Thursday, March 4, 2010

Doulas Behaving Badly

My daughter Kayleigh came home a couple of days ago from her gym intensive class with some interesting information. She had been distance walking with a girl in her class who is a nursing student. It turns out she works in the Labour and Delivery unit at a hospital I practically live at. When my daughter told me her name, I was familiar with it. A nice girl, who always greets me with great friendliness. I enjoy working with her. So it was with mixed feelings when I heard from Kayleigh that this nursing student generally doesn't like doulas. Kayleigh informed this young woman that her mom was a doula and mentioned my name, and this is when she said, "Oh, Lesley is one of the few doulas I really like. But most of them I don't like. They take my patients off the monitors and mess with IVs."

What I want to know is WHO of you doulas out there are doing this?! Because you know what? You've gotta stop. I don't know about you, but I have worked long and hard to get in a position where doctors and nurses trust me. In fact, most of my business is through doctor referral. It is this trust that has led to my good success as a doula. I did not sign on to be a doula who works mainly in hospitals because I am personally a big fan of hospital births in general. I'm an avid home birther. But my purpose and my goal is to ensure women get the best possible care within the system they choose. This is not by control, but by support. I truly feel if all members of the team took time to look into each others' hearts, we would most likely find the same intention...to hold a space, the way we know best, for a safe and happy outcome for the mother, father, and baby. We may have different approaches to this goal, but each member has a valuable role that deserves respect.

I personally think it is extremely bad behaviour on a doula's part to fiddle with equipment in a hospital because you are trying to reduce intervention. This is not advocacy! This is blatant rule breaking, and creates the risk of getting us banned from hospitals altogether. In fact, one of my clients told me that at one of the hospitals I work at less frequently, there is a group of family doctors who refuses to work with patients who have doulas. This breaks my heart, because I know if they could only witness a few good experiences with doulas, they would relax, and see the value of our services for their patients. My best experiences are usually ones in which family doctors are involved, and I think these doctors who have banned doulas are denied of seeing the kinds of births that are common with the presence of a good doula. It only takes a couple of bad egg experiences to put people off eggs.

Why should you not take women off the monitors? After all, they're on there way too long a lot of the time. Because, it is not your role. You can track down the nurse and ask her to please take off the fetal monitor, explaining your client has been on it for the required time. In my experience, once I ask permission, I see the beginnings of trust start to happen. The nurses know I am not out to sabotage their work. Imagine being them for a minute. They are responsible for the monitoring of their patients. It is they who usually decide whether or not a doctor needs to come into the room to check things out based on what's going on with the mother and baby. If a nurse is required to have a mother on the monitor because that is the rule of the hospital, she comes back in and you've undone the whole thing, something happens with the baby, who do you think gets in the most trouble? Probably the nurse.

I'm a pretty experienced doula, and am capable of reading a monitor, getting a general sense of how things are with the baby. But I am not qualified to diagnose this for certain. There are probably a lot of things I DON'T know about reading a fetal monitor, and I'm not going to assume anything. If your client wants to take off her monitor, it is her right to do so whenever she wishes. But not at your request or suggestion. And it is certainly not your right to take her off the monitor for her unless there has been an agreement between you, the client, and the nurse. Ask the nurse. If she doesn't agree for some reason neither you nor your client understand, ask the head nurse. In my experience, when a nurse sees I am playing by the hospital rules, she often gives me permission saying, "okay, take it off, but just buzz me and let me know so I can mark it down." Building this rapport of trust is essential for us to continue our work, so we can demonstrate the kind of birth outcomes that make doctors and nurses stand up and take notice of how important our work is.

Combative doula behaviour is not going to change how the hospital operates. If you go up to a nurse, get in her face, and say, "What do you think you're doing?" every time she has to turn up the Synto (because it's her job), you are not going to teach that nurse a lesson in Synto administration. It's going to make her say, "Screw you and the little weekend workshop you came in on." At the nursing station, they will laugh at you for having the audacity to assume you know the "right" way for them to conduct themselves. Now, perhaps you do. Perhaps you are savvy of evidence based medicine based upon things they have not studied. No matter. Your behaving this way will not ever get your thoughts listened to. No change will be created. In fact, you set it up so there will be a very shaky future for you and your doula sisters to work within.

