Hi everyone,

I am brand-new here as a poster though I have lurked and browsed a bit in the past year looking for information and perspective, I realized it's probably time to properly join and I will make my next post a proper introduction one.

I am also a brand-spanking new doula, working on my DONA certification with just 3 births attended so far. It's been such an eye-opening experience, starting to attend births. Especially in the hospital, wow.

I personally had my first baby in the hospital, without an epidural and it really sucked - I pushed on my back with my legs up for 2 hours, people holding my legs and forcing them back as I was yelled at to 'PUSH' when I didn't feel it and to 'not push and take a break' when my body was telling me the opposite.

The last birth I attended brought back so many of those hard memories as this mother had much the same experience, but it was much worse for her and as her doula I cannot shake these awful feelings of guilt that I was not able to save her from that and was one more person 'not on her side'.

I stayed within my scope of practice, I advocated for her as much as I felt I could without being adversarial when they were not listening to her when she said she did not want cervical checks, when she said she wanted to continue standing, when she begged to not be forced on the bed on her back.

There was no drastic emergency as far as I could tell, they were watching fetal heart rate carefully and insisted on internal fetal monitoring as my client was a VBAC, and this is with the most VBAC friendly, doula & midwife friendly OB practice in Austin. The attending OB was wonderful in many ways, she was very sweet with a calming demeanor, stayed with my client for the majority of her labor and watched her more than the moniters and was wonderful in early labor about not wanting to do cervical checks, and after birth was not interested in clamping and cutting for a very long time. I really trusted her......

It was really hard and surprising to me when she forced her down on the bed, and manipulated my clients cervix for hours and made her push and push I felt so caught between trying to comfort my client through events neither of us had any control over, and feeling like I should have demanded my client's wishes be respected.

UGH. It feels so much worse since my client had been practicing Hypnobirthing and was relying on that to get her though, she had all these beautiful images of unhindered natural birth burned in her brain, so many words of calm and gentle birthing brain-washed in her head and her experience was anything but. She never had that oxytocic rush of joy after birth, she was totally traumatized and kept saying 'This is so much different than I thought it would be....I thought I would feel so different' through tears.

I'm just really in a place of confusion and frustration and know that this is the place where people will know exactly how I feel! I'm looking to vent, and for any words of encouragement.

I'd also like some realistic advice (I'll even happily take a slap in the face ) for my next query....

I have a prospective client who got my info from her Hypnobirthing class, she's birthing in a hospital with an OB who from what I can find seems totally old-school and will not be very supportive of natural relaxation and probably thinks the idea of a woman birthing instinctively in a position of her choosing is the craziest thing he's ever heard of. If this more 'natural minded' OB I just saw in action would not consider catching a baby on the floor there is no way this old dude will.

My current thought is this:

If a client has done her birth education and preparation in a way that is TOTALLY ANTITHETICAL to the birthplace and birth attendant she has chosen, I feel like it is my responsibility to be real with her and judiciously find her a practical middle ground, if my ultimate goal is a safe and satisfying birthing experience for her.

I recognize a selfish element to these thoughts.....I really REALLY dislike seeing a woman in pain. It's horrible. The first hospital birth I attended my client requested induction for non-medical reasons (against my advice of course) and went on the have an epidural and I saw it work BEAUTIFULLY for her. She was happy, totally fine being on her back and eager for instructions to push when and how hard. She pushed her baby out easily without breaking a sweat and had none of the common complications of analgesic, neither did her newborn who was alert and bright-eyed and eager for her breast right away.

I just feel like.....if a woman is going to be forced to birth on her back, forced to be told when to push, and all her instinctive tools to manage birth on her her own are taken away.....rather than have her suffer through it how do I best help her take advantage of the pain medicine her doctor prefers her to have?

I don't want to encourage the epidural, but I want a woman in that position to know that I fully understand and support her and do not in any way think she's a failure or am disappointed in her if she wants it. I feel like my goal in this situation should be to help her determine the timing for the epidural, to keep her as comfortable naturally for as long as possible.

Okay I could write more but my computer is about to die, thank you for reading and for your experienced advice!

Probably one of the most beneficial lessons to learn is that Pain doesn't have to mean that one is suffering. Especially in labor. You don't need pain to suffer, and just because there is pain doesn't mean there is suffering.

