On Ethics and Beliefs

Hello, Readers!  I realize it has been some time since we've posted to the blog.  We hope you all had a wonderful holiday season and are now enjoying spending joyful winter days with your family.  The following post is based upon recent concerns I have had in practice as well as in the birth profession overall.  Enjoy!

On Ethics

In September 2011, we authored a post pertaining to the distribution of product samples and coupons to our clients.  Mothers-to-be are often given samples of baby lotions, diapers, coupons for private ultrasound companies, etc. from a variety of sources including doctors offices, formula companies, and maternity stores.  We, too, have provided certain sample products to mothers in our client packages which we hand out at our initial consultations.  Our primary sources had been from companies such as Lansinoh, Medela and Seventh Generation.  We are revamping our policy on samples for the following reasons:

1. Medela is no longer compliant with the WHO/UNICEF Code of Marketing of Breast Milk Substitutes; therefore, we cannot in good conscience distribute their product(s).
2. While we support companies that are WHO Code Compliant, we will no longer distribute samples of their products unless requested by our clients.
3. We feel that we have a responsibility to families to provide them with excellent care, support, and evidence-based information that is not coloured by commercial sources.

On Beliefs

Please note: The following are my personal beliefs and are not necessarily the opinions of my colleagues.

As I grow and continue to learn in my role as a doula, and through my personal life experiences, my beliefs regarding pregnancy, birth, breastfeeding and parenting continue to evolve and become more clarified.  Therefore, I wanted to share with you what is in my heart.

1. I believe that woman were created to birth without unnecessary interventions.
2. I believe that women are strong.
3. I believe that pain is subjective, yet also that fear and tension exacerbate pain.  See The Fear Tension Pain Cycle - based on the research of Dr. Grantly Dick-Read.
4. I believe that families deserve complete evidence-based information on all potential interventions in pregnancy, birth and breastfeeding in order to make truly informed decisions.  I believe I would be remiss if I did not assist them with finding this accurate information.
5. I believe that birth is safer and healthier for mothers and babies when medications are not used.
6. I believe that babies are active participants in their own births.
7. I believe that babies are born wired to be breastfed.
8. I believe in the WHO Hierarchy of Infant Feeding Choices.
9. I believe breastfeeding is possible for the majority of mothers and infants with knowledgeable and compassionate support.
10. I believe birth belongs to mothers and babies, not to any caregiver or system.
11. I believe mothers will birth in their own time.
12. I believe babies will be born when they are ready.
13. I respect technology and medical interventions, as they have their place in emergency situations.
14. I believe birth is a natural process, not a medical event.
15. I believe that I do not empower women, rather they empower themselves with strength, trust in their bodies and the process of birth, and knowledge of the benefits and risks of all of their options.
16. I trust women!

I believe this list is not finished and that I will be continuously learning and evolving.  I am so thankful to all of the families I work with as it is they who truly teach me.

A Doula's Focus - Is your doula putting you first?

You are the reason a doula does her job.  Her responsibility is to "mother the mother."  Is your doula putting you first?  Here are some things to look and listen for:

1. Your doula leads in gently, asking you how you found out about her practice, etc.  Not pressing for too much information too soon.
2. Your doula asks questions beginning with - Who, What, Where, When, How
3. She does not ask leading questions with the answer "built in," i.e. "You're not going to do that are you?"
4. Your doula offers the information you request.
5. Your doula does not offer her own story unless requested by you, but may give insights when appropriate.
6. She is a reflective and interpretive listener.
7. She offers helpful feedback always keeping you and your desires at the forefront.
8. Your doula does not overwhelm you with what ifs, too many statistics or technical jargon.
9. She is supportive, positive and caring.
10. She is humble, genuine and empathetic.

In short, you are the primary focus of your doula.  Her opinions, desires, etc. do not come into play.  She is 100% focused on you and your experience.  She is there to listen, comfort, inform and gently guide you through your birthing journey ~ honouring it as your precious life experience.

Whose birth is it anyway?

