By Sharon Muza, BS, CD(DONA), BDT(DONA), LCCE, FACCE, CLE
Today is the fourth post in the occasional series, “Doula Me This!” Each post in the series provides a common scenario that a birth or postpartum (or both) doula may face. The “correct” answer (if there is one) requires some synthesis of the situation and at times consideration of the DONA International’s Standards of Practice and Code of Ethics. Today’s dilemma is not necessarily an unusual one for birth doulas to face. When I consider it, I have an initial gut reaction but further consideration gives me pause. How would you handle this in your own practice? Read through the scenario and let me know what you would do.
Doula Me This!
You have a client who has been scheduled for a planned cesarean for several weeks now. You receive a call from a different client in labor at 4 AM asking you to join them in labor now. Your client’s surgery is scheduled for 9 AM.
Kristin and Jamie are having their first baby. Kristen has been diagnosed with complete placenta previa and is having a scheduled cesarean at 38 weeks in order to avoid labor and the great complications that would result. Their surgery is scheduled for tomorrow at 9 AM and you have completed your prenatals and are planning to join them as requested at check in at 7 AM at Beechstone Hospital.
You are woken up at 4 AM with a phone call from another full term client, Melissa and Boaz. Their labor has started and contractions are really picking up. They are requesting your support now in order to continue to labor at home before heading to the Millbank Hospital to get admitted.
Obviously you cannot be in two places at once. You have solid back up ready and able to go wherever you send them. If you join your laboring clients, you will not be able to attend the planned cesarean. If you attend the planned cesarean, you will not be able to support your laboring clients until much later that day.
What would you do?
Do you send your back up to the planned cesarean? To the laboring family? Do you have a gut response but change your mind after more consideration? Does your contract offer clarification on what you should do? Have you ever had exactly this situation before in “real life?” Drop your thoughts on how you would handle this situation in the comments section below, and share a bit about your thought process.
First of all, I probably wouldn’t have taken on 2 women with births so close together, avoiding this dilemma.
My suggestion is to send a back-up doula to the cesarean mother and attend your client in active labor. With any luck, you will be able to make the 9am operation.
I don’t think it is a question of taking births close together, two clients a month apart can have their baby on the same exact day.
I would go to the client in active labor and send my back up to the Cesarean mom. I have never left a client after I have already begun supporting them. I am thankful for this question because I see I need to clarify my contract a little more to reflect this situation.
I would attend the family in labor, put my back-up in alert, and check in with the previa family. In my mind right now, I would have the back-up take over for me with the laboring parents while I hang with the previa family. I would hope I could stay with the previa family theougu their experience, and return to the laboring family, in addition to the back-up if I were losing steam.
I ll go to the women labouring for 2 hours. Once there I ll propose tools, or advices if necessary and assess the situation : if they need continuous support for the 2/3 following hours, I ll ask the back up doula to come for the time I ll be at the clinic with the caesarean.
The doula support for the cesarean is as important as for the vaginal birth and definitely shorter. I ll be available in the afternoon and the vaginal birth may not even be for that day…
I believe this case would depend on the specific needs and support situation in each clients life.
That being said, the Cesarean client is already committed to a cesarean. She has no choice.
The client at 4 am has a better chance at a positive natural birth if she is fully supported by you.
I would send back up to my cesarean client and hope to make it to the 9 am if the other mother progresses quickly.
Yes, these need to be addressed in my contract. Thanks for this question. It helps me see the need for clarity.
For me this isn’t an obvious answer. I would really consider who each mother is, and what her needs are going to be.
Yes, the Cesarean mother wouldn’t need me in such a physical way, but maybe her need for me emotionally to support her during this twist in the road is what’s really important .
Is the laboring mom experienced- her first or second, or even third? Has she been through labor before? Is she pretty definite on what she wants and knowledgeable about how labor progresses? If so, I would feel more comfortable sending back-up to her, knowing that once she’s in the throes of labor, an experienced doula is going to help with whatever she needs.
Maybe the situation is reversed and the cesarean mom is cool, calm, and collected, while the laboring mom is having her first and really needs me present because of the relationship we’ve developed.
Great question and no cut-and-dried answer, IMO.
That’s exactly what I was thinking, Denise. It depends on who I assess as being “neediest”. Who needs “a doula” and who needs “me”? Is the backup doula a better match for either of the two clients/situations? Also I would add that I would make this decision and not involve either of my clients in my dilemma.
I would attend the birth by cesarean and send my backup to the family starting active labor, hoping to join them later. As the birth by cesarean was scheduled, I would have already committed myself to that birth, and should have told any other clients that I would be unavailable that day, and that my backup would be on call.
Love it! Anticipation, pro activness, transparency and commitment. Love your thinking!
I agree Rosalyn! That is the way my contract reads. If, however, during the pregnancies I found, that the needs of the client that is now in labor were such that I needed to be with her, that would have been discussed and decided before the labor started, so that each client would know where they stood beforehand.
