When OB's advice is different from doula's...

lalaith50 · February 2014

What do you do?

I REALLY want a natural birth. I know my OB is supportive, but she is also "medical," and I suspect her first reaction if anything is possibly going wrong will be to c/s the baby out, ya know? I also have an extremely experienced doula (she has seen literally hundreds of births,) so she takes her job very seriously and has seen all kinds of scenarios. Also, I realize OB's don't really "labor sit," so they never really see the entire natural labor process, whereas the doula does, so she knows what's "normal" in a natural birth and what's not.

--My OB seems to think that b/c I'm 38 weeks and already a few cm dilated, that I need to get to the hospital fast, b/c that means I'm going fast. My doula thinks that there is no way a FTM is going "fast;" rather it will be at minimum hours and hours. My OB acknowledges that usually she tells moms who want to give birth naturally to "labor at home as long as possible" bc she recognizes the difficulty of doing that in a hospital, but for some reason in my case she thinks being dilated already means an extra-fast labor? But I don't know why my doula is so convinced that basically FTM's "never" have a short labor... my own mother's first labor was approximately 4 hours, and I've certainly heard other stories of similar! I'm just terrified of not knowing when to go to the hospital, especially with my family history of a short labor.

--My doula thinks that having an OP baby (which I currently have) is terrible and will for sure make labor even longer and more difficult. My OB thinks that is no big deal and babies turn during labor all the time.

--And finally, my OB thinks that if my water breaks I need to come to the hospital immediately (I think she is saying that b/c that means I will go extra fast from that point on?) But my doula says to not even call until I really am ready to go and contractions have really picked up. (bc once you call and say your water has broken, they tell you that you have to come in, then you are on the clock.)

Thoughts? Either on these specific issues, or on the general question of "what to do when an experienced doula's advice contradicts the doctor's...?"

barnwife · February 2014

I only have time now to address a few things you brought up.

If your water breaks, the big risk your OB is worried about is infection. You need to do your own research about this and decide your comfort level. Your feelings about this may be influenced by your GBS status.

FWIW, my water broke with LO3 and contractions didn't start for 48 hours. My MW and I were comfortable waiting it out. I took my temperature regularly to monitor for signs of infection. And, just as important, put nothing in my vagina. Even one cervical check increases the risk for infection. I ended up having my third amazing HB.

You won't know if you will have a short or long labor until after the fact.

As for differences in opinions from your OB and doula, you are going to have to listen to both and make up your own mind based on your own research and what you believe to be in your (and your LOs) best interests.

lalaith50 · February 2014

RedheadBaker said:

Have you actually asked your OB what she would do/what she would recommend in certain scenarios?

If you mean, like, "medical emergency" type situations, no, I haven't really talked to her about that. I wouldn't even know where to begin, as I know there are so many possible variables to any situation.

And @barnwife - thanks. I am not GBS+, so that's one less thing to worry about! This could probably be an entirely different conversation, but one thing that my doula was telling me about that has influenced her thoughts on when to go to the hospital if your water breaks, is that she had a client whose water broke very early, and the doctors basically just put her on bed rest for several weeks until they decided she could deliver the baby. So my doula is like, "If she can go for weeks with her water leaking, then why do they have to RUSH everyone else to the hospital once their water breaks?!" You're pretty much less likely to get an infection in your own home than you are at the hospital!

But I *think* in my case, my OB is more worried about the speed at which my labor will go once my water breaks than about infection.

MommyAtty · February 2014

I'm sorry, but I wouldn't trust anyone who tells you that all FTMs are the same. That all will labor for hours and hours. I had to be induced for my first birth, with piticin, which is notorious for making labor longer, and from the moment they started the pitocin to the moment I was holding my baby was just over 3 hours. My OB had warned me to go to the hospital the second I thought I was in labor, not to wait and not to call his office to ask questions, because he could tell I was going to go fast. This was obviously before he knew he was going to need to induce. What's funny is a woman I work with was due a week after me and used the same OB. He specifically told me NOT to share that advice with her bc his normal advice is to labor at home as long as possible. Especially for FTMs. So your OB may be concerned about you not making it to the hospital in time. Ask.

oliversmommy32912 · February 2014

My first labor was four hours. It really does happen. I completely skipped early labor and went right into active labor. I asked my current midwife if there is any correlation between how dilated you are before labor and how quickly it can go because Im concerned about having an even faster labor this time. She said it can but it doesn't always.