The environment I work in is accepting and allowing of my doula care, through familiarity, careful diplomacy, and trust. If I were uncomfortable with a way a nurse was administering Synto, I would suggest the mother or her partner to ask, "I really am having stronger contractions now, would it be possible to wait a little before upping the Synto?" (in the hopes that the mother's body will take over, negating the need for more). Most nurses say, "Sure, we can wait a bit if that's what she wants." If they are really adamant about not allowing this and you're not sure whey, you could talk to the resident or doctor, though not in a way to make it seem like you're "telling" on the nurse. They may give you a very valid reason you didn't know about or consider. If everyone says, "no," and you don't get it, the client herself or her partner can certainly speak for themselves. They're not victims here. It is ultimately their battle, not yours. And if they decide to accept this treatment, even if you think it is inappropriate, what do you do? Suck it up. It's not your choice. Yes, it's hard to see things administered when you are very aware of the risks and see them unfolding before your very eyes. But you have to remember: your clients CHOSE hospital birth. By going into this environment they are aware that for the sense of personal safety they're buying by being there, there are some challenges associated with that. Don't assume that because they acquiesce to a procedure you don't like means they feel victimized. Don't assume, "oh, if they had all the information, they wouldn't make this choice." Not true. Your clients are not representatives of your own personal agenda to educate staff members on what you feel is the "stupidity" of their protocols.

You may ask, "what if my client doesn't have the type of personality where they can stand up for themselves?" If you inform them to the best of their ability, giving both sides of the coin, your client can tell you what she wants when you have a private moment, and you can communicate it, letting the staff know you are stating your client's wishes, not yours. I'm not personally a fan of doing this, as I think even if women can't speak because of the labour, their partners can. But sometimes you're with a very vulnerable woman who is alone, and you make exceptions. If, however, she can't stand up for herself even with your help because she's afraid of creating conflict, making choices based on not rocking the boat instead of on what she needs, you have to wonder at what point you are at the line between empowering and enabling. Where does your role of advocacy end and your journey of owning the birth for your client begin? Stand back and re-examine your intention.

If you can't stand the heat, get out of the kitchen. If you loathe attending hospital births, stop. If you cannot abide the procedures and the way women are sometimes treated there, fair enough. Not everyone can stomach it. If you feel like you have to weep every time a woman gets an unwarranted vaginal exam, even if she doesn't seem to mind, you are in the wrong profession. Maybe midwifery is more your calling, so you can provide consistently compassionate clinical care. You know what? I don't like MOST of the ways birth is dealt with in the hospital. And that is precisely WHY I'm there. I know, through experience, that gently and lovingly going about my work, being present for each experience, finding the best in people, making friends, respecting ideas, and working together is how the change is made. I have to digest an awful lot of crap and witness some yucky things in order to do so, but I can tell you it is working. The head of OB at one of the hospitals my colleague Rivka and I work was at a meeting some nurses and doctors had invited us to. She acknowledged and honoured our work there, recognizing the importance of our statistics, and is interested in using us as resources to help lower the rate of some of the interventions. The doctors and nurses had to qualify, "Lesley and Rivka are GOOD doulas," implying there are problems with doulas out there who are on political rampages, in violation of active but non-violent communication.

Doulas, you have TREMENDOUS power to bridge the gap between holistic and medical maternity care. We can help warm up a frosty nurse with friendliness. We can have our clients ask questions about their care which lead to their choices being honoured. We can encourage and praise a new doctor for catching a baby in an "alternative" position so he feels more confident about it for the next lady who comes along. We can show them that most women can give birth without pain management if they choose and circumstances favour this choice (if you set up a lot of tension and conflict, this will be less likely...it may not after all be the "system" to be "blamed" for the woman's epidural..it might be you). I have had lots of doctors and nurses ask me about the non-pharmaceutical ways I help to ease back pain in labour. They are interested. We can buffer the environment, and support our client strongly when things go out of every one's control. These are small but powerful ways we work, creating momentum. But we need a mellow environment for that work to grow.

Simply put, women are not all gonna be running off and having home births just because we embrace it to be a safe, wonderful option for most families. The vast majority of births are going to be in a hospital, like it or not. Is our mission to be "right" and go about snottily proving it to every nurse who ups Synto through an IV, or is it to lovingly welcome in a baby to a mother who feels as empowered, respected, and loved as we could make her feel? If she has a crappy birth experience in spite of all your good work because the people at the hospital were nasty that day, well, that might make her choose a different option the next time. And if she has a wonderful experience, is this not MARVELLOUS enough?

