I've decided to share a difficult situation that has been a dark cloud over my life for the last 6 months. Some of my colleagues may have heard that something was happening at Methodist/Park Nicollet Hospital in St. Louis Park, MN that was antagonistic towards doulas but few know the full story. I share that now in the hopes that doulas and birthing families will read this and make informed choices when deciding where to give birth.
In early September of 2019 I received a call from a doula client (client "A") who was about 37 weeks pregnant. She informed me that her midwife at Methodist said there was a problem with me attending her birth and that I needed to call to get it sorted out. It was made to sound like a simple problem with me signing the doula agreement, though I knew I'd already signed that and had attended many births at Methodist, so I figured it would be easy to sort out.
In early September of 2019 I received a call from a doula client (client "A") who was about 37 weeks pregnant. She informed me that her midwife at Methodist said there was a problem with me attending her birth and that I needed to call to get it sorted out. It was made to sound like a simple problem with me signing the doula agreement, though I knew I'd already signed that and had attended many births at Methodist, so I figured it would be easy to sort out.
I was able to connect with the head midwife at Methodist. She informed me that at a birth I had attended in early February (7 months earlier), my client had asked about the ingredients in the vitamin K shot. The nurse had offered to go get the package and then the nurse claimed I said something along the lines of "you should know the ingredients, this is your job, you do this every day." Now, this made me feel better because I knew I would never say something like this. I also didn't advise my client on whether or not she should get her baby the vitamin K shot. That is not my job.
The head midwife and I emailed back and forth and two new "allegations" were charged. One was that I told a client to go in when they were on divert. I didn't, but the midwife on call that day did. She didn't even tell the client they were on divert until after baby had arrived. I'm sure this was because she knew the client wouldn't get the high level of care that Methodist typically provides if she went somewhere else. But clearly a nurse did not like the extra hassle that this birth created. This client had a very speedy birth and since the hospital was so full she ended up giving birth in the tiny triage room. It was a lovely birth that you'll be able to read more about below.
The second allegation of these two was the first true one. I took a video of a birth which is against hospital policy. The policy is alleged to state the no video can be taken from when the baby is crowning until when baby is born. Unfortunately now the hospital refuses to show me that policy. They did show me the policy that they give patients and all that says is that no pictures or videos can be taken in the hospital at all.
It is widely understood that this policy is only to protect providers from being sued and not patient-centered in any way. Doulas I know have had very mixed experiences with this "policy". Some doulas have even told me nurses offered to take a video while others (including me) have been yelled at by nurses when taking a video. A couple years ago I had another client who was birthing at Methodist but needed a video because that was how she had helped process her previous births. Being a rule-follower by nature I reached out to the head midwife at the time. I asked if we could ask the administration for permission to film this birth since it was so important to the mom. She said that would be pointless. She said "I know some doulas who pretend to be taking photos on their phone and are really taking video. Maybe just tell her that you heard it from another doula to do that. You can just tap the screen like you're taking photos but really it's a video." So this is what I started doing. Because I work for my client, not the hospital. I've taken dozens of birth videos at locations all over the Twin Cities without issue. Because the policy actually says no pictures too I've heard from some doulas and photographers that they've been told no pictures of the moments between crowning and birth can be taken either. Methodist is an outlier with this policy and birthing families need to consider this "rule" before choosing to birth at Methodist. Photos and videos of your birth experience are priceless!
By mid-September I had passed client "A" on to a colleague because it was clear this conflict wasn't going to be resolved any time soon (responses were very slow) and I didn't want to bring this drama into her birth. Along the way Methodist insisted I had already been told I wasn't "allowed" to attend births due to these allegations. I knew this wasn't true. Client A and a client from earlier in the summer had switched their care to Methodist late in their pregnancy on my recommendation. Soon one of their patient care managers would acknowledge I hadn't been informed due to a "miscommunication and breakdown." She did apologize for that.
Fast forward to January when I was finally able to meet with the Clinical Nursing Director of the birth center Elizabeth Anderson, along with the head midwife Mary Sanderlin and head OB Matthew Banfield. I took two doula colleagues along with me to "doula" me through this meeting. I gave verbal permission for Elizabeth to share any allegations against me with my support people.
At this point they dropped the allegations that I had said anything about vitamin K or told a client to go in when they were on divert. They had four issues:
1. Taking video of a birth.
2. A birth story one of my clients posted (more below)
3. "Something to do with pitocin" but they wouldn't say what. Earlier in this process they claimed I interfered with a hemorrhage but later backtracked on that.
4. "Unprofessional behavior" but they wouldn't say what that meant.
