Left Field Consultation!

[SerenityDoula]

ok, so went and met a women for a consult yesterday she is due in about 3 weeks. She has an OB and is delivering at a local hospital that i frequent! She tells me that she has been educating herself since she got pregnant, and for insurance reasons has to deliver at hospital or she would be at home! She intends to be extremely admit in breaking all procedures. She is doing them for the right reasons, she she intends to really refuse some thing. she WILL be eating drinking walking moving bathing (tub- against policy after water is broken) will NOT be strapped to monitor, yhave IV's blood draw- the whole nine! she intends to allow her temp to be taken (no reason to fight that) and intends to allow them to listen to fetal heart tones via styth. She does not want to be bothered talked to by the staff including her OB which has no idea what he has coming, and she intends to deliver her baby herself, her OB can be their for legality reasons, she is sure he will need to be watching, but NO ONE WILL BE TOUCHING HER! Now she wants me to be her labor support!
I have several concerns, first being the hospital what measures can they take? can they deem her a donger to herself and baby and take some drastic measures? Secondly i will look like a very serious case of DGB really bad, but largly i am very concerned about what this could mean for her! She is single middle aged, highly educated, and successful women in her everyday life, she isnt used to taking no for an answer, and will do things as she sees fit! (quotes from her mouth) she has all the right cards- just not lying them out in the right order ykwim! I tried to see if there was any negotiating room with how we address this wih staff but no-

God help me any one have some words for me- I always get the nutty ones!!!

[dorothyh]

Has she discussed all of this with her OB? If she is planning on fighting all of these battles while in the middle of active labor, without having discussed this ahead of time with her dr, no matter how used to "not taking no for an answer" she is, she is not going to win. And arguing with people in the middle of her labor is going to make her labor harder and more painful with all those extra stress hormones; she needs to "get into the zone" during labor, and focus on her labor and herself, NOT with arguing with staff.

I would want to make sure that she isn't expecting you to be the one fighting her battles with hospital staff, and my concern would be if things DON'T go her way - is she going to blame you.

If she hasn't done any prep work with all of this, she is likely to end up with all of those things that she doesn't want, unfortunately. And there is a good chance she'll blame you. Make sure she understands what your role in this is.

[amymaew]

Why not deliver at home, and save all that energy for fighting with the insurance company to cover it? I don't know what to tell you - I agree with Dorothy. Good luck!

[tlcdoula]

Quote:

Originally Posted by dorothyh Has she discussed all of this with her OB? If she is planning on fighting all of these battles while in the middle of active labor, without having discussed this ahead of time with her dr, no matter how used to "not taking no for an answer" she is, she is not going to win. And arguing with people in the middle of her labor is going to make her labor harder and more painful with all those extra stress hormones; she needs to "get into the zone" during labor, and focus on her labor and herself, NOT with arguing with staff. I would want to make sure that she isn't expecting you to be the one fighting her battles with hospital staff, and my concern would be if things DON'T go her way - is she going to blame you. If she hasn't done any prep work with all of this, she is likely to end up with all of those things that she doesn't want, unfortunately. And there is a good chance she'll blame you. Make sure she understands what your role in this is.

My guess would be that regardless of how strong she is and what she says she might be setting herself up for a failure and disappointment because I do not know too many women who really, truly have it in themselves to fight all the way through their labor. I would discuss with her the importance of being able to relax and let go in order to birth her baby. I would discuss with her what that means to be fighting all the way through labor and how often times women just can't do it while they are trying to allow their body to labor and birth.

Personally I think she has a very unrealistic idea of what her labor is going to be like and how she is going to be able to manage it while managing to fight for what she wants. I would have a very, very serious talk with her about all of that and how unrealistic she is being.

Even the strongest of women need to be able to let go and surrender to the birthing process.

[scarborogal]

Honestly, if it was me, I'd run away from that one. Only because I would hope she doesn't want you to be her voice while she is in active labour. I wouldn't want to piss off a hospital I work at for sake of one obstinate client.

K.

[Mile High Doula]

VERY important that she understands your role especially since she will NOT have a partner who can speak for her at the birth. You WILL look like the one who is influencing her to be this way so it is imperative you NOT say a thing maybe just ask some questions and look like the dumb doula.

As for her fighting tooth and nail...I have had 1 client like this. Should would have had a homebirth but she was a paramedic and has seen all the bad things that can go wrong so she wouldn't have forgiven herself had something gone wrong. I think she did an excellent job of "fighting" for what she wanted in labor. She took a VERY relaxed approach and when they wanted to do something, she didn't "fight" with them, she just said no. She never raised her voice, she always spoke softly to remain calm and connected to what was going on. She let them know that she understood that they were uncomfortable with not using the EFM and allowed them to monitor once for 10 min (hospital policy was 20min). She walked around the room as she pleased, she ate in front of the nurses and when it was time for pushing, pushed where she wanted but before the head crowned, she flipped over so she could have the baby on her belly right away. She just stayed in the position, pretending she didn't hear everyone until she decided to flip. I think it was perfect actually. Her hubby didn't say much either.

