# repercussions of doula's redefining the word "advocate"



## jennica (Aug 10, 2005)

The word advocate means;

From Dictionary.com

advocate
-verb (used with object)
1.*to speak* or write *in favor of*; *support or urge by argument*; recommend publicly: He advocated higher salaries for teachers.
-noun
2.a person who speaks or writes in support or defense of a person, cause, etc. (usually fol. by of): an advocate of peace.
3.a person who pleads for or in behalf of another; *intercessor.*
4.a person who pleads the cause of another in a court of law.

intercessor
-noun
a person who intercedes.

Advocate does NOT mean, "to empower, to support (just support), to encourage, to remind, or to hold the space for".

Now, I am not making judgements about doulas here or doula certifying organizations, because I realize they are in a pickle, and if they did actually advocate, they would risk being barred from the delivery room altogether. I just want to discuss what the ramifications of calling yourself an advocate, yet clearly not advocating, are. And why exactly do doulas, and some doula certifying agencies, use a term that they do not really fulfill? Why confuse what your role is by using a term, and then redefining the term? Why not simply leave the term out of it?

If you say, "I'm an advocate for you" and then stand by and watch a birth go sour, powerless to do anything lest you lose your certification, what affect does this have on the mother? And if she comes back and says, "you didn't advocate for me", you will just say "no, I DID, it's just that, well, when we say advocate we don't mean advocate." Huh? Honestly, does this really fly in the doula world? How do you doulas reconcile this obvious conflict?

I think that representing oneself as an advocate, and then being unwilling to actually advocate, sets women up to arrive at their births unprepared to protect themselves. It also leads to feelings of anger and betrayal at the doula, as in, "why didn't she say something? why did she just stand there and watch this happen?" It also leads to the doula feeling traumatized, and being forced into a role where she has to witness clients being manipulated, coerced, or abused, yet she is powerless to do anything about it.

There is also the issue of a doula, who is not allowed to actually advocate, yet who has to try to convince clients that this alternate made-up definition of the term advocate is really what advocate means despite what your dictionary may say, has to then sugar coat the birth to make for good birth memories for the clients. Doesn't this feel like jumping through many convoluted hoops for the doula? So, if a birth goes sour, and a doula is forced to simply stand by and watch, she then must convince her clients that advocate doesn't really mean advocate, and that the birth was actually a great experience, despite the trauma the woman herself may actually be feeling. And some certifying agencies actually discourage contact between clients and doulas after the 1 or 2 postpartum visits, so when the woman's true feelings of the birth do come to the surface, the doula, who "held the space", who "protected the memory" is generally long gone out of that woman's life, which makes true processing impossible.

How does this benefit women in the long run? The hospitals can just keep getting worse and worse, and doula's can just keep buffering and reframing it to the clients. But then will change ever occur?

Of course, my above comments are only applicable in cases were an "advocate" is needed. In wonderful smooth hospital or home births, a doula can simply do what a doula does best and support and comfort the mother. I wish that is how all births went and then this wouldn't even be an issue. But the truth is, the hospital system is not a great place to give birth in, and doulas must encounter this issue quite often I would imagine.

I had a doula and I found her to be a big comfort, and to some extent an advocate, but she could only go so far and her main job was trying to reduce the stress on me that was being caused by the hospital staff. So, I am not anti-doula, I am simply wondering how they and others feel about these issues.


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## sapphire_chan (May 2, 2005)

I don't know, but that's exactly why my interest in becoming a doula lasted all of a week.

I thought the whole point was to speak for those who could not speak for themselves due to the hormones of labor so that women could be in their own space and in control of their own births without having to worry about pressure from the outside world. So that women didn't have to say "yes" again to what they had already asked for or "no" again to what they had already refused.

But it isn't. And if you try to make it that, you get in trouble and get a bunch of other people in trouble too.


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## BensMom (May 4, 2002)

I dont think I have ever used that term in reference to myself to a client. I am a birth advocate in the general sense of the word, in my work with the community, our birth network, etc. But as a doula, I define my role as one who supports and educates the families and helps them learn how to advocate for themselves. Handing over that job to a doula is no better than handing over your birth to an OB. I think a grander goal is to give the power back to the birthing families.


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## channelofpeace (Jul 14, 2005)

Quote:


Originally Posted by *BensMom* 
I dont think I have ever used that term in reference to myself to a client. I am a birth advocate in the general sense of the word, in my work with the community, our birth network, etc. But as a doula, I define my role as one who supports and educates the families and helps them learn how to advocate for themselves. *Handing over that job to a doula is no better than handing over your birth to an OB. I think a grander goal is to give the power back to the birthing families.*











It isn't my job to get them the birth they want. I can remind a woman/ her partner of her desires in the heat of the moment, but it is her birth, she must advocate for herself.


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## SublimeBirthGirl (Sep 9, 2005)

I am very specific that I am NOT their advocate. I am their support and their memory, more than anything else. I tell them, dad has to advocate for mom if she becomes unable to advocate for herself. I'm not certified and have no interest in certifying, so it's not that for me. I think about the greater good, and women being deprived of doulas because of something I do that causes some hospital to outlaw them. I am also not a particularly confrontational person and the idea of fighting with medical staff gives me cold sweats.

So, I'll say, "Do you want a few minutes to think about that?" when nurses suggest things, so that when the nurse leaves I can tell them what I know and they can make a decision. I say, "What did your birth plan say about X?" to remind the mom to remind the doctor about what she wants.


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## sapphire_chan (May 2, 2005)

Getting the *family* to advocate I can see, but getting women to advocate for themselves during labor? Too much neocortex.


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## channelofpeace (Jul 14, 2005)

And that is why, in a perfect world, woman and their care providers would be on the same page... so you aren't hashing things out during labor. One of the huge disadvantages of birth in a hospital.


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## jennica (Aug 10, 2005)

Quote:


Originally Posted by *sapphire_chan* 
Getting the *family* to advocate I can see, but getting women to advocate for themselves during labor? Too much neocortex.


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## txgal (Jul 16, 2003)

I agree with others, I am very specific that I can not speak for them in labor. Most of the work I do happens before labor, when we discuss the birth plan and I make sure the parents are well educated about the possibilities. Of course we can't talk about everything, but I make sure they have a pretty strong grasp of the common procedures so that I don't have to start from scratch when the doc comes in and wants XYZ... I can tell clients I can remind them what is in their birth plan and help them get the information they need to make an informed decision, but I will not speak for them.


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## honeybee (Mar 12, 2004)

I remember my doula very specifically telling us what her role did and did not entail. She was very specific in saying that she would help facillitate communication, but that the decisions would all be up to me and dh. So, I never felt like her role was to "advocate" for me.

I think it's a really hard line for a doula to walk. Because the family really does need to be the ones with the power and the responsibility, and should be advocating for themselves (although, ideally, they would have supportive caregivers and "advocating" wouldn't be necessary). But, often moms really aren't in a good position to advocate for themselves while in labor, and they do NEED an advocate. And sometimes it really is in mom's best interests for the doula to assert herself a bit more. I know my doula suggested that I get a cervical check, based on my emotional and physical signposts. My nurse, who had not been around during my laboring, poked her head in and said cervical checks were not a good idea since my water had broken, and how about a bath instead? That sounded good to me, but I didn't realize I would have to wait another hour while she went and "got permission" from my doc to use the bath. Meanwhile, my vocalizations really changed, and my doula made a stronger suggestion that I might be ready to push, and perhaps I would like an exam? When I said okay, she went to find the nurse. I found out later she had to practically drag her back into the room so we could tell her I wanted an exam. Sure enough, I was complete and baby was not much longer in coming! So, thanks to my doula choosing an appropriate moment to be a bit more assertive, ds1 was NOT born on the toilet!










There was another point in the birth, when my doula's encouragement/suggestion turned out not to be the best course of action. I was finally told it was okay to push (although my body'd been doing so for awhile at that point all on its own anyways), and my doc asked if I wanted to change positions for labor, as per my birth plan. Worn out and not wanting to make a decision, I heard my doula say that I was progressing really well the way I was, so I just stayed there. Well, in hindsight I'm pretty sure the lithotomy position was the cause of my 3rd degree tear. So, I kind of wish someone... doula or doc... had given me a bit more of a push to change positions. Staying put is what I wanted to hear at the time, but not what I NEEDED to be told, kwim? But, really, it WAS my decision, and neither one of them are fortune tellers. So, I never blamed them or spent too much time kicking myself for that decision. I just chalked it up as a learning experience and decided that next time I would change positions! (Well, next time I stayed home and never had to get back in a stupid bed to begin with, but that's another story!)


