Lies the Doula told Me

pregnant-woman-child

Okay, “lies” is too strong a word. Errors would be better. Besides, I have no doubt that the vast majority of Doulas are fine, well meaning, caring individuals who want to part of the health care team making every woman’s birth experience safe and satisfying. There are a few however that worry me. I’d like think that most of the time these other Doulas are just misinformed and not being deliberately misleading. Sometimes I’m not so sure.

Error Number One: “Childbirth can and should be pain free.” Excuse me? If it was easy, men would do it. Bill Cosby described childbirth as being like taking your bottom lip and pulling it up over your forehead. I think he was right. With a few very rare exceptions, labor is hard and painful. No matter how “centered” you are, or how much you meditate, or listen to soft music, it is going to hurt. That does not make you a failure or weak, it makes you human. No matter what you have planned, if you are finding the pain excessive or you are having trouble coping you have the right to get some relief. It doesn’t matter what you decided and wrote down before hand, and anyone, your doula, your best friend or even your husband, who tries to talk you out of pain relief should just be quiet.

Error Number Two: “Epidural’s always slow down labor.” This is simply not the case. In the majority of the cases, a well timed and administered epidural will not take away the sensations of labor. Just the pain. When it is done well, it relieves the pain while still allowing the woman to move her legs and feet, even walk around, and feel each contraction. If anything, the well done epidural allows the woman to relax and for the labor to proceed more quickly. Sometimes the epidural doesn’t go as well and occasionally the woman can’t feel the contractions. This is the one occasion in which it may prolong labor by making it more difficult to push. Fortunately, these cases are uncommon.

Error Number Three: “Doctors do episiotomies so they can leave quicker.” This one really makes me laugh. If the patient has a tear or an episiotomy, the doctor has to sew her up. This takes time. If there is no tear or episiotomy, the doctor can leave earlier and let the woman start bonding to her newborn. I do everything I can to prevent tears and episiotomies. I do perineal massage during pushing, apply hot compresses between contractions, support the perineum during delivery, and try to make sure that delivery of the head and shoulders is slow, gradual and controlled. Tears still occur sometimes. Episiotomies as a rule are easier to suture than tears because they are usually straighter and shorter. A delivery without tearing or episiotomy remains the goal.

Error Number Four: “Home deliveries are always just as safe as hospital deliveries.” This is a big one. There are some studies that suggest home deliveries are safe. Recent reviews however are showing this to not be correct. These older studies are misleading because when problems start and a woman is rushed to hospital with complications, it is listed as a hospital birth not a home birth. This skews the statistics. Furthermore, these studies tend to be done in places like urban Britain where immediate emergency care is available. Not so much in rural Saskatchewan where the nearest hospital with an OR may be 3 or more hours away. The reality is that in the vast majority of low risk obstetrical cases, the delivery is simple and straight forward. But, and this is a big but, you cannot predict those uncommon cases when things go suddenly wrong.

When the membranes rupture, once in awhile the cord comes out. This is a medical emergence and requires an immediate emergency C-section. Sometimes a hand comes out. Sometimes the baby’s shoulders get stuck. Sometimes there is an unexpected or undetected birth defect. Sometimes there is excessive postpartum bleeding. These things need immediate and rapid medical treatment, and in Saskatchewan at least, may not be available in a home delivery.

It’s always important to be sure that we are all working toward the same goal. While I truly wish for my patients to have a wonderful, satisfying and enjoyable experience in child birth, that is not my main goal. My primary goal is to have a healthy child and a healthy mom at the end of it all. That means I will always err on the side of caution to protect the mother and the child.

I like delivering babies. I enjoy working with the maternity nurses and with the doulas. I’m hoping that that good work relationship can continue and that together we can avoid any errors or problems.

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One Response to Lies the Doula told Me

  1. Dr Mark Brown says:

    Thanks for posting this Kevin, always enjoy your opinions with a touch of humour ! I would add error No 5. Syntocinon injection is NOT given by doctors to ‘EXPELL’ the placenta and hasten the subsequent departure of the doctor !! It is administered to prevent a life threatening post partum hemorrhage -a severe bleed that can occur immediately after delivery if the uterus does not contract down nicely after the baby is born. Dr. Mark Brown

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