So, all you doulas behaving badly out there, please understand you are hurting the cause. You may justify yourselves all you want by making snide remarks about brown nose diplomacy. I would rather wipe off the occasional stain than have my spotless snout shut out entirely and responsible for leaving vulnerable women unbuffered in that system. Because that is effectively what you are doing. Instead of healing this birth culture through your angry, righteous approach, you are going to get doulas, the very ones who hold the power to heal it, barred from hospitals entirely. When that happens, those hospital birthing women will not have access to the care they need from us, thus limiting their choices and potential for amazing experiences within that harsh environment even further.

A woman's birth is her own journey. It unfolds for her, provides lessons, transforms her, and gives her a baby. There is not a lot of control over that. Sometimes you have to sit back and watch things you don't agree with go on. Midwives and doctors do this too. If you think a birth full of interventions is necessarily a reflection of how good or bad you are as a doula, and this is one of the reasons you are so viciously opposing them, you are working from your Ego. Let it go, Sister, and focus on the bigger picture. We need you.

Lesley
http://www.motherwit.ca/

36 comments:

  1. Thank G-d there are doulas out there that are willing to go the extra mile to help mom in the hospital! They just went up a notch in my book.

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  3. oh, forgot to say, but I agree with your post. :) Just was adding my 2c.

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  4. deleted my last post because of some typos, sorry...

    Hmmm... I never fiddle with the IVs, but I will buzz the nurse station and tell them that I am going to unhook the monitors for mama to get her to the bathroom. Then, I rehook mama and readjust when we get back. I have never had a nurse NOT like my help, and, in fact, usually get comments like "thanks for helping, one less time I have to come in and bother you all!"

    I have buzzed nurses stations to let them know the "xyz" alarm is sounding (IV bag is finished, EFM paper out, BP cuff leak, etc..) and that I am turning off the alarm. Then, I silence the alarm (so as not to disturb mamas focus) and them point out the machine to nurse when she gets in. Again, never had a bad reaction to it.

    I would NEVER, though, even consider messing with the medical...

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  5. Well, yeah, of course, this is what we do. We are asking/informing. If they said, "no", of course we wouldn't. I will turn off alarms too, because usually they're useless, and will inform them to come when they have time. That's not being a badly behaving doula at all. It's the ones who don't buzz or inform, just "do" the nurse's job without letting the nurse know.

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  6. And I completely agree with that.. I didn't want the avg. joanne to go "wait, my doula..." :o)

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  7. Fair 'nuff. Good point! Thanks, Nicole.

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  8. I love your post. I am a labor and delivery nurse at a teaching hospital-an environment that I know consider hostile....I know that some of us are more comfortable with natural birth than others. I think it is a beautiful experience when the family is well prepared. I have worked with some wonderful doulas. I have also worked with some nightmares. You made a comment about "the agenda," which is a lot of what makes many of us uncomfortable with working with some doulas. I do what I do because I ALSO want to give my patient and her family a beautiful birth experience...and in order for that, I need for them to trust me. It is very difficult for this trust to be built if I am working with a doula who makes her disapproval of the hospital, the nurses, the monitoring, the IV etc. known every time I walk into the room; and I sometimes get the feeling that it's been talked about even when I'm out of the room. I don't like to be made to feel like an outsider when I work my tail off to make sure to give every patient the best birth experience possible; while still keeping she and her baby safe, and keeping me out of court.

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  9. oops. I meant to say "an environment that I know some consider to be hostile"

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  10. I have worked L and D for a little over 18 years...maybe it was the area I lived in....I do not know....but I worked at a community hospital and also at a large teaching hospital...my experience with the doulas was very negative:
    - out in halls with family...not at bedside
    - declining a mom's request for foot massage "I don't do feet"
    -talking on cell phone in and out of patient room
    -requesting staff to allow her to read the chart
    -hanging around nurses station to talk with staff
    -giving medical advice to pt regarding meds etc
    -messing with IVs EFM etc
    These things were not with one or two doulas...it was with 5 different doulas between the two hospitals. I am a Lamaze Certified Childbirth Educator....would have loved to promote doulas in my classes. Could not in all good conscience. The one doula was so pathetic I made it a point to get rid of any pamphlets or cards I came across. I am sorry...these women are killing a very valuable asset to pregnant women.

