Improving the Outcome of Pregnancy Through Science

This article is long and technical; but after reading it, I'm having a hard time with the
"As Doulas we need to support what the mother wants". See if it has the same effect
on you.

I was also surprised today to read on the Gerber Good Start website, that they actually state
that breast milk is best for babies; and they have a lot of information on breastfeeding, including a video!:jaw

61 views of this article and not one response, comment, nothing.
Amazing! Maybe I'm in the wrong place; thought fellow Doulas
would be insensed by this article and surprised about the Gerber
website!

Sorry????? I dunno..... It was to long and technical for meto feel like reading, my brain is tired. But I will say "as a doula I support what the mother wants". I tell her to do research, whether she does or doesnt is up to her. I am doula for my own sister.... she is pro ultra sound, induction if overdue, pain meds if needed and even elective c-sections. So I support her in all her choices, and love her and respect her.
Why?? Because she is not me. She has a brain in her head and she will do whatever makes sense at this time in mind. Thats how I treat every one.

Wow. I just finished reading through that article, and it's actually quite frightening.

I'm still learning, so I can't speak from any experience save that of my own pregnancies/births, but I can tell you that I read everything I could lay my eyeballs on when I was pregnant with both my 2nd and 3rd babies. Learning about some of the potential side effects of "typical" interventions and/or procedures played a huge part in my decision to pursue a natural, midwife-attended birth. Some things are so commonly done, I think many women don't even consider that they have other options, or that they can just say, "No thank you." A lot of people assume that, since a doctor is ordering it, that it's "safe." After all, a doctor wouldn't tell you to do something that could potentially harm you or your unborn, right? RIGHT??

I support a mother's right to make an INFORMED decision about her care. If she is my client, I feel that it is my obligation to make certain that she has the information available to her so that she CAN make an informed decision; not doing so would feel, to me, like negligence. I can't make her read handouts on the possible negative side effects of various "normal" interventions, but I can give them to her. What she does with that information is her choice, and that choice is what I support.

Apologies if I offend anyone; this is something I feel pretty passionately about.

What upsets you? As doulas we are supposed to support our clients choices not run our own agendas.

What upsets me, is the fact that so far many Doulas on this board seem to be as apathetic and have a head in the sand attitude about these interventions; as the mothers that are allowing them to be performed on them. This is not "my agenda". These are scientific medical risks to routine procedures that are not evidence-based. More mothers than not, do not even have Doulas. In my experience mothers do not receive the legal "INFORMED" consent from their medical providers. They are told that these procedures are "safe". They also do not receive the true risks in hospital-based childbirth classes. I therefore feel that as Doula's it is our responsibility to mothers and babies to make sure that
mothers know what they are agreeing to. Some of you may be certified by organizations that mandate that you support the mothers choice no matter what. I support the mother's choice too; but as a Professional, I also feel an obligation to make sure that mothers are FULLY informed. This country has a higher infant mortality rate than third world countries and our C-Sections rates are escalating every year. We also have the most advanced technology. That speaks volumes to me. I don't think that "the Doula Effect" that has been shown to have better outcomes makes any difference if Doulas just become an extension of the status quo. I feel that I have an obligation to the babies, who will be our next generation.

Ramona, I'm confused. I always give my clients risks of each procedure. Some women choose to consent to interventions anyway. How is that "sticking my head in the sand?" If she chooses an intervention knowing the risks, I'm not going to walk out on her. Do you do that?

To be frank, I find it a little offensive that you believe we are apathetic b/c we didn't get up in arms over this article (which was written in 2000,btw). Sorry, but I already knew all this information. Did you not? I've read about theses risks over and over again. I'm already doing what I can. What exactly do you think we should do?

As for Gerber, I wouldn't trust anything they wrote at all about breastfeeding. They are owned by Nestle. Here's a great article on how "helpful" Nestle is with breastfeeding advice: Helping Themselves: Breastfeeding Advice Nestle-Style

Thanks I agree.... yeah, I have been a doula for about 10 years. I have read these studies I have spewed them off to who ever would listen. Actually people would avoid discussing the topic of birth after a while. I have been passionate before. Then after years I burned out.
I am certainly not going to go all wild eyed and crazy over an article with info I have read a million times. My head is not in the sand....my head is in reality. I can reach more women with my low key approach than I can if women avoid me and cross the street if they see "crazy doula lady" coming.

I am a doula, and have a doula at my births, and I would still consent to interventions if they were warranted. I'm not uninformed about the risks vs. benefits, I understand that interventions have risks and benefits and that when used judiciously they can be very helpful to some births.

I am not quite sure I understand your point. Do you think no woman should ever have pit, an epidural or a c/s? That doulas abandon their clients for choosing things they would not choose themselves?

It sounds like you want women to make the choices you would make.

None of the information in the article is new info. I discuss benefits and risks of interventions with my clients. I'm also fully aware that most women don't make their choices based on the hard data. They listen to their gut, their choices will be influenced by what their friends and family did and how they felt about such interventions and they will be equally influenced by the circumstances are at the time.

Penny Simkin opened a conference session with such a statement in her talk on Supporting the Woman With an Epidural at this years DONA conference. She used to think that "If they just knew all the risks they wouldn't choose intervention." What time has taught her, and many of us who have been in the business for at least a decade, is that's just not how most women tend to make choices. We can give them all the information in the world, they're still going to come to their own conclusions and the data on risk is a minuscule part of that.

It is our job as doulas to support our clients in their choices and follow THEIR lead through their births. To push our agenda on them is equally as bad as providers pushing theirs, something which we jump very readily to criticism for.