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## April422 (Nov 28, 2007)

I'd really like to see this thread moved or re-posted in the Birth Professionals area, is that a possibility?

I know there has to be more than 9 people willing to give it some deep thought and a good discussion!


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## MammaB21 (Oct 30, 2007)

Quote:


Originally Posted by *sapphire_chan* 
Getting the *family* to advocate I can see, but getting women to advocate for themselves during labor? Too much neocortex.

Yup, I think it is unreasonable to expect a laboring woman to have to fight her way thru her birth, even after being upfront about what she wants and doesn't want.

If you write in your birth plan, I don't want my water broken for any reason. You shouldn't have to fight off nurses, and docs your entire birth to not get your water broken. This is the part that makes me so angry about the system. Why can't the doula just say, "it is in her birth plan that she doesn't want her water broken." The doula isn't 'making' the discision for the mother. She is reminding everyone in the room that the mother has allready made her decision.

Okay, so I know what the answer is and 'why' they can't do that. It just makes me mad is all.


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## Belle (Feb 6, 2005)

Quote:


Originally Posted by *sapphire_chan* 
Getting the *family* to advocate I can see, but getting women to advocate for themselves during labor? Too much neocortex.

No, I simply remind her and her partner of their desires that they had communicated to me ahead time. Birth is not the time to be going over this.

For instance,
Mom expresses to me that she doesn't want an episiotomy. Doctor picks up the scissors. I say "Mom, Dr. So and so is going to do an episiotomy, is that okay with you?" Chances are she's going to say no. If I hadn't said anything then she would have had no voice whatsoever. Pushing is not the time to be making any decisions that require heavy thinking.

I really hate that birth advocacy is neccesary. I think all women's choices should be valued.


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## onetwoten (Aug 13, 2007)

Quote:


Originally Posted by *Belle* 
No, I simply remind her and her partner of their desires that they had communicated to me ahead time. Birth is not the time to be going over this.

For instance,
Mom expresses to me that she doesn't want an episiotomy. Doctor picks up the scissors. I say "Mom, Dr. So and so is going to do an episiotomy, is that okay with you?" Chances are she's going to say no. If I hadn't said anything then she would have had no voice whatsoever. Pushing is not the time to be making any decisions that require heavy thinking.

I really hate that birth advocacy is neccesary. I think all women's choices should be valued.

This is what I have told my clients I will do. I have it written into the contract that I will not be making decisions or having 'discussions' with their providers, but make it clear that I will get as much information as I can beforehand, so that if the doctor asks me a question, I can say "Well Sarah here said she didn't want the pitocin, but we'll let you know if she changes her mind". Or... if I see him starting something she doesn't want, I have told clients I will do exactly as the PP said- I will loudly confirm with the clients that this is NOT what they had wanted.

It's not up to me that yell at the doctor to put down the scissors immediately- but it is up to me to make sure that the woman is able to make her choices heard. So if she's in the middle of a contraction and I see the doctor reach for the IV, or the scissors, or whatever it may be, then I'm going to let him know that he needs to wait until the woman is able to talk to him.

I think one of the big worries of being an "advocate" is that the woman will start to lean on your ot make their decisions for them- and then as PP'er mentioned- you're no better than an OBGYN..


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *jeninejessica* 
This is what I have told my clients I will do. I have it written into the contract that I will not be making decisions or having 'discussions' with their providers, but make it clear that I will get as much information as I can beforehand, so that if the doctor asks me a question, I can say "Well Sarah here said she didn't want the pitocin, but we'll let you know if she changes her mind". Or... if I see him starting something she doesn't want, I have told clients I will do exactly as the PP said- I will loudly confirm with the clients that this is NOT what they had wanted.

It's not up to me that yell at the doctor to put down the scissors immediately- but it is up to me to make sure that the woman is able to make her choices heard. So if she's in the middle of a contraction and I see the doctor reach for the IV, or the scissors, or whatever it may be, then I'm going to let him know that he needs to wait until the woman is able to talk to him.

To me, this would count as advocating.

I could've sworn I'd read a doula someplace write about not being able to talk to the hospital staff at all, only the laboring mother. It was this huge thing about how it didn't matter if the mother had already made her wishes totally clear she had to be the one to fight for them in labor. The doula could only stand by her and offer support, can't say anything bad like "the doctor wants to do X, you requested no X in your birth plan." Can't "lead" the client into refusing things even if you're 99% sure she's only saying "yes" because of the way labor makes some women complacent, even if she'd said before labor that she absolutely did not want something.

If you are allowed to say, "her birth plan said no X, you need to give her a chance to consent or refuse" that's a huge improvement. If you're allowed to tell nurses "she would prefer no vaginal exams, you'll need to have the doctor come in here and get her consent if s/he feels an exam is necessary." If you can say "Sally has asked not to be coached during pushing, please respect her wishes" and do things like turn the lights back down, the music back up, and keep people from telling your client to be more quiet in labor--that's advocating.


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## Belle (Feb 6, 2005)

Quote:


Originally Posted by *sapphire_chan* 
To me, this would count as advocating.

I could've sworn I'd read a doula someplace write about not being able to talk to the hospital staff at all, only the laboring mother. It was this huge thing about how it didn't matter if the mother had already made her wishes totally clear she had to be the one to fight for them in labor. The doula could only stand by her and offer support, can't say anything bad like "the doctor wants to do X, you requested no X in your birth plan." Can't "lead" the client into refusing things even if you're 99% sure she's only saying "yes" because of the way labor makes some women complacent, even if she'd said before labor that she absolutely did not want something.

If you are allowed to say, "her birth plan said no X, you need to give her a chance to consent or refuse" that's a huge improvement. If you're allowed to tell nurses "she would prefer no vaginal exams, you'll need to have the doctor come in here and get her consent if s/he feels an exam is necessary." If you can say "Sally has asked not to be coached during pushing, please respect her wishes" and do things like turn the lights back down, the music back up, and keep people from telling your client to be more quiet in labor--that's advocating.

Your first paragraph is correct. I remind her of her previous decisions. I don't get into direct conversations with doctors. I _have_ communicated Mom's wishes to nurses. But I develop a lot more report with nurses while I'm there. Doctors only show up for catching. Almost every nurse I've worked with liked having me there because I made her job easier.


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## jenneology (Oct 22, 2007)

Jennica, thank you for posting this discussion! You know I have been frustrated by these pondering and I'm glad you were able to put the words together that I struggled to come up with and then thought to post it here. Thank you!!!


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## CorasMama (May 10, 2002)

:


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## paquerette (Oct 16, 2004)

I wonder if it's different with different doula training programs. It was presented to me that the scenarios of telling the mom "dr is about to do an epis, is that what you want?" and telling the dr "mom did not want an epis. can you talk to her about why you want to do one now?" etc are both appropriate to do, depending on which you feel is more appropriate in the situation. We were, of course, taught that it doesn't pay to get snippy or bitchy or argumentative with the staff, and that even being respectful and gentle in the things we say to them is no guarantee that someone will not get their panties in a wad. But we were not taught never to talk to the staff or anything like that.


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## jennica (Aug 10, 2005)

I should be clear here, that I don't think the doulas themselves are presenting themselves as advocates (they perpetuate it by brochures and things they give out, but they didn't come up with the term and present it to people on their own accord). I do think that the doula certifying agencies are though. If anything, I think that the doulas themselves are trying to counteract this term with prenatal counseling, and since the term is used, and used incorrectly, the doula is standing there with the job of redefining it to her clients. Maybe some doulas do a great job of this, and maybe some don't. A lot of women think that doulas are supposed to advocate, because the agencies tell us that is what they do, printed material lists "advocacy" on it, and websites and books call doulas advocates. Yet they are prohibited from truly advocating. Women are then left to fend for themselves in a hospital during labor. I know what it is like to have people asking you "did you want this, did you want that" during labor, and no, it didn't remind me of what I wanted, it made me feel like I was being yelled at to make one decision after another. If this is advocating, then it is a very poor method of doing so.


