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First doula job and I feel like I didn't do the right thing (long, sorry)

(35 Posts)
FailedDoula Sun 05-Oct-08 17:25:08

I have recently had my first 'job' since training as a doula, for a very close friend who was having her first baby.

She was very keen to have a homebirth, which I am a big supporter of (had my first baby at home). But right from the start I had my doubts as to whether it was a realistic expectation for her - she is morbidly obese (over 20 stone), she copes with any sort of pain very badly, she developed SPD early on and spent the last three months of the pregnancy on the lying down, and has a strong family history of high blood pressure. I didn't voice these concerns to her as I felt it was my job to offer support, but now I'm not sure if I did the right thing.

Throughout her pregnancy, all the professionals involved in her care expressed concerns about her insistence on HB - she asked me to attend some consultant appts with them, not to speak but just for support, which I did. The concerns expressed were about her BMI (which I know is not necessarily a contra-indication) and erratic blood pressure (which she insisted was due to the stress of appts).

She went into labour on her due date and I went round when they called (I am a good
friend of her husband and mum, who was there as well). As I'd been worried she would, she panicked as soon as she went into labour, and it was really really hard to keep her calm and relaxed. The pain terrified her, she was screaming constantly, tense (she refused massage), convinced she was going to die, and using a huge amount of gas&air (18 canisters in 12 hours which I was shock at the midwives for allowing). She didn't want any of us to leave the room.

After about 6 hours the midwives started suggesting she go to hospital, and she resisted fiercely. After 12 hours they called an ambulance anyway (she was pretty much delusional by this time) and told her they would not give her any more pain relief at home and if she wanted any them she had to go into hospital.

She went, was given an epidural, and the state she was in at this stage was quite worrying as she was almost crazy with pain, thrashing so much they could not site the epidural, screaming and swearing. She had stated before hand (on birthplan) that she wanted myself and her husband to insist on her being consulted about any interventions, which we tried to do but it was almost pointless as she was so distressed. The staff were efficient but had no compassion, calling her 'hysterical' which whilst true was not heplful ti hear. They kept trying to add syntocinon to her saline drip without her permission and I and her husband kept insisting that they consult her first - she kept saying no and then when she fell asleep later that night they added it anyway.

She ended up having an emergency c-s 10 hours after arriveing at hospital.

They told her afterwards that she and the baby had nearly died (though of what, she has never been told). She now thinks that she should not have tried for an HB as it went so badly wrong and is having counsellign for birth trauma and pnd.

I worry a lot that I have failed in one or more of several ways...

a) My concerns about the HB she wanted being unrealistic - could she have picked up on them somehow and they could have undermined her confidence? I didn't voice them and fully supported her wish for it, which leads me to

b) Did I have a responsibility to voice my concerns? Or was I right to just offer support of her wishes?

c) Do you think I should have encouraged her to go to hospital when the midwives first suggested it, rather than back up her wishes? The same goes for the interventions in labour - should I have backed away and let the staff carry the induction out without her consent as maybe it would have been better than the c-s?

Sorry its so long but I am very lost and unsure about all this - she and her husband
say they're glad I was there and couldn't have managed without me but I feel very sad about it all

lauraloola Sun 05-Oct-08 17:52:34

Sounds like you did all you could given the circumstances. She should have listened in her appointments to the concerns of her having a hb but you supported her in her wishes which is what you should do.

It probably wasnt the best of labours to start with but at least you have a 'difficult' over and done with smile

FailedDoula Sun 05-Oct-08 18:01:09

Do you think?

I'm really concerned that I didn't do the right things and that maybe I should have said I was not sure about an HB - but then its not my place to offer a medical opinion, I know that.

I did talk to her a lot about how to handle the pain, about using water and massage etc, but when it came to the labour she didn't want to do it. I also tried to encourage her to move around as much as possible late in pregnancy for optomal foetal positioning but she basically took to bed due to the SPD.

monkeymonkeymonkey Sun 05-Oct-08 18:02:26

My impression was that Doulas were for support not advice?
Is that true?

FailedDoula Sun 05-Oct-08 18:06:51

It is true yes. But I worry that as a friend I should have been upfront about it, and maybe said something. Should you support someone regardless of how unrealistic they might be? Should you even agree to support someone if you have concerns like that, no matter how well you can hide them?

