Friday, July 28, 2006

You forget how much you once didn't know

Some months back I interviewed with a prospective client. She was very nice. I appreciated her interest in doulas and what they can do for laboring women. Her first round of questions, however, had to do with epidurals: Should she get a doula if she knew she wanted an epidural? Would doulas work with her if she wanted an epidural? How soon can one get an epidural? If you have an epidural and need a Caesarean delivery, do you have to get general anesthesia?

That was her segue into Caesarean questions: Do you get put completely under for Caesareans? Could her partner come with her to the surgery? How long do you have to labor before they give you a C-section?

As I answered her questions, I tried to bring in a more normal view of birth. One in which there were a variety of strategies for coping with pain, and a majority of situations that ended in vaginal birth.

She seemed to appreciate the information and confessed at the end of our conversation that she was very scared about birth. The two things she knew about -- epidurals and Caesareans -- were the result of her cousin who'd recently experienced both.

I left the interview astounded and disappointed. How could a healthy, educated woman have such a narrow perspective on this profound process?

Let me tell you my own story of ignorance and good fortune. When I was pregnant the first time, I did what I'd seen other pregnant friends do: purchase What to Expect When You're Expecting. That right of passage, and a friend's gift "The Girlfriend's Guide to Pregnancy" were all I had to prepare with. They were scary. We all know how What to Expect is a month-by-month account of what can go wrong and what benchmarks you're falling short of. I don't remember much about Girlfriend's Guide other than the author was constipated and advised partners to present new mothers with jewelry after the birth.

I took the recommendation of a friend and signed up with one of the well-regarded OB practices in town and was on my way.

Until a box of hand-me-down clothes arrived from a sister-in-law. Enclosed in the box was a used copy of Natural Childbirth the Bradley Way. My life took a whole different path.

I like to believe that I would have found "normal" birth on my own. But I remain thankful to my sister-in-law for introducing me to an alternative approach to birth. I could well be the case that but for that, I'd have learned the hard way about medicalized birth.

For similar reasons I think the increasing popularity of doulas is important. Perhaps the main users of doulas are women who already are educated about birth and are doing all they can to improve their chances of a satisfying one. On the other hand, the woman I interviewed with was not seeking a doula to help enforce a birth plan. Rather, she'd heard of doulas and thought they were as much a part of the process as a a Quad Test, an ultrasound, and, well, an epidural.

When women at that stage of their birth awareness are connecting with doulas, I have a lot of hope. It gives us a chance to plant a few seeds, whether we're hired or not, about ALL that birth can be.


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

I find more and more that I can educate in those situations, as you did.

The first two books you mentioned have wrong information that continues to breed the scariness of pregnancy and birth.

We can be the change agents one potential client at a time.

11:34 PM  
Anonymous Vera said...

I hope you don't mind me posting as I am unkown to you. I stumbled upon your blog a few weeks past and have been reading since.

Can you clear up some confusion for me? Are you suggesting that women not be told of the risks of pregnancy and birth?

3:16 PM  
Anonymous Hollyrhea said...

I have a friend who is currently trying to conceive. She is already set on an epidural and is in no way entertaining the idea of anything otherwise. However, she is such an intelligent person - I think I'll give her Henci Goer's "The Thinking WOman's Guide to a Better Birth" as a conception gift.

7:27 PM  
Blogger doulicia said...

Vera -- thanks for asking for the clarification. I certainly am not saying women shouldn't be educated about birth's risks.

I guess my perspective is that most normal pregnancies are more "at risk" for unnecessary intervention than they are for a truly emergent situation like placental abruption or prolapsed cord.

That said, it is also important to prepare women for ALL the possible outcomes in birth, including those that they might prefer to avoid. I always explain to women, even those who are dead set against epidurals, that there are times when epidurals are very useful and they should not consider the use of one "failure."

Similarly, I think families should know what happens during a Cesarean birth so that they aren't caught off guard if that situation arises.

Is that any clearer? I do not think information should be hidden or downplayed.

10:53 AM  
Anonymous Vera said...


Thanks for taking the time to respond to my question. It reinforced my first impression of you. A good one, I might add.

10:59 AM  

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