The Ordinary Doula Podcast

E54: Plan for the Negative

• Angie Rosier • Episode 54

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Discover the pivotal elements that can unexpectedly turn a birth experience from joyful to challenging. On this episode of The Ordinary Doula Podcast, we draw on a wealth of insights from my 20 years as a seasoned doula and the compelling data from a comprehensive 15-year retrospective survey. We unravel the mystery behind why 60% of surveyed clients found lengthy labor to be a major hurdle, often catching expectant parents off guard. With labor sometimes stretching on for days, even the most prepared individuals might find their birth plans shifting dramatically as time progresses and fatigue sets in.

But what about the unseen dynamics in the delivery room? Forty percent of respondents pointed to their interactions with nurses as another significant influencer of their birth experiences. As a doula, I've witnessed firsthand how nurses tread the complex line between hospital policies and patient advocacy, which can sometimes lead to tension. I share strategies for expectant parents to navigate these interactions, potentially transforming what could be a stressful situation into a more empowering and supportive one. Join me as we explore these crucial topics, offering fresh perspectives and practical advice to help you and your partner prepare for a more positive birth journey.

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Show Credits

Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

Speaker 1:

Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

Speaker 2:

Hello and welcome to the Ordinary Yule podcast. This is Angie Rozier and if you heard our recent episode just before, this kind of a companion episode we talked about factors that most led to positive aspects of a birth experience. So, as promised on this episode we're going to flip that coin and we're going to look at factors that most led to negative aspects of the birth experience. So again, this was research I did when I was getting my master's degree and I pulled data from about 15 years worth of clients, hundreds and hundreds of clients, and kind of pooled through the data combed through it. It's a fascinating, grueling, tedious experience but pulled a lot of really interesting things from 15 years of doula work and looking at that. And this particular piece was done in a retrospective survey that was sent to hundreds of clients and this was so. This is people looking back right and answering questions about their birth experience. So some of them were looking back just a few months. Some of them were looking back up to 15 years or more. So you know there's a lot of factors going on here and I gave them some, some components to consider when they were thinking about what led to negative parts of their birth experience. So not that they had a negative experience, but just the the parts that maybe weren't their favorite. Why? Why was that? So the factors they got to choose from? Again same thing with the positive aspects of a birth experience. Same factors communication, partner participation, childbirth, education, birthplace, midwife, doctor, nurses, doula, length of labor, meeting your goals and initial contact with your baby.

Speaker 2:

So not everyone answered this. I had better, a higher response rate to the positive parts, which is awesome. I was glad about that. I had about an 83% response rate to this and much higher response rate to the other, to the positive aspects, specs, which is cool. So the most common component maybe you could guess that led to any negative aspects of the birth experience was long labor.

Speaker 2:

So 60% of folks said the length of labor. Well, actually it just says length. I am assuming and I happen to know because I was there. But long labors, you know, when we're looking at two, three, four days, you know even, you know even one day, 24 hours of labor in a lot of cases can be long, super normal, but it's long. A lot of times people aren't realistically prepared for how long labor can be. But 60% said the length of labor was the top most contributing factor to anything negative about their birth experience. Now that is outside of people's control, right To a large extent.

Speaker 2:

We can look at the nuances of like are we inducing? When are we inducing? How are we inducing? Why are we inducing? Are we augmenting? There's a lot of reasons. What's the baby's position? There's a lot of reasons.

Speaker 2:

Labor could be long, but it can. It can be long and that is hard, super hard. When I have someone who has certain birth goals and then we're looking at you know we're going on hour 30 of labor. That's hard, but things might shift, preferences might change as labor draws itself out and becomes fatiguing and tiring. So, other than that, the next most common thing that contributed to negative aspects of the labor was nurses. So 40% of the folks that. Well, that was our next most common answer, 60% for length of labor, and then 40% was nurses.

Speaker 2:

So I thought that was really interesting that we jumped from length of labor to nurses. That's what people didn't like. So whether that was how nurses treated them and I call nurses are kind of referees like nurses have to be referees on a labor and delivery floor. They have to meet you where you are and they also have to meet the rules, the policies of the place that they are, wherever they work, right, that's who they work for, that's who pays them, that's how they have a job. They have to uphold policy and they have to be a patient advocate. Sometimes that puts them in a tough spot. Sometimes nurses aren't coming off super compassionate, kind and caring. Sometimes you know we hit them after a super long shift. They might be tainted. They've seen a lot. Maybe they haven't seen anyone very well prepared for labor. I see that a lot where nurses might not be super supportive. So interesting, I thought that was a little shout out to like hey, nurses, let's like see what we can do to become a positive aspect.

Speaker 2:

Because from these people in this survey, that was the after a long labor, that was the next most negative thing about their birth experience was their interaction with nurses. Following close behind, we got oh sorry, that was 39%. 39%. So almost 40% was nurses and then a 34 percent was doctors. So doctors weren't far behind.

Speaker 2:

Um, whether that was, you know how the doctor came across the interactions, but I will tell you from working with thousands and thousands of people that the birthing person and her partner want to be treated with respect. They don't want to be mocked, they don't want to be nothing condescending, they don't want to be chastised, they want to be respected, they want to be supported. And sometimes nurses and doctors are not the best at supporting and showing respect, kindness and compassion. A lot of times they do work on the efficiency of the process, kind of cranking through the process, forgetting the human component. That's why doulas have a job is because we are all about the human component being there for that. Taking the time we have the time to take, we can devote time to one patient be a continuity point. We can be in the room the whole time. Where nurses can't, doctors can't. They have a lot of other roles to to fulfill. So that's part of it, just the way the system is set up. But please, doctors, nurses, approach with kindness, compassion and respect. It's very important.