Maybe it was just too blurry as I am a close friend of hers as well, and if she'd been a stranger I would be thinking differently?

lulumama Sun 05-Oct-08 18:06:57

your job is not to talk any woman in or out of making any decisions, but to offer unconditional and unequivocal support

you did that, and did as she asked and you ar not there to make clinical decisions or to make her do anything

did you discuss anything about what would happen if she needed to transfer in etc. and what would happen if she did not cope at home?

you can do all the birth plans you want, at the end of the day, you cannot predict how things will happen nor guarantee they will happen a certain way

she does need to find out why she had the c.s and why she and baby nearly died, if that is the case , 10 hours after admission is hardly a crash c.section on arrival...

she needs to go through things with a MW and get to the bottom of what happened

she tried for a HB knowing she had contraindications and made an informed decision to go ahead..a lot of first time HBers to transfer in for more pain relief, she is not the only one !

i am so sorry she is traumatised

have you talked all this through with your mentor?

Rolf Sun 05-Oct-08 18:07:47

Poor you, it sounds like a very distressing labour for all concerned.

FWIW when I fretted with my doula about my fears about induction, she let me talk myself to a standstill, and then very gently and tactfully pointed out that it was only a different room in the same hospital (I had a bee in my bonnet about using the MLU, which I couldn't with an induction) and that with the detailed birthplan I'd drawn up, and the support of the doula, most of my fears about induction could be dealt with. So although she didn't voice any concerns about me having built myself up to using the pool in the MLU, she steered around it by finding out what my fears were and working out how we could address them wherever I had the baby. It was more subtle than specifically voicing concerns.

lulumama Sun 05-Oct-08 18:17:53

did you raise any of your concerns ?

mabanana Sun 05-Oct-08 18:23:47

I think you did the best you could in very extreme and unusual circumstances. The only lesson I think you could learn is to not actually take a job where you think people's expectations are wildly unrealistic and they are rather stubborn and hysterical. I feel sorry for you - you sound pretty traumatised yourself.

FailedDoula Sun 05-Oct-08 18:25:29

Ah lulu was hoping you'd see this!

Firstly I don't have a mentor - did the training (as in the course) a while back and have not been in a position to be at four births (am single parent, no reliable childcare etc) so have not kept up DUK membership, was at this birth as my friend really wanted me to be there so more as a 'favour' than a job. No payment at all.

We talked about what would happen if she was to transfer but she was not very open to considering the idea, as she was so set on HB. I worried she had unrealistically high expectations of it being a beautiful natural event, but that to say so to her would not be the unconditional support she deserved from a doula. I did talk to her about it as far as I could but didn't press it when she steered away from the subject of 'what if...' And having had only HB myself I was basically unprepared for what happened in the hospital, with staff trying to carry out interventions without her permission etc. They spent hours trying to get her to consent to the c-s but she refused until they told her it was now a real emergency as the foetal heart rate was 'erratic'.

I've suggested she try to get the notes from the hospital and talk them through but she is not sure it would be helpful to go through them - she thinks that the staff did a fantastic job and blames herself for being 'stubborn'. The counselling she is having seems to be encouraging the idea that 'thats just how it was, the important thing is your healthy baby'.

lulumama Sun 05-Oct-08 18:30:13

sounds like you did a fantastic job in that case.. you can lead a horse to water etc etc

and it is always harder with friends. it is so much more emotionally involving

you raised concerns, as did the hospital, and she made her choice to go for the homebirth, as her doula, you supported her all the way and stuck by her and tried your best to support her in the way she wanted

you have not failed

hatorihanzo Sun 05-Oct-08 18:30:13

this lady's experience makes me want to rant. i have read doula uk's code of practice and these points are cognet:

will refer clients to other appropriate resources/professionals should the client have needs beyond the scope of their doula role

AND

will be honest and show integrity and respect at all times towards their clients, doula colleagues and the other professionals with whom they may be working alongside

I'm a big supporter of homebirths, but she was always at risk of just about every conceivable adverse birth outcome, not only because of her weight, but because of her personality and attiude.

FFS i'm the first to complain about the medicalisation of pregnancy and childbirth but women and babies used to die at home. The culture of wanting to be in control of every aspect of pregnancy and labour is laughable.

Personally, i think you are a great friend, but you should have been honest with her from the start.
Sorry rant over
PS is she breast feeding?

lulumama Sun 05-Oct-08 18:35:44

hatori, the lady did have appointments with doctors, which the doula attneded with her!

ultimately the client made an informed choice

a more experienced doula may have declined to doula this lady, but with friendship in the mix too, it would complicate things

am not quite sure who you are ranting at though !

lauraloola Sun 05-Oct-08 18:37:24

You supported her in her decision. You did the right thing and should be proud that you did so. It may not have gone to plan but then I think deep down she knew it wasnt going to after the medical advice she was given.