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## Belle (Feb 6, 2005)

Quote:


Originally Posted by *jennica* 
Yet they are prohibited from truly advocating. Women are then left to fend for themselves in a hospital during labor. I know what it is like to have people asking you "did you want this, did you want that" during labor, and no, it didn't remind me of what I wanted, it made me feel like I was being yelled at to make one decision after another. If this is advocating, then it is a very poor method of doing so.

I agree. It is really frustrating from a doula's perspective. Most of us have gotten into this line of work because we believe in the rights of birthing women. But we cannot make decisions for the parents and we cannot get into confrontations with doctors. I have gone home from a birth really depressed because once the doctor asserted her authority and put her foot down, I was pretty powerless to stop her. I tried the best I could but I swear this doctor when out of her way to punish this woman simply because she was a teen mom. Its maddening.


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *Belle* 
Your first paragraph is correct. I remind her of her previous decisions.

Oops, sorry that wasn't clear. From what I remember, the person said that saying something like "you said you didn't want an epidural" would be considered "leading" the mother.


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## Sage.Naissance (Feb 5, 2008)

Very good topic of discussion. Thanks for bringing it up, and thanks also for posting the definition.
Very interesting. How proactive I am in a birth depends on the client, however I am always non-combattive and communication works well without too much thought. I do talk to the hospital staff and they talk to me. They often ask me questions about the client. Depending on the question I may answer or I may relay the question to the client.
I just wrote a lengthy post on the role of the doula, and a doulas responsibility(or lack thereof) and a womans responsibility for her birth experience which I think pertains to this discussion, if you are interested in reading it.
http://www.mothering.com/discussions...d.php?t=907778

One of the reasons why I do not certify is because I often do not like the language or certain philosophys of the certifying agency.


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## channelofpeace (Jul 14, 2005)

Do you have specific agencies in mind, jennica? I trained with ALACE and never was under the impression that i would be advocating, nor do i recall them using the term in their literature. I quick peruse of their website doesn't lead me to the term "advocate" either


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## Belle (Feb 6, 2005)

Quote:


Originally Posted by *sapphire_chan* 
Oops, sorry that wasn't clear. From what I remember, the person said that saying something like "you said you didn't want an epidural" would be considered "leading" the mother.

ooh, that is a whole different thing. We were talking about advocacy. This is more along the lines of support. We are tight rope walking advocates. *Support* is what we do.

Way before a mom is even asking for an epidural a doula should be able to tell if mom is having trouble coping. Suggesting trying something different for 5 contractions is usually what I would do. I always talk to moms before labor to let them know that I will try this. Once mom is asking for an epidural. I'm not going to try to talk her out of it on the basis that she said she didn't want one earlier. What Mom wants, Mom gets. This is very different from trying to prevent an unwanted intervention.


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *Belle* 
ooh, that is a whole different thing. We were talking about advocacy. This is more along the lines of support. We are tight rope walking advocates. *Support* is what we do.

Way before a mom is even asking for an epidural a doula should be able to tell if mom is having trouble coping. Suggesting trying something different for 5 contractions is usually what I would do. I always talk to moms before labor to let them know that I will try this. Once mom is asking for an epidural. I'm not going to try to talk her out of it on the basis that she said she didn't want one earlier. What Mom wants, Mom gets. This is very different from trying to prevent an unwanted intervention.

Oh, Mom wasn't asking for an epidural in the example, she was being offered one despite having said that she didn't even want to be offered one.

I suspect the doula in question was either exaggerating or was working in a super-hostile environment.


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## jennica (Aug 10, 2005)

Quote:


Originally Posted by *milkydoula* 
Do you have specific agencies in mind, jennica? I trained with ALACE and never was under the impression that i would be advocating, nor do i recall them using the term in their literature. I quick peruse of their website doesn't lead me to the term "advocate" either

From DONA's website:

Quote:

They are advocates and a listening ear for birthing mothers, as well as facilitators to her partner.


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## Belle (Feb 6, 2005)

Quote:


Originally Posted by *sapphire_chan* 
Oh, Mom wasn't asking for an epidural in the example, she was being offered one despite having said that she didn't even want to be offered one.

I suspect the doula in question was either exaggerating or was working in a super-hostile environment.

Ah, I missed that.


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## April422 (Nov 28, 2007)

Quote:


Originally Posted by *sapphire_chan* 
If you are allowed to say, "her birth plan said no X, you need to give her a chance to consent or refuse" that's a huge improvement. _*If you're allowed to tell nurses "she would prefer no vaginal exams, you'll need to have the doctor come in here and get her consent if s/he feels an exam is necessary.*_" If you can say "Sally has asked not to be coached during pushing, please respect her wishes" and do things like turn the lights back down, the music back up, and keep people from telling your client to be more quiet in labor--that's advocating.

Thing is, why can't the woman use her own voice?

As a doula I don't speak for my clients, I can't, neither can her partner unless he has medical power of attorney. At the end of the day it is the woman and the woman alone who can consent to or deny treatment. They're not going to listen to me, they're not going to listen to her partner, they need to hear it out of her mouth.

If a woman doesn't want a vaginal exam, she needs to say no. Not depend on a doula to jump between her and her care providers and the doula tell them what she does or doesn't want.

When I have someone call me and inquire about services and the word advocate comes up I'm very clear that I don't practice as an advocate for clients in the traditional sense. I will not, and can not speak on their behalf. Ethically and legally. I am a huge outspoken advocate for natural birth and informed consent in birth, but I can't not be a woman's voice.

If I see that things are deviating from her birthing goals, then I remind her of what we spoke about prenatally and ask if her plans have changed.

There are times when I will ask leading questions of the DR-Nurse-Midwife in order to start a conversation that will lead to informed consent. Or I'll simply turn to the client and say "we discussed prenatally your desire to avoid this particular intervention, would you like to ask any questions or do you want some time to think about it?"

And there are times where I'll turn to a nurse and ask if a particular alternative intervention may be appropriate. If cytotec is being mentioned and induction is necessary I may ask if they use cervidil at this hospital and open up the discussion between the nurse and the client about the benefits and risks of both.

But I don't come in and say "She doesn't want this." "She'd prefer to do that." It's no my job.


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *April422* 
Thing is, why can't the woman use her own voice?

Lots of women can't speak during contractions. Lots of women can't speak during transition. The very act of engaging the rational brain sufficiently to clearly say "don't do a vaginal exam" or even just "no!" will take many women out of the head space they need to be in to labor and will cause the labor to be more painful and could even stall their progress.

Physiologically, the neocortex should be stimulated as little as possible to best allow the body to give birth. Things like asking the mother questions or even just having conversations in the same room can severely hinder the fetal ejection reflex. "The most important thing is do not disturb the birthing woman" as Dr. Odent is known to say.

If the woman has used her own voice before even coming to the hospital in discussing things with both her care provider and her doula, if she has written her own wishes down, why should she have to think about it again? Why should someone who isn't even her care provider, like a nurse, be given the right to force her to respond to something she's already declined?


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## MammaB21 (Oct 30, 2007)

Quote:


Originally Posted by *sapphire_chan* 
Lots of women can't speak during contractions. Lots of women can't speak during transition. The very act of engaging the rational brain sufficiently to clearly say "don't do a vaginal exam" or even just "no!" will take many women out of the head space they need to be in to labor and will cause the labor to be more painful and could even stall their progress.

*Yeah, even AFTER labor this is true. After I gave birth to DD in the tub, I was asked what I wanted to do. My response...."I don't know, what do you think I should do?" Even though I had it in my birth plan what should be done, I was still asked, and at that time I had NO rational thinking in my head what.so.ever.*

Quote:

If the woman has used her own voice before even coming to the hospital in discussing things with both her care provider and her doula, if she has written her own wishes down, why should she have to think about it again? Why should someone who isn't even her care provider, like a nurse, be given the right to force her to respond to something she's already declined?


Exactly. Again, I will use my own experience. I had it in my birth plan NOT to offer me and epidural at all. I asked for one. I asked because I was not given any other means of pain management at the time. Thank god nobody listened. Had they complyed to my 'wishes' at the time, I would have been ferious at the hospital staff and my 'advocates' at my birth. Women say crazy things during labor. They are not in a mind frame to be making any decisions IMHO.