Thank you Angie, that is so incredibly wise and I am happy I have learned that lesson for myself in wonderful ways. I need to figure out how to help other women as they learn it for themselves....that is such a challenge as a doula and in all of life really. You can tell someone something 'till you are blue in the face and they can 'think' they understand but so often it is impossible to truly understand something until you have experienced it and learned it in your own way, the hard way is often the best teacher. I think maybe I just need to come back to the perspective of birthing as a journey for each woman, do what I can in the moment and not place too much responsibility on myself for her experience, honoring her journey and supporting her however it plays out.

Sorry my previous reply was so abrupt. Give me a day or so. I'm willing to offer my .02 I just have ten things up in the air right now and posting from my phone (1st reply) stinks. LOL

That you are willing to explore and learn, is HUGE. It says a lot about you and your willingness to learn

I find these things a bit frustrating, as a doula. If a client wants a natural birth, they need to be in a place and with a provider that supports their wishes. Many times they think they can still get what they want bc they have "researched" or bc they have a doula. WE ARE NOT MIRACLE WORKERS! If you want a natural birth, hire a provider that supports natural birth. It puts us in a bad position, because our client expects our help and support, but we cannot overstep our boundaries and speak FOR our client or tell the doctors what to do or not do. I am going to be very up front about this with my clients from now on. It would save a lot of stress and pressure from both of us. And when I am in a situation like this, I always let the mom know I support her no matter what. If she chooses to get pain meds, I WILL support her. I don't want her to feel she has to "perform" for me just bc its what she told me she wanted to do earlier. I realize birth plans can change. A woman who wanted a natural birth can be put into a horrible situation very suddenly and may need pain meds and needs to NOT feel like a failure or that she let anyone down.

Thank you Btown!

I experience this alot. I am an L&D nurse - and I do work with various types of doctors. Some more pro do whatever comes naturally than others. Anyway I do feel the more you experience the more you will come up with creative ways to get the mom who is chained to the monitors to labor naturally. Sometimes I can't believe with all the obstacles my mom’s face they are still able to do it!
I also have experienced the mom who practiced her hypnobirthing and threw it out the window as soon as labor got real. I have spent countless hours doing back massage and hip squeezes as my only tools because the patient didn't bring anything from home and when they are on continuous monitoring alot of options are not available.
As for the epidural issue, most of the time people feel doulas are meant only for natural child birth, but I recommend them even to those who plan an epidural. I feel a doula is a great asset to have that keeps them laboring at home for as long as possible before coming in. and maybe even longer when they get to the hospital.
I also encourage birth preparation classes, talk to them about the spinning babies techniques because if you are going to plan an epidural the least you can do for your baby is do your best to put them in an optimal fetal position with a few easy daily activities. An epidural isn't really going to stop a baby who is in the best position to be born. It is the malpositions and asynclitic babies we have difficulty with - and I think alot of moms are not aware of this philosophy.
I like what btowndoula said about the choice women make about who they choose for an OB. Even working with my own dr.'s- my opinions often don't matter. I think educating your moms about the importance of choosing someone who shares the same beliefs is important. I totally recommend being upfront about this, this is their decision but a doula is not the person to argue with the doctor to make them do what your client wants. It isn't a good place to be as a doula. Alot of nurses I work with don't want doulas around because they think they are trouble makers. I often have to defend the position doulas are put in by patients to my coworkers and since there isn't alot of doulas that are brought to our hospital- even one bad experience can have a lasting impact and you won't see those nurse recommend doulas to women nor welcome them to the floor.
Just be honest about the chance of them not having the freedom they think they are going to have and what alternatives you can provide should the plans change. Especially when you are dealing with a VBAC- there is very high risk to the dr’s and they aren't going to play around- they are going to watch that baby like a hawk even at the expense of the mother’s desires.
Sorry this is so long. I do hope some of it helps you.

Thank you Rya, your response definitely helps. It's really nice to hear the perspective of an L&D nurse, I try so hard to be as sweet as possible to nurses and I really appreciate insight to the way they see things.

I am feeling better and more prepared to talk to this prospective client tomorrow.

Working as a doula means helping women get through their pain to the other side (where they aren't pregnant anymore). I really do think that learning to be ok with her discomfort is something that doulas and midwives need to be able to do. Women hire us because we're there to reassure them that the pain is normal, it's ok and they can get through it.

Thank you for reminding me of this. I really need to work on this if i'm going to serve a birthing woman effectively, it's definitly been hard for me. Much harder than I thought.

