Wednesday, July 27, 2005

DONA conference debrief

The conference. Hundreds of doulas in one place at one time. Teen doulas. Old doulas. White doulas. Black doulas. Mexican doulas. Israeli doulas. (DONA International indeed!) Straight doulas. Lesbian doulas. Pregnant doulas. Nursing doulas. Earth Mother doulas. Business-suit doulas. Certified doulas. Uncertified doulas. Birth doulas. Postpartum doulas. Homebirth doulas. Hospital-based doulas. I was surprised by our diversity. Especially when the first national doula survey found the majority of us to be white, roughly 40 years old, college-educated, mothers.

The general sessions I went to were on Preparing Parents for the Postpartum Period, Updates in Anesthesia, Intimate Partner Violence, and the Doula Backlash. The last two were particularly good, though the other two were also informative.

I learned that on average, one in six women doulas encounter working with a general pregnant population is in an abusive relationship. Zoinks! That means I would have encountered three such women if I had a statistically representative population. I don’t think I have had such a population, though I had one client who I’m certain is abused and another who I suspect may be. The presenter gave us great tips for being useful. What I took away was making sure I’m able to, at some point, get every woman alone, to ask her if she’s ever scared or hurt by her partner. I ask about abuse in my general client history questionnaire, but the partner is usually present for this. I also learned what to say when a woman reveals abuse: “Thank you for sharing this. I believe you. You are not crazy. You do not deserve to be hurt. There are safe places you can go when you’re ready.”

“Queen Doula” Penny Simkin closed the conference with a discussion of doula backlash and what we can do to prevent it. I cannot think of a better icon for the doula movement than Penny Simkin. I have to put her picture here so you can see (if you haven’t already) how kind and wise she looks.

When she speaks, even to a full conference hall, you feel as if you’re sitting across the kitchen table from her. She is that informal, personable, humorous and vulnerable. That she still works as a doula blows me away. How lucky her clients are to have her smarts, experience and heart with them through birth.

Enough gushing. The take-home lesson I got from her lecture is to introduce myself in advance of a birth to my clients’ midwives/doctors. I came home and promptly wrote a letter to my current client’s doctor explaining that I’m a team player and carry no agenda beyond facilitating my client’s getting the information and care she desires during the birth. I also put in a business card so that he can refer other women to me if I leave a good impression.

And as to why the doula backlash? There are turf and control issues, of course. There is misinformation and misunderstanding. But we can’t do much about a doctor who wants a woman to just follow his orders with out question. By the time we’re in a delivery with that sort of person, we just need to help the mother through it with as much of her dignity as possible. And we can be there to record and later acknowledge the slights she felt.

We can, MUST, also stay within the scope of our practice. Doulas do not provide medical care. Some nurses and doctors have reported catching doulas in the act of doing a cervical check. Some doulas apparently listen to heart tones or take blood pressure. Some doulas counsel for or against medical procedures. We are not supposed to do those things. It confuses our role. It opens us to liability. It does our clients a disservice.

For the breakout sessions, I attended one on “Latch On,” where I learned that Fentanyl is the epidural drug that causes problems in newborns and that patients can ask their anesthesiologist to give an epidural without it.

I attended “Positions for the OP Baby.” We went station to station trying various tips and tricks. I was pleased to know of most of them, but picked up a few good ideas along the way (2 tennis balls tied tightly in a sock provides bilateral pressure along the spine, instead of 1 ball, which can only be on one side at a time). Here are two doulas demonstrating lap sitting (not to be confused with lap dancing), with a third doula supporting the “mother” with a bed sheet under her arms.

This saves the seated partner or doula from having to bear all the mother’s weight. Note: this is the resting position. During a contraction, the partner spreads his or her knees very wide and the mother slides down into the space below, opening her pelvis nicely.

Penny Simkin gave a breakout session on “Supporting the Mother through Difficult Procedures.” She covered everything from stillbirth to diagnosis of a fetal anomaly to external version of breech babies. Her reminder that frequently in these situations, especially those of loss, “less is more” was helpful. Often our most helpful role is as quiet observer and note-taker and, later, listener.

Lastly, I went to “Birthing with Pride,” a session on working with lesbian, bisexual and transgendered couples. The lesbians in the crowd stressed that the non-birthing woman in a lesbian relationship is not just an analogue for the dad in a heterosexual couple. Non-birthing mothers may have many issues: jealously, equality, redefined identity, etc. Again, great stuff to think about.

The funniest moment was the closing slide of the anesthesiology presentation. The doctor showed this image:

The accompanying text says,

Among the Huichol Indians, the father traditionally sat above his labouring wife in the rafters of the hut, with a rope tied round his testicles. When his partner felt a painful contraction she would tug on the rope, so that he too would experience the pain which would bring new life.

Whether it’s true or not, I think the though resonates with any woman who’s felt labor pain while her partner stood comfortably by.

The conference closed with all the doulas gathering hands around the perimeter of the room and singing “Dona Nobis Pacem.” Something else I learned about doulas? We can really sing!


Anonymous Anonymous said...

The practice the anesthesiologist was describing is somewhat akin to a condition that some men experience during pregnancy called "Couvade" where men experience physical symptoms of pregnancy such as weight gain, breast tenderness and nausea. The tribal activities you described are sometimes referred to as being related to the Couvade syndrome.

1:32 PM  
Blogger I am a Milliner's Dream, a woman of many "hats"... said...

We were in at least two breakout sessions together! (I was also in "When Baby is OP" and "Birthing with Pride".)

Your debrief is excellent and I am continually impressed with you ability to convey thoughts and feelings so well.

Your fellow blogger/doula,
Hannah :)

9:56 AM  
Anonymous Anonymous said...

Speaking of doula backlash, check out this offensive blog that is completely misinformed and mocks doulas. I found it through blogging baby.

12:59 PM  
Blogger Julie said...

What a great report, Doule. Sounds like a you had a wonderful experience.

4:04 PM  

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