Challenges

DoulaMegz · 10-11-2009, 08:35 AM

What chllenges do you face with your volunteer and/or community clients that you don't think you face with private clients? How do you handle these challenges, and what have you learned that others may benefit from in preventing or minimizing those challenges?

doulajamie · 10-12-2009, 09:47 PM

How about clients who don't call you with updates? With private clients, this is almost nil...they are paying for your advice, support and encouragement. Community clients don't pay and sometimes don't call us or lose our information. In addition, getting in touch is often much more challenging because many do not have cell phones and are very transient (especially homeless clients).

DoulaMegz · 10-13-2009, 08:39 AM

I was going to post the EXACT same thing. I seem to have "lost" my second client this month because of this! I find myself chasing random leads to get my moms, and I only have so much patience for this. A few weeks ago I actually called a listed emergency contact to get a mom's number as the one I had was disconnected...that worked for a day. Then that number was disconnected to.

My other big challenge is missed appointments. When I got 25 miles out of my way only for the mom not to be there. Again, not an issue with private clients (pay=value right?) But this happens at least once a month to me. Thank goodness for our new center opening, now if they miss an appointment I just get to hang out! haha!

doulajamie · 10-13-2009, 05:27 PM

So what do you do to keep in touch with clients? We have discussed offering incentives like: 1) something when they complete 9/12 weeks in the chidbirth education series, 2) something when they call the doula in labor, and 3) something when they complete the program (meaning at least one prental visit every other week while enrolled and 6 postpartum visits). Has anyone offered incentives? Did it work? Was it worth the cost?

doulajamie · 10-15-2009, 07:28 AM

Does any one else witneess their client being used as a guinea pig for residents and nursing students?

I had a client who went into hospital in active labor, when they moved her to L&D she began having significant decels and the drs waited through 3 contractions where it didn't resolved and began preps for c-section. Anestheiologist came in and wanted to give an epidural with mom lying on her side in the bed (which I have never seen provide effective relief). A anesthiology student came in and was guided through the procedure by the initial anesthiolgist. Then my client was wheeled to c-section and the anes. gave her a spinal because the epidural wouldn't work. oh, I was so agitated by this situation...so you did a procedure you knew wouldn't work so a student could experience? That's just wrong!!! There have been other situations where I really think things are done to these vulnerable women for the purpose of teaching.

Any one else have these experiences, particularly with your vulnerable community clients?

momofmany · 10-15-2009, 09:57 AM

I find that the moms who are offered a free doula take one even if they plan to have full medication. I can tell them about the risks of pain meds and interventions but they don't care - they just want that kid outa there! Then I sit and wonder why I am there and feel bad for using grant funds up. Seriously, I wonder why I am there. Oh yeah, I was free. I have to tell myself that I am influencing them in SOME way, if not now, maybe later...

Paying clients listen to my advice, call me with updates, I can tell they really want the best for their baby and their body.

Funny thing, I sense that the nurses and doctors would rather have the first type of patient, the one who sits back and takes what they have. The second type, the one who studies and knows what is healthy for her and baby, really tick them off.

DoulaMegz · 10-15-2009, 10:31 AM

Quote:

Originally Posted by doulajamie

Does any one else witneess their client being used as a guinea pig for residents and nursing students?

I had a client who went into hospital in active labor, when they moved her to L&D she began having significant decels and the drs waited through 3 contractions where it didn't resolved and began preps for c-section. Anestheiologist came in and wanted to give an epidural with mom lying on her side in the bed (which I have never seen provide effective relief). A anesthiology student came in and was guided through the procedure by the initial anesthiolgist. Then my client was wheeled to c-section and the anes. gave her a spinal because the epidural wouldn't work. oh, I was so agitated by this situation...so you did a procedure you knew wouldn't work so a student could experience? That's just wrong!!! There have been other situations where I really think things are done to these vulnerable women for the purpose of teaching.

Any one else have these experiences, particularly with your vulnerable community clients?