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  11. I love this post! (In fact, I've loved every single post I've read of yours. :-)

    Of course, there will always be care providers who dislike doulas because they (can) encourage their clients to ask questions! And in these cases, there's probably not much we can do to get them to like doulas. (For what it's worth, I don't think you're describing these sorts of CPs here.)

    But as you rightly point out, doulas are new enough in the "birth world" that we still have loads of work to do to make positive connections between OB/GYNs, midwives, L&D nurses, and hospitals.

    What's more, I think it's important for us to remember that a client's birth is never *our* birth. It is *her* birth. And sometimes it's difficult (though necessary) to walk that fine line between *rescuing* a mom from a hospital policy, procedure, etc. and *empowering* her to ask the right questions, make informed decisions, etc.

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  12. Lesley, AMEN, HALLELUJAH, TESTIFY SISTER! Wow. This is masterful and covers it all - your final point being the slam dunk.

    Thank you for this. Bookmarking and sharing.

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  13. BRAVO...... I teach a doula workshop that conveys this sentiment. I love the "organizational citizenship" flavor to your rant and it was especially perfect because of the light you shine on true empowerment. Well done
    Sheri Deveney
    Western Canada Regional Director
    DONA International

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  14. When I have a woman with a doula, I always check out WHO the doula is first - if it's one I know and trust, I am very happy to have the doula there! If it's one I do not know, I make sure I get to know her :-) Then I can add her to my list of "good doulas".

    (I've been a L&D nurse for over 8 years)

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  15. a thanks to "AtYourCervix" and all other medical staff for approaching a doula they do not know with this attitude of "I can get to know her and add her to my "good doula" list" When I am in the hospital working as a doula I keep thinking, at all times, about how I can make the environment a good one, how can I prove I am not out to attack nurses and make their job harder. I try to do all the right things, not step on toes, and be very respectful of the knowledge and expertise I know the nurses and doctors bring to their jobs. What can be hard is when a nurse I have not met before walks into the room, and I can tell from the start she dislikes me as a doula, and is going to treat me badly. She is not going to meet my eyes, is not going to openly communicate with me, will not smile at me, does not even really want to tell me her name, she may snap at me, or just ignore me like I am furniture. I often feel that despite my attempts to be very unobtrusive and polite, she may go back to the nursing station and say generally negative things about me, and my work, to her colleagues.

    And you know, okay, fine. I expected when I took the job of doula that I would have to stomach and suck up some of this. I expected it, and i'm a big girl, and I can handle it. BUT, when I am there I rarely have a colleague for support, I am often on my own. And what would be sooo nice, and what is sooo nice, is when the nurse walks into the room, and honestly and kindly tries to get to know me. I am thankful, so so thankful, when a nurse smiles, gives me her name, turns to the client and tell them that they seem to have good support! I have had nurses recognize me from previous visits when I arrive, and smile at me. I have had nurses kindly teach me a small skill of two, and I felt thankful and respected and valued. I have had nurses take me aside and offer a suggestion or tell me something she noticed about the client which proved to be hugely valuable. These births have been wonderful, no matter the outcome, c-section or vaginal, wonderful because the environment was so respectful of all, and the client got the best care because of that two-way respect.

    Its a two way street! I try hard to be a "good doula" I hope to recognize more kind faces of "good nurses". we can be so great together.

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  16. I'm sharing this article with my regional DoulaCARE group. Thanks for the reminders of what is outside our SOP and for your leadership.

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  17. This is a great post :) As a new doula, I am going to try my best to not overstep any boundaries. I hope that I meet some nice L&D nurses like many of the ones who commented here!

    And I agree wholeheartedly with Kristen:
    "What's more, I think it's important for us to remember that a client's birth is never *our* birth. It is *her* birth. And sometimes it's difficult (though necessary) to walk that fine line between *rescuing* a mom from a hospital policy, procedure, etc. and *empowering* her to ask the right questions, make informed decisions, etc."

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  18. I once overheard the nurses at the nursing station going thru the status of patients with the nurses who were coming on next shift. They said such positive things about me and the healthy state of my client because of my presence..it's one of the high points in my doula-hospital relationship. Speaking of outrageous acts...just heard of a doula here in the Okanagan Valley of BC telling clients they'll pay a lower fee to her if they have an epidural and/or cesarean. Must be a newbie...cesareans and epidurals have never meant my job was made easier!

