Log onto Squarespace
Archives

Entries in scope of practice (1)

Sunday
Jun052011

This is Informed Consent?

Recently, I was asked to view a blog post on the Babies in Bloom site, written by Amber Plyler of Heath Springs, South Carolina. She is a doula, a midwifery student and an admitted “birth junkie.” Amber’s post, now pulled, was entitled “GBS+” and began this way:

“There are many various tests that pregnant women in America are recommended, encouraged, and sometimes coerced into doing. Testing for GBS (Group B Strep) is one of those tests.”

Right out of the gate, this lays out Amber’s prejudice against GBS testing. She goes on to malign routine testing, saying it is a:

“highly inaccurate way to judge if a woman will be GBS+ in labor seeing as GBS results can change depending on the day and you may not be + during labor even if you tested + at 32 weeks.”

While her information is incredibly inaccurate (testing is done between 35-37 weeks, not 32) and she has zero place as a doula to give a recipe for Hibiclens use (incorrectly and dangerously, I might add), the biggest irk I have about this piece and others like it are the promotional aspects that are designed to sway a woman’s thinking towards her own. I certainly share my thoughts and opinions (loudly and freely), but when I’m counseling a woman, I am as middle-of-the-road as I can be, offering each option as clearly as possible so she is able to have all the information with which to make her own decision. This piece by Amber was being touted as an educational piece, something for women to look at as an “option.” Her bias was showing.

If you decide to stand your ground, you’ll most likely be told that you’ll be given IV antibiotics during labor in the hospital –‘just in case’.”

Note the inflammatory language?

Here is my comment to her post:

First of all, it is so far out of a doula's scope of practice to recommend, offer, teach, suggest a treatment for Hibiclens, I'd personally like to see this post removed. If you are a Certified Doula with anyone, you are surely extremely outside the bounds of that contract. 

Secondly, you must live in some crazy world if they are testing at 32 weeks. IF the women are being tested at 32 weeks, their OBs, CNMs and midwives are asking for a buttload of lawsuits and are seriously putting women and babies at risk... if not just the risk of GBS infection, but at risk of not having all the information they need to make an educated decision. 

Thirdly, the Hibiclens wash does not Not NOT go IN the vagina. AT ALL. Suggesting that any douche go IN the vagina, especially in labor and ESPECIALLY with ruptured membranes is asking for an infection/possible embolism. GET YOUR INSTRUCTIONS RIGHT. 

Do you see why doulas aren't equipped to give this information? You think you've got it all wrapped up after talking to a local midwife, but maybe talking to many midwives, some nurses and even listening to a doctor or three would help you have balanced information with which to share with your client. 

As providers, we are so not supposed to shove our agenda down the client's throat. We are supposed to offer options and let the women choose what works for them. One of my major irks about (too many) non-nurse midwives is they 'sell' the treatment they are good at or are allowed to do. All too often, it has zero to do with what is truly safer for the baby, but is all about the midwife. 

I've recommended the Hibiclens wash as well, but after learning even more and talking to parents who've had GBS-infected babies (and learning about two homebirthed babies that died from GBS), I'm much more inclined to recommend the antibiotics. Antibiotics are sucky, I agree, but sick, NICU-kept and dead babies are even worse. 

However, women should be given TRUE Informed Consent. ALL the information; not just the information that's the crunchiest or easiest to employ.”

I hope my message is heard.