To add to this, our clients look to us for reassurance that they're doing ok. If we offer them the epidural or our body language, choice of words, etc convey that we think they aren't doing well then we can undermine their confidence.

I talk to partners prenatally about how sometimes (oftentimes) a woman who is coping quite well in labor can look like she's suffering. We also talk about coping vs suffering. Its ok to feel pain, but when the pain is so all consuming and you feel that you just can't cope any more, you just can't do one more contraction, it may have changed from coping to suffering, then we need to explore other options. If mom looks to her partner for reassurance and they offer her drugs, she may feel like she's ok, but start to doubt that she really is because her partner presumably knows her best and if he/she thinks she's not doing well them maybe she isn't. It's a really fast and easy way to undermine her confidence, and it's likely that afterward she may have feelings of resentment. So what can we do about that?

I usually suggest that mom develop a code word that means "I'm done, I'm suffering, I want out, now." Penny Simkin speaks on Pain vs Suffering and has found that women who use a code word are actually less prone to accept drugs. They know they have an out, they know that at the mention of a word that the wheels will be put into motion to try and eliminate the pain with medication. On the other hand if she gives us her code word I will ask "Are you sure?" and if she says yes we call for the nurse and get the ball rolling on medical pain relief.

Wow, how awful to have to witness a traumatic birth experience and not be able to do a darn thing about it. I'm so sorry that happened.

As for the epidural though, it is definitely not a guarantee of freedom from suffering or a miserable birth experience. I personally know women (friends, not clients) who had an epidural and experienced: an epidural fever leading to emergency c-section, incomplete/patchy relief that resulted in horrific pain, a stalled labor that lasted hours longer than it should have, and major breastfeeding problems due to weak latch.

Anyone who is suffering and wants an epidural should have one, but I think it's really common for women having a normal labor, who are committed to having a natural birth, to have a phase where they are freaking out and would take that epidural had it been mentioned at that point, but were ELATED when that hard part was over and no epidural was used (myself included). This is one place I think some L&D nurses may not realize the difference between women who are vocalizing and complaining, but really just want positive encouragement and support to carry on, vs. those that are not coping and want the drugs, now. Like Angie, I warn expectant dads that labor can look and sound really scary when mom is really into it, but this is a coping mechanism and it's normal. I'm not an expert yet, but I don't think an excruciating pushing experience where the OB's hand is in the cervix is typical (or even foreseeable?).

I do wish that moms doing hypnobirthing or hypnobabies would stop chosing high c-section rate OB/GYN practices and hospitals with mom & baby unfriendly rules!

Thank you so much for your response Summermoon & Doula CBE. I think you are so right about how the hospital staff typically sees a laboring woman, and that is exactly why a doula can make such a difference right?

Re-reading my initial post I'm kind of struck by this:

"If a client has done her birth education and preparation in a way that is TOTALLY ANTITHETICAL to the birthplace and birth attendant she has chosen, I feel like it is my responsibility to be real with her and judiciously find her a practical middle ground, [I]if my ultimate goal is a safe and satisfying birthing experience for her."[/I]

I feel like here I am placing too much responsibility on myself for the outcome. Of course I want her birth to be safe and satisfying but I feel like my ultimate goal should be support and respect for her journey. A challenging experience is an excellent teacher and women are SO strong, I am continually learning this secret.

I had a really good meeting with this woman today, she was awesome. I 100% believe she can birth her baby without an epidural no matter what's going on and I am going to be enthusiastic about telling her that during her birth.

DoulaCBE I totally referenced Penny Simkin and suggested she and her man talk about a code word! You guys are giving me great ideas for encouraging things to say to her during labor, thank you!

This is a great post. I think we have all been here. I will be dealing with much of the same as there are very few providers that support natural birth. What word did my friend use? Schitzo, they preach that yeah they will do this and that and then once the mother is in labor its another story. I am praying the CNMs are on call when my clients go into labor. Thank you for posting as it's helping me in the way I think about it as well.

There will be a time in your career as a doula that you will know you changed the outcome. With time and experience you will gain knowledge and skills that can really help you effect change. We have a journey of our own and this is part of it. I have births where I think back and say "Man if I only knew then what I know now I could have suggested X or done Y and things might have turned out differently." Ultimately though you're right, it should always come back to supporting this family on their birth journey and sometimes our job is to merely be present, accepting and supporting.