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## MammaB21 (Oct 30, 2007)

Sorry, my last post was not set up right. The bold is my response.


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## April422 (Nov 28, 2007)

Quote:


Originally Posted by *MammaB21* 
Exactly. Again, I will use my own experience. I had it in my birth plan NOT to offer me and epidural at all. I asked for one. I asked because I was not given any other means of pain management at the time. Thank god nobody listened. Had they complyed to my 'wishes' at the time, I would have been ferious at the hospital staff and my 'advocates' at my birth. Women say crazy things during labor. They are not in a mind frame to be making any decisions IMHO.


In 8 years as a doula i have to say in hospital, home and birth center clients I've never had a woman who couldn't refuse a vaginal exam, even if by simply closing her legs.

I've given birth myself, and I've never found myself unable to answer questions asked of me between contractions. I was able to decline vaginal exams, AROM, medication, etc. It didn't take much engagement of my rational brain at all.

I really don't agree that if a client gives in to say an epidural in a moment of weakness that it's the fault of her "team" that she did so. If client tells me she doesn't want meds prenatally and asks for meds during labor I ask if she's sure, I ask if she wants to wait for 5 more contractions to think about it, and if she says no to either of those, then we begin the process of getting set up for an epidural. Just as if a mom tells me she wants to transfer from the BC or home. It's not my job to doubt her, she's a big girl, she's free to change her mind and I'm not there to deny her or talk her out of it. I'll explain what needs to happen so we can get there and get the meds, and it's her choice to proceed or not.

I think that we do women a HUGE disservice by assuming that they're poor little helpless things in labor and can't make necessary decisions. Just imagine if the OB world decided such, what an uproar "that" would cause!

It takes the same amount of cortex to decide if you want to change position or decline a vaginal exam. It takes a bit more to make informed choices that might arise during labor, but in 90% of my clients who have unmedicated births it really hasn't been an issue at all.


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *April422* 
I really don't agree that if a client gives in to say an epidural in a moment of weakness that it's the fault of her "team" that she did so. If client tells me she doesn't want meds prenatally and asks for meds during labor I ask if she's sure, I ask if she wants to wait for 5 more contractions to think about it, and if she says no to either of those, then we begin the process of getting set up for an epidural.

You don't also suggest other techniques for pain management? I hope you didn't mention doing that because it's so obvious a thing to do.


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## April422 (Nov 28, 2007)

Quote:


Originally Posted by *sapphire_chan* 
You don't also suggest other techniques for pain management? I hope you didn't mention doing that because it's so obvious a thing to do.

suggestions are made throughout the course of labor. I was speaking from the assumption that we're using coping techniques throughout. To me that's a given. Even while waiting to get the IV in, the bolus delivered, waiting for the anest to come in we'd be continuing to use coping techniques to get her to the point where she is hopefully comfortable once the epidural is in place.


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *April422* 
suggestions are made throughout the course of labor. I was speaking from the assumption that we're using coping techniques throughout. To me that's a given. Even while waiting to get the IV in, the bolus delivered, waiting for the anest to come in we'd be continuing to use coping techniques to get her to the point where she is hopefully comfortable once the epidural is in place.

Whew. Had to double check because assumptions are bad, but that's what I figured you'd do.

I'll redirect you to a sentence from MammaB21's post:
"I asked because I was not given any other means of pain management at the time." Seems like a failure on the part of her birth team.


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## Synchro246 (Aug 8, 2005)

Quote:


Originally Posted by *April422* 
Thing is, why can't the woman use her own voice?

Like saphine chan said, it's because the part of the brain that needs to engage in this kind of decision making conversation NEEDs to turn off for effective labor.

From my own experience:
First labor--after transfer to hossy--I did advococate for myself a lot, but I also let a lot slide because I wasn't really there and I wasn't able to weigh risks and benefits.

Second labor--homebirth--Totally out of it. I experienced the miracle of natural childbirth complete with the total out-of-head hormones that caused me to be unconsious between contractions. It was so real. There is no way that 1) I would have experienced that hormonal situation in the hospital and 2) that in the hospital I would have been so away from such hormonal influence that I would have been an adequate advocate for myself.

You know how people can have a mis-trial because of bad representation in court even if they chose to reprsent themselves? Well, women don't make great self-representatives in labor, but there is no opportunity for mis-labor. No do-overs. It's really too bad that doulas can't be advocates in the true sense of the word.

NO. It's too bad that women need advocates at all


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## jennica (Aug 10, 2005)

Quote:


Originally Posted by *April422* 
In 8 years as a doula i have to say in hospital, home and birth center clients I've never had a woman who couldn't refuse a vaginal exam, even if by simply closing her legs.

I've given birth myself, and I've never found myself unable to answer questions asked of me between contractions. I was able to decline vaginal exams, AROM, medication, etc. It didn't take much engagement of my rational brain at all.

But you do recognize that not all women labor the same, right? Each individual woman has different reactions to labor, and to pain. Your reaction was how it works for you, but it doesn't mean that other women will be able to refuse exams, close their legs, or answer questions between contractions.

For your statement above to work, we have to first assume that the provider asks before they start an exam, or will stop the exam once the mother says no. We then have to assume that the mother is able to hear and respond to questions while in labor. We also have to assume that there is down time between contractions where these conversations can occur. We also have to assume that the act of closing ones legs is "simple" during labor, and that a woman will even think to do it. We also must assume that when she closes her legs, they will not be forced back open.

Also, the situation you seem to be describing isn't even an "advocate" situation. You seem to be describing a situation where a very calm respectful provider asks a woman, in between contractions, if she would like a vaginal exam. She says no, or yes, and everything proceeds as planned. What does a doula do if her client tells her in advance that she wants no exams at all, or that she only wants exams when she asks for them, and then a provider comes in the room, slips on a glove, and proceeds to start the exam while telling the client, "I'm just gonna see how things are going here." What if her client says, "no, I don't want one" and the provider proceeds anyway? This is where a true advocate is needed, and this is a very typical hospital experience for birthing women. How can she close her legs without risking the exam becoming more uncomfortable? How can she say no to something that has already begun, that is already a violation of her wishes? If a doula at this point says to her client, "is this what you want" and her client says "no", what good does that do? What if her client becomes confused, or wants to protect herself from the shame, so she says, "it's fine".

I don't think any of us have the answers to these questions, but I wish that someone did. I wish that doulas really were advocates and weren't just labeled as such. I wish that all women could think logically and argue on their own behalf during labor, but some of us just can't do that.


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## April422 (Nov 28, 2007)

Quote:


Originally Posted by *jennica* 

Also, the situation you seem to be describing isn't even an "advocate" situation. You seem to be describing a situation where a very calm respectful provider asks a woman, in between contractions, if she would like a vaginal exam. She says no, or yes, and everything proceeds as planned. What does a doula do if her client tells her in advance that she wants no exams at all, or that she only wants exams when she asks for them, and then a provider comes in the room, slips on a glove, and proceeds to start the exam while telling the client, "I'm just gonna see how things are going here." What if her client says, "no, I don't want one" and the provider proceeds anyway? *This is where a true advocate is needed, and this is a very typical hospital experience for birthing women.* How can she close her legs without risking the exam becoming more uncomfortable? How can she say no to something that has already begun, that is already a violation of her wishes? If a doula at this point says to her client, "is this what you want" and her client says "no", what good does that do? What if her client becomes confused, or wants to protect herself from the shame, so she says, "it's fine".

I don't think any of us have the answers to these questions, but I wish that someone did. I wish that doulas really were advocates and weren't just labeled as such. I wish that all women could think logically and argue on their own behalf during labor, but some of us just can't do that.


I can't say that the above bolded is my experience as a birthing woman or as a doula. Sure there are providers like that where I am, I'm sure it happens, but I'm not sure it's the rule and more an exception.

If a woman has not consented to a vaginal exam and one is being forced on her, I'd speak up. "I hear her declining a vaginal exam. (client) do you want the (dr/nurse/midwife) to stop?"

I think that our power as doulas is most effective if used prenatally. Help our clients find providers whose birthing philosophy most closely matches her. Education her about her options, her "rights". I cover the right to refuse, anything. No means no. Absent of a court order they can not force treatment or exams upon a woman. I wouldn't be adverse to mentioning that I hear the refusal, and my clients are aware of what "battery" means in a medical setting and the power of using that word.

