I Am Mad and I Am Sad

I just spoke to a mom who is with a practice of midwives and doctors who practice out of the large hospital on the north side of town. And she is with a large insurance company which is a global pay system. She is being told by her practice that they do not allow doulas. She will get either a doc or a midwife- you rotate through both and it is whoever is on call.

And her hospital childbirth educator- was great about teaching her “to stay up and moving- using the birth ball, etc”  but told the students who lived a short distance away (5 to 10 minutes) to arrive when the contractions were ten minutes apart but since she lived almost an hour away- she needs to go to the hospital at 15 minutes apart. I reminded her that that was only four contractions an hour and would be very, very, very early labor! She called me to find out about doulas because the hospital tour person and hospital educator and her friends have all said use a doula, even labor nurses she goes to church with recommend she use one. But she is unsure if she is “allowed” to do so with this practice and wondered if I knew if they would allow us to be there!

I have never done a birth with this group to my knowledge (in 20+years of being a doula!)- and told her perhaps they had had a bad experience with a doula and made this policy. But I also told her it was scary to me that they could decide who she would have with her when they do not arrive until the very end of her labor anyway! She feels the global pay plan does not give her the option of switching practices since they pay in one lump sum once she gives birth. And she loves one particular doc who got her through two miscarriages and shares the same faith with her. And she is considered high risk due to those “two early miscarriages and she is old”- she is 39! I told her it would be based also on when and why the miscarriages occurred based on my understanding. I also told her that some practices would not consider those factors alone to determine that she was high risk but would look at her overall health and well being. I was mad that this practice was controlling such a thing as a selection of who she wanted for labor support! And I was made that this educator would direct couples to the hospital in such very early labor if they wanted little intervention and no epidural as this mom desires.

She did learn at the tour that this particular hospital  has a 95% epidural rate and over 44% cesarean rate but she was told they are working on improving that cesarean rate! Another doula told me, “They cannot delegate who she wants as a support person, no matter if she has paid them to be present or not.” But I reminded her that they can dismiss her if she goes against them at this point.. And this is when I felt very sad. She asked, “Can they do that? Tell me who I can have with me?” I told her if they wanted to do that, I personally would run. Because what does that say? It says they want to be making all of the decisions in her labor and not allow her to be thinking of what she wants even now. They are in charge. She will have no voice in her birth decisions, no power. Money is directing her due to the who global pay issue.  Money has power over her as it does most of us, sadly.

A doula who is my friend wrote. ” Yup. Power. She needs to regain those reins and find someone willing to work for/with her and not delegate. So sad.” This mom already feels powerless at 29 weeks. How will she feel if she continues under their power when she gives birth.?

I heard of another practice at this hospital that gives their patients a birth plan option sheet with the options they allow. You fill it out based on what they feel is important for her birth. This made me sick to my stomach.  And this was given to this client by a midwife! What happened to our hospitals when they not only cookie cut your births but also design the recipe for you and give you only options that they feel are important? It makes me want to throw up!

I just got off the phone with a mom who said when she brought what she thought was a basic birth plan- “low lights, intermittent monitoring, movement in labor, eat and drink as desired, no offer of medication,” the doctor threw it all out and treated it as nonsense. It infuriated her but she was with a huge teaching facility in town who mandates that she pays extra if she goes outside of their system. Money is motivating her to stay with them! Money is power again. This time though she plans to have a doula.


You may read this and feel it only effects a few. It does not! It effects everyone! Our future is based on births- how babies feels about the experience effects them forever. How moms feel either empowered or dis-empowered changes them forever! How disengaged a partner is made to feel at the birth effects them as well. We have to stand up and say ENOUGH! Birth is about power. But it needs to be HER BODY, HER BIRTH, HER POWER, HER CHOICE! A physician’s role is to do no harm! Yes keep the baby and mama safe, but goodness gracious give the power of who she wants to be with her in labor back to her! Unless you are going to be there to be her full time labor support- with her continuously, move out of the way of her selecting what she needs!