Monday, March 1, 2010

Worst Frickin' Doula Luck

My third doula client is due the end of March. Do I have the luck and privilege of supporting her in labour? No, I do not. Her baby is breech, her doctors referred to an OB, her OB has recommended against "taking the risk" of a vaginal breech birth (despite the fact that this OBs own surgical SOCIETY has revised the breech position recommendations to include shooting for a vaginal birth BECAUSE IT IS SAFER, and performing surgery if the baby shows signs of distress). Cut, cut, cut, slice, slice, slice, chop, chop, chop--are we making a salad? Oh, no. We are making holes in uteri against the recommendation of our overseeing college because we feel that surgery is safer. Do we think about this woman's future increased risk of placenta previa? Placenta accretia? Uterine rupture? Infertility? Adhesions? Infection? Hemmorhage? Ectopic pregnancy? Future cesareans? Nope. How about the baby's increased risk of transient tachypnea? Premature birth? Laceration with the surgical scalpel? Breastfeeding problems? Hospital-acquired infection? Nope. Well, maybe we do. But we're pretty confident that those things won't happen, because we see them rarely. We're pretty confident that we WILL see complications if we 'let' this woman deliver vaginally though. Because we see them rarely (actually, never, because we surgically deliver all babies who present this way!). Hey wait! That doesn't make sense!

I'm frustrated. No, the whole frickin point isn't just to avoid a cesarean, and don't worry I'm spilling it ALL HERE so that my client has no idea that I'm frustrated. My personal agenda has no business anywhere near her birth. I just get frustrated when I see evidence of very little effort to strive towards natural birth, like it doesn't really matter how a baby enters the world, just so long as it does. Of course it doesn't matter how a baby enters the world if the woman or her baby either would have died or could likely have died or suffered injury from a natural birth. OF COURSE. But when the choice is between a safe vaginal delivery and a safe cesarean, the statistics show a higher risk of complications with the cesarean. The WHO meta reviews have shown that if a region's cesarean rate is higher than 10-15%, women and babies are being harmed more than they are being helped. Why? Because those risks I listed above sometimes come true for some women. This becomes statistically significant at cesarean rates higher than 15%.
So. I want women and their care providers to choose safer options, which strive towards physiological birth. Baby out of vagina. Period. I want this because it is BETTER FOR WOMEN.

Another frustration for me is that my client's OB has not ordered an External Version. Cutting without even *trying* to rotate the baby makes me mad. I've encouraged my client more than once to ask for an EV, so I hope she remembers. And I hope he DOES ONE. And baby FLIPS. Of course I have recommended a host of other baby flippin' tricks as well, which haven't worked thus far. Flip, baby, flip! Because physiological birth is healthiest for woman and baby.



ms emili louann said...

RAWR! this makes me mad too! my face is getting HOT.

i remember all these feelings when elijah was breech, and i "had no other choice" but to have a c-section... why did i not know you then?? why do we feel bullied by doctors!?!? ahhh....

ms emili louann said...

oh, and awesome pictures, btw!

nancy said...

I see you destined for midwifery and maybe not doulaship!

Be encouraged that you are working towards supporting women who are likeminded towards natural childbirth, by pursuing midwifery.

You may be able to advertise your doula services to those determined to deliver with as few interventions as is safe for babe and mom(as determined by WHO recommendations).

I so empathize with your frustration and anger. I am learning to reserve my support for those families who have educated themselves enough to appreciate the beauty of birth as it is meant to be. With everyone else, I feel I am required to give evidence based info, then disengage as they make their decisions. This protects me from unhealthy increases is BP, HR and feelings of disatisfaction and frustration.

love mom

Rachel Clear said...

Shoot, shoot, shoot!! I'm sorry... this is a real bummer.

I don't know about Doula care there, but I think the need is just as great in the hospital and even greater in a C-Section IF (that's a big if) the mom has wishes she will need you to advocate for.

I actually have a doula friend (who I met at doula and midwifery school) who, although SHE is a huge natural birth advocate, doulas mainly at c-sections and she has a host of valuable information and ways she has helped in situations like that. Some women might not need it as much in that situation (obviously labor support is out) but it's an idea. And it would give you a chance to still be with her, telling her of her options. She might not realize that even with a c-section, there are still lots of variables and options that she CAN decide. I hope it goes okay.

I'm sorry. Aaaaack! This sort of thing stresses me out and makes my blood rise because I hate seeing women "feared" into things... sniffle.

Asheya said...

Great vaginal breech birth photos!

Someone needs to start educating doctors, don't you think? But how to go about belling the cat....