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 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 about it all