I've seen the guinea pig scenario but also I have seen the staff badger moms who do not speak english as their first language. It's very frustrating because these women perhaps deserve even more compassion than the middle class educated moms. These moms have been through the ringer, and their birth is one place that we have a significant opportunity to create a window for change.

DoulaMegz · 10-15-2009, 10:36 AM

Quote:

Originally Posted by momofmany

I find that the moms who are offered a free doula take one even if they plan to have full medication. I can tell them about the risks of pain meds and interventions but they don't care - they just want that kid outa there! Then I sit and wonder why I am there and feel bad for using grant funds up. Seriously, I wonder why I am there. Oh yeah, I was free. I have to tell myself that I am influencing them in SOME way, if not now, maybe later...

Paying clients listen to my advice, call me with updates, I can tell they really want the best for their baby and their body.

Funny thing, I sense that the nurses and doctors would rather have the first type of patient, the one who sits back and takes what they have. The second type, the one who studies and knows what is healthy for her and baby, really tick them off.

I have this same dialogue with myself at many births for my community clients (and I probably hae 95% community clients right now). I educate them until I can not talk any more, I cannot answer any more questions they don't know to ask, and I cannot provide anymore ammo for them...then they walk in there, get AROM, Pit, epidurals, episiotomy etc etc. Like you I wonder...why am I here? I had one where I sat and played sudoku while the mom slept after her epidural and wondered...why is my 1st trimester tired self sitting here, away from my home, and away from my bed? But in the end, someone cared about her, stuck with her, gave her compassion, was a consistent source of support, always answered her calls, her questions, and made her feel valued and important. It's not like they have to have the ideal "doula birth" to feel empowered, and to feel the love and support we send their way. Just that can make a difference.

doulajamie · 10-15-2009, 10:58 PM

I think that being a community doula requires a significant paradigm shift from being a private doula. My goal is not to have my moms avoid getting epidurals; my goal is to develop a relationship and provide support through an experience that can be very traumatizing. Many of the women we work with in community programs have experienced relationships which include emotional, physical and sexual abuse, many have no model of a decent partnership or of parenting. Our role is so much more than education or the typical doula statistics. The women I serve are amazing women, they have been through so much and they are trying to put their lives in order. Building a relationship, showing that you can be trusted, and supporting their decisions...even when they are not ones I would make or would want them to make...all impact how they remember their births. One of my women called me at 2:00 am because she was in labor and I showed up about 45 minutes later at the hospital. She told me later that she thought I would be mad at her and that I wouldn't show up. She said when I took over and helped her breathe through her contractions that she was so happy and surprised. She had been disappointed so many times by those in her life that she expected disappointment again. It's a blessing to serve these women...I truly believe that. It does, however, take a paradigm shift.

momofmany · 10-16-2009, 10:03 AM

Thanks Jamie! That IS why I do it. Sometimes I forget that just sitting beside someone who is sleeping with the epidural is also helping them in a way. Especially the teens I work with who may feel alone. I have gotten two thank you cards from the four I have worked with so far, both of them had epidurals. Also, who knows what we say, do or teach them for THIS birth that they may not "get" this time around but, maybe if they have another child, it will make sense that time around.

Comfy · 10-16-2009, 11:15 AM

I took on my first volunteer client earlier this fall. When I was certifying, I did do a birth or two pro bono, but I wanted to give back a little to the organization that I network here in my home province.
She was a young Mom with a baby under 2, no baby Daddy (so no support), he is in jail for domestic abuse , no job and had walked a really hard road before I met her. She is younger than my own daughters, and I had a couple of prenatals with her, and she barely made eye contact. She didn't know what a doula does, and the idea was not hers, but her social worker's. I knew almost from the beginning she wouldn't call me when she went in labour. Same thing, I would ask for feedback after Dr appts. and ultrasound testing, and it was always me following up. I got an email from her, and she said "she already had the baby about a week ago and everything is fine, and she was sorry she thought I was a sweet lady, and she appreciated my help and concern".

Still I think that maybe I did some good. Even if just to help her to trust people, and that I was genuinely concerned about her. She may remember some of the things we talked about, and how I praised and told her she was a good mother.

I plan to volunteer again in the future.