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  19. Thank you for such a thoughtful post. I've been an L&D nurse for 13 years, a nurse educator in L&D for the past five years. My fondest wish is for the younger L&D nurses to embrace natural labor when that is what a patient desires. When a doula treats them with hostility and interferes with their already stressful jobs, they develop a more negative view of natural labor and the cycle perpetuates. When a doula treats them well and encourages their efforts, they become even more empowered to care for their patients. If nurses and doulas would view each other as vital members of a healthcare TEAM, we could be a force to be reckoned with in this overmedicalized birth environment.

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  20. we would be a force to be reckoned with indeed! I am very happy for the positive relationships i have made with nursing staff. We have some fabulous nurses here in Montreal!

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  21. Oh, my we do! Montreal has the best nurses in the world. Verna, tonight you were a star, my nurse friend. And love to Mea, Tara, Anne, Sylvia, Yvonne, Marjorie, Claudia, Marie, Mimi,Carole, Jen, Rosie, Mary-Rose, Rona, Flora, Diane, Jodi, and the hundred more I could rattle right off the top of my head. You ladies have my utmost respect.

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  22. Thank you for being the biggest voice for "the Cause." If only all doulas understood you can catch more flies with honey than you can with vinegar. Those of us who believe in empowering women need to be careful who we alienate in the process. Like you said, it will only lead to more harm than good. Thank you again for being the voice we need.

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  23. Great article. However, as DONA certified Doula, it is my understanding with respect to our SOP, that we are NOT ALLOWED to touch the 'machines' regardless of the trusting relationship we may have with nursing staff,EVER. It is our responsibility like you say, to bring attention to the staff when necessary, but not to touch ANY equipment.

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  24. A great article that I have forwarded to all our fabulous doulas! I would just add that hospital personnel should check to see whether the doula is certified, as certification should ensure that such bad behavior doesn't occur. There are lots of folks calling themselves doulas who are not certified as professional doulas. If a certified doula does misbehave, it is in the interest of everyone who cares about women and babies that a grievance be filed with Doulas of North America at dona.org.

    Cynthia Flynn, CD, CNM, PhD
    Former DONA-certified doula trainer
    General Director, Family Health and Birth Center, Washington, DC
    Past President, American Assn of Birth Centers
    Expert Midwife, pregnancy.org

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  25. Thanks, Cynthia. I see what you're getting at, but to be honest, I think standards and certification are different things. I'm actually not myself affiliated with any organizations. My doula training was so small compared to the other things I've done, that after almost 17 years, the actual workshop training certificate has become wildly irrelevant. Papers are not stopping these girls from bad behaviour. And my lack thereof is not preventing my success at performing my tasks as a doula and trainer with integrity. The only power an organization has is to tell a doula she can't work under that name anymore, but it doesn't stop her from working on her own. I've had a couple students I wouldn't certify, and they're still working (though probably not for long given the things I hear), but if I see my or my school's name anywhere on their literature, the contract I have given them to sign in advance about not doing so until certification will create some problems. So while it's true in many cases checking certification might help, it's not the be all and end all.

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  26. Beautifully said. Thank you, thank you, thank you for this perfect challenge to be exactly who we ought to be.

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  27. I get what you are saying however, you would have been kicked out of any hospital I work in for touching the synto pump no matter what kind of relationship you had with the staff. I would hate for any new doula reading this to think just because they see what they perceive to be a problem it would justify straying that far outside SOP. Turning off a synto is not even a grey area, like say, unplugging monitors to go to the bathroom.

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  28. Does this really happen? L&D nurse for 10 years here, never seen it. Ever.

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  29. That's a really positive thing, that you haven't seen it! That makes me happy. Doula for over 16 years...heard many a story from lovely LandD nurses like yourself about aggressive doula behaviour. I don't think it's the norm....it only takes one or two to make a lastingly bad impression.
    Thanks for your comment!

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  30. I came back and read it again... I love everything you had to say here!

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  31. A thousand thank yous for your resolve to stay with the hospitals for the birthing mothers.

    I had a hospital birth at 34 weeks (induced) and I am still reliving the emotional trauma, 5 months later. I felt like a war ravaged soldier walking through the valley of death, my doula's kind eyes and hands kept nudging me one tiny step at a time till I was safe. Of the 3 nurses and 2 drs who attended my birth , only 1 has my respect but nothing close to the gratitude I feel for my doula.