To be quite honest, I don't want to be an advocate in the dictionary sense. To me, speaking for a woman means taking away HER voice. I can't do that. I'm more than happy to help her communicate her plans and desires but there are ways to do that without removing her voice.


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *April422* 
I think that our power as doulas is most effective if used prenatally. Help our clients find providers whose birthing philosophy most closely matches her. Education her about her options, her "rights". I cover the right to refuse, anything.

I would've thought this would be more the role of a CBE.







Oh wait, you are one of those as well. Okay, so your thoughts on those two roles? What about people who are "only" doulas?

(By the way, I hope you aren't feeling picked on, one of the dangers of making articulate and well-thought out posts is that I'll pounce on you to get your knowledge and input. If you seemed clueless I wouldn't be reading your posts so carefully to get you to clarify stuff.)


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## Belle (Feb 6, 2005)

Quote:


Originally Posted by *sapphire_chan* 
I would've thought this would be more the role of a CBE.







Oh wait, you are one of those as well. Okay, so your thoughts on those two roles? What about people who are "only" doulas?

Doulas have to be both. There is a lot of prenatal discusssion between doulas and their clients about what to expect during their birth. I've had the opportunity to be a doula who does shift work at a hospital and I haven't pursued it. I don't like the idea of not having prenatal contact with moms and just meeting them in labor.

Quote:


Originally Posted by *sapphire_chan* 
(By the way, I hope you aren't feeling picked on, one of the dangers of making articulate and well-thought out posts is that I'll pounce on you to get your knowledge and input. If you seemed clueless I wouldn't be reading your posts so carefully to get you to clarify stuff.)

A little bit, but I'm enjoying the lively discussion.









Quote:

I don't think any of us have the answers to these questions, but I wish that someone did. I wish that doulas really were advocates and weren't just labeled as such. I wish that all women could think logically and argue on their own behalf during labor, but some of us just can't do that.








Exactly. I hate being an advocate. It seems so confrontational to me. The last birth I attended as a doula was so much less stressful on me because the CNM and the nurse respected the mom's wishes. I wish that every birth could be like that. Its especially sad from someone such as myself who had a birth at home. I didn't UC but my midwives were on _my_ territory and I was in charge of the birth. To be a mom in a hospital is so very different. I'm not saying that hospital births can't be great, but I wish every mom could have a birth like I did. That's the reason I became a doula in the first place. To help moms have great births.


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## April422 (Nov 28, 2007)

Quote:


Originally Posted by *sapphire_chan* 
I would've thought this would be more the role of a CBE.







Oh wait, you are one of those as well. Okay, so your thoughts on those two roles? What about people who are "only" doulas?

(By the way, I hope you aren't feeling picked on, one of the dangers of making articulate and well-thought out posts is that I'll pounce on you to get your knowledge and input. If you seemed clueless I wouldn't be reading your posts so carefully to get you to clarify stuff.)


Honestly, any good doula (absent CBE credentials) in my opinion should be able to provide the information I outlined there. I provided it long before I became a CBE, maybe it's what led me to BE a CBE though, wanting to give more.

I don't feel picked on. I cut my online teeth on debate boards, so I'm used to needing to defend or be questioned on my position.


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## onetwoten (Aug 13, 2007)

Quote:


Originally Posted by *April422* 
I can't say that the above bolded is my experience as a birthing woman or as a doula. Sure there are providers like that where I am, I'm sure it happens, but I'm not sure it's the rule and more an exception.

If a woman has not consented to a vaginal exam and one is being forced on her, I'd speak up. "I hear her declining a vaginal exam. (client) do you want the (dr/nurse/midwife) to stop?"

I think that our power as doulas is most effective if used prenatally. Help our clients find providers whose birthing philosophy most closely matches her. Education her about her options, her "rights". I cover the right to refuse, anything. No means no. Absent of a court order they can not force treatment or exams upon a woman. I wouldn't be adverse to mentioning that I hear the refusal, and my clients are aware of what "battery" means in a medical setting and the power of using that word.

So... Can I come live where you live then?

I'm sorry, but although your options there seem to be quite wonderful, reality is that in many many places, doctors WONT listen to their clients, even if it has been laid out very plainly in front of them beforehand. They will continue offering drugs, and doing vaginal exams without asking. If they get caught during, then they just say "ohh it's just a quick one, I'm almost done." I don't think it's as much the exception in other places as you'd like to believe.

I live in a place where we are having a huge doctor and midwife shortage. If you've been lucky enough to find ONE provider, you don't switch. You have to call for a midwife before 6 weeks or you are pretty much guaranteed not to get one. And even then- I've heard some horror stories about a few of the midwives, but when it's your only option, what do you do? I have a client right now who is working with apparently one of the best obgyn's in the city as far as natural delivery. Yet my 27 week pregnant client was told last week that since her placenta MAY not have formed properly, she's automatically being diagnosed with IUGR, preeclampsia, and they want to induce her in July. She's not due til September, and they don't even want to wait to tmake the decision. This is what the BEST gets you in my city. No wonder I want to UC.

Quote:

To be quite honest, I don't want to be an advocate in the dictionary sense. To me, speaking for a woman means taking away HER voice. I can't do that. I'm more than happy to help her communicate her plans and desires but there are ways to do that without removing her voice.
But we've gone over this, and while you may have been able to speak- many women aren't. They aren't not talking because they figure their doula will speak for them- they're not speaking because their brainhas physically shut off the portion required for speech. They are dealing with labor, which they should be.

A mother should have every opportunity to use her own voice first. But if she can't, then we need to be able to step in.

I wanted to thank the original poster here as yu've given me a LOT to think about with what I want to be providing in my care. I was very worried prior to this about certifying and 'following the rules', and I think I"m leaning much more now towards not worrying about it. Do I want to belong to an organization which tells me I can't talk to doctors and nurses for the client when she needs? I don't know....


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *jeninejessica* 
I wanted to thank the original poster here as yu've given me a LOT to think about with what I want to be providing in my care. I was very worried prior to this about certifying and 'following the rules', and I think I"m leaning much more now towards not worrying about it. Do I want to belong to an organization which tells me I can't talk to doctors and nurses for the client when she needs? I don't know....

I think if I were training as a doula, I'd rather be a pre-birth CBE for the family and act as a coach for the DP during labor. If you can't be an advocate, back the person who can be an advocate.


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## Synchro246 (Aug 8, 2005)

Quote:


Originally Posted by *jeninejessica* 
I was very worried prior to this about certifying and 'following the rules', and I think I"m leaning much more now towards not worrying about it. Do I want to belong to an organization which tells me I can't talk to doctors and nurses for the client when she needs? I don't know....

Me too! I let my cert lapse, and maybe it's for the best. Not that I'm an active doula anyway, but I at the births that I did attend I was uber worried about towing the line and following the rules.

About the woman's voice issue. I think labor/birth isn't too much the time for worrying about stealing a woman's voice. If she obtained information and expressed opinions prior to labor that IS her voice. As long as the advocate acts as the woman herself would then there's no stealing going on--it's pure support. Her voice remains intact, it's just that birth sometimes necessitates that it be channeled through another.


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## jenneology (Oct 22, 2007)

Quote:


Originally Posted by *Synchro246* 

About the woman's voice issue. I think labor/birth isn't too much the time for worrying about stealing a woman's voice. If she obtained information and expressed opinions prior to labor that IS her voice. As long as the advocate acts as the woman herself would then there's no stealing going on--it's pure support. Her voice remains intact, it's just that birth sometimes necessitates that it be channeled through another.























Bravo for this!!!

I have been frustrated by this issue since I realized that my doula wasn't there for me in the way she had presented herself to me when we agreed she'd be my doula. And then I considered becoming a doula. I felt strongly that I needed a spokesperson or a voice that is somtimes "channeled through another" as you put it. I was very disillusioned when I discovered that if I were to become a doula I would be prohibited from being that spokesperson which I know is so desperately needed, as it was in my case. In the last few weeks, I've been getting into it with doulas on this topic and have been very frustrated by the responses I've heard.

Jennica, thank you for bringing this conversation here. I'm glad its being discussed.


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## April422 (Nov 28, 2007)

Quote:


Originally Posted by *sapphire_chan* 
I think if I were training as a doula, I'd rather be a pre-birth CBE for the family and *act as a coach for the DP during labor*. If you can't be an advocate, *back the person who can be an advocate.*

Isn't that what doulas do?

