I am proud to be introducing a new occasional series “Doula Me This!” that challenges doulas to consider how they might handle a birth or postpartum situation, in consideration of their training, experience, professional judgment and DONA International’s Scope of Practice and Code of Ethics.  From time to time, I will present a situation and ask you to share how you feel a doula should proceed given the information provided and the role of the doula.  There are many times when we must take a step back and assess how we can best serve a client while staying within professional guidelines.  The answer at times may be difficult to find, or sometimes easy to identify, but difficult to carry out.  It is good to have healthy discussions with colleagues and share thoughts and ideas.  I hope that can happen here in our comments section and we can all learn and grow.

Doula Me This!

You have been hired as a birth doula by clients for their upcoming birth.  This is their first baby.  They have completed their childbirth class series.  At 34 weeks, all of you have now gathered for the first prenatal and your client and their partner have shared their birth plan with you.  Together you are discussing their birth preferences.

The Details

As long as the pregnant parent and the baby are doing well, this family is comfortable waiting until 42 weeks for labor to start, hoping to go into spontaneous labor, avoid any unnecessary interventions, and have a vaginal birth without pain medications.  In skimming their birth plan, everything seems “do-able’ and they are not asking for anything unusual or atypical.

You are familiar with their healthcare provider and in fact, recently have had three other clients who have birthed with the same doctor.  You recall that your other clients had similar birth wishes and were reassured by this healthcare provider all throughout their pregnancy that everyone was on the same page.  When those clients were just shy of 40 weeks, the doctor strongly suggested that an induction be scheduled for their due dates.  The doctor was very persuasive, citing increased risk of a stillbirth and had even told the families that “nothing good ever happens after 40 weeks” at the 39-week appointment.

After the 39-week appointments, your three previous clients all agreed to be induced at 40 weeks and after long labors, two had a cesarean for failure to progress and one did squeak by with a vaginal birth but they had an epidural and a long, physically and emotionally exhausting three-day induction.

After these recent experiences with your past clients, you are doubtful that this same provider will continue to support your current clients’ wishes and things will most likely unroll in a similar fashion.  You expect that at the 39-week appointment for this family, a discussion about the dangers of remaining pregnant will be had, and a strong recommendation to induce at 40-weeks will be made.

Your Dilemma

While listening to this family explain the type of birth they are hoping for, you sit and wonder if you should mention to them how unlikely it is that this doctor will be supportive of their wishes as they get closer to their due date.  You feel strongly that the three recent experiences you had with this doctor are very revealing about the doctor’s true colors.  You might be able to help this family avoid a lot of stress and heartache and some difficult decisions later if you speak up now and suggest they explore other options to be sure they are working with the most supportive provider possible.

What Would You Do?

Doula Me This! What do you do?  What do you say?  What are your next steps?  Share your thought process, actions, and opinions in the comments below.  I look forward to a lively discussion and will expect that even if people disagree, we will be respectful of each other and our colleagues’ opinions.