A doula offers support and comfort measures
The story I’m about to share with you was hard for me to believe. Yet when I listen to women tell their stories, I realize that it is not unusual.
Claire was a new patient to my office, expecting her second baby. T
The first visit with me is usually a longer one, because I take a detailed health history, as well as talking to the client about her nutrition and exercise habits, and how she is feeling emotionally about her pregnancy and day-to-day life. I really enjoy these visits, because it’s where I get to know the new client a little bit, and establish a relationship with her.
When I asked Claire to tell me about her first birth, she said the pregnancy had gone well, but the birth was “bad”. I asked her to tell me more about the birth. Claire said that she had been induced, and it had taken three days of induction to finally get contractions starting. I asked the reason for the induction, and Claire shrugged. “They never told me. They just said it was time to have the baby. I think it might have been because I was a couple days past my due date.”
After three days of cervical ripening agents and pitocin, Claire finally began to have contractions. She was dilated to one centimeter at that time. In the late afternoon, someone checked her and found she was five centimeters, and broke her water. Two hours later, she was checked again, and it was found that she was still five centimeters. At that time her doctor told her they were going for a c-section. Claire protested, because she wanted a vaginal birth. She asked for more time. As she related the story, Claire become somewhat agitated. “I told them NO! I said I would not consent to a c-section until I had had more time to labor.” I asked Claire if there had been any sign of a problem with the baby, and she said no. The doctors simply told her that she had “failure to progress” and that her baby could not be born vaginally because she was not dilating.
Then came the part that stunned me. Claire’s doctor told her that unless she agreed to a c-section, her medical insurance would not cover any of her hospitalization fees. Knowing that she could not afford to pay the several-thousand dollar bill on her own, Claire, feeling trapped, signed the c-section consent.
I felt very conflicted at this point. Should I tell Claire that her doctor had lied to her? Or would that make her disappointment over her first birth even worse? I decided to tell Claire the truth:
“Claire, I’m sorry to tell you that you were given incorrect information. Some insurance companies will deny payment if you leave the hospital against medical advice, but I am not aware of any insurance company that can deny payment because you refuse a c-section. The law protects you here. It is your right as a patient to decide what happens to your body. On top of that, your body did not fail you. As a first-time mother, your c-section risk, if your labor was induced, rose to about 50%. Because it took so long to get your body into labor, I suspect your cervix was not ready for labor. Then when labor finally did begin, you dilated from one to five centimeters in a few hours. That’s really fine progress for a first labor and an induction! They broke your water when you were five centimeters, and then you didn’t change for two hours. That’s not unusual at all. First of all, it was too soon to break your water. Breaking the water doesn’t usually speed up labor, and it takes away the cushion around the baby’s head. Many times, the bag of waters acts as a wedge, bulging through the cervix with every contraction. This actually helps the progress of labor. And the current thinking is that a first-time labor should not be considered as a failure to progress until she is at least six centimeters dilated, because until then, she is not even in active labor. Claire, you didn’t fail! You were taken to c-section before active labor had even started!”
We then talked about her chances for a vaginal birth this time around. I encouraged her to be positive, and told her that, especially if we waited for labor to begin on its own, I saw no reason to think she would not give birth vaginally. Claire seemed very encouraged by this news.
I wish this were an unusual circumstance, but it’s not. All too often, I hear providers either outright lying to their patients, or telling only partial truths to manipulate patient behavior:
- “We could keep laboring for another hour, but it won’t make any difference”
- “Breaking your water will move things along”
- “Your baby doesn’t know if he’s with you or not. Let him go to the nursery so you can sleep”
- “One bottle won’t hurt your baby”
- “Your pelvis is on the small side”
- “Your baby is measuring big. A c-section would be safer”
- “We need to monitor your baby just for a few minutes so we know he’s OK”
- “Being out of bed doesn’t help labor move any faster than being in bed”
- “Your baby is breech. There’s a really high risk she will die if you don’t agree to a c-section”
- “If you try to have this baby vaginally, your uterus will burst open, and both of you will die”
- “Squatting doesn’t give you any better chance of delivering normally than lying on your back does. That’s an old wives’ tale”
- “I need to give you just a little cut down here to make more room because it’s much worse if you tear”
May is International Doula Month. I encourage all my clients to use a doula. Few of them actually do, mostly because of the cost. Yet when you consider the cost of some of the interventions listed above, a doula begins to look like a really good bargain. Most doctors and nurses, and some midwives, dislike having a doula at the birth. Why? I believe it is because a doula can speak up when she knows that her client is being lied to or manipulated. She can request to have a private moment to speak to her client, and then tell the laboring woman the truth. A doula can provide support for a tired Dad who’s trying to be a good coach, and wants to support his wife’s desire for a natural birth, but is worried: what if the doctor is right? What if we really do need to break the water to speed this up? A doula is an experienced, educated, objective voice of reality, and that is why many providers don’t want them around.