With that said, she also had a VERY fast labor. It was 3 hours and 9 minutes from start to finish (2nd baby). I think your client can properly handle the situation if she stays at home as long as possible and arrives in or near transition. Timing that can be rough though.

I also believe that she needs to let her Dr. know ahead of time. She can be determined a "difficult" patient, that's fine, but at least he knows this is how she feels ahead of time. You know, that she wants to catch the baby and such. Some OB's are actually fine with that or will even allow the hubby to catch the baby. She might be surprised at how her Dr. reacts so it's worth telling him or putting it on the birth plan. Whether her plan says alot or just "I would like to move about during labor without being interrupted or monitored and will eat and drink when I feel the need. I would also prefer not to have vaginal checks or be touched in any way. I prefer my baby be birthed by himself, with no hands on my baby's head or perineum and I will catch my baby and bring my baby to my chest." She needs to inform her care provider how she feels whether he likes it or not. Going in blindsided is not a good set up for birth and will actually make things worse in the long run.

Good luck! This is a difficult situation to be in.

[AussieDoula]

It sounds like she is unhappy about "having to" birth in a hospital at all, and is holding a grudge against her care provider and hospital staff right off the bat.

I would say the most important key to unlocking her desired birth experience is to open communication with her OB and discuss her wants for this birth. She may just be surprised at how accepting her OB is.

In all of her self-educating, did she not read anything about birth plans? I would start there with her; putting together something during a prenatal visit that she can then take to her care provider to facilitate communication, possibly even going with her to one of her check-ups.

In the end, if you are not comfortable taking her on as a client, you should just refer her on. Good luck!

[AltHealthMomma]

Yeah, I'd have to say I'd avoid that situation like the plague. At my first birth, the L&D nurse said something about a doula who tried to keep everyone away from the client and the nurse said "if you don't want interventions, don't come to the hospital. this is what we do. if you want a totally natural birth, stay at home." Have to say, I agree.
Now if we could just get HB on the radar to HMOs as SAFE AND less expensive than hospital births, maybe we'd see more low-risk women willing to birth at home, but that's another issue.
Let us know how it goes with this one. She sounds rather, er, demanding (and like a stressful client to take on!).

[brilliant]

i have to say i would LOVE to attend the birth, but mostly because i'm curious to see how it plays out.

is she planning on surprising all of these expectations on her OB at delivery? is it because she's afraid he might drop her as a patient?

[1stimestar]

And until women start putting their money where their mouths are, and having homebirths EVEN when they have to *gasp* pay for them out of their own pockets, things will remain the same.

If she is so against hospital protocol, then she really should rethink having a hospital birth. I would definitely have her write up a simple birth plan and go over it with her OB. If is is longer then 30 days before her delivery, he can then fire her as his patient, BUT only if he provides her with a referral to another dr. She does have the option of just showing up at the hospital in labor.

[UtahDoula]

Another possibility to consider is that this mom may be planning an accidental "oops!" homebirth with you catching. I interviewed with a couple much like this and that was the distinct impression I got. I passed and did not take them as clients.

[DoulaCBE]

Quote:

Originally Posted by 1stimestar And until women start putting their money where their mouths are, and having homebirths EVEN when they have to *gasp* pay for them out of their own pockets, things will remain the same. .

Oh I just totally and completely disagree. You'll never see homebirths in the US in numbers large enough to effect that kind of change. It's the women who come in educated, well prepared and ready to demand that her providers practice informed consent and truly evidence based medicine that is going to garner the change we want to see.

With a national epidural rate upwards of 85% last time I checked, the medicated majority is going to rule.

[SerenityDoula]

Thank you all for your responses, i appreciate it! I met with her Sat night posted this sunday morning and was out for 4 consults, i didnt have much chance to really think about it, or post back! Her EDD puts her due in 3 weeks hardly enough time to really work with her on this very real issue, technically she could go into labor any time. She had NOT informed anyone other than myself of her plans, she was just going to spring it on everyone! I spoke with her again this morning, she called to see if I was willing to take her on as a client and after a lengthy discussion, i apologized and declined the job! I offered to email her a list of other doulas in my area, and she declined admitting to me then she had interviewed 5 doulas sat, i was her last interview and they all declined the offer on the spot. Now i feel guilty that this women isnt going to have any support at all! I turned to my husband about how I was feeling, his response. "Cant save them all" and in a way that helped, I would have wore myself thin trying to save her from herself, she could have what she wanted if she was more open on the approach! I try to run my business on the throry that i dont want to help, i want to empower, but thats really not what I would have been doing! And i think some of you were right, the nursing staff and Dr.'s who have come to respect and trust me with their "patients" (ughh) could have mixed emotions on my involvement, and it has taken years to build this respect being from two different worlds and all, my business cannot afford a hit of that size!
So again, ladies thank you for your support and input-
I think I did the right thing, for the right reasons, now lets hope i can sleep tonight!