As a mom, a childbirth educator, a consumer of health care and a doula, I am sad for THIS mom and her doula.  It reads like a story of a naive mom and an over-reaching doula; a hospital staff that missed warning signs in labor.  Thank God and the care providers who were on top of their game, the baby sounds like she is thriving today despite her rocky start.

How terrible to learn the hard way that a doula is NOT a medical professional. I am sad that her doula did more than facilitate her decisions by asking open-ended questions.  The doula influenced and made medical decisions.

There are many GOOD and GREAT doulas out there who understand their role as a support person ONLY.  Besides labor support, doulas are knowledgeable about pregnancy and birth based on their education, continued reading, and client experiences.

A good doula will share information (i.e., articles or good studies to read for both the pro and con of every option/consideration/intervention) and she will ask questions.  A good doula may share past experiences from previous clients, and she will NEVER decide for her client.

It is up to the client to use their BRAIN.  In short, what are the Benefits-Risks-Alternatives? What does my Intuition say? What will happen Next if I say yes, or what happens if I do Nothing?

It is up to each family to question more and trust less.  True informed consent means reading, educating, and asking questions, not just blindly following advice – be it medical or otherwise.  Even medical professionals can give you bad advice, and not because they are evil. They may be slow to catch up on evidence-based care while doing CYA to keep their insurance companies happy. Doctors have their biases, too, usually based on previous outcomes.  Their reasons are worth listening to – they are after all, professionals with years of education and experience.

What if their practices and/or malpractice insurance carriers are not caught up to evidence-based care as per American College of Obstetrics and Gynecology (ACOG)?  I encourage all pregnant mothers to read up on ACOG guidelines* so that you know what the current practice standards are.  If your care provider is not following the guidelines as set forth by their professional organization, ask them why.  And LISTEN to the answers so you can weigh the information against what your intuition and research is telling you.

It is the responsibility of every parent to weigh the benefits, risks, and alternatives to all the information they are receiving BEFORE they make a decision, whether it’s for their care or their children.

I will offer these words of caution: if someone on your care team is setting up an “us vs. them” mentality, it is a red flag to RUN the other way get more information. Pregnancy care is definitely a team effort. If someone says otherwise, whether it’s the doctor, midwife and/or the support team – some part of the story is is missing. Find out what their history is if you can, decide if it’s something you can work around, and if not, build a new team.

My little equation:
Childbirth Education + Supportive Care Providers + True Informed Consent = Empowered Birth

Making true informed consent decisions are part of the equation in empowered birth.  In addition, choose your care providers wisely – both the medical and support team should be willing to work with you for a Healthy Mom, Healthy Baby outcome.  Another part is to set yourself up for success: eat well, exercise, meditate (relaxation practice), avoid harmful substances, educate yourself on the process (Bradley Method® classes cover all these topics). Having a good foundation for what is normal, the variations, and true complications of pregnancy and childbirth will help inform you as you make decisions about your care.

Will every birth play out just as you imagined?  NO WAY.  However, by following the above equation, I believe that every family CAN have a birth experience that they are proud of: they know that they did all they could to have the birth they planned for, they recognized the forks in the road, they made carefully considered decisions as a team, and proceeded with the informed choices that yield a Healthy Mom AND Healthy Baby.

What are your thoughts on doulas, doctors and informed consent?

Want more info in evidence-based care? Read my feature article in the ICAN Clarion, a quarterly newsletter HERE,  Usually only available on a subscription basis, this issue was made public in honor of Cesarean Awareness Month.

*ACOG publications – three to start with
Term is redefined as 37-42 weeks
Reducing the primary cesarean rate
VBAC guidelines