Physicians and Labor Support

[May_baby]

A friend of mine in a nearby state was recently told at 36wks by her OB that if she and her husband hired a Doula the Physician would not attend her delivery.

I am nursing student and also have extensive experience (200+ births) as a hospital-based doula. I have never encountered a provider who made it a rule that clients could not seek out a professional support person during labor.

I should add that the physician did not reject me in particular, but Doulas in general.

I would love to help this friend during labor, and be present only as a friend that just happens to have some undisclosed doula training... But on the flip side I know the Physician might be suspicious and this could create tension.

What is your take on a friend serving as a Doula in a situation like this?

I would hate to cause tension with the Physician or hospital staff.

*Clarification*

I am the Doula/Friend.

My friend is the one expecting.

[May_baby]

Wow, I really appreciate all the feedback!

Just to clarify, I am the Doula/Friend.

My friend is the pregnant client.

I guess my greatest worry is that if I am her "undercover Doula", "sister in law", or "cousin" the OB might still ask for me to leave at some point. Or demand that I leave.

I'm definitely no firestarter as a Doula and I have great respect for the Physician/Client relationship.

I just wanted to make sure it was not unreasonable/unethical to fly under the radar and be her labor support person.

[firstyearstudent]

I don't really get the difference between telling a mom who she can or can't have in the delivery room and refusing to take a patient who wants a doula for labor support. In terms of the physician not wanting someone medddlesome in the delivery room, he should ban expectant grandmothers before doulas. Heh heh.

[SmilingBluEyes]

While your doctor's comments about having a doula certainly raise some red flags, I would talk with him further before running off to find another provider. If he is opposed to ALL doulas, then I would be concerned that he may be inflexible, overly controlling, and insecure in his own practice, not good qualities in an OB. However, if he is referring to one particular doula with whom he has had bad experiences, then you may be able to come to some kind of agreeable arrangement.

I used to work in a birth center with a great group of MDs and CNMs. Most of our patients had detailed birth plans, and we were usually able to accomodate their wishes. One local childbirth educator was so militant and over-the-top that her patients came in to deliver with the (incorrect) impression that we were there to ruin their plans and destroy their birth experiences. It was impossible to provide safe care for some of these patients due to the "brainwashing" they received from this woman. Our manager tried to reach out to this educator to work out a teaching curriculum that was more realistic, and offered to have one of our nurses co-teach with her. She refused, and subsequently some of our MDs and CNMs began to refuse this "educator's" clients as patients, citing their inability to practice safe medicine.

It is one thing for a doctor, nurse or CNM to have to work out differences of opinion regarding treatment with the patient and her partner. That is our job. But it becomes impossible when an "third party", especially one without detailed medical/nursing knowledge, is pressuring a patient to go against medical advice. Due to the litigous nature of OB, many providers are just not willing to deal with this type of situation.

Of course I don't know for sure that this is why your doctor reacted the way he did. It's just a possibility that may be worth checking into.

I agree with the above posters who stated it is not up to your physician to decide who is present during your labor. So, if you can't come to an agreement with him, I would encourage you to start looking for a new provider.

You took the words out of my mouth. It would be nice to communicate with the Provider to see "why" he/she feels this way and THEN decide next how to proceed. There may be reasons; there may be misunderstanding. Just running off to another provider is not the most logical first next step, however, if this is a doctor this lady trusts.

Good advice here. I need say no more.

[Jolie, BSN]

I don't really get the difference between telling a mom who she can or can't have in the delivery room and refusing to take a patient who wants a doula for labor support. In terms of the physician not wanting someone medddlesome in the delivery room, he should ban expectant grandmothers before doulas. Heh heh.

Having spent 11 years in OB and NICU, I can say that there is usually a HUGE difference between a meddlesome grandma-to-be and an overbearing professional support person such as a childbirth educator or doula. I don't want to sound like I am bashing educators and doulas. That is not my intention at all. But I have dealt with a few who have gone way out of bounds in being argumentative and have pressured their clients to refuse pain medication and refuse other interventions that were suggested in good faith, in the best interests of mom and baby. Now, if a patient WANTS to refuse care, that is certainly her right, but I have witnessed cases where the patient was agreeable to an intervention, and her birth attendant basically bullied her into refusing. That is the type of interaction I was referring to in my previous post, when I suggested that perhaps this physician has it in for doulas because of a bad experience with one.