That client who birthed quickly in triage when the hospital was on divert? She shared her birth story on the Hypnobabies Twin Cities website. You can read it here. Originally the picture showed the faces of the nurse and midwife. This was a mistake and apparently the nurse was upset. But no one ever reached out so we could edit it. As soon as they did, 10 months after the story was posted, we quickly covered the faces. As you can see, that story is only positive and does not mention Methodist.
I've wracked my brain to try to figure out what I might have done "wrong". All but one of my recent clients received pitocin so I don't know what they mean about "something to do with pitocin." I certainly always try to make sure my clients understand what is happening to them so they are making informed choices along the way. That is part of the doula's role. This is completely within my scope of practice. If a client of mine chose to decline pitocin that is their right. But I never tell someone what they should do. I tell them to consult with their doctor or midwife who are the medical experts in the room and can determine if they are bleeding too much and need medication like pitocin to quickly and safely stop the bleeding.
At the January meeting I was told if I admitted what I did was wrong we could make a plan to allow me back. I responded that I couldn't admit anything if they wouldn't tell me what I actually did. I tried to follow up via email to get more information. They had offered this option at the meeting because, despite asking for and receiving my permission to share what I did that was unprofessional and unsafe with my colleagues, later in the meeting they had decided they weren't going to share what I did. Their response to my follow-up email said, in part, "Concluding this investigation and your continued reach out for information I’m letting you know that we’ve now exhausted our resources for the purposes of additional communication regarding our investigation." I took this to mean they were done with me and would not be telling me what I had done.
The midwife group at Methodist used to be one of my top hospital recommendations in the entire metro area. I left all the births in question feeling like they went wonderfully and enjoyed the team that day. Which has made this situation much more painful. Many other doulas report a big cultural shift happening at Methodist lately, especially with the nursing staff and with their own in-house "doula" program that started a few years ago.
The Twin Cities birth community is phenomenal. We have more options that most other places in the country. This is in large part due to the work and advocacy that doulas have done to empower families to demand the care they deserve. But it's two steps forward and one step back, and right now I'm hoping that bringing this story to light will help us figure out a way to move forward again to improve working relationships with doulas and medical providers. We should all have a common goal of making the birth experience the best it can possibly be for each family.
"Best" means not only safe, which is a given, but also empowering, personalized, and patient-centered. I encourage expectant families to do their due diligence when choosing where to give birth. Ask friends and family for recommendations. Hire a doula and ask them for suggestions, then take those suggestions seriously. And most of all ask lots of questions when you interview providers to ensure they truly offer the kind of birth you want. Don't ignore red flags. There are too many good options out there to let that happen. Lastly, know your rights. Just because something is hospital "policy" doesn't mean you have to do it. You can always say no. Familiarize yourself with the MN Patient's Bill of Rights section 7, part a, which allows for a doula to be present continuously during your birth. This includes during placement of a epidural and during a cesarean birth. Not all hospitals are currently offering this and it's up to families to demand what is their legal right.
For me, the lost income and lost sleep from this experience were painful, but my on-going concern is for families and other doulas. If this could happen to me, it could happen to any other doula out there just following her scope of practice and working hard to improve the birth experience for all families.
The head midwife and I emailed back and forth and two new "allegations" were charged. One was that I told a client to go in when they were on divert. I didn't, but the midwife on call that day did. She didn't even tell the client they were on divert until after baby had arrived. I'm sure this was because she knew the client wouldn't get the high level of care that Methodist typically provides if she went somewhere else. But clearly a nurse did not like the extra hassle that this birth created. This client had a very speedy birth and since the hospital was so full she ended up giving birth in the tiny triage room. It was a lovely birth that you'll be able to read more about below.
The second allegation of these two was the first true one. I took a video of a birth which is against hospital policy. The policy is alleged to state the no video can be taken from when the baby is crowning until when baby is born. Unfortunately now the hospital refuses to show me that policy. They did show me the policy that they give patients and all that says is that no pictures or videos can be taken in the hospital at all.
It is widely understood that this policy is only to protect providers from being sued and not patient-centered in any way. Doulas I know have had very mixed experiences with this "policy". Some doulas have even told me nurses offered to take a video while others (including me) have been yelled at by nurses when taking a video. A couple years ago I had another client who was birthing at Methodist but needed a video because that was how she had helped process her previous births. Being a rule-follower by nature I reached out to the head midwife at the time. I asked if we could ask the administration for permission to film this birth since it was so important to the mom. She said that would be pointless. She said "I know some doulas who pretend to be taking photos on their phone and are really taking video. Maybe just tell her that you heard it from another doula to do that. You can just tap the screen like you're taking photos but really it's a video." So this is what I started doing. Because I work for my client, not the hospital. I've taken dozens of birth videos at locations all over the Twin Cities without issue. Because the policy actually says no pictures too I've heard from some doulas and photographers that they've been told no pictures of the moments between crowning and birth can be taken either. Methodist is an outlier with this policy and birthing families need to consider this "rule" before choosing to birth at Methodist. Photos and videos of your birth experience are priceless!
