Wednesday, February 3, 2010

I think we should go to the hospital. NOW.

As doulas we are expected to continue our childbirth education. It is important for us to understand medical terms, tests and procedures. To understand possible complications in labour and delivery. But we are NOT to offer medical advise or do any clinical tasks that would be preformed by a healthcare provider (though, out of pure motherly instinct, I have checked a client's forehead when she said she felt like she had the chills). We do observe our clients, take notes (bathroom breaks, what snacks they've eatin, length of contractions and space between them.) But when we observe signs of possible complications (including a very fast labour ) and we are with our clients pre-caregiver, how should we approach this? We don't want to alarm our clients, we don't want to "make" them go to the hospital. It's a bit easier, I find, when my clients have a midwife. Any time a concern arises, for example: slightly heavier than usual bleeding. Clients ask: "Is this normal?" I say:
"Every labour is different, but this does seem a bit unusual, so you may want to give your midwife a call." Easy, midwife asks questions/answers questions and may/may not come over/suggest they meet at the hospital. But when the caregiver is a Dr. and it is not office hours, something that is just a little unusual, needs to be checked out at the hospital. Just in case. Though, I find myself, feeling the need to "cover my butt" sometimes. There have been times that I admit, after a client has told me she doesn't want to go to the hospital to get something checked out, that I reiterate what her Dr. has told her about when to go to the hospital (if it applies) or retold them that what I was observing was not typical of labour, but if she wants to stay at home, I will support her wherever she wants me to. I'm sure this felt like pressure from me to her and her partner. There has been times though, where I've ushered clients out the door, carrying their labour bags. Is this beyond my scope? probably. If I were in the same position would I do it again? Yes. It's a hard line to walk, I want to support her in all her informed choices...but I don't want to have to give baby catching instructions to dad via a 911 call either. Sometimes when mom's suddenly 2 minutes apart and 60 seconds long, squatting saying she doesn't want to go; you just got to step in and say: "I think we should go to the hospital. NOW."