So, here is the situation and I just need some feedback.

I had a client who was due on July 3rd.  On Tuesday July 6th she called to tell me that the baby had turned breech.  They had her scheduled for an ultrasound at 3 and then a non-stress test.  She said that she would call me after the appt.  At 4:30 I called to check in and see how things were going.  They were in the process of putting in an IV to increase her fluid and then the doctor was going to come over and try to turn the baby.  I asked her how she was doing and she was fine.  She said they were going to keep her overnight regardless.  So, we both agreed that she would call me when she knew more of what was happening.  That was the last that I heard from her until 1am when she texted me to say that they had tried to turn the baby and it didn't work so they took her to the OR right then and there for a c-section.

I am torn about what else I could have done.  One friend of mine suggested that I should have just shown up at the hospital regardless of whether she called me or not.  My feeling is that doing that would cross the boundary of professionalism.  My feeling is that the whole situation kinda've spiraled out of everyone's control and there is nothing that either one of us could have done.  Am I right, or am I just trying to make myself feel better about not being at the birth?

I am planning on sticking to my contract and refunding a portion of their fee, per the contract.

Any ideas or input is appreciated!

Thank you!

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Replies to This Discussion

Hello!!

I just attended a birth for a couple who had a successful external version, which is what "flipping a baby externally," is called!! My sister on the other hand, had a breech baby, and attempted the version, and it didn't work, back in May. Showing up, and just being there for the mom, who has to have a c-section, is showing support!!

As doulas we all wish that the births we attend will end with a successful vaginal birth, and even better...a successful Natural Vaginal Birth. I am always sensitive to the fact that a c-section is still a birth, and to go gentle with the mom who has one, especially as all her expectations go out the door, or shall I say... off their birth plan!!

Showing support can come in the form of being in the room when they bring mom and baby back for recovery, taking some pictures, and letting your mom, dad/parter, and newborn, know that you will be back over the next couple days while they are staying at the hospital. Just being there, no matter how the birth story turns out, is showing your support.

Remember, your presence is powerful!!! All the best to you. :)
Yes, I know what external version is, thank you.
My note really was asking for feedback on my feelings about the lack of communication and me not being there because I didn't know what was going on.
As a doula my number one priority is to be there to support my client in whatever birth she chooses. I have no bad feelings about how it turned out, just frustration about not being there at all due to lack of communication. I acknowledge that a c-section is still a birth.
Thank you for your input!
Corie
Personally, I agree with you. I think that, from what you described, this was situation that was unpredictable. It sounds like the client was not expecting things to turn out the way they did or I would expect them to have asked you to come and be with them. I do not agree with your friend who told you that you should have just shown up at the hospital. I think that if you spoke with your client and they did not feel it was necessary for you to be there then you have to respect that. If she already had the c-section, there really wasn't much you could have done about not being there. If it were me I would have asked to come visit in the morning and make sure mom and baby were doing well, breastfeeding(if applicable) was going well, and mom was OK emotionally.

I would certainly speak with your client and see how they are feeling about you not being there. You may find that they are feeling bad about the situation also.

I understand how disappointing it can be to miss a birth. Hang in there.

--Kate
Hey Corie, so just my two cents on the situation. I have been a part of 4 births myself that ended in c-sections, 2 of which ended in emergency c-sections; however, I was already with them when we transported them (one was attempted home birth, the other a birth center birth). I feel like you did the right thing in waiting for them to invite you before you just showed up. My suggestions for future situations is always remind your clients in your prenatal visits, and in the current situations, that if there is ever a possibility of having to do a c-section, I feel its extremely important that they know that you can be there to support both of them during that surgery. Its up to the anesthesiologist as to who can be in the OR with the couple, and when its presented as their requests, and your job of continual support for the mom, while the husband goes with the baby, which most times they take the baby to the nursery to clean and monitor unless requested to stay with the mom if there are no problems. In my experiences, my clients made it known (with my reminding) to the hospital staff that they want me with them throughout the surgery, and into recovery while the husband tends to the baby, which I also feel is essential as that babies first experiences in the world should be with one of its parents. They know their daddies voices already, and I've seen babies calm right down, when the dad goes over to the baby while they check them out. They can touch and talk to them, and put them at ease from their birth experience. In the mean time, I stay by the mom's side as she is usually very emotional during these moments, and you can be encouraging her, telling her whats going on as she can't see anything, and I usually take pictures or video of dad's first moments with baby, mom's first moments with baby, and the first moments with the new family. I accompanied her to recovery, and sat with her while she came through the anesthesia giving reassurance of what an amazing job she did, what ever the experience was, until dad & baby came back to start nursing. I usually stay with them until they transfer to their private room and get them settled in before I go. I can completely relate your feeling of detachment as I did have another go into c-section while i was away getting food for the husband, and that one felt a bit strange, as I was with them for over 18 hrs of their birth. I know I did what I could, and sometimes things happen really fast in those situations, especially with hospital birth as they want to get things done. As we all know as doulas, birth can be unpredictable and fast, and my suggestion is to just include these types of conversations in your prenatal appointments, so your clients know their options before they face them. You did what you could in the way that particular birth went. Learn from every birth to become the best doula you can be. Best of luck with all your future births!
Thank you Jessica! I needed some confirmation that I am truly doing the best I can do as a doula. I am learning as I go and changing things that need to be changed. I love this venue of sharing and feedback. I get input and feedback from my friends and family but none of them are doulas! :) Thank you again!
Corie
Hi Corie,
I, too, have been Doula to several couples who ended up with c-births. All of them (3 total) were "emergencies", meaning, mom & baby were not in medical danger at the time of the decision, but it was the best outcome for the circumstances at the time. 2 were extremely long labors, one of which had mom stuck at 9.5 cm with the baby's head in a transverse, extended position. The third was a baby that was breech long before mom's EDD and decided to come at 36 weeks. I was in the OR for only one of those births because I was her only support and I knew the OB very well. In my area most of the facilities (I've doula-ed at 7) do not allow non-family members, non-facility staff into the OR during surgery or even during the repairing, only in the postpartum recovery room. Therefore, the suggestion that a doula can provide support to the mom during her c-birth does not apply in those facilities, as much as I disagree with that policy (and pictures are rarely, if ever allowed in the OR).

My experience has been that interventions or changes to the hopes and preferences for a birth are sometimes harder for us, as doulas, to process and accept than it is for the mom and her partner. I have learned to tread carefully when discussing the birth at the PP visit and let the parents lead the conversation. I find that, more often than not, they do not remember things the same way I do and, in fact, the 3 c-birth moms and their partners were all extremely satisfied with their birth experiences.

I am sure that your client will be touched by your adherence to the contract and giving a refund and I am equally convinced that she will express to you her appreciation for the emotional support you provided for her that day.

Every birth we experience gives us the opportunity to learn something that will make us better doulas. We must work within the parameters of a system that sometimes frustrates our best efforts; but by accepting that we always give our best support with the knowledge and circumstances we have at the time, we can forgive ourselves when the unplanned and unexpected intervention occurs.
Best wishes to you always!
Exie

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