Give me a grandma any day over a militant childbirth attendant.

[firstyearstudent]

Give me a grandma any day over a militant childbirth attendant.

What if grandma is a militant childbirth attendant? Heh heh.

[matchstickxx]

If this doc was so strongly against a patient hiring a doula, why did he not tell her earlier in the pregnancy and not when she was near term? I do not think it is very fair to the patient to spring this on her near the end of her pregnancy. If he feels so strongly about this then he should include this restriction in the info provided to new prenatal patients. It should not come as a surprise to the patient in the last month of her pregnancy.

As stated before, she should ask specifically what his objection is to doulas. Then she can decide whether or not she should be looking for a new ob/gyn in the future.

[tinyscrafts]

I'm a doula and I recently had my first experience with a dr that came into the room, saw me there and proceeded to rip my client a new one, in their native language (picture me being clueless here) "I don't allow doulas..." they played dumb and I stayed. the nurse had no problem with me at all and was willing to back me. This mom did not tell the Dr. I would be there and I did not know it (Nor do I ever ask). It was a very uncomfortable/unpleasant situation, and surely affected moms labor. The next time he came in he threw another hissy fit. He was a very controlling OB but she was pretty much stuck with him. No doubt she worked him to get things her way. By the end he told me "it's not my cup of tea, but that you do good work" I need to send him some business cards:lol2:

I sure wouldn't go into that situation knowing about it. To me to play 'friend" or sister or whatever is unprofessional. You are a professional doula, research shows you are a help, it's the clients call... don't hide, Hold your head up and be a doula

[firstyearstudent]

What about Midwives? When I was checking out my childbirth options, I visited a birthing center. (I eventually went with an OB because my insurance didn't cover it.) Someone asked about doublas and the midwife frowned and said that they discouraged people from bringing doulas. They really didn't need them there and the midwives would provide all the support they needed.

[May_baby]

Tinyscrafts,

I just want to acknowlege your statement about honesty.

What you had to say about presenting myself professionally really rings true with me.

Honesty is the best policy.

Afterall, I don't want to give this one Physician any future ammunition against Doulas.

[CMCRN]

Jolie, absolutely right on!! As L&D nurse for 27 years I have worked with some wonderful doulas. Then in the last 5 years we have started having major problems to the point where my favorite group of OBs banned doulas from their practice completely because as Jolie stated they didn't feel they could practice safe medicine.

[Jo Dirt]

Actually my understanding of the OP was the MD wasn't banning the doula from the labor room, he was stating his position on who he would accept as a patient. He just wouldn't accept a patient who wanted a doula. His right to do so but not choice I would agree with. Any idea as to why he has objections?

I imagine some "hired help" could be pushy and cause conflict during labor and the doctor probably doesn't want to take a chance on having that kind of interference.

He probably has his way of doing things and wants to leave it at that (even though he probably won't show up until the baby is ready to come out.) It might also be about the scrutiny of someone making judgements about the decisions he makes and the way he does things. Maybe this doula would be seeking him out to do things he doesn't see the need to do at the time (like check dilation, position and such).

[midwife2b]

What about Midwives? When I was checking out my childbirth options, I visited a birthing center. (I eventually went with an OB because my insurance didn't cover it.) Someone asked about doublas and the midwife frowned and said that they discouraged people from bringing doulas. They really didn't need them there and the midwives would provide all the support they needed.

Speaking as a CNM, I LOVE doulas!

There are times when I have 2 or 3 ladies in labor at the same time. If it hadn't been for doula care I would have FAILED miserably in providing emotional and physical care. The more people involved who understand and respect the patients birth choices, the better, IMHO.

HOWEVER, I have worked with the occasional doula who has argued with the doc (or me) over management of prolonged or arrested labor. I dont mind argument/disagreement with me, but I do wish the doula hold her opinion until the physician (who I have called, consulted with, and prepared the parents to see) has left the room.

It is one thing to suggest an alternative strategy. It is another issue to argue with physicians over medical management.

I am still recovering from my last birth... where the doula did not want me to do AROM. The poor woman labored at least 6 hrs. longer than she had to. She was 8 cm. for 6 hrs. When I finally broke her water she had a wonderful birth 20 minutes later.