If you are planning a hospital birth, I strongly encourage you to take a doula with you. If you don’t know where to find one, start with Doulas of North America (DONA) and their “find a doula” feature on their website. It may make all the difference in the world for your birth.
My 26 yr old daughter will be “slowly” induced tomorrow at 8 PM ct. Her due date is tomorrow, her weight is perfect,no health problems,heathiest eater ever! I’m an old RN (not my field) trying to make sense of this. My daughter is a child therapist (educated), she really likes her docter. any ideas on what I can do or watch for? What are the standards these day when the bag of water is broken and medication? She is signed up for an edidural. I wished I’d hired my own Doula since she wants me and her husband in the delivery room, Any thoughts?
althy eater ever. i don”t understand a “slow induction”
I have a lot of thoughts on this, but there’s only so much you, as the mom, can do when she has made a choice that may not be the best for her. We will certainly hope for a good outcome, but statistically, she has a 50% chance of ending up with a c-section if she is being induced. Many physicians will break the water as soon as the cervix is 3 cm dilated, or enough dilated that they can rupture the membranes. This has not been shown to speed the course of labor, it increases risk of infection, and increases risk of fetal distress because the baby’s “cushion” is removed, and contractions can compress directly on the umbilical cord. The epidural will likely be given in the earlier stages of labor, because the pain from artificially induced contractions is greater than normal contractions, as well as the fact that the laboring mom must be tied to the bed in order to be continually monitored during induction. Being able to move about freely helps mothers cope with contractions. The earlier the epidural is given, the greater the likelihood of an epidural-induced fever. Since providers cannot be sure if a fever is due to the epidural or due to an infection, mother and sometimes baby will receive antibiotics if this occurs.
A slow induction is the latest trend, since evidence has shown this to be safer for labor inductions. However, when you throw an epidural in the mix, you need higher levels of oxytocin to counteract the effect of the epidural on contraction frequency and strength.
I don’t know what you can say to her, other than to tell her these facts. I have blog posts on all of these interventions and links to the research that shows the risks of these interventions. She certainly would be wise to postpone her induction at least another week, but it’s her decision and there’s not much you can do to avoid problems when she decides to be induced without a medical indication. I will keep my fingers crossed for her (and you!) and hope for an easy birth (they do occasionally happen with inductions)!
A few months ago, pregnant with my second son, I wrote to you asking your opinion on going past my due date with a suspected larger baby. I wanted to trust my body to go into labor naturally this time (I was induced with my first) and I was worried my midwife would pressure me to induce at my 41 week appointment. Your advice helped me to renew trust in my body and with a little luck, I went into labor the evening before my appointment and had a great birth experience! I comment on this post because I love what you said about doulas. For my first I was too “cheap” to get one and wish I had. This time I hired one, and I credit her with so much that went right this time. Thank you again for your site, and for responding to my email months ago! I appreciate all you do. Here is my birth story and an article I wrote about my doula experience as well on my blog. Enjoy! http://popsizzleeat.com/2011/04/24/benjamin-rhys-boan-4411/
http://popsizzleeat.com/2011/04/27/what-is-a-doula/
So this is what has been bugging me since my c-section in Sept 2010. I was in labor for 56 hours, 7 of those hours I was on pitocin. I had no pain meds, until they wheeled me into OR, gave me a spinal, and cut my daughter out.
When I was admitted to the hospital (We’d planned a homebirth, but transferred once I was getting warm…by the time I got to hospital, I had a full blown fever. I had PROM), they said I was 2cm dilated. Baby was OP, so I knew things would be slower. They gave me antibiotics and put me on pitocin. I had maternal techachardia and baby had techachardia as well. But seven hours after being on pitocin, the doctor came in and did a vaginal exam. It didn’t feel anything like the initial exam – I felt soft and her fingers slipped easily in and out. And she claimed I was STILL 2cm dilated. And that since baby’s heartrate was still techachardic, we needed to have a c-section right away.
My midwife was in the room at the time, and I was so disoriented, it wasn’t till later I told her that that vaginal exam felt nothing like the previous two where I’d been told I was only 2cm’s dilated. I still wonder – am I crazy? How could it feel so different and I still only be two cms dilated after all those hours on ever-increasing pitocin? I was relaxing through the contractions – the nurse said she has never seen someone have contractions back to back like that on pit be so calm and relaxed. SO I have no reason to think that I couldn’t dilate on pit.
Any and all thoughts on this would be welcome. I’m going for a VBAC in January 2013, and I’m trying to get some clarity. Did my body actually not dilate at all after 56 hours of labor?