My mom had 3 c-sections so I didn't think about family history. I found out after my son was born that both of my grandmothers' first labors were under six hours. I would pay more attention to your own family history than to what is typical of first time moms. That's just my experience.

As for knowing when to go to the hospital - you will know. That's annoying to hear but really, a change happened in me that is hard to describe. One minute I was telling the nurse that I didn't want to come in because my water had broken and I didn't want to be on the clock. The next minute I was packing a bag between contractions and waiting by the door for my husband to get home to take me. There was no question. It was time.

A posterior baby may very well make labor more difficult. But your OB is right, too. It is common for posterior babies to turn in labor. If you are having a difficult labor your doula should be able to show you what positions to labor in to encourage the baby to turn.

Bottom line is do your own research. Be educated. Then, you can be confident in your choices and it won't be what your OB wants vs what your doula wants. It will be what you want.

emma&grant · February 2014

I'm a doula, and I would ALWAYS defer to what the OB says. No matter how experienced a doula is, she is not a medical professional and should not be giving advice that contradicts your health care provider's.

As other posters have written, some first time mums can go as quickly as 2 hours from first contraction to baby's birth.

Is your doula certified through any training association? It seems as though she may be practicing outside her scope a little.

As a doula I can completely understand that your doula might have background info about your OB, or might truly wish for the best birth outcome possible for you. However, she must acknowledge that her opinions cannot contradict a health care provider's. She needs to be supporting you to have confidence in your health care provider, and supporting you with ways to ask questions that get you the information that you need.

Aurora_Borealis · February 2014

Any OB who normally advises patients to labor at home as long as possible is probably not c-section happy or quick to order unnecessary interventions.

As far as the rest, here's my take:

-FTMs absolutely have fast labors. It is not the norm, though. Mine with DD went from 'hm, I think that was a contraction' to 'it's a girl!' in less than 10 hours. DH practically begged our doula to come over at hour 8 of 10 because he said I was hysterical and he didn't know what else to do. Uh, yeah, because I was in transition and freaking out that I was going to deliver in my bathroom! She took one look at me and said 'let's go' and we were at the hospital 90 minutes before I delivered.

-Laboring with an OP baby is indeed painful, but it certainly doesn't mean your labor will be long. Your doula should know full well that babies can change position during labor.

-It is entirely possible you will want to go to the hospital *before* your water breaks. Mine didn't break until my midwife broke it manually 20 minutes before DD was born. Be up front with your OB and tell her you don't necessarily feel comfortable coming in before you feel 'ready' and ask her what her plan is to support your wishes to have a med-free, low-intervention birth if you show up and are not in active labor. Or would it be possible to go to the hospital and walk around/not check in right away?

JonandJennifer · February 2014

You have to find that meeting place between the two. I normally air on the side of the doula because she is your voice when you will not have one. They both are exaagerating. There are all sides and kinds of labor. My natural labor was 12 hours from start to finish. My daughter was LOA. Early labor was 4 hours, active labor was 7:45 and I pushed for 15 minutes. When I was asked to come in to her office due to my gbs I was measured at a 4, however before she could check my water broke. I progressed to a 5 when we got to the hospital and then labored slowed a little as I rested. Most FTM are somewhere in between or a little over. It all depends on you and the baby. And I say you can live in a utopia if you want. Be determined to have that natural childbirth and you will have it! Just educate yourself!!!!!! Know what labor is and all of the options! Trust what both say but talk to both about why they feel the way they do. Ask your OB her c/s rate too. That's always good to know.

JonandJennifer · February 2014

You will know when to go. When does the hospital admit? 4,5, or 6 cm?? Normally the 4-1-1 is generally a good time to go. Contractions that last a minute long, 4 minutes apart and consistent for an hour. It also depends on your drive. We had a 35 minute drive. We left when I was 5-1-1. The hospital I delievered at would admit at 4cm, although I was hoping to be further along I was admitted at 5cm. But hey I made it halfway. If you have a hard time timing contractions, there is an app for that (check out iBirth) then listen to your body. When you can't talk and have to have the stimulation reduced around you then its a good time to go too! Trust me you'll know!

