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Not Going to Catch

The program I am working through in Honduras puts volunteer doulas in public hospitals.  The idea is that the presence of a doula will begin the process of making changes in the way women are treated.  It is a nice concept, and only time will tell if it will really work.  In the mean time, it does provide some comfort for women who would otherwise be left to manage labor alone.

The problem for me is that I now have skills beyond childbirth educator and doula, and the staff of the hospital knows this.  This gives me a bit more freedom with what I can do. For example, I make suggestions to the students when they are working with patients and have even given a shot when I was left alone in a room with the patient and one physician student. I don’t really like this part of it.  Not that it is difficult or that I cannot do this work, but that my presence is not intended to cover the problems of inadequate staffing.  I am here for the women, not the staff.

Yesterday one of the attending physicians asked why I wasn’t attending the births (meaning why was I not catching), and she reassured me I could do that if I wanted to.  Sounds like a great opportunity, doesn’t it?  It is not, and I have no intention of purposefully catching.

You see, her comment was not based on her seeing my skills and feeling I am competent to provide care. In fact, the attending is almost never in the room.  Her comment was made only because she knows I attend labors in the US – which she assumes means I am competent.  I don’t think she understands I am still a student.

Beyond her misunderstanding is the fact that my Spanish is poor.  If I had a problem alone with the patient (and the students are almost always left alone with the patients), I might not be able to get the help I needed because it would be too much work to figure out how to communicate what was happening.  It took me three tries yesterday to get one of the doctors to give an oxytocin shot (which I felt uncomfortable doing because I was with a student who didn’t speak English and I didn’t know how he would react to my doing it). Once the birth was completed, how would I ensure the student who would be responsible for charting the birth got the correct information?  I know it seems like a small thing – but for the postpartum nurses to know who is at risk for problems they need to understand what happened during the labor.  I don’t go into the postpartum unit, and have never met the nurses.

There is another layer of problem, that of authority.  This doctor is one of the attending physicians in the maternity, but there are others.  What if they do not all share her openness?  I have permission from hospital administration to be in this closed unit (not even family is allowed to peek in) as a volunteer.  If I broke that trust I could risk the possibility of other volunteers being allowed in.  This doctor also does not have the authority to permit me to provide nursing or medical care in Honduras – I am not here on a work visa and I am not licensed to provide services in this country. I know many Americans have an idea that you can just go into a country and start catching babies, but it really isn’t true.  Although the chances of being caught are small, I could be jeopardizing my ability to come back to Honduras with legitimate work papers.

Finally, and the biggest problem of all for me, is that in permitting me to do births this doctor is showing that she doesn’t really value the work I am doing.  I expected this, doula is a new concept in Honduras.  She doesn’t understand the importance of keeping the space or providing a presence and positive experience for the laboring women. She thinks I will be happier if I can catch babies, and she will then see the value of my being a volunteer in the hospital.  If I accept her offer, I will be demonstrating my agreement that catching the baby is the important part, not being with the women.  This sends the wrong message, and will hinder future volunteers who may not be trained as midwives.

I’m not willing to say it will not happen, I’ve had too many close calls alone with a crowning baby to be comfortable thinking I’ll never have to catch.  But to willingly change my role from doula to midwife would undo all the work I’ve accomplished in the past month. Just another reason why it is important to really think through things before jumping in and “helping” when working in a different culture.

 

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Jennifer Vanderlaan CNM MPH is the author of the BirthingNaturally.net website. She has been working with expectant families since 2000, training doulas, childbirth educators, and midwives. She has worked with midwives in Central America and Sub-Saharan Africa. Her interest in public health grew in 2010, and she is now a PhD student learning to become a producer of knowledge.

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