    When I read anonymous's post I totally know that's exactly what my doula had to go through, what a horrible experience to go through for our sake. God bless all of you who chose to support us in a hospital environment. Most of us have no clue what we are getting into. For all the books we read and the movies we watch in preparation of the birth , we think maybe it won't happen to me, not at this hospital, not by this Ob Gyn. A doula should be a mandatory service provided by hospitals esp for mom's like me who are to be induced.

    Coming back to the original post, you can't entirely blame all the bad doulas for the current attitudes of L & D nurses and docs. We all have our prejudices in our jobs but we are intelligent women who can make up our own minds about who is a good person to work with and who is not. When I walk into an office I acknowledge everybody in the room. When I have a business meeting I ask for everybody's input. When I am factfinding about an issue, I gather all concerned and work towards a solution. I do this because I take pride in being an excellent professional and I stand above my peers in my abilities. Why is a nurse excused of such common courtesies ? why doesn't a nurse feel the need to collaborate with a doula ? What a sorry excuse it is to say, I had some bad ones in the past so I am not going to bother with any of you.

    There are going to be more and more doulas coming into hospitals. A nurse/ doctor can give 1001 reasons for not liking doulas but they are coming, more and more everyday. Its time they were accepted as part of the team helping the mom deliver.

    S.V

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  32. This is so right on! I didn't know there were doulas who were turning off monitors, etc! Yikes! It's the nurses' licenses on the line if someone gets hurt! It is a very fine line the doula walks, and most hospitals have accepted us just fine. As long as we have the CLIENTS ask, then the hospitals will usually grant thier requests. Some of the hospitals even relax and one let us(the midwife and myself as assistant) do the birth! But we never touch anything medical at all unless the staff asks us to...Ever. I am there to help the mom and dad, and stay out of the staff's way, whenever possible...

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  33. MY GOD Lesley! Every time I read one of your posts, I get so fired up inside. I totally agree with your views on how we are going to heal our birth culture. I've got to say I'm really excited to have the opportunity to have you as a mentor. REALY, your passion never ceases to amaze me!

    Lindsie

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  34. Lesley,

    I happened upon this posting, and I must say that I would never hire a doula again. I'm sorry to say that my unpleasant interaction happened to be with you. I'd called you early in my pregnancy, and you we had a tentative agreement that you would be my doula. You told me to call back a few months later. Later in pregnancy, I called again, and when I mentioned I now had a slightly higher-risk pregnancy, you told me your "intuition" said you shouldn't take me on after all.

    You simply would not tell me why, which left me in tears after our phone call due to fear that you might have had a bad intuition about my birthing. I had a beautiful, healthy baby a few months later, but was left with a very bad feeling about doulas. I've kept this in for five years now. I think it's important to share these feelings; you simply do *not* frighten a pregnant woman that way, especially after having agreed in principle to be her doula and changing your mind. And, I should add, women with higher-risk pregnancies needs support more than ever. Thank you for listening.

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  35. Wow, I feel awful being responsible for scaring you! I'm really glad you took the time to let me know.

    I don't remember any circumstances, but I just want to clarify that I do work all the time with ladies with high risk pregnancies...often very high risk.

    If I had a gut feeling about not working with you, it wouldn't have been because I was scared about your outcome and didn't want to deal with it. I can't predict anyone's future, so I would never tell someone I was worried about their birth outcome. I would never scare anyone about their birth. I probably didn't take you on at the time because I had a nursing baby and was only taking on a limited amount of births, and only ones that needed standard support. My intuition would have been about my not being the right doula for you given whatever situation you were going through BECAUSE you needed and deserved more support than I could provide at the time, not because I was weirded out by your situation becoming high risk. The vast majority of my high risk clients have had great birth outcomes, so it wouldn't have had anything to do with my intuition telling me yours wouldn't be great. I'm certainly not pyschic, and even if I were, it wouldn't scare me off supporting higher risk clients...it was simply a matter of logistics and knowing you deserved more than I sensed I could give, and would have received that from someone who didn't have a baby at home to tend My intuition only works in the here and now, not in the future. If I did not explain that properly, as I clearly didn't, I offer my most profound apologies. Please don't let the mistake of one doula ruin your opinion of all the great birth supporters out there. Thanks for taking the time to share that. I am grateful for feedback that will make me more aware in the future.

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