Speaker 2:

Um, after doctors came the birthplace at 25%. So whether and generally, you know 93% of these births were taking place in hospitals. So that's probably the one I'm going to select is probably just self-select, is probably the most common. This could be something about the place, the hospital policies that were there. Sometimes people get frustrated with that. Different rules. Hospitals abound with policies and rules.

Speaker 2:

The next most common after that was meeting your goals. So this came in at 19%. So they felt like they didn't meet their goals and that led to negative aspects of their birth experience. Whether they wanted to not be induced, they ended up being induced. Whether they wanted a VBAC had a repeat C-section. Really common one is they wanted to go unmedicated. They ended up using narcotics or getting an epidural. And that's tough like having your goals met, meeting your goals, your expectations, largely in childbirth, so many things, so many variables are outside of our control, so that can be difficult in just meeting our goals.

Speaker 2:

The next most common one, at 15%, was communication. So whether it was poor communication not being able to get your point across or desires, or feeling like you weren't heard, that your communication was bad, there was a barrier to communication somewhere led to negative aspects of that. Next it was partner participation, which kind of surprised and didn't surprise me. Some partners are gung ho, super supportive, some go overboard, some get bored. I heard today of a story a friend of mine had to go support her sister in a different state because after 72 hours well, in the middle of a 72-hour labor the partner said I can't take this anymore. This is taking too long. And he left. He just left. So she drove up to Virginia and helped her sister in the labor process. So partner participation whether it wasn't what you thought wasn't as much as you thought but sometimes that can contribute to negative aspects and hopefully, you know partners are prepared. I think partners mostly want to help. You know if they have the right tools and are supported in the right way, they're going to hopefully be pretty supportive, and doulas can help facilitate that, of course.

Speaker 2:

And then we also the next after that kind of interesting was doulas. So that at 5.7%, so almost 6%, like doulas led to a negative component of the experience and I think this is a little reminder to doulas that we're we we, you know do our best but we are not a guarantee that things are going to go beautifully, positively. We're not going to have a perfect, empowering birth just because there's a doula there and we might do or say some wrong things that didn't go well. For this client too of ours that definitely can be a case. And doing this research was actually really humbling to me as I got these survey responses and dug into a lot of different data points. Um, it was really eye-opening to me that uh and and kind of informed how I moved my practice forward, um, and learned new things that doulas aren't a guarantee to anything and sometimes sometimes we make missteps and misspeaks, sometimes as well.

Speaker 2:

Other ones that were super low, at less than 4%, were childbirth education. So childbirth education had very little to do with negative aspects and if you remember, in our other podcast it was pretty high on positive aspects of the childbirth. So get some childbirth education, do some preparation. It does not contribute to negative and it was really impactful and positive. Midwives Midwives did better than doulas when we're looking at what led to negative aspects of the birth experience. So go midwives. I'm a huge proponent of midwives, I think everyone should have a midwife in their life. And then initial contact with baby was also low. So childbirth education, midwives and initial contact with baby were all 3.8%, so the smallest things that contributed to any negative aspects of the birth experience. So again, as I said in the other podcast about positive aspects of the birth experience, once you consider aspects of the birth experience which, if they came in, if they were negative, what would they be to you? And that's going to be different for everyone. Maybe having a long labor would be a negative component. Maybe not having the communication you need and want, or having too much communication, maybe having overboard support or not having enough support. Everyone's different.

Speaker 2:

We can't write anyone else's story, but consider what would make my birth negative and consider, even more than that, what would make my birth positive and prepare towards that. These are some components to consider that we've talked about. Come up with these and just come up with more. Come up with your own. What parts would make your birth experience positive? How do you want your interactions with your nurse to be and how can you facilitate those with your nurse? You can use a birth plan to facilitate that. Um, create connection with your nurse.

Speaker 2:

Nurses can be a very impactful tool but, as we saw here, they can also be one of the most negative parts of the birth experience. Partner participation, communication, the place you're at the length of labor Gosh, I wish we could hit a sweet spot for everybody on that. But people tend to really like the initial contact with their baby. That's a highlight, for sure and they tend to really like midwifery care, which is awesome, and they never have regretted childbirth. Education is what this data tells us. So go forth as you consider aspects of your preparation for your best birth experience. Kind of consider what that is for you and how can you get there. What questions can you ask? What people can you involve or incorporate? What shifts and changes might you want to make to ensure that you start out in a great place, that you're in a comfortable spot physically, emotionally, mentally, psychologically, that you like what you're getting into Because it's a ride. I tell you what it is quite a ride and we want it to be thrilling, exhilarating, positive, empowering as we go through this journey of childbirth, labor and delivery and into parenthood.

Speaker 2:

Thank you so much for being with me here today on the Ordinary Doula podcast. This is Angie Rozier, your host, signing off today. Come again next time as we dive into more components of childbirth, labor, delivery, breastfeeding and the postpartum period. It's quite a journey. Go out and do something you enjoy today. See something that inspires you, seek for the goodness in the postpartum period. It's quite a journey. Go out and do something you enjoy today. See something that inspires you, seek for the goodness in the world and I promise you will find it. We will see you again next time.

Speaker 1:

Thank you for listening to the Ordinary Doula podcast with Angie Rozier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth.