Discussing different scenarios with clients

[napualani]

I just attended my second birth, which was in a hospital, and it's brought to light a question so I can better educate my future clients.

I'd like to find out how you discuss different scenarios with clients, their options, and empowering them in their decisionmaking, especially if that means they would be going against their doctor's advice. For example, if there is SROM and labor doesn't start soon thereafter, what should she do? If labor still isn't starting after so many hours go by, should she go to the hospital or try to start labor on her own, and what are her options? What if she goes to see the doctor and she does not want to get admitted yet? What verbiage can we offer her to tell her doctor No?

I feel that many women feel powerless when their doctor has told them, "your baby is at risk if we don't do XXXX". How do you discuss what they are fearful of, to get them past a blanket statement of "the unknown" or "not being in control"?

I want to give them information so they feel empowered, and I don't want to scare them or bring on fear of something they may not have feared before. I want to give them actual words they can say that will help them be assertive with their caregiver rather than adversarial.

If anyone is open to sharing actual handouts, online resources that might address these types of topics, or books, I would be really grateful. My lack in confidence mostly comes from a lack of information, and I don't know what resources I can go to that will help me.

Thank you!

[celebratelife!]

Thats a GREAT questions and I'm really looking forward to what our seasoned doulas have to say...
The only thing I've said to my clients so far is that THEY are in charge of their birth. I try to assess how comfortable they are with their caregiver and go from there.

[ama2j]

I make sure I've given each client information about informed consent questions after we have our second pre-natal meeting/discusssion. I also give each of them an informed consent card to carry with them so they can remember it when speaking to their provider. It is wallet size.

1. Is this an emergency or do we have time to talk?
2. What would be the benefits of doing this?
3. What would be the risks?
4. If we do this, what other procedures or treatments might we end up needing as a result?
5. What else could we try first or instead?
6. What would happen if we waited an hour or two (a day or two, a week or two, etc.) before doing it?
7. What would happen if we didn't do it at all?

I also urge them strongly to take a good childbirth education class ahead of time.

As doulas, childbirth educators, etc. we can answer questions w/o giving medical "advice", and we can educate what a "normal" birth is and what can happen during that birth. We can empower women. Isn't that an awesome calling?

Doula hugs,
Sara CD (DONA) CCCE & CLD (CAPPA)

[DoulaKaren]

Quote:

Originally Posted by ama2j I make sure I've given each client information about informed consent questions after we have our second pre-natal meeting/discusssion. I also give each of them an informed consent card to carry with them so they can remember it when speaking to their provider. It is wallet size. 1. Is this an emergency or do we have time to talk? 2. What would be the benefits of doing this? 3. What would be the risks? 4. If we do this, what other procedures or treatments might we end up needing as a result? 5. What else could we try first or instead? 6. What would happen if we waited an hour or two (a day or two, a week or two, etc.) before doing it? 7. What would happen if we didn't do it at all? I also urge them strongly to take a good childbirth education class ahead of time. As doulas, childbirth educators, etc. we can answer questions w/o giving medical "advice", and we can educate what a "normal" birth is and what can happen during that birth. We can empower women. Isn't that an awesome calling? Doula hugs, Sara

Are those cards available for order?

[ama2j]

Not that I know of. I just typed it up on my computer and then printed on card stock.

Doula hugs,
Sara

[DoulaCBE]

Quote:

Originally Posted by MomOfImAndZee Are those cards available for order?

Penny Simkin used to sell them. I don't see them listed on her web site at this time, but that's where I got mine from in my doula training many years ago.

[Iarwain]

In addition to the kind of questions listed above to work through things in the moment with the HCP I find it really helpful to give my clients information about their options. Usually at prenatal meetings we talk about some topics and I lend them books to read. I also suggest that anytime they are presented with something unexpected that they ask for a few minutes to think about it (provided there is time). Henci Goer's Thinking Woman's Guide is GREAT for a number of different issues. I try to give information (research studies and the like) rather than advice. When I come across an interesting study I print it off and file it for times like this. Of course this is more helpful with things they deal with ahead of time (i.e. doctor wants to induce for X reason) versus actually in labor.

[aetrusty]

There was just a discussion about this on another doula list. Someone suggested asking what the ideal birth would be and then using cards with different interventions asking how their perception of the birth would change or how they would handle if that intervention were to happen.

That way, they get an idea prenatally about how to handle things during labor because they've already done some of it before.

I don't know where to get the cards though. I'll go on the other list and try to find out.

[ama2j]

Another topic I consider very important caused me to order brochures to give all of my clients and all those who interview me. I've given the link below. It is called "The Rights of Childbearing Women". Many women don't know the information that is contained in the brochure. I was talking to a doula friend a couple of weeks ago that wasn't aware of some of the information in it either. The link will give you a summary of what is contained. Again, it is such a privilige to help empower birthing women today.

http://childbirthconnection.org/arti...Link=0&area=27

Penny Simkin's Informed Consent wallet cards:

http://www.pennysimkin.com/products

Doula hugs,
Sara

PS I found a place to order the laminated cards giving situations that might arise during birth. It's a great item and good price. Here it us:

http://www.birthsource.com/scripts/p...?idproduct=270

[1stimestar]

I use BRAIN which originally was BRAN.

And this is something I teach the dads the most.

Use your BRAIN!
Benefits, what are the benefits of the procedure?
Risks, what are the risks of the procedure?
Alternatives, what else can we do?
Intuition, what does your intuition say (Moms)?
Nothing, what if we do nothing?

I like this as a TOOL to help them discuss their options with their careprovider in unexpected situations.

For something such as their water breaking with no contractions....

I tell them to take note of the color, amount, and smell of the fluid. These are things the CP will want to know, especially if there is any meconium in it, and if so, how much. We talk about what the different amounts, color, smell, etc. can mean and why they would want to know.

If you call the hospital, they are REQUIRED to tell you to come in. You do have the option to tell them you will come in later or when contractions start.

The main concern is that now your water is broken, bacteria can get to your uterus (with no contractions) and cause an infection which can advance very rapidly. It's not like a cut on your finger that after a couple of days becomes infected.

Another concern is cord prolapse. Where is baby? High? Low?

Anyways, most of my clients want to stay home for a while, but if contractions don't start within a few hours, I ask them if they want to call their doctor to discuss their situation as well as their options and we take it from there.

[Iarwain]

That BRAIN/BRAN acronym is a great tool!

[delilahdr]

In addition to all the great information above, I also will basically draw on my knowledge of common practices in my area to give the client an assessment of her options.

"I don't know your care provider specifically, but I can give you examples of what is commonly done in this situation in previous clients' situations, to give you a sense of what your path could look like based on your choices. For example, if this happened and you were expecting a birth center birth at so-and-so birth center, they would ordinarily want you to come in, they would listen to the baby, and then send you home until contractions begin, and they would probably like to listen to baby once every six hours. If 18 hours pass and no contractions begin, they would probably suggest certain herbal concoctions and encourage you to do an enema or take castor oil, and walk, to hopefully have you in good active labor by about the time you are 24 hours post-SROM.

If you were having a homebirth with the midwife at such-and-such birth center, she would ask you the time, amount, color and odor of the fluid, if the baby was moving normally, and would listen to the baby once every eight hours and want your temp taken and baby listened to periodically but has no set timeline for when labor MUSt start unless you start to run a fever or baby doesn't sound as good.

If you were using Dr. Whozit at so-and-so hospital, her protocol is that you need to come straight to the hospital when your membranes rupture, but she won't do anything to get labor started until 12 hours after, unless you begin running a temp. However, they will be doing vaginal exams at least once on admission and every ~3 hours, which does increase the likelihood of infection. And, due to your water being broken, that hospital does not allow you to get in the tub. Once 12 hours pass, if you are not contracting well, they will want to start you on Pitocin. [insert long speech about the benefits and risks associated with Pitocin.] If you are not in good active labor, close to pushing, by 24 hours past membranes rupture, you won't get an automatic "failure to progress fast enough and 24 hours post-rupture-of-membranes is out policy" c-section, but they will start talking about it a lot, which encourages some people to work harder to hurry the baby out, and freaks other people out and causes them to stall and it becomes a self-fulfilling prophesy. But you do still have some room to negotiate there.

Or, if you were using Dr. Scaredofbirth, at MostEveryHospitalinmyarea, he would want you to come in as soon as your water breaks, and start on a Pitocin drip immediately, unless your cervix is firm, long, thick and only 1cm dilated, in which case he would use Cytotec first as soon as you arrived, and Pitocin six to eight hours later, because he would start talking about the need for a cesarean about four hours into your labor, so that by 18 hours, which is is deadline, you would have been desensitized to the idea by his mentioning that it might need to happen during every two hour interval that he came in to your room during your 12 hours of excruciating induced labor, so that a c-s sounded like a great idea at 18 hours post-rupture of membranes."

(Well, I wouldn't actually say it like that fourth one, but along those lines.)

Anyway- the point is, I would show them kind of the broad spectrum of approaches to a situation and what sorts of things might be suggested and the pros and cons and potential pitfalls of each of those scenarios. Then I would ask them if they know what their care provider's usual practice is in their situation, and if they know what they would like to do?

[DoulaCBE]

Quote:

Originally Posted by DoulaCBE Penny Simkin used to sell them. I don't see them listed on her web site at this time, but that's where I got mine from in my doula training many years ago.

Quoting myself here, if you're a Childbirth Educator, the Prepared Childbirth The Family Way Educator's Manual also comes with one sheet of the cards premade and a template for photocopying with the questions to ask a care provider about interventions and procedures.

[1stimestar]

Quote:

Originally Posted by delilahdr (Well, I wouldn't actually say it like that fourth one, but along those lines.) Anyway- the point is, I would show them kind of the broad spectrum of approaches to a situation and what sorts of things might be suggested and the pros and cons and potential pitfalls of each of those scenarios. Then I would ask them if they know what their care provider's usual practice is in their situation, and if they know what they would like to do?

Heeheee, I LURVED your last one.