The Globe and Mail has the headline "C-section not best option for breech birth" and everyone cheered. Everyone, but a few people maybe. I mean, I cheered and then I said "Don't get too excited."
Here is the thing; there are some pretty unclear things with the news story about the Society of Obstetricians and Gynecologists of Canada releasing the new guideline that doctors should no longer automatically opt to perform a cesarean section in the case of a breech birth. The forget that for nearly 20 years in birth, c-sections have been performed for breech babies and therefor this idea is "new" to a lot of care providers.
These care providers have been taught to be afraid of breech birth. So this guideline changes nothing until training is offered and more than just offered, demanded and expected. Without training and practice a guideline is useless. Until then we are still going to see doctors recommending c-sections because it is their comfort zone. To speak some honest truth the matter is that things will be more risky if a doctor isn't comfortable.
Women are going to continue to be disappointed. Maybe even more so disappointed because they will know this is a guideline now yet their care provider is not up to par of the expectation. Sounds like training will be coming but in what capacity, it doesn't say. Who is responsible for that? Who will enforce the need for training? How soon do they expect to have people trained? What expectation are we setting for mothers showing up to deliver? Will a doctor who is trained be there or be called in, if the doctor on call is not trained?
There was also this quote: "If a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally." As a doula I know this statement to be true, but then I also ask, who is responsible for this preparation? Who is providing with this preparation? Where is the over worked system going to begin to even start preparing women for birth? Shouldn't that already be happening, breech aside? If this isn't already happening, why would we expect to see that change in regards to breech birth? This is a large part of what doula's do! It almost reads to me like the SOGC is recommending doulas. And childbirth education that focuses on a woman strength and ability. These are wins, to me.
Today I celebrate the SOCG and their new guideline but I also feel the sighs of the women walking into the hospital in the near future who are told they will not be supported in their choice to deliver vaginally.
I will continue to watch how things progress locally on this front and will update the information as I can.
When people hear the word doula, they often respond with "Oh, I have heard of those. They are like midwives?"
Doulas are like midwives as far as working with expecting and new families but their roles are very different. Choosing to have a midwife or to have a doula, is not a one or the other, like it would be when choosing a midwife or a doctor. A midwife is a primary care provider, just like a doctor. Expecting mothers need a primary care provider, either a midwife or doctor. Doulas on the other hand work with families who have midwives or doctors.
Midwives are experts in normal, low-risk health pregnancy, birth and early postpartum (6 weeks). They care for healthy women throughout pregnancy, attend to them in birth and check in often during the first 6 weeks as the primary care for the mother and the baby. Midwives are paid for by the provincial government. They offer, order and interpret all prenatal tests and screening, just as a physician would.
Midwives can prescribe medications and recommend supplements in pregnancy, if needed. This includes pain management options in labour. (Yes, you can have an epidural if you have a midwife!) They can attend home births and hospital births, where they will monitor mothers and baby (babies), assess the labour and do all vital checks and exams. If concerns arise at home, they know when transfers to hospital should be recommended and made, and they continue the care once at the hospital. They are in charge of all clinical tasks and procedures. They can collaborate care with obstetricians if and when needed, to ensure the best care of everyone. Midwives have a very defined scope of practice in each province they practice in. You can see more info on midwives on the Saskatchewan College of Midwives website.
If that is what midwives are all about, what are doulas all about?
In contrast doulas are not the primary care providers but rather focus on non-medical, no clinical topics. Doulas focus on the emotional, physical & information pieces of pregnancy, birth & postpartum period. While doulas are accepted in the medical community and the evidence for improved outcomes exists, the fee of a doula is not paid for through provincial health. The fee is paid for by the family. There are some extended health plans that cover the fee. There are also some programs for financial supports for families if the cost of a doula is prohibitive. In Regina, the Doulas of Regina, have a relief fund. A doula is going to get to know their clients on a different level and help them plan for their birth and postpartum that matches their desires, needs and ideas. Doulas will direct all medical concerns and questions back to the primary care provider. If a client is concerned with something the primary care provider has suggested or misunderstands, a doula will help the client communicate more effectively with the care provider, but not on behalf of the client. Doulas are often in the know about other resources families would benefit from so they will guide clients to resources as needed. Doulas focus all their energy into the emotional and physical supports during labour without the distractions of clinical care needs. They also ensure the partner is supported and taken care of in the process. Doulas want to ensure mothers feel confident, informed, supported and comfortable during all aspects of pregnancy, birth and postpartum.