Since I can't directly advocate for clients, I help the partner be her voice if that is their preference. I can cue him/her to say something, I can remind him/her of her wishes and let him/her handle the staff if she doesn't want to.

But really, the bottom line here is that in the hospital setting, the ultimate acceptance or refusal of any procedure or intervention must come from mom and mom alone. Absent a medical POA.


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## April422 (Nov 28, 2007)

Quote:


Originally Posted by *Synchro246* 
Me too! I let my cert lapse, and maybe it's for the best. Not that I'm an active doula anyway, but I at the births that I did attend I was uber worried about towing the line and following the rules.

About the woman's voice issue. I think labor/birth isn't too much the time for worrying about stealing a woman's voice. If she obtained information and expressed opinions prior to labor that IS her voice. As long as the advocate acts as the woman herself would then there's no stealing going on--it's pure support. Her voice remains intact, it's just that birth sometimes necessitates that it be channeled through another.

I'm certified, and I can't say I've ever been worried about crossing the line, and I can say I've walked a fine line or two in my time, but not when it comes to speaking for women.

I really want to honor those of you who say you can't speak up in labor. However, my experiences don't lead me to the same conclusions. Not just my own births, but the countless births I've attended as a doula hasn't led to me see women as fragile things that can't be spoken to or can't speak for themselves in labor. Maybe it's the population I work with (doubt it as they're as varied as the women here) or maybe it's that most of the providers I work with are gentle, respectful and wait for appropriate moments to speak to a laboring woman when a decision must be made.

The whole other side of this "can't think, can't speak" thing that counfounds me is that I'm hired to help women cope, to utilize the tricks and comfort measures I've learned and developed over the years. Doing this work requires that I speak to mom. It requires that I gain her consent to touch her, tell her how I"m going to touch her, and why I think it might help. Sure, we use as few words as possible and there's no long lecture on what I'm doing, but a "I'm going to come around behind you and try a counterpressure point on your back, is that ok?" (Mom nods or says yes) I approach her and touch her and ask "How does that feel?" (she replies better or worse or asks for more pressure or less or asks me to stop) <insert here speaking is done between contractions not during contractions>

It's the same dance I see with a client and a provider. Enter the room, wait till a contraction is over, speak to the woman and wait for a response.

I really don't want to come across as invalidating the experiences of those who say they can't focus that way in labor. I just haven't seen or experienced a woman totally incapable of speaking for herself in labor. 90% of my clients give birth without pain medication, so it's not like I've only experienced numbed out moms who are disconnected from their bodies during labor because of epidurals.


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## Synchro246 (Aug 8, 2005)

Quote:


Originally Posted by *April422* 

I really don't want to come across as invalidating the experiences of those who say they can't focus that way in labor. I just haven't seen or experienced a woman totally incapable of speaking for herself in labor. 90% of my clients give birth without pain medication, so it's not like I've only experienced numbed out moms who are disconnected from their bodies during labor because of epidurals.

I think it's Heisenberg's uncertainty principle at work. Being in a totally safe space that allowed me to labor as nature intended; allowed me to be totally out of it. When I was in a space where I needed to be a social being (hospital) I was. I participated actively in my care. I did still deal with contractions and I coped, but my ability to cope was diminished. It may have not _seemed_ that way, but it was. I was on Pit for 14 hours (after 36+ hours of natural labor) before I gave up and asked for an epidural, but it really DID affect the process. I wouldn't have known that until after experiencing totally secluded labor at home.


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## April422 (Nov 28, 2007)

Quote:


Originally Posted by *Synchro246* 
I think it's Heisenberg's uncertainty principle at work. Being in a totally safe space that allowed me to labor as nature intended; allowed me to be totally out of it. When I was in a space where I needed to be a social being (hospital) I was. I participated actively in my care. I did still deal with contractions and I coped, but my ability to cope was diminished. It may have not _seemed_ that way, but it was. I was on Pit for 14 hours (after 36+ hours of natural labor) before I gave up and asked for an epidural, but it really DID affect the process. I wouldn't have known that until after experiencing totally secluded labor at home.


I think I said previously that I've attended home and birth center births I'm not a hospital only doula. I still haven't experienced a situation where a mom couldn't speak for herself if she needed to.


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## Synchro246 (Aug 8, 2005)

Quote:


Originally Posted by *April422* 
I think I said previously that I've attended home and birth center births I'm not a hospital only doula. I still haven't experienced a situation where a mom couldn't speak for herself if she needed to.

I don't think it has anything with being specifically at home, in a BC or, or in a hossy. I know I didn't go into this un-reachable state of mind with my first at all. I labored at home for 36 hours. I had my two best friends and my mom (to whom I am very bonded). Any time they would so much as speak, even across the house--what should be out of range of hearing--I told them to shut up.
I guess it was inaccurate for me to say that "being in a safe place" was why i could check out. I was in a safe place both times, so there must have been something else at play preventing me from traveling to laborland with my first.

Ok, I did a little brain experiment thinking about my out-of-it birth from the perspective of an outsider. I do think that they would probably agree with you. I could speak for myself. I did make decisions about whether or not to do a couple things.
It DID break me from the process. I would wake up, come out (to a degree) and participate. I was NOT in the same, sacred, labor-space for this interaction. I think that the ammt of interaction required from a naturally un-interventive HCP is probably less consequential to the process than is the type of interaction required by a more active HCP.
I know that I could not have done what I did if I were in a hospital advocating for myself. The experience would have been more intense. I can almost guarantee.


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## April422 (Nov 28, 2007)

Quote:


Originally Posted by *Synchro246* 

Ok, I did a little brain experiment thinking about my out-of-it birth from the perspective of an outsider. I do think that they would probably agree with you. *I could speak for myself.* I did make decisions about whether or not to do a couple things.
It DID break me from the process. I would wake up, come out (to a degree) and participate. I was NOT in the same, sacred, labor-space for this interaction. I think that the ammt of interaction required from a naturally un-interventive HCP is probably less consequential to the process than is the type of interaction required by a more active HCP.
I know that I could not have done what I did if I were in a hospital advocating for myself. The experience would have been more intense. I can almost guarantee.


I totally agree that women shouldn't be put into the position to come out of their labor land (as they define and experience it) the way that it happens in most hospitals with "things" coming at them from all directions. But I believe that it is best if that woman speaks for herself, or she has her partner or family member speak for her where appropriate. I just don't think it's the doula's role, nor should it be.

A big part of what I do as a doula is help clients evaluate and change, if necessary, providers to one who is most in alignment with their own birth philosophy. IMO this minimizes all the un-necesary interruptions that can distract a woman from her labor's rhythm.

I wish women were given the respect to birth freely, but until that happens, as a doula I can't be their voice. So far, so good.


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## MammaB21 (Oct 30, 2007)

Quote:


Originally Posted by *April422* 
In 8 years as a doula i have to say in hospital, home and birth center clients I've never had a woman who couldn't refuse a vaginal exam, even if by simply closing her legs.

I think that we do women a HUGE disservice by assuming that they're poor little helpless things in labor and can't make necessary decisions. Just imagine if the OB world decided such, what an uproar "that" would cause!

I had an exam that I screamed thru. Saying 'stop, no, get out....etc'. This was by a midwife no less. When she finally finished I broke down crying. She walked out of the room as if what just happened was completely normal. So yes, it happens. And I would bet alot more then you are assuming.

I agree that women should be given a voice. In fact, I beleive that their voice should be the only one that truely matters. Noone ever said laboring women are poor and helpless. But in a typical hospital setting, they are simply patients. Their voice is not heard.

Alot of women ask for epidurals during transition. It is not allways because they truely want one. But because they want to be heard. They want someone so understand how much pain they are in. Even women birthing at home ask for pain reliefe. I think should be something that doulas talk about with their clients before hand. I know alot of doulas do, and they set up a code word. If I would have had a coed word during my labor, I wouldn't have used it, even though I was screaming for and epi. I just wanted to be listened to. For someone to take me seriously.


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## onetwoten (Aug 13, 2007)

Quote:


Originally Posted by *April422* 
A big part of what I do as a doula is help clients evaluate and change, if necessary, providers to one who is most in alignment with their own birth philosophy. IMO this minimizes all the un-necesary interruptions that can distract a woman from her labor's rhythm.