MrsP7309 · February 2014

I'm side eying your doula a little. My first labor was under 5.5 hours. DD was born about 15 minutes after I got to the hospital. Fast first labors might not be the norm, but they certainly happen.

lalaith50 · February 2014

I'll respond more later when I have more time, (thanks so far everyone!) but don't get me wrong, my doula has ABSOLUTELY given me tons of advice on how to flip an OP baby, and earlier in pregnancy tons of lecturing on how to not have th OP baby in the first place! :-)

alphahelix · February 2014

Everyone else has made great points, but I wanted to add that neither your OB nor your doula really can estimate how long your labor will be. You won't know until things get moving.

That said - YOU are going to have to make the decision on when you are ready to go to the hospital. Do you have a partner or spouse who will be with you as well? They should be ready to support your decision of when to leave, even if your doula is recommending you stay. There really will come a point when you feel the time is right - and it's frustrating to hear, but you will 'just know'. Your doula should be there to support your decisions, not pressure you to stay home longer than your feel comfortable with.

I also don't think your doctor has any concrete evidence to say you'll go fast (dilation at 38 weeks doesn't equal a fast labor), so I would try to not let that influence how you labor. If you feel things are going OK, I wouldn't rush to panic and go in the second your water breaks. Trust yourself and your instincts and you'll do great!!

GPeterson24 · February 2014

As a doula myself I never provide advice to my clients, I provide them with information that allows them to make informed decisions.

I think your OB and your doula need to back off a bit and let this labour play out as it will. Most women I've worked with "know" when they feel they need to head to the hospital, it may not be as late as others but sometimes they feel more secure being there even in early labour. It all depends on your comfort level and situation.

robyn2201 · February 2014

I will start with the potential scenario of your water breaking, my first OB's policy was you head to the hospital immediately after your water breaks. This was her policy for all moms, not just those who she thought mom might "go fast" This seems pretty standard for most OB's based upon the post that I have seen here on TB. They are concerned about infection.

Based upon the research that I did, I do not think this is necessary. I did not want to be put on the clock right away. I did not want them to push pitocin if contractions did not start right away. Well my water broke prior to labor starting both times and I didn't call and I didn't go in right away. The first time we waited about 4 1/2 hours and just went in because contractions were picking up.

Just because you are dilated does not mean you will have a fast labor. And also just because your are a first time mom does not automatically mean a long labor. Like one of the PP's said, you just don't know till after. I would say be prepared to be in the middle. OP can mean a longer more difficult labor.

You will know when to head to the hospital. Some factors like distance, may make it that you have to make a choice to go in before you really feel ready. But I would say as long as you the thought of staying makes you worried then go on in. The other advice I have heard is if the thought of being in the car is the last place you want to be, then it's time to go.

My OB and I didn't agree on a lot of things and for several reasons stayed with her but because of this I did have a doula. She was awesome. Provided me with lots of information but she never gave me advice. It was always information to help me to make the right decision for us.

GL!

margaritachikita · February 2014

I guess the big question is, how far are you from the hospital? If you are just a few minutes away then it is really a non-issue, whether your labor is fast or not you should have no problem getting there. It sounds to me like you need to spend a little more time just educating yourself on the issues and deciding what is the right choice for YOU. It is true you should be able to trust the people around you like your doula and your OB, but ultimately it is your birth, and you need to make the decisions that you feel comfortable with. Best of luck!

lalaith50 · March 2014

Just wanted to update-

Here's a copy of my birth story in case anyone is interested - I was able to go completely med-free all the way up until delivery! (They ended up having to numb the area for an episiotomy.)

https://forums.thebump.com/discussion/12283015/he-s-here-my-med-free-labor-lalaith50

In terms of my initial questions, I would say my doctor was more correct, but when push came to shove (haha) it didn't really affect any decisions I had to make. It really was only about 4 hours from when I was pretty darn sure I was in labor to actually giving birth. But I think I would have left the house at the exact same time no matter what - I did just "know." (labor intensified FAST!) And I don't know exactly when the baby turned from being OP, but he was definitely facing the right way when he arrived! But that's just as likely attributed to my being extra diligent about positioning and laboring on hands and knees, but I do wish I hadn't stressed so much about it. And thankfully my water never broke (had to be broken at 10 cm,) so I never had to make that decision!

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