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An open letter to prenatal care providers

21 Jul

To my dearest OB, CNM, CPM, LM,

Please feel free to assume that if your name is not on the aforementioned list, and you  provide medical care for pregnant women, that I am talking to you as well….

I have come to learn in the 10+ years of Birthwork as a Doula, that regardless of the fact that I spend more time with the moms you are providing care for during their prenatal, birthing, and postpartum time that I am at the very bottom of the totem pole in the birthing room….  I get that… I don’t think it’s right, but I get that my existence has very little importance in your world…  BUT I want to shed a little light on the situation…  while a mother largely depends on her medical care team, she also greatly depends on her Doula, who she hired to guide her through the birthing experience.  I’m sure you are wondering WTF my point is here, and be patient my friend…   I am getting to it….

I am fully aware that every provider gets nervous when their patients go post dates (past 40 weeks) and even more nervous when the idea of a mother being Post Term (past 42 weeks), but for the love of all that is

3527-nervous good…   can you stop ROUTINELY stripping membranes of all your patients?? Especially BEFORE 40 WEEKS!!!!!  I realize that trying to make a mom start her labor on your clock is way more convenient (because we are all in this business for convenience right??) but please just take one considerate moment out of your life to think about the other people in the equation…  you are not the only one with a proverbial clock here! (Hard to imagine…  I know…  you may need to sit down and take a breath…    let me help you with this one…  close your eyes, relax your brows and your jaw, start with a deep breath in through your nose and out through your mouth…   low moany sounds can really help…See? It helps right?  I’m really good at this.)

Okay, now that you are nice and relaxed and ready to focus, let me list the people that your intrusive actions affect when you try to rush a mom and baby…

1~  most importantly…  BABY!  While yes, many mothers birth as early as 35 weeks and their babes are fine…  and yes 37 weeks is considered “full term” ( a statement I wish every pregnancy book would delete in their upcoming additions), not every baby is ready 28612003at 39 weeks, or 40 weeks and sometimes or even by 41 weeks!!!   Maybe one baby needs some extra time to get into a good position, while another is still has developing lungs and isn’t quite ready for the outside world…  There are so may reasons that a newborn might not be ready to make their entrance into the world…   How can you live with yourself when you are interrupting the beautiful and natural process of a person’s journey earthside??

2~ mama!  Maybe YOU didn’t get the 2 AM calls for the 3 days with mama crying on the other end saying she has been having on and off contractions ever since her provider did a cervical exam and stripped her membranes…  no no..  why would YOU get the call when she hired a DOULA?  So you aren’t the one that has to tell mama through her tears of discomfort and frustration to trust her body even though her care provider doesn’t….    you aren’t the one who may possibly get up and travel in the middle of the night to rub a mamas back while she copes with uterine irritation that doesn’t turn into real labor. So since you aren’t the one who gets to witness all of these things, let me explain to you, that you are indeed causing unnecessary pain and  emotional rollercoasters..  You know those births that you go to, that mama has been up all night 15-best-cat-memes-ever-meow--3283dd863ebefore her labor started, and when you get there she is battling maternal fatigue??  Did you ever stop to consider that it MIGHT be linked to the unnecessary membrane sweep you did the day before…

3~ Dads! Surely you know that men are completely out of control in a birth situation…  (unless you are a controlling male OB in which case you could possibly have no idea what I am talking about, but let me assure you that out in the real world…  men are not the ones that call the shots when it comes to birthing)  so when these dads are having to miss work because their wives keep thinking they are in labor because their care provider told them that stripping their membranes would likely start labor and then nothing happens,…..    they are usually taking time away that they have when the baby is actually here…   when the moms REALLY need the help…  Not to mention that NO MAN likes to watch his wife suffer, and MOST MEN are very nervous when it comes to contractions and babies, and broken water and the like…  this causes a lot of unwarranted hysteria….  Let me tell you…    THOSE 2 AM phone calls REALLY make me love you!

not impressed4~ The Doula~  ah yes now we get to my original point…    maybe you THINK that doulas  have nothing else on their plate than this one mama, but I would like to clear that thought out and remind you that Doulas not only have usually more than one birth client that she spaces appropriately, but they also have their own families, sometimes another job, and their own personal lives…  and if you cause a mom to labor earlier than necessary, I might be at another birth…  I’m sure you are sittin there thinking “what’s she complainin about, doesn’t she have back up? “  well, yes I DO have backup…  But have YOU ever had to call a mom to tell her that you can’t make it to her birth even though she has been visuallizng her birth experience with you there for months?  No…  my guess is that you likely just have your back up do the talking for you…  but it doesn’t work that way for me…  Hearing the sadness in a mom’s voice when you have to explain that is heart wrenching…  it changes her experience…   maybe that doesn’t matter to you…  (which would make you a mean person just to clarify) but it DOES matter to me!!!  When one woman’s unnecessary membrane strip or unnecessary induction affects someone else’s birth, there is a problem here!! (inductions / membrane strippng for medical reasons or as a last resort doesn’t apply here…)

YES we live for our doula clients and their births. YES we are passionate and don’t mind hearing from these families in the middle of the night…  YES we knew what we were getting into when we got into it…   but it can be very frustrating when the root of these multiple calls (and hours of conversation) is simply because YOU CAN’T WAIT!

So let me ask you…   DO YOU live for your clients and their births?  ARE YOU passionate about your job? DID YOU know what you


were getting into when you got into it?? If not, then maybe you should reassess your situation and decide if you are equipped to handle the pressure of spontaneity… THIS IS BIRTH!!!!  An industry that SHOULD be based on spontaneity and mystery & WE HAVE TO STOP PLANNING BIRTH!!!

I encourage you to take a moment to just enjoy the progression of a natural birth, just how it stands..   Take your ego out of the birth experience…   YOU!  The OB, the CNM, the LM, the CPM….   YOU WERE INVITED!!!!  So honor the process and only step in when necessary …. (and I assure you that a routine membrane sweep is unnecessary regardless of the gold game you want to make, or your cousin’s  wedding that you might miss)…  maybe just try to be supportive of the parent’s wishes for their birth, even if it is something that you would choose to do differently…   recognize that your opinion is just a recommendation and that each mother has the option to take it or leave it…

All of that being said….  Yes I understand that some situations are different… but I’m not talking about the “different” situations, I am talking ROUTINE..  and if you are doing a sweep on more than 10%-20% of your patients, (or routinely encouraging labor to start in other ways), and if ANY of those patients are less than 40 weeks, you should seriously evaluate why you do this job…  if you can’t handle your patient load without managing labors that haven’t even started, then you should possibly consider taking on less so that you can provide more…  this isn’t a factory line…   this is the miracle of life and you get the golden ticket to be a facilitator…

OH!!!   And one more thing….  If you are the type of provider that just shows up to catch…   then why aren’t YOU the low man on the totem pole???

The saddest part of this post (to me anyway) is the need to direct it at more than just OB’s…    hey MIDWIFE!!!  Stop meddling!  Start supporting and empowering the women you work for!  (yeah that’s right!  You work for them!)  start practicing your preach…

Sincerely and in the most loving way possible,

The Doula


by Sable Swirl