Maybe I need to be clearer in what I'm saying. First of all, I have also been a Doula for a decade; I am not new to this. I don't disagree that many moms go along with whatever has been the experience of their family and friends. What I said was, mothers do not receive "LEGAL, FULLY INFORMED CONSENT" from their medical providers, and many do not have Doulas. So I don't think that you can make the assumption that if all moms knew the risks, they would make the same choices. At every birth that I have attended the medical provider has told the mother that epidurals are safe; and when questioned about the risks, they were minimized. There are situations that interventions are best for the health of the mother and/or baby; that is not what I'm talking about. What I'm talking about is the ROUTINE use of these interventions that are KNOWN to cause more problems. What I am also saying is that you can't say your are supporting the moms' choices; because in many cases they don't KNOW what they are choosing, therefore you are not really supporting "their choices"; you are supporting the medical profession's choices. Do you also support "membrane stripping" without the mother's knowledge and consent? Are you also familiar with "Pit to Distress"? I have been at many births, natural, external versions, Pitocin, epidural, C-Section; and no I do not "walk out". If a Doula's only job is to support whatever the mother wants there is no point in having a Doula. She can "do whatever she wants" without a Doula; unless she wants a truly natural birth. There is no progress in anything by just accepting the status quo; history has taught us that. If you are resigned to accepting routine interventions that add to our infant morbidity and mortality problem, maybe you should re-evaluate why you are a Doula. It is not possible to have a positive impact on outcomes if you just don't care.

clearly you missed where I and others above said we discuss benefits and risks of interventions with our clients. I'm hired by my clients because I'm an outcome driven Doula. My goal is to always keep things moving in the direction of a vaginal birth which is all about avoiding routine interventions for the sake of routine. When people hire me they know I'm not going to pull any punches or gloss over risks. they also know if they say "hear ya, don't care, give me the . . . " then I fully support their right as a consumer to make that INFORMED DECISION. So yeah I can say that I am supporting my clients in making FULLY INFORMED CHOICES. Their own FULLY INFORMED choices, not that of their provider, hospital, nurse, etc.

I don't disagree that the medical model has accepted the complications from common interventions as part of their definition of "normal birth". However demanding doulas be outraged by info that is old hat to most of us and running around yelling like our panties are on fire also gets us nowhere. It also doesn't change the situation you're ranting about. I live the "each one teach one" motto, I educate my clients and their families.

Since you feel this information isn't readily available what is YOUR plan to get it out to the masses in a readily accessible and understandable way? Demanding that those who dont share your outrage should no longer be doulas isn't gonna get you anywhere so what is your next step?

I know this sounds wierd, but I was fortunate to receive the medical care I received when I had my children. I was "hollering" for an epidural the moment I walked into the hopsital with all of my children and was advised to wait until I had dilated at least 4cm (I was 3 when admitted each time). By the time I had dilated enough to receive an epidural, I was at 6cm and the health care professionals were trying to talk me out of the epidurals!!!! They were encouraging me to go natural because I only had 4cm left, but I chose to have epidurals - I was a young, scared mom in what I thought was excrutiating pain, and back then had you tried to tell me about a doula my response would have been " a do WHAA?!" I had no idea what labor support was at the time and my spouse was just as young and clueless as I was. Needless to say, the health care team that delivered my babies gave me all of the pros AND cons to receiving an epidural, and they definately wanted to make sure I was in active, progressive labor before I received one. Shoot! I almost never got one.

With that being said, I don't think making it appear like it's an "us against them" (natural childbirth proponents and mainstream medicine) issue is going to resolve anything. I know there are those of us who are passionate about natural birth, but we have to remeber that we are public servants. I don't think anyone is poo-pooing the data here, but I do think we have to remember that when people know better they do better. Some women don't have strong support when they go into labor and are afraid and have been told over and over again about how much it hurts until it is ingrained in them to expect pain. Of course they will want an epidural or some other anesthesia. Also, bear in mind that some of the data given was anecdotal in nature. Has there been a proven correlation between pitocin and anesthesia and the rise in ADHD and autism? I would think there would be more mental health issues with my parents generation if it was solely based on the use of drugs in labor and birth - back when my grandmothers had babies people were given scopamine and chloroform and God knows what else.
Until there is concrete evidence of the effects of drugs given during labor and birth, we need to be responsible with the information we give those we serve. It doesn't do the expecting mom any good to terrify her and make her feel bad if she decides she wants an epidural, or if pitocin is needed to speed up a stalled labor. All we can do is provide information and support,and let the woman and her partner do what is best for them and THEIR baby.

Sorry I got wordy

BTW, Ramona, I can understand you chagrin over routine interventions. I'm from where you live, I have family that work in the hospital systems there, and I have been the unfortunate recipient of some of the medical care in a hospital there. Please know that the type of medical care being offered where you are is not indicative of all medical facilities across the country. You can PM if you would like more input from me about some of the hospitals where you are.

For me its not the info that I am disputing. As I said lots of us have been doulas forever, we know this stuff, we preach it ( to who will listen) and we teach it to clients. When I was doulaing...I retired. I had about a 50% natural unmedicated birth rate. Our hospital has a 90% epidural rate.

What I am disputing is your tone, in that thinking we either don't care enough to post in your thread, or that we are all lazy ass doulas who sit in the corner and eat cheesies and let whatever happens happen. You came across as pretty rude! With all info on the internet most women are finding this info themselves. Even my sister who i spoke about earlier... she is finding the info, she knows it, and yet she is making her own decisions.