I wish women were given the respect to birth freely, but until that happens, as a doula I can't be their voice. So far, so good.

But for many women this IS NOT an option! Simply finding a better provider isn't as easy as you make it sound for all women.

Quote:

Not just my own births, but the countless births I've attended as a doula hasn't led to me see women as fragile things that can't be spoken to or can't speak for themselves in labor.
Nobody said women were fragile things that can't be spoken to... what we're saying is that many women (albeit not ones you've seen), find that they cannot speak during labor, or during contractions. They are doing what they can to cope with their labors in a productive way, and having to answer questions and come out of their space to talk, is simply not possible. We're not talking about moms being too afraid or too nervous to say something, we're talking about a physical inability to speak.

Should I punish a woman by not standing up for her because she is coping on her own by going into her own space and can't come out to tell her doctor "no please don't ____"? She's doing the best she can, dealing in a deep state of meditation, concentration, etc, and sometimes that takes all that you have, you simply don't have enough left to use your words.

MamaB21- *hugs* I've heard too many of those stories. It's not fair.


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## jennica (Aug 10, 2005)

Quote:


Originally Posted by *April422* 
I really don't want to come across as invalidating the experiences of those who say they can't focus that way in labor. I just haven't seen or experienced a woman totally incapable of speaking for herself in labor. 90% of my clients give birth without pain medication, so it's not like I've only experienced numbed out moms who are disconnected from their bodies during labor because of epidurals.

The thing is, you CAN speak, but you can NOT advocate for yourself. There is a very distinct difference. If somebody breaks into your labor land and demands, "I'm going to give you an exam now", you can say "no, I don't want one." However, most women can't say, "don't you remember doc in the discussions we had prenatally that we agreed that I would only get vaginal exams when I asked for one. Perhaps you should read over my birth plan again to remind yourself of my wishes." Now, the first sentence doesn't sound too convincing to many providers because they quickly counter with, "it will be really quick" or "we just need to see how things are progressing" or some other phrase that is supposed to reassure the woman that it is okay to allow this procedure. The second phrase would likely stop the provider from what he is about to do, or at least give him pause while further communications happen to determine what his next move will be. The very reason women need an advocate is that providers know that they can not advocate for themselves and they take advantage of this vulnerability in order to accomplish their own agenda. They know very well that if there is any negative response to their intention to perform a procedure, it will not take much to convince a woman to go along with the procedure. Perhaps you have had clients that can say, "no, I don't want that" and amazingly every provider you have worked with just says, "okay then" and turns and walks out of the room. However, if you ever had a provider challenge your client after she already did speak up for herself, then you might see that she truly can not advocate for herself while in labor.


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *April422* 
hasn't led to me see women as fragile things that can't be spoken to or can't speak for themselves in labor.

If this is how you're interpreting that, you still aren't understanding the issue I have with women having to speak for themselves in labor. They have already expressed what they want. They should not have to deal with people trying to push things on them that they have already declined--vaginal exams, epidurals. They should not have to fight to get things they've already requested--changing positions, having silence or at least a minimum of talking.

This, to me, is not about decisions made during the birth, it is about protecting the woman from having to remake decisions that she has already made so that she can get on with the work of giving birth.

It's not about being 'fragile' it's about not having to deal with the irritation of oxytocin reducing, adrenalin increasing BS.

And I have changed to a provider who will respect my wishes in this 100%--ME.


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## MammaB21 (Oct 30, 2007)

Quote:


Originally Posted by *sapphire_chan* 
If this is how you're interpreting that, you still aren't understanding the issue I have with women having to speak for themselves in labor. They have already expressed what they want. They should not have to deal with people trying to push things on them that they have already declined--vaginal exams, epidurals. They should not have to fight to get things they've already requested--changing positions, having silence or at least a minimum of talking.

This, to me, is not about decisions made during the birth, it is about protecting the woman from having to remake decisions that she has already made so that she can get on with the work of giving birth.

It's not about being 'fragile' it's about not having to deal with the irritation of oxytocin reducing, adrenalin increasing BS.

And I have changed to a provider who will respect my wishes in this 100%--ME.

This is a good point.

I just wanted to add, that women are usually extreemly happy directly after their birth, reguardless of how the birth whent. They are overjoyed to have their new baby, and are far from being able to process the birth. So this is what the doula sees. Most doulas have one follow up with the mom, and then are told to cut off ties with her. In the few weeks after the birth, the mom may still have not processed the birth. Or, she may be upset with sertain aspects of it, and feels like she can't talk about it or bring it up with her doula. So the assumption that women are speaking up for themselves in labor, is just that, an assumption. I will give an example of something that is completely common.

Doc comes into the room and sais to mom, "Your labor is stalling out, we would like to break your water."

Mom, "no, I don't want you to."

Doc, "okay, I will allow you to labor for one more hour, if you haven't progressed when I get back, we will have to break your water."

Mom is left in fear, and anxiety, and pressure to progress, so of course mom doesn't progress.

Doc comes back and starts vaginal exam without asking in the middle of a contraction. He sais, "well, looks like you haven't progressed I'm going to go ahead and just break your water here for you."

Mom is upset, but doesn't 'stop' it because she was told it has to be done. Meanwhile, the doula and other onlookers see this as her choice, since the doc originally complied with her, and then it was 'necessary' to do otherwise later. The rest of the labor goes beautifully, and all of moms wishes are met. Mom doesn't focus on this one thing until months later when she realizes how upset she is that her wishes weren't respected. Meanwhile, doula has seen 2 or 3 other clients by then, completely believing that mom was happy and content with her labor.

Just because women in labor 'appear' to be able to talk and give answers, I would be willing to bet that at least some of the time, those answers are scripted, knee jerk reactions to being bullied into doing something they didn't want to do in the first place.


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## jenneology (Oct 22, 2007)

Quote:


Originally Posted by *MammaB21* 
I will give an example of something that is completely common.

Doc comes into the room and sais to mom, "Your labor is stalling out, we would like to break your water."

Mom, "no, I don't want you to."

Doc, "okay, I will allow you to labor for one more hour, if you haven't progressed when I get back, we will have to break your water."

Mom is left in fear, and anxiety, and pressure to progress, so of course mom doesn't progress.

Doc comes back and starts vaginal exam without asking in the middle of a contraction. He sais, "well, looks like you haven't progressed I'm going to go ahead and just break your water here for you."


This is exactly the situation I was in, but I wasn't the mom who consented to it. Instead I found my voice and used it, refused again, tried to negotiate, and got totally out of labor land, had all sorts of stress hormones come into my body. And the result is that the midwife got frustrated and impatient with me, and pulled out the heavy handed tricks of "you need to be drugged and you don't have a choice about it." And then it was after more "advocating for myself" and using all of the brain power and negotiating skills I possessed, I was then told that all of my options had been taken away and I needed to leave the hospital right then, no more discussion allowed. It was those manipulative techniques, and all the stress I felt trying to fight for my bodily integrity and my wishes to be respected that is the root cause of the PTSD that I experienced.

So was I capable of speaking up for myself, yes. It interfered with not only my birth process, but also my mental health, the attachment to my child, my transition to motherhood and my marital relationship. All because my doula was required that I advocate myself and speak up using my voice when she had told me before hand that that was what she was going to do.

Based on my experience and my desire to become a doula, women may be capable of advocating for themselves in labor and reaffirming the decisions they made previously with thier providers, but they shouldn't have to do that. They should be respected enough to have their providers treat them in kind and supportive ways and since OBs and midwives are frequently not good at this, it falls to the doula to stand as the laboring woman's advocate. Especially since that's one of the reasons she was hired in the first place!


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## Sage.Naissance (Feb 5, 2008)

I am not sure if anyone actually read what I posted (in a link) before about choice.
I will just respond with a few statements to thinks I saw mentioned before.

