I’m not the only one who has made this hard choice. The topic has come up with peers and it’s clearly a difficult one. Some doulas do very well in that hospital, they feel comfortable there, their clients are able to be treated well. Those doulas tend to have been working for a long time and are confident and outspoken in their normal lives, let alone in the birth space. I, however, don’t feel like it’s my role to have to fight every arbitrary decision being made for my clients around misused testing and labeling in pregnancy and the lightening speed toward interventions. At the end of the day, these folks chose where they are planning to give birth, chose their providers, and deserve bodily autonomy.
HOWEVER, despite not taking clients at this hospital, when folks email or call me for an interview and tell me they are planning to give birth at this hospital, I often spend some time talking about why I don’t take births there, rather than just funneling them along.
I can say the same things about pretty much every hospital and why the cesarean birth rate is too high (the tipping point is thought to be somewhere around 19% of all births), but there are definitely some practitioners and some hospitals where the outcome of a cesarean birth is much more likely. I feel like I owe it to my clients to be forthcoming about this.
Furthermore, I owe it to them to talk about the non-clinical reasons why most unnecessary cesareans occur, which start building LONG before the day of labor and have EVERYTHING to do with practitioners and where they get their care. If my client describes their visits with care providers with lots of, “well, they don’t ALLOW that,” or “I asked about X but they told me I had to do it anyway,” I don’t shy away from brining up that their care providers aren’t actually able to make them do or not do anything. Ultimately, my clients are in charge of their care and that of their fetus, so they should have the final say in refusing interventions, when they come into the hospital in labor, who is allowed in their room, what tests they may refuse, interventions they may refuse, firing nurses or doctors who make them feel uncomfortable and who’s decisions they don’t agree with, leaving the practice at any point in care, leaving the hospital if they don’t agree with the decisions being pushed on them, and what can and can’t happen to their baby after birth. Too often, doulas are the only gatekeepers to this important dialogue and unfortunately, we’re often the lowest rung on the ladder of care since we are non-clinical providers working with families often after they’ve gotten negative messaging from their clinical providers since conception.
Not all cesareans can or should be avoided, but there is a crisis in maternal care in this country and overuse of technology, interventions, and operations is a large part of the worsening picture. As doulas, we are obligated to speak up about the realities of why this happens. Too many doula trainings shy away from teaching newer doulas how to navigate these gray areas of scope. I do think it’s valid for us to stay within our physical scope of practice in terms of what we can do to help direct outcomes, but it is ABSOLUTELY our role to be forthcoming about systematic neglect of evidence and widespread abuse of role if we see it time and time again in certain places of care. More doulas need to be told this and we need to be more supportive of each other in navigating these tricky territories.
We are not magical talismans to ward off cesarean surgery if our clients are going to be told that their “high risk” from conception without good reasoning. It is not our job alone to protect our clients from unnecessary interventions — we guide them to the sources of empowerment, but they must ultimately empower themselves. And we must collectively empower one another to take the professionally risky move to speak up to our clients prenatally about the abuses we see. Remember that medical bullying often comes with a smile and a reminder that it’s the woman’s fault she’s high risk. We need to fight that language in our own practices and not shy away from telling the truth about certain places of birth.