The Blog post “Doula’s and Don’ts” (http://greatminuseight.wordpress.com/2014/04/14/21-doulas-and-donts-my-cautionary-tale/) seems to have appeared on every birth oriented Facebook page and group recently – as a warning. Cautioning doulas to “make sure you practice within your scope” and warning women “doulas aren’t allowed to give medical advice”. Both are VERY important messages and it is important to see these discussions – important for doulas to remember that they are accountable for their actions, important to remember our scope of practice and important for families to be aware of just what a doula can and can’t do.
But I’d like to look at a couple of different issues which really jumped out at me. These issues are TRUST and RESPONSIBILITY. At the end of her article the writer tells us to “listen to your doctors” as though this would solve all problems. But let’s for a moment ponder why some women DON’T trust their care providers. We didn’t just wake up one day and start a “don’t trust the doctors” movement – these are doctors, after all, not politicians and are generally considered to be quite trustworthy. So why did we stop trusting them? Women did trust doctors and (some) doctors betrayed that trust by using intervention/s when not necessary. Trusting doctors gave us a 30% c-section rate. For some of us: trusting doctors left us or our babies with hospital acquired infections. For some of us it left us with babies spending time in the NICU for iatrogenic prematurity. For some of us it meant that we suffered life threatening placenta problems in future pregnancies. Trusting doctors put many of us at a higher risk of death. Trusting doctors left many of us with significant birth trauma.
The writer herself states that “I wanted nothing to do with the hooked-up, overly medicated and doctor-controlled environment of modern births I’d seen and heard about.”
Almost every woman has heard a tale that goes the same as the one in the original blog – except with the word “doula” replaced with “OB” or “midwife”. “My OB told me that I had to undergo a) test because that’s just what they do, and then as a result of that I needed to undergo b) procedure, which led to c) procedure which set me on the path of the cascade of interventions and my baby ended up in the special care nursery or NICU and months later I’m still suffering the effects of birth trauma. So, if trusting my OB got me into this situation the solution is simple – next time I won’t trust them”. And it is NOT the fault of doula’s that our obstetric culture has betrayed women for so long.
So why is it that the onus is on women to trust their doctors? Why aren’t doctors being asked to do more to earn that trust?
How can women be expected to have safe and positive births when they feel that they can’t trust their care providers? Instead of (or perhaps as well as) getting angry at a doula who operated outside her scope, perhaps we should be getting angry at a system that has left women feeling like they can’t trust their care providers to give them accurate, honest, unbiased information and advice. Because this is what happens when women feel they can’t trust their care providers – babies get harmed.
When I made the choice to birth within our hospital system a second time one of my biggest issues was trust. I bawled my eyes out in a birth trauma support group as I spoke about my lack of trust in our medicalised birthing culture. I shared how scared I was that I would just automatically say “no” to every single suggestion made by my care providers, simply because I didn’t trust them to be giving me advice that was in my best interests, and that this would cause my baby to be harmed. Many women face this risk.
“From the start, my doctor was the enemy, someone to be dodged and avoided, my appointments and checkups to be feared, and my birth plan was to avoid my ob’s intervention at virtually any cost.”
I see it every day online – women posting that they have just been to see their OB who has told them they must undergo a certain test or procedure and then they hop online and ask “is that right”? “Is there actually evidence to back this up”? “What are my alternatives”? “Do I really have to just do what they say”? Or they say “I’m off to see my OB today. I know he’s going to try and make me set a date for a cs / induction. Hopefully I can win this fight. Wish me luck”. I find it sad that women feel the need to ask for “luck” to get through an appointment with their care provider.
Women seem to feel that their only options are the obstetric culture of “every birth needs intervention” or alternatively “no birth needs intervention”. Why aren’t women being told that there is a third option – that every pregnancy and birth is unique and sometimes intervention will be necessary and sometimes (perhaps most often) it won’t. Why aren’t women being offered individualised care from a known care provider? The doula in the article told the writer that had she had a homebirth the baby would have been fine. I cannot say whether this is accurate (although from the story it sounds like this is definitely not true) but if the writer had a care provider she trusted, one who she felt would only recommend intervention if necessary, then maybe the baby would have been fine. Because the woman would likely have consented to the intervention as she trusted her care providers advice and intentions. If you truly don’t trust your care provider’s advice and recommendations then you need more than a doula – you need a new care provider.
And this is where things can get tricky as options for a lot of women are limited. Not every woman has access to gold standard, continuity of midwifery care. Many women in the public system find that they see a different midwife or ob each appointment and then will likely have someone they’ve never met at their birth. Even women who hire a private OB may find that they have someone unknown to them at their birth. Not every woman has access to (or the ability to afford) a private midwife, for either a homebirth or a hospital birth. And this is what happens when women’s choices and options are restricted: they are forced to hire a care provider they don’t fully trust and when women feel that they can’t trust their care providers babies get harmed.
So is the idea that you should trust your doctor really any better than you should trust your doula? This brings me to the point about responsibility and something which may come as a surprise to some people – neither your care provider nor your doula is responsible for the health care decisions you make for yourself and your family. Guess who is responsible? YOU! We seem to have forgotten that when we choose to become parents we choose to take on a massive responsibility and that we become responsible for making some BIG decisions. And this responsibility can’t be delegated.
Why did we stop taking responsibility for our own care? Again let’s talk about obstetric culture. The culture that tells us, oh so subtly, that we are not capable of making good choices for ourselves and our families. The first thing we do when we get pregnant is that we go and see a doctor. And they tell us what to do. Go for this scan and that test, don’t eat or drink anything from this long list. They don’t give us information about the risks and benefits and tell us we should do some research and make an informed choice. How many of us have gotten to 28 weeks and just been given the form to go get the GTT done? How many of us were told of the risks and benefits of this? Was anyone out there told they didn’t actually have to do the test? That, not only are you allowed to make this decision – it is actually your responsibility to make this decision. Again I see it online all the time “my OB has said I’m not allowed to go overdue”, “I don’t really want to do such and such test or procedure but my OB said I have to”. Your OB doesn’t have the right to make decisions for you – YOU have the sole responsibility for making decisions in regards to your baby’s health and well being. If you want to hide behind an OB (or midwife or doula) who said you must do this or that then fine – but that doesn’t make you any less responsible for what happens.
For me the moral of the story isn’t to trust your doctor or your doula. Because it isn’t one or the other. Choose people for your team based on how they will help you achieve your goals, trust them to assist you but remember to trust yourself. Because you are the mum, you are the decision maker and you are the one who has to live with what happens.