When you choose to give birth within the system (through a public or private hospital or one of the homebirth programs), you must be aware that Obstetricians and Midwives will treat you according to the policies of their hospital and state. In South Australia, these are the Perinatal Practice Guidelines, and you can find a link to them at the end of this blog. 


The government website states that "The statewide guidelines do not address all the elements of clinical practice and assume that clinicians are responsible for discussing care with consumers in an environment that is culturally appropriate to ensure informed decision-making and individualised care for pregnant women, mothers and their babies. 


The emphasis on specific terms is mine. Because although the health departments mention this in their documents, women rarely receive wholly culturally appropriate, individualised care with a real opportunity for informed decision-making.  


Let me share some examples. 


Is it culturally appropriate care to tell a woman she can not have her placenta straight away for burial because part of a policy says that the hospital must stick it in a fridge for seven days, along with every other placenta born there that week? No. 


Is it individualised care for a midwife to tell a woman that the last person she saw with higher blood pressure was induced straight away, so that is what she will need to do also? No. 


Has the opportunity for informed decision making been given when a midwife performs a stretch and sweep while doing a cervical exam without asking the woman first? Just because the midwife wanted to "razz things up a bit" No. 


Is a decision free from coercion when the unit manager storms into a woman's birth space without introduction, demanding to know why the labouring woman isn't consenting to a suggested course of action? No. 


Is it individualised care for a midwife to tell a woman that she will not attend her birth if she doesn't consent to cervical checks, despite knowing the woman has a history of sexual abuse? No. 


Has a woman given legally valid consent to have continuous monitoring if the OB only tells her that if she refuses, her baby could suffocate and they won't know about it until it is too late? No. 


These aren't made-up scenarios. 


My clients have disappointingly experienced them all and I have witnessed the majority of them. 


So as your doula, what do I do in these types of situations? How do I advocate for you? It's a question I often get asked.


I know that these are all stressful situations which can interrupt the labour process, so my first action is to remind my client that she isn't alone in this - reassuring her with a touch, eye contact or even a smile to help her settle her nervous system as much as possible. 


Depending on the situation and timing of the event, I might also do any of the following:

• Check in with how she (and her partner) feels about the given information or what happened.

 

• Remind them that they have the final say about how to proceed

 

• Spend a lot of time prenatally with my clients to make sure they are clear about how they want to feel and be treated during their child's birth. Everyone has varying levels of comfort with the responsibility for decision making.  Everyone has different life-experiences and values that affect how they make decisions.  Everyone has different priorities for their birth.

 

• Support them to go through a decision making process. This may look like helping my clients formulate questions for the doctor or midwife to ensure they understand the proposed actions and their options. Reminding my clients of their original birth goals and seeing how they can be supported to achieve these still. Getting the clinician to explain medical terms or asking my clients if they would like time in private to talk together about what they want to do - with or without my presence. Often it is enough for me to demonstrate these behaviors with my clients to remind the health professional that they should be doing the same.

 

• I might give my client & partner a distinct look so they know that my doula "bullshit-o-metre" has picked up on something they're being told which isn't realistic or may not be the whole story. We talk about this in prenatals, and it serves as a great reminder for the partner to step up and do an excellent job of advocating for their choices, like we've prepared for beforehand.

 

• Sometimes I will communicate my client's choice to the midwife or doctor once they have made a decision, other times the client or partner will do it themselves. I think it's important to note here that there is a big difference between informing a clinician of a person's choice once they've been through the decision making process and making decisions for the client or telling them what you would do in the same situation. A good doula will never do the latter.

 

• Provide my clients with resources for further learning and understanding.

 

• Validate that what has just happened wasn't okay and see if they would like to request a different care provider or put in a complaint when they are ready.

 

• Let my clients know what I see happening in the room if it's against their birth plan. Perhaps I've noticed that a student midwife is in the room when they didn't want students or that the obstetrician is getting out the equipment for a forceps delivery or episiotomy when I know my client didn't want those things.

 

• Ensure my clients understand what real, informed consent looks like from a legal perspective and how that can be used in their birthing space.

​Further Reading

1. SA Perinatal Practice Guidelines 
2. What is my role as your doula?
3. When your birth doesn't go to plan.

My approach to birth-planning with clients draws inspiration from different areas.  One of them is goal-planning.  Setting goals can be fun, exciting and also stretch you to consider different areas of your birth you might not have previously thought of.

Through my Clarity Sessions, you (and your partner) get up to four hours of one-to-one time with me. What do we go through:

1. Your previous pregnancies and births.  Let's see what worked for you and what didn't.

2. The power of emotion - how do you want to feel during your labour, birth and immediate postnatal period?

3. Defining your biggest, juiciest goals. 
WARNING: you might be surprised that these are different to what you originally believed.

4. A reality check - are your current actions in-line with your goals and circumstances?

5. Action steps - finally we will nut out specific actions you can start taking straight away and make achieving your goals one step closer.



How do you make your birth-plan unique to your circumstances, powerful yet flexible?

In this infographic I share 5 tips to help you to develop a fabulous, meaningful birth plan.  If you'd like to delve deeper with me and get crystal clear on what you want from you birth, book in a Clarity Session asap.



Which of these 5 tips most INSPIRES you? 
​Let me know in the comments below.

We are faced with making a lot of decisions for ourselves and our child during pregnancy and birth. Some couples prefer to let their obstetrician call the shots but many want to feel in control and confident of the decisions around their care.

How can you know if you are getting all the information you need to make an informed choice?
Do you understand what you have been told?
What if you feel uncomfortable with what the doctor or midwife is telling you to do?

As your doula I will find out what your preferences are for childbirth and how you feel about communicating these to your care provider.  We can role-play different styles of communication with you and your partner so that when you are faced with making a decision, you feel more confident to do so.  I will also talk about various decision making tools to assist you with the myriad of choices available to you.

​Here are 10 handy questions to get you started.

1. I don't quite understand what you mean, could you explain it a little more?
2. Can you tell me why you want to do this procedure?
3. What are the pros and cons of making this choice?
4. How will this help me achieve my goal of ______________ for my birth?
5. Are you wanting to do this because it is hospital policy or will it actually give us more info?
6. I'm not feeling 100% comfortable at the moment with what you want to do, could you please explain it step-by-step.
7. What are the other things we can try instead?
8. I want to _____________, how can you help facilitate this?
9. What is likely to happen if we wait a little longer or choose not to do this?
10. I understand the risks and benefits in this moment, but how could this choice affect me or my baby in the future?
    
    How did you approach asking your care providers for more information?  Was it something you and your partner felt comfortable with? I'd love to know in the comments below

Birth Affirmations can act as reminders of your birth philosophies, help set a positive frame of mind, relax you and make your birth environment your own. 
Print them out, hang them around your home or hospital room as reminders to you and your care providers.  Share them with friends

Click on each picture to be taken to the pdf download.  Enjoy and have a positive birth
​Kelly x

PS If you're local to Adelaide you might like to also join our free antenatal classes through the Positive Birth Movement.  
More information is available in our Facebook group ​www.facebook.com/groups/1394215413942214/