I believe that a lot of the most important doula work is done prenatally.
Part of that is discussing the persons care provider and what they have discussed about the birth, the clients expectations and assumptions about birth, how they might deal with conflict or interventions in the birth room, and risk assesment: the decisions they have made and the risks of them.
This brings me to a point about choice, which I think is very relevant to this discussion.
I live in an area where midwives have to be employed by birthing centres which are funded by the government. They only meet about 10% of their demand. Therefore 90% of women are turned away by midwives.
There are illegal midwives. There are family doctors, and there are OBs.
Family doctors are hard to get, legal midwives are almost impossible to get. A good OB may be hard to find but they are out there. There are several hospitals and some are better than the others.
The choices arent vast or fantastic but there ARE choices. Women have choices, and they do assess the risk of each and assume the risks of their choice.
Therefore a woman may seem to have no choice but to give birth in a hospital because she didnt get in at a birthing centre. However she has the choice to have an illegal midwive, a UC, or a hospital birth, or to relocate to an area with better access to care for their birth(my mom stayed with relatives 3 hrs away from her home during her pregnancy with me to avoid a caesarean).
Now if a woman is not willing to assume the risks of a UC or an illegally assisted birth she is willing to assume the risks of a hospital birth.
This understanding is an important part of prenatal preparation for problems. If she is 100% unwilling to consent to unneccesary intervention at any time she needs to reconsider having a birth at a hospital. Is it fair? No. Is it ideal? No way! Is it reality? yes. We are functioning in a broken system and we need to empower ourselves to make decisions that we can live with. Clients also need to know that they absolutely have the right to refuse anything, but what they will have to go through to have that happen in a hospital and that if they go in with their fists up they are going to wind up with a battle.
what is each woman willing to sacrifice/deal with for the intervention free birth? Fighting with the doctor or nurse or midwife? or taking the risk of having an out of hospital birth/unassisted birth etc?

So I equip my clients to know what they might face, and let them know that they can refuse or accept anything and that I will support that but they have to be the one to accept or deny it, not me. I will reframe questions to make more sense to my clients (and I will not ask them in a contraction-and will tell a doc to wait for a contraction to pass), and if a doctor ignores the wishes then will I be more forward in a more 'advocational' manner. But the responses come from my clients. This has not posed any problems for me so far and as a result of the fact that I am obviously not answering for my clients but asking for their opinion docs respect me and have never accused me of witholding epidural or interfering. Is it interfering with the birth process? Yes. Birthing in a hospital is, in essence and some manner, interfereing with the birth process. This is reality. If we want no interference we should go home to our bathrooms turn of the lights and birth by ourselves.

Hope I expressed that well. I have no illusions of the birthing system and its pretty damn bad here but there is still choice. There is always choice, and weighing of postitives and negatives etc.


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## onetwoten (Aug 13, 2007)

That was expressed well, thanks









Do you happen to have a handout or similiar about patients having the right to refuse? I'm in Canada also, and while I know that they can refuse, it's often hard to convey that idea to a client, especially when they've been socialized to believe that doctors know best, and if the doctor says so, then they have to go along.


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## jennica (Aug 10, 2005)

Quote:


Originally Posted by *Sage.Naissance* 
The choices arent vast or fantastic but there ARE choices. Women have choices, and they do assess the risk of each and assume the risks of their choice.
Therefore a woman may seem to have no choice but to give birth in a hospital because she didnt get in at a birthing centre. However she has the choice to have an illegal midwive, a UC, or a hospital birth, or to relocate to an area with better access to care for their birth(my mom stayed with relatives 3 hrs away from her home during her pregnancy with me to avoid a caesarean).
Now if a woman is not willing to assume the risks of a UC or an illegally assisted birth she is willing to assume the risks of a hospital birth.
This understanding is an important part of prenatal preparation for problems. If she is 100% unwilling to consent to unneccesary intervention at any time she needs to reconsider having a birth at a hospital. Is it fair? No. Is it ideal? No way! Is it reality? yes. We are functioning in a broken system and we need to empower ourselves to make decisions that we can live with. Clients also need to know that they absolutely have the right to refuse anything, but what they will have to go through to have that happen in a hospital and that if they go in with their fists up they are going to wind up with a battle.

Where do I even begin? Women don't have choice if they don't know that the hospital system is messed up. If they don't realize that this "choice" they make will impact them in ways they never imagined possible. If you had told me before my son was born that I can either go to the hospital and get birth raped and end up with PTSD, or I can stay home with an illegal midwife, now that would have been a choice. But, you are asking women to choose between things that they have no understanding of before it happens. That's like telling someone, "well, you chose to travel to the west coast right before an earthquake hit, that was your choice, you could have traveled to the east coast or the midwest, or you could have just stayed home, but you chose the west coast."


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## paquerette (Oct 16, 2004)

Quote:


Originally Posted by *jenneology* 
I was then told that all of my options had been taken away and I needed to leave the hospital right then, no more discussion allowed.

You were actually thrown out of a hospital in labor?


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## MammaB21 (Oct 30, 2007)

*Sage.Naissance* I am confused by your post. It sounds to me that you are putting the blame back onto the womanfor anything that goes wrong in her labor, because she made the 'choice' to birth where she did.

The thing is, that no matter where a women choses to birth, or who she picks for her care provider there is no gaurentee that her wishes will be met. Even the crunchiest midwives sometimes do things that are less then ideal. There are some serious issues with birth in our country, and it is ashame that there are so many people out there willing to throw the blame back on the mothers, when in reality, we need to put it where it belongs. In hospital systems. In the media portryaing scary, high risk births. In the lack of education this country porvides for pregnant women. In the law that prohibits women from laboring with midwives or at home, or doing UC.


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *MammaB21* 
In the law that prohibits women from laboring with midwives or at home, or doing UC.

Small note here, homebirths aren't actually illegal in any state. What tends to be illegal is being an unlicensed midwife. Which is impossible to avoid in states that refuse to license midwifery.


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## jenneology (Oct 22, 2007)

Quote:


Originally Posted by *paquerette* 
You were actually thrown out of a hospital in labor?









That's what I beleived that the time, yes so I reacted like that was the case. In truth, I was 3.5 cm dilated in early labor. Just a half centimeter from being considered in active labor when I would have been "allowed" to stay in the hospital. Why they admitted me in the first place, or sent me up to L&D I'll never know.

I did send an email to the midwife who told me to go to L&D and told her the effects of her actions on my labor and transition to motherhood and she apologized that she had contributed to my distress and she would take my experience into consideration the next time she encountered a first time mom in early labor who was wanting a natural birth. She should have known not to send me up and given me the Penny Simkin advice of resting, going home, and enjoying myself until I was in active labor. Instead the midwife led me to beleive I was in active labor and deserving to be admitted.


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## MammaB21 (Oct 30, 2007)

Quote:


Originally Posted by *sapphire_chan* 
Small note here, homebirths aren't actually illegal in any state. What tends to be illegal is being an unlicensed midwife. Which is impossible to avoid in states that refuse to license midwifery.

Ya, I was refering to unliscensed midwives, and illegal UC's. But, I thought there was a momma or two on here that said homebirths were illegal in her state, and was considering doing a UC because of that. Maybe she was reffereing to unliscensed midwives as well.


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *MammaB21* 
Ya, I was refering to unliscensed midwives, and illegal UC's. But, I thought there was a momma or two on here that said homebirths were illegal in her state, and was considering doing a UC because of that. Maybe she was reffereing to unliscensed midwives as well.









UCs aren't illegal. Doesn't mean there isn't a risk of being treated like a criminal for having one, but there isn't actually a law in any state about it. I'm not sure if there are states that have laws prohibiting anyone from attending a home birth, but then I only know for sure of one group of OBs who are willing to attend to home births at all, so it might be a moot point.


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## MammaB21 (Oct 30, 2007)

Quote:


Originally Posted by *sapphire_chan* 







UCs aren't illegal. Doesn't mean there isn't a risk of being treated like a criminal for having one, but there isn't actually a law in any state about it. I'm not sure if there are states that have laws prohibiting anyone from attending a home birth, but then I only know for sure of one group of OBs who are willing to attend to home births at all, so it might be a moot point.

AAAaaahhhhh....







...okay, you got me again. I honestly haven't really researched what states have what laws. I just remember hearing other momas on here talking about it. But, even if it isn't illegal, it is sometimes really hard. Especially conserning medical insurance and midwives and homebirths.


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *MammaB21* 
AAAaaahhhhh....







...okay, you got me again. I honestly haven't really researched what states have what laws. I just remember hearing other momas on here talking about it. But, even if it isn't illegal, it is sometimes really hard. Especially conserning medical insurance and midwives and homebirths.

Totally.


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