Last spring, an obstetrician gave the following letter to his patient
An OB's Birth Plan - Nursing for Nurses:

Dr. ________ "Birth Plan"
Dear Patient:
As your obstetrician, it is my goal and responsibility to ensure your safety and your baby's safety during your pregnancy, delivery, and the postpartum period. My practice approach is to use the latest advances in modern obstetrics. There is no doubt that modern obstetrical advances have significantly decreased the incidence of maternal and fetal complications. The following information should clarify my position and is meant to address some commonly asked questions. Please review this information carefully and let me know if you feel uncomfortable in any way with my approach as outlined below.
* Home delivery, underwater delivery, and delivery in a dark room is not allowed.
* I do not accept birth plans. Many birth plans conflict with approved modern obstetrical techniques and guidelines. I follow the guidelines of the American College of Obstetrics and Gynecology which is the organization responsible for setting the standard of care in the United States. Certain organizations, under the guise of "Natural Birth" promote practices that are outdated and unsafe. You should notify me immediately, if you are enrolled in courses that encourage a specific birth plan. Conflicts should be resolved long before we approach your due date. Please note that I do not accept the Bradley Birth Plan. You may ask my office staff for our list of recommended childbirth classes.
* Doulas and labor coaches are allowed and will be treated like other visitors. However, like other visitors, they may be asked to leave if their presence or recommendations hinder my ability to monitor your labor or your baby's well-being.
* IV access during labor is mandatory. Even though labor usually progresses well, not too infrequently, emergencies arise suddenly, necessitating an emergency c-section. The precious few minutes wasted trying to start an IV in an emergency may be crucial to your and your baby's well being.
* Continuous monitoring of your baby's heart rate during the active phase (usually when your cervix is dilated 4cm) is mandatory. This may be done using external belts or if not adequate, by using internal monitors at my discretion. This is the only way I can be sure that your baby is tolerating every contraction. Labor positions that hinder my ability to continuously monitor your baby's heart rate are not allowed.
* Rupture of membranes may become helpful or necessary during your labor. The decision as whether and when to perform this procedure is made at my discretion.
* Epidural anesthesia is optional and available at all times. The most recent scientific data suggest that epidurals are safe and do not interfere with labor in anyway even if administered very early in labor.
* I perform all vaginal deliveries on a standard labor and delivery bed. Your legs will be positioned in the standard delivery stirrups. This is the most comfortable position for you. It also provides maximum space in your pelvis, minimizing the risk of trauma to you and your baby during delivery.
* Episiotomy is a surgical incision made at the vaginal opening just before the baby's head is delivered. I routinely perform other standard techniques such as massage and stretching to decrease the need for episiotomies. However, depending on the size of the baby's head and the degree of flexibility of the vaginal tissue, an episiotomy may become necessary at my discretion to minimize the risk of trauma to you and your baby.
* I will clamp the umbilical cord shortly after I deliver your baby. Delaying this procedure is not beneficial and can potentially be harmful to your baby.
* If your pregnancy is normal, it should not extend much beyond your due date. The rate of maternal and fetal complications increases rapidly after 39 weeks. For this reason, I recommend delivering your baby at around 39-40 weeks of pregnancy. This may happen through spontaneous onset of labor or by inducing labor. Contrary to many outdated beliefs, inducing labor, when done appropriately and at the right time, is safe, and does not increase the amount of pain or the risk of complications or the need for a c-section.
* Compared to the national average, I have a very low c-section rate. However, a c-section may become necessary at any time during labor due to maternal or fetal concerns. The decision as to whether and when to perform this procedure is made at my discretion and it is not negotiable, especially when done for fetal concerns.

I can argue against many of the physicians points, but all research aside, the most important question that remains is – Whose birth is it anyway?  The physician isn’t giving birth to the baby, he is merely a facilitator in the process: a process that is natural and has been working well for the majority of women for centuries.  In the end the birth experience belongs to the mother, her baby and her partner.  The choices made by the mother require the respect of all of her caregivers – doctors, midwives, doulas, nurses, partner, family, friends, etc.  She will remember her birth experience for the rest of her life and we, as her caregivers, are there to protect the memory.

Informed Choice

"If particular care and attention is not paid to the ladies, we are determined to foment (promote) a rebellion, and will not hold ourselves bound by any laws in which we have no voice or representation." - Abigail Adams

For too long women have been told to accept things at face value. It is our time to take responsibility for our lives, our health and our informed decisions. We need to regain our trust in ourselves and our instincts. Then, we can live our lives the way they are meant to be lived.