Evidence based care and why my opinion doesn’t matter

Yesterday I met up with my lovely doula friends for a nice dinner out.  It was a fun time, I dressed up in my tea party dress and hat and wore make-up, actually I felt a little like a clown with how much eye shadow I had on but I think it probably looked good since my husband didn’t laugh at my appearance… (but that is a different topic).

While we doula’s were enjoying our delicious french food we talked about what doulas usually talk about, female bodies and birth.  We talked about evidence based care too.  We talk about this a lot, but one comment was made that sort of stuck with me, and I’ve been turning it over in my head since.

It was pointed out to us all that while we are encouraged to educate our clients on evidence based care, and to get what they want out of birth we really have no right to tell what ‘we would do’, because it could be construed as us giving medical advice.  As a Midwife put it “it’s a fine line they (doulas) walk.”

I didn’t just learn how fine this line was, it has been a part of my training and an intimate part of every prenatal appointment and birth I’ve ever participated in as a doula.  My area of interest is specifically to be highly educated in evidence based care, so of course my inclination would be for every parent to make choices that would be supported by evidence.  But that just isn’t going to happen, for multiple reasons, and if I made it a priority to have my clients make those decisions I would have a lot of dissatisfied clients and I would not be following the guidelines of my position as a doula with DONA, and I would guess many other doula certifying agencies.

Early in the process of becoming a doula I would get a righteous anger about the situations I saw people (my clients and others) getting into and how they were treated and the lack of evidence based care that I saw them receiving, but then it slowly occurred to me that it didn’t matter at all what evidence said.  Don’t get me wrong, I still would prefer to see my clients receive care that isn’t just done because it’s done, but because it is best for the client and baby, but as a doula I’m not there to make the birth happen the way I want it to happen.  I’m there to make sure, to the best of my ability, that the mother delivering her baby is respected, heard, and feels good about her experience, so that if something goes wrong she can process it and deal with it and it doesn’t become a life long sore spot associated with the birth of her child.  So essentially it is my job to help a mom to make her own medical decisions, and own the decision she makes (which isn’t possible if she made it  because I encouraged it and for that reason only).

It is my job to learn my clients.  It is also my job to be sure I have all the resources to help them learn options during birth.  Those prenatal appointments that I offer my clients are my opportunity to do that.  Even the moms who have no questions and wonder why we spend an hour together (sometimes more) twice before their birth are benefiting themselves greatly by giving me the opportunity to learn them.

During these appointments if a mom says “I think I want to have an epidural during my birth, what will you do if I get one?”  I can respond, “Typically during an epidural birth  my job becomes a lot less physical, but at that point I would make sure that you have all the information you  may desire about what is happening with you and baby, get you and daddy some water or food, or just be with you, watching for signs of progression in your labor.  I typically will bring something to do (like crocheting) while you rest. But while we are on the topic of epidurals is there anything you’d like to know about them that I can help you with, now they are given, what is in them, what effects they have on labor or the baby?”

And then this mom can have an opportunity to ask me about those or other things she wants to know.  Often I will leave them a flyer that describes the risks and benefits of epidural and how they are placed, and let them read it when they want, if they want, and then though I may personally have thoughts or opinions about laboring under an epidural my thoughts and opinions don’t matter one lick, because I’m not the one who will deliver that baby.

My goal as mentioned before is to serve mamas, in a way that makes them feel respected and informed.  I have to have all this information on hand if a mom wants it, but the hardest part is not offering information that is unwanted, I need to take my cues from the mamas.  I can’t offer too much, but need to be sure I give enough, I can’t give my opinion on procedures or care, and I can’t pretend that it doesn’t matter, because what matters to you is very important to me, not only because it is my job but because it is my passion.  To serve mamas is the best calling a woman can have, and I’m blessed to serve.

Are you looking for a doula who will serve?  A doula who cares?  A doula who is concerned about your birth experience?  Then look no further, I’ll be that lady, and if it turns out I’m not the personality for you, don’t worry my service doesn’t limit me, I know plenty of other personalities in the doula world (I had dinner with a few of them last night) and I will help you find the perfect doula for your birth… I’m not under the illusion that I can serve everyone equally, but I am under the opinion that I will do my best for each individual who crosses my path, regardless of what evidence says, regardless of the choices you make, I will serve, that is what I’m here for.