I think you did really well especially as she is your friend so made it slightly different for you aswell x

FailedDoula Sun 05-Oct-08 18:41:10

Thanks everyone, I feel a little less of a failure about it now. It has made me aware of lots of things I need to prepare myself for, thats for certain.

Hatori - yes, bf well from the start (despites staff trying to give formula) and I managed to support her well with that as I am a bf supporter with local NHS/SureStart.

chipmonkey Sun 05-Oct-08 19:31:23

FD, I really can't see that you have anything to blame yourself for.

Your friend wanted a Homebirth. So do a lot of people, so did I once upon a time.

My understanding of a doula is someone to support the mother and be a voice for her.

It is not your job to offer medical advice, quote statistics or give a medical opinion. That would be overstepping the mark.

You did your job and you did it well.

FWIW, I posted on another forum about a possible HBA3C. Even the most vocal advocates of HB were very iffy about it when I gave my history. But one doula said that if I did want to attempt it, she would support me. Knowing I would have some back up was a great comfort to me, even though I ultimately decided to go for the "safe" ELCS.

Mintpurple Sun 05-Oct-08 19:34:25

Just to add my tuppenceworth.....

From what you have said, it sounds like your friend was not a great candidate for a homebirth for a first baby from the outset, but it sounds like you did everything you could do to support her, which is what doulaing (is that a word?) is all about.

As a friend, maybe you should have voiced some concerns, but it sounds like the doula and the friend aspects have clashed slightly. What Im trying to say is that if you were not a doula, you might have said something differently, but it really doesnt sound like it would have made a difference.

It sounds to me like you did everything right and circumstances were against your friend for various reasons.

I know you are beating yourself up about this, but if she had been doulaed (sorry to all doulas for mangling the word 'doula') by someone else, the outcome would very likely have been the same.

When I have a birth that goes badly (for whatever reason), I always reflect on each aspect and ask myself 'Would I have done anything differently?' and if I can honestly answer that I wouldnt have changed what I did during the birth, then I feel I have done my best. With the best care and attention in the world, there are still some births which are going to be bad, and sometimes there is nothing we can do to change that .

I think you have done a great job with her, so use the experience to learn from and hopefully your next time will be a much better experience.

And please change your name - you sound lovely and 'faileddoula' really does you an injusticewink

AnarchyAunt Sun 05-Oct-08 19:47:00

Oh thank you again - you are all making me want to cry now, as I have so honestly been worrying I had somehow done the wrong things, and that my suport had maybe encouraged her to do something that was not a good option for her circumstances.

Its quite true that as a friend I might well have said, 'I'm not sure you are going to get what you want', but as a doula I felt I shouldn't. I have to say I cant see what I could have done differently that would have still fitted into the doula role, and tbh I'm not sure anything would have made any difference to her determination or the eventual outcome.

Thank you all again smile

lulumama Sun 05-Oct-08 19:48:05

big woooo hooooo for anarchyaunt smile

AnarchyAunt Sun 05-Oct-08 19:49:07

I am op btw, forgot to say I'd changed back to usual name.

AnarchyAunt Sun 05-Oct-08 19:49:58

Thanks Lulu!

lulumama Sun 05-Oct-08 19:50:08

i know! have another wooooo hoooo ! grin

noonki Sun 05-Oct-08 20:07:18

Having read all thread sounds to me like you did all you could in difficult circs and well done, sounds traumatic for you all

If I were your friend I would get her to get someone to explain what when wrong, why her baby nearly died etc

as it could help you both and help you both realise it was no ones fault

AnarchyAunt Sun 05-Oct-08 20:16:22

I am going to try again to talk to her about going over the birth with hospital staff, though I think she will still find it too hard to do sad. I have thought before it would be helpful but the counselling she has been offered seems to be encouraging her to forget it and concentrate on her baby (who btw is delightful and I am her godmother!)

Sycamoretree Sun 05-Oct-08 20:17:46

Can I just add to then end of this that one last thing you could do for your friend is to get her some sort of counselling - preferably someone with birth trauma experience who can come to her at home. A good friend of mine did this for me when I had a crash section after a week of inductions, and every intervention on the planet (supposed to have been in a birth centre... )

It was the most helpful thing anyone did. I did not have pnd - and potentially your friend might not either, I had post traumatic stress, which is subtly different, and she needs to come to terms with all aspects of what scared and shit out of her, that she felt violated by etc in order to move on and forward. Getting hold of her birth notes is important - she should understand what happened, and why she almost died. Understanding that things got so complicated may help her come to terms with the fact she didn't get her home birth, but that being in hospital and having the section were possibly the best and only outcome in the end.

You sound lovely by the way. I'm sure you're going to do great as a doula smile

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