My gut reaction is to ensure I can attend the cesarean, since my clients have been informed I have a backup, hopefully have also met (and love) her, and the cesarean Mom has had this on the books for a while now. She will need a lot of moral support in a scary time, and has planned for my support being there. That being said, nothing stops me from going to Mom at home and assessing the situation, possibly discovering labor has begun, and calling my backup in to assist at 5am, taking over at 6:30am so I have time to make it to cesarean Mom. At that point, depending on the progression of labor, as well as the agreement between myself and my backup, I may attend to the other mom, or I may just visit the following day.
Yes the above response makes the most sense to me. Go to laboring mom and reassure/asses the situation first. Have back up join them at 6:30, go to Csection parents, rejoin laboring mom when Csection is finished. Then also go check back in as soon as possible with Csection family.
I think my in- the-moment- response would have a lot to do with my relationships with these clients. Sometimes it is more important than others that the support come from me, not my backup, if humanly possible because of their personalities, our fit, etc. Other times it is pretty clear another doula who I trust could fill the role and their expectations interchangeably without much kerfuffle. I would try to lean on this intuition when making a choice.
If distance wasn’t an issue between these two clients, I would offer to go to the client’s home to labor with them and offer support until I had to leave for my scheduled cesarean, and offer to return as soon as I could after giving necessary support to my first client, and provide a back-up while gone.
Since the cesarean is planned, I would not leave that client at the last moment. I feel they deserve my support too.
A clear contract is helpful here. Being upfront with clients that ‘these are the days I would be unable to support you’, offering them the opportunity to meet with and hire your back-up preventa any disappointments and tension in situations such as these. And then in the event dates collide, I would do my best to offer whatever support is reasonable in the circumstances, even though you are not contractually obligated to do so. For me that would likely mean, calling the back-up to join me at the home of the labouring couple within a given time-frame, and then excusing myself to join the c/s clients for as long as they need me, knowing that the back-up is there and (hopefully) things were going well when I left. When I am free to leave the c/s clients I would likely call the back-up doula for an update on the progress of labour and then talk to the husband and/or the labouring mama about what they would prefer happen at this point: complete their birth with the support of the back-up, or have us switch. Obviously, that would need to be how my back-up and I had arranged things previously. I wouldn’t remove her from a birth she was expecting to stay for and get paid for completing. I would make a postpartum visit with the labouring clients whether I was there for the birth or not, usually with the back-up if she attended the birth through to the end. Hard to know exactly without living it, but that seems like a fit for how I would approach this scenario.
Hello! I nice had a couple who who had a planned c-section due to a breech baby! They were told to be at the hospital at about 7:00am and wanted be to join them, so I did. We ended up waiting in the room for 11 hours before she could get her surgery! Since I know now that surgery can be postponed, I would go to the active labor when requested and gave the c-section family call the back up nice they knew exactly what time they are going to have their surgery. I think you could do more good for the laboring couple than taking a chance to be sitting around all day with the c-section couple. You might even be able to do both in the end.
This is a good one. I haven’t been in this situation yet as a primary doula, but I’ve been the backup. I’ve been thinking a lot lately about how I will manage it when it inevitably occurs.
One thing that most of the replies here don’t consider is that “scheduled” cesareans rarely happen on schedule! And I often find that clients need more support after a cesarean delivery than vaginal. Sometimes, but not always, I’m there for more than 1-2 hours after the birth.
Great question! I’m always guilty of being overly optimistic and thinking I can do everything…so this scenario gives me some good things to consider. I enjoyed reading everyone’s comments. Before I would go to the family in labor, I would call my back-ups and make a tentative plan. In this scenario, we miss all the things we would know about our clients in terms of confidence, partner’s views, extended family support, if we would be in the OR or not, etc. Knowing that people check in hours ahead for a scheduled c section, I would call them around that time and explain the situation. I would offer them options like (a) I could join them prior to surgery and stay to connect postpartum (b) I could join them postpartum only (c) I could send my back-up to them for pre-op and postpartum. Once I have a plan with the c section family, I know how to proceed with my laboring family and whether I stay with them or call in the back-up. I’ve found that most people are quite flexible and understanding when we explain the complexities of what we balance as doulas.
New Doula here. Although I’d be eager and excited to attend the laboring couple, I think I would attend the Cesarean and send the backup to attend the labor. Once I’ve committed to meet a client on a specific date and time I have to fulfill my duty with that couple; it is in a sense like if her early labor had started and I am just waiting for her to be in active labor to join them.
My back-up and I make every effort possible to meet each other’s clients and get to know them before labor. That way, no matter what decision is made, I am not sending a total stranger to the birth. A good point has been made to clarify for clients the reasons that might necessitate sending the back-up doula.
I would contact my backup for the planned surgical birth, letting her know that she will be attending that birth, as I have been called to another birth. I would text the family who is having the surgical birth and tell them I have been called to another birth. I would apologize for missing their birth, but let them know they will be in excellent and loving hands with our backup, whom they had an opportunity to meet before their birthing day. I would then join the family who is laboring at home.
After all the babies have made their journeys, I would check in with my backup and ask her how things went. I would visit the family in the hospital and then do a follow up postpartum meeting in their home and include the backup doula in the meeting.