Because I can't change everything all at once...

...it's important to try to remember the times when I may have done something that changed one person's mind or experience a little bit.

The normal newborn exam. At my most recent birth, the family doctor wanted to examine the baby, but the mother was reluctant to give her up. I asked if it could be done where mother could see. The doctor said sure, and motioned to the infant cart, which was several feet away against a wall behind the mother's head. I asked if it could be moved closer. The nurse pointed out that it was under the warmer, which was bolted to the wall.

I mused about how at home they do the newborn exam beside the mother on her bed, but too bad that the hospital bed was too small for that. The doctor then suggested that perhaps he could do it with the baby right where she was - skin to skin with her mother. Sometimes the indirect method works better than my asking for something for my clients outright. I wonder if he'll think about doing that at his next birth?

Pushing. Once, I had a client in hospital with a medical student observing. She was beginning to push, and needed to pee. The nurse, per protocol, did not want the mother pushing on the toilet - they always think the baby's going to fall in. With a first baby, when a mother's just begun to feel pushy, the risk is vanishingly small. I said something of the sort, and the nurse agreed to let the woman go as long as she promised not to have the baby there. :-)

When she came out of the bathroom the mother asked me for help understanding a squatting position. Before she got back on the bed I demonstrated squatting by holding onto the bed and squatting on the ground. I intended to help her do this on the bed, but she got right down beside me and began to push in a very focused way. The nurse was a bit flustered, and whispered that she was concerned about not being able to see what was going on. So I turned on the mini maglight that hung around my neck, and the nurse and I proceeded to sit or kneel on the floor and watch the mother's perineum by flashlight.

I was thrilled that all of this was happening, but even more thrilled that it was happening in front of a med student. She got to see a midwifery-style labour in the hospital that night. I was pleased that we had a nurse who was flexible and willing to let curiosity override custom.

IV for antibiotics. GBS protocols have been a moving target over the last ten years. A few years ago the standard of care at the hospitals around here was to start an iv in active labour, hang a bag of antibiotics, and keep the iv running with ns or rl for the rest of the labour. Then I attended a home birth with a client who was GBS+. When the time came, the midwife started an iv, ran in the antibiotics (hanging the iv bag from a coathanger hung on the edge of a door), and then disconnected the iv tubing and capped the iv port. Four hours later, she reconnected the iv for the next dose of abx.

So, the next time I had a hospital birthing client who was GBS+, I told her this story. She asked her ob about it, who said "I don't see why not" and placed instructions in her chart. From then on I encouraged every client to talk to their doctor about this option. At first the nurses thought it was odd, but they are now encouraging it for clients who want an unmedicated birth and want their freedom of movement. I'm sure hospital policies have not changed because of my small handful of clients, but I'm sure their requests didn't hurt.

There must be more - I'll try to dig one up whenever my flagging spirits need a boost.

Really back now - and the baby's okay

I attended my first birth last week - my first birth since coming back into doula work after nearly two years off. Lovely family, very inquisitive, worked hard to get the birth they wanted. Nearly sabotaged by an ob resident who just was not on the same page at all.

It really does feel like I never left. I've been wondering what sort of changes I would see in the hospitals I go to, the care providers I come in contact with. I was very excited about this birth because the parents were just so willing to ask questions, do some research, do some work and keep their experience and their baby's experience of childbirth as centrally important concepts.

Sometimes people have difficulty getting it, though. Even a family member, when I was talking about my disappointment in the care my clients received, said "but was the baby okay?". Yes, the baby was okay - of course the baby was okay. The doctors want the baby to be okay, I want the baby to be okay, and I guarantee you that the parents want the baby to be okay more than the rest of us put together. If it happened that the baby was really not okay, the parents would be more than willing to change their plan and do what was necessary. But that's not all that matters.

Have you had an experience with a doctor who was overbearing, who tried to scare you into compliance, who steamrollered over your requests because "that's the way we do it"? Were you okay? Were you okay physically? Were you okay emotionally? If the answer was yes to the first but no to the second, did you go back? Many of us have changed specialists because we did not feel emotionally okay with the person. Sometimes we're able to separate these feelings to the extent that we realize the person is probably competent and will do their job well, but we just don't like them. Sometimes we can't separate those feelings: a doctor who makes us feel bad emotionally may very well leave us feeling that we can't trust their clinical judgement, and we just don't feel safe with them.

Feeling safe is critical in birth. Fear and anger flood the body with the kind of stress hormones that can slow labour, create tension in the muscles and make it very difficult for a woman to release - or even want to release - her baby out into the world. Late in labour, fear for her child's safety can make a woman push in ways that may be designed to get the baby out faster, but which compromise her oxygen supply (and thus the baby's), increase her risk of tearing, and affect her ability to welcome her baby with openness and joy, rather than just relief.

On the provider's side, fear and anger make a patient/client suspicious, resistant, and disconnected. Why on earth would you want that? If you can gain compliance, get your patient to do things your way, you may have a good outcome: a physically healthy mother and baby. But what about their emotional health? What about your emotional health? It can't feel good to be having to bully patients into compliance. It can't feel good to have families toss you out of the room and know they're discussing your actions in your absence. On paper, the baby may be okay, the mother may be okay, your actions may be okay. But is that really all that matters?