot more than just have a discussion to ruffle me.

[DL]

Quote:

Originally Posted by Kim Trower ahh...there in lies the problem....don't agree to labor sit and always make your knowledge and your responsiblities known.

Excellent advice, Kim! In other words....."Doulas, use your noggin!!"

Quote:

Originally Posted by Kim Trower No feathers ruffled at all...you'd have to do alot more than just have a discussion to ruffle me.

Me too!.....My feathers never got ruffled....not once. I love to discuss back-and-forth; it gets me thinking, and it's how I learn! I really appreciate everyone's input!!! Thanx, ladies!

[motherwise]

Kim, you said it! Thats what I was trying to say all along, and I just didn't know it lol.
thanks