Ask a Doula: My Client’s Doctor is Jumping the Gun!

My client just had a prenatal this afternoon. She said her blood pressure is “a little high” and that her doctor said if it’s this high or higher next week she should be ready for an immediate induction. She’s 37 weeks and has had a perfect pregnancy. I feel like her doctor is totally jumping the gun talking about induction when her blood pressure is “a little high”! How can I help my client press back and get more time to go into labor on her own with just a minor thing like this means the doctor panics about preeclamsia?

This is a hard situation, and a tough thing to stay balanced as a doula! I’ve experienced similar situations many times over the years. The first thing I would suggest is asking your client how they feel about this possible change in plan. You may find they are completely okay with the possibility of an induction in a week! If that’s the case, time to pull out your “It’s not my birth, it’s not my choice” mantra and use it (quietly, in your head) as much as is needed. You can help them prioritize the things on their birth plan and figure out an induction version of the birth plan for them.

On the other hand, you may find that your client has concern and/or resistance to the possibility. This presents its own set of challenges. A couple things to consider:

  • Your client might be minimizing the problem to you. I’ve had it happen. The things she was telling me about her test results and what her midwife was telling her just didn’t add up with my extensive experiences with this midwife. I was confused, and asked her if there was something I was missing. Eventually – with my client’s permission – I talked directly with the midwife, and I found out that my client was seriously downplaying – and leaving out some – her test results.
  • There may be factors you don’t know or understand. I find this especially true with newer doulas. As doulas, we simply don’t have the medical training to interpret what a test result means, how the risks of something might be different based on mitigating factors you are not privy to, etc. Remember that your clients are not always going to give you a complete history, and certain family histories or chronic conditions might change things from the very general information you have. This is exactly why clients have care providers!
  • Your client chose this care provider, has a relationship with them, and (probably) has a level of trust in their judgement. As a doula, you should not be interfering with that relationship. You need to really take your client’s lead on this and tread VERY carefully. This late in the game, it may not be an option to switch care providers, so if you undermine that relationship you might be causing your client MORE stress and disruption at the very time they could be developing complications. Respect that relationship.
  • Complications DO happen. Birth is not always safe. Even if pregnancy went just fine so far, that does not mean something isn’t emerging now. Remember that the care provider has a deeper knowledge and understanding than you do about the complexities of managing complications.
  • Stay in scope. – No matter who you certify with, making recommendations like “You do not need that induction your doctor is recommending.” are out of scope.

So here is what you CAN do:

  • Focus on supporting them to ask questions and discuss with the care provider. This might include some role playing, helping them figure out how to approach it, etc.
  • Help your client figure out what to ask. Literally brainstorm a list of questions with your client. They can bring it to the prenatal if they’d like. The BRAIN acronym is a good technique to teach, as well.
  • Help your client to script ways to talk about what her priorities are. This could include role playing as well. One script I frequently use is “(Something from birth plan) is very important to me because (reasons). How can you help me still do that?”
  • Help your client to feel confident. Express your confidence in their ability to navigate this change in plans. Be specific about things you have noticed or learned about them that help you believe in them. Remind them that you’ll be with them the whole time and they don’t have to do it alone.
  • Don’t treat induction and/or medicated birth as a failure. Every birth is different, and the birth path may not lead the way you or your client wants it to lead. Keep in mind Penny Simkin’s research on how people felt about their births later, and preserve their memories and feelings about how they did that day in a way that they can look back at their birth knowing they were respected, supported, and navigated it well.
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