Saturday, May 6, 2006

doula interview number two

She was very nice and is probably an excellent doula for couples who are absolutely committed to a natural birth. Long, blonde hair, a comforting, calming voice, a lifestyle congruent with her beliefs and values ... organic foods, locally-supported agricultural co-ops, homeschooled children, attachment parenting, babies in slings, gentle discipline. We had to admire that about her.

But after spending time with her this morning, both Steve and I definitely felt we clicked better with doula number one. This one has clear biases in favor of natural childbirth - and against "medically managed" births. Not that her opinions are wrong, and yes, we do hope for a natural birth if that's how it turns out. But I don't want to feel guilty, or like I failed somehow, if it doesn't turn out that way. And ... I think that's how I'd feel with this doula. We told her about some friends of ours, who went in thinking maybe they'd try to go natural, but they were flexible about it. The mother ended up having a narcotic painkiller and an epidural, plus an episiotomy. The doula listened with a look of something between sympathy and disdain, and said: "And they felt this was a good birth?" Hello ... judgmental?! They had their beautiful baby, and she is healthy, and they made their own choices, and they are happy. Doesn't that count for something?

She did have a lot of experience - five years of attending births. And she gave us some food for thought about what we might encounter at our particular hospital, which apparently is known for a higher degree of medical management than some. We learned, for example, that we may have to be more assertive about declining drugs and an episiotomy if that's what we choose to do.

She also put some seeds of worry in my head, making me rethink our decision to go to an OB clinic with no midwives. I have had other friends tell me what good experiences they had with midwives - more personal care and attention from prenatal checkups through the birth; more mother-focused, less clinical treatment throughout labor and delivery. But I was willing to let it go because we have an OB we like and who is well-respected. (And hey, we are going to have a doula there.) Now, though, after talking with this doula today, I am somewhat regretting not having sought out a clinic that offers midwives. I think I may check around at my old clinic - I know they have midwives, and I know they deliver at another St. Paul hospital near ours - a hospital that has birthing tubs, to boot. Ugh. I don't know. I don't like that she left me second-guessing things. Maybe it doesn't matter. Maybe we're fine where we are. But maybe it's worth checking further if this is something important to me.

Anyway, we won't be hiring her. She raised some really valid points, but I didn't feel jazzed and empowered after she left like I did with the first doula. Neither did Steve. (He told me afterward he could see the worried looks I was getting on my face, and he didn't like it!) This is a good thing. It makes the decision easier. We have one more woman left to interview, and then we'll make our choice.


liz said...

Well, for what it's worth, I'm glad that Doula #2 is out of the running, since it's always nice to have those decisions made easier for us! Though I'm sorry to hear she made you question some of your choices. I can see how it would be nice to look into midwives, but I would also think that if you like your OB, then that counts for a LOT. Isn't it more important that you interact well and feel well cared for (does that get hyphenated?!), then what the person's title is - OB v. midwife? I'm sure there's no harm in looking around, but I wouldn't want you to give up an OB you love in favor of a midwife you don't.

Emilie said...

Liz - Those things are important, true, and we do like our OB. As doctors go, he is good, and Steve likes him, too, which is important. (By coincidence, he delivered my sister-in-law's two children, by C-section, and he is apparently a very good surgeon.) But if I have a normal labor, the odds are that he will not be the one who actually delivers our baby, since they rotate on an on-call basis. If we had a midwife, it's more likely that she would be the one delivering, as well. So there's more a sense of continuity from prenatal care through delivery.

And midwives, I have heard, take a different philosophy than OBs do in the delivery room; it's not just about the title. Here's something I pulled from HealthEast's Web site:

Certified nurse midwives focus on birth as a natural event, providing support to women throughout the normal process of labor and delivery. Stressing the importance of the non-medical, as well as the medical, aspects of pregnancy, childbirth and breast feeding, they concentrate on the physical, emotional and social well-being of the mother and her extended family.

We have an appointment with our OB on Friday, and I think we'll just ask him about all this stuff and see what he says. I really would hate to leave him, and maybe he'll give me the reassurance I need.

Emilie said...

Just to add: I think one of my fears is that I'll be having a "normal" labor and be doing OK with it, but there will be a lot of pressure to choose clinical/medical options just because they're there. Or that the nurse will slip a drug into my IV without me having the presence of mind to think through whether I really want it, or that I'll say OK in a moment of pain, just because it's offered. Or that they'll bring out the episiotomy tray and start cutting without telling me because that's what they do with everyone, even if I don't really need one. (I've heard of those things happening.) I know that just because there are certain ways of doing things in the medical world, they aren't necessarily the *only* ways. Midwives are less likely to take this approach, from all I've heard.

Of course, all this might end up going out the window, and I will decide (once I've learned what labor actually feels like) that I want nothing more than to give myself over to complete medical management! At any rate, this is one reason having a doula is important to me, and thank God Steve is on board with that, as well.

liz said...

You know, I wasn't really clear - I do have a bit of familiarity with midwives (my friend is one) and of course you are right that it's more than just a difference in title! Silly me. I think I just meant that if you like your OB and hospital, then you can probably have confidence that they will try to follow your birth plan as much as possible. I bet those mishaps (with unwanted episiotomies, etc.) happen most frequently when there is a disconnect from the start about philosophy. But if you and your OB are on the same page now, I'm guessing you will be in the heat of battle, too. And I would think that a doula's presence would be incredibly helpful in that regard as well.

Midwives are SO great, but liking your OB is pretty great, too. I wonder if there's any way you can have both. At any rate, having a doula will be superb. I hope you have a reassuring appointment this week!

Emilie said...

Therein lies the dilemma, Liz. As you know, we like our doctor, and I'm happy with the prenatal care I'm receiving, but we haven't talked gotten to the point of talking with him about what to expect from the actual hospital. (Maybe we should have done that early on.) And that will be a whole different ball game, since he most likely won't be there for delivery, and even if he is the one who delivers our baby, we won't see him until the very end. (We're actually encouraged to get to know the other doctors in the clinic for that reason.)

The doula we met Saturday said our hospital is one of the most "medically managed" birth centers in the area, largely because it handles quite a few high-risk births as well as normal ones. She said when she has worked there as a doula, she has noticed things that made her have to step up her intermediary/advocacy role between the staff and the parents. When I asked her about other hospitals, she said they were like yin and yang (particularly with the presence of a midwife).

This was something I hadn't heard prior to talking to this doula, though. I have also heard good things about our hospital. It probably all depends on one's outlook toward the whole birth process!

I'm sure I'll have a better feeling - and definitely more knowledge - after we talk to our doctor on Friday.

Thanks for being a sounding board and letting me hash through my feelings on here, though. I appreciate it! :)

Emilie said...

Oh, and the other thing that triggered some worry was this post on my TTC board last week:

My labor & delivery nurse was telling us that when people come in with all sorts of detailed birth plans, they might as well have c-section written across their forehead. She said at least 90% of the people who want to follow detailed plans are so focused on their plan, they cannot relax and let their body do what it is supposed to and therefore, end up having a c-section.

Frankly, I wouldn't want to labor within 100 feet of a nurse like that! I would imagine that some of the anxiety she is talking about might be the result of an unsupportive and uncooperative medical staff ... Obviously, parents have to go in with a degree of flexibility, but I think they also have the right to go in expecting a level of support that is in line with their desires. (In all fairness, I have heard good things about the nurses at our hospital, so maybe I have nothing to worry about!)