By mid-September I had passed client "A" on to a colleague because it was clear this conflict wasn't going to be resolved any time soon (responses were very slow) and I didn't want to bring this drama into her birth. Along the way Methodist insisted I had already been told I wasn't "allowed" to attend births due to these allegations. I knew this wasn't true. Client A and a client from earlier in the summer had switched their care to Methodist late in their pregnancy on my recommendation. Soon one of their patient care managers would acknowledge I hadn't been informed due to a "miscommunication and breakdown." She did apologize for that.
Fast forward to January when I was finally able to meet with the Clinical Nursing Director of the birth center Elizabeth Anderson, along with the head midwife Mary Sanderlin and head OB Matthew Banfield. I took two doula colleagues along with me to "doula" me through this meeting. I gave verbal permission for Elizabeth to share any allegations against me with my support people.
At this point they dropped the allegations that I had said anything about vitamin K or told a client to go in when they were on divert. They had four issues:
1. Taking video of a birth.
2. A birth story one of my clients posted (more below)
3. "Something to do with pitocin" but they wouldn't say what. Earlier in this process they claimed I interfered with a hemorrhage but later backtracked on that.
4. "Unprofessional behavior" but they wouldn't say what that meant.
That client who birthed quickly in triage when the hospital was on divert? She shared her birth story on the Hypnobabies Twin Cities website. You can read it here. Originally the picture showed the faces of the nurse and midwife. This was a mistake and apparently the nurse was upset. But no one ever reached out so we could edit it. As soon as they did, 10 months after the story was posted, we quickly covered the faces. As you can see, that story is only positive and does not mention Methodist.
I've wracked my brain to try to figure out what I might have done "wrong". All but one of my recent clients received pitocin so I don't know what they mean about "something to do with pitocin." I certainly always try to make sure my clients understand what is happening to them so they are making informed choices along the way. That is part of the doula's role. This is completely within my scope of practice. If a client of mine chose to decline pitocin that is their right. But I never tell someone what they should do. I tell them to consult with their doctor or midwife who are the medical experts in the room and can determine if they are bleeding too much and need medication like pitocin to quickly and safely stop the bleeding.
At the January meeting I was told if I admitted what I did was wrong we could make a plan to allow me back. I responded that I couldn't admit anything if they wouldn't tell me what I actually did. I tried to follow up via email to get more information. They had offered this option at the meeting because, despite asking for and receiving my permission to share what I did that was unprofessional and unsafe with my colleagues, later in the meeting they had decided they weren't going to share what I did. Their response to my follow-up email said, in part, "Concluding this investigation and your continued reach out for information I’m letting you know that we’ve now exhausted our resources for the purposes of additional communication regarding our investigation." I took this to mean they were done with me and would not be telling me what I had done.
The midwife group at Methodist used to be one of my top hospital recommendations in the entire metro area. I left all the births in question feeling like they went wonderfully and enjoyed the team that day. Which has made this situation much more painful. Many other doulas report a big cultural shift happening at Methodist lately, especially with the nursing staff and with their own in-house "doula" program that started a few years ago.
The Twin Cities birth community is phenomenal. We have more options that most other places in the country. This is in large part due to the work and advocacy that doulas have done to empower families to demand the care they deserve. But it's two steps forward and one step back, and right now I'm hoping that bringing this story to light will help us figure out a way to move forward again to improve working relationships with doulas and medical providers. We should all have a common goal of making the birth experience the best it can possibly be for each family.
"Best" means not only safe, which is a given, but also empowering, personalized, and patient-centered. I encourage expectant families to do their due diligence when choosing where to give birth. Ask friends and family for recommendations. Hire a doula and ask them for suggestions, then take those suggestions seriously. And most of all ask lots of questions when you interview providers to ensure they truly offer the kind of birth you want. Don't ignore red flags. There are too many good options out there to let that happen. Lastly, know your rights. Just because something is hospital "policy" doesn't mean you have to do it. You can always say no. Familiarize yourself with the MN Patient's Bill of Rights section 7, part a, which allows for a doula to be present continuously during your birth. This includes during placement of a epidural and during a cesarean birth. Not all hospitals are currently offering this and it's up to families to demand what is their legal right.
For me, the lost income and lost sleep from this experience were painful, but my on-going concern is for families and other doulas. If this could happen to me, it could happen to any other doula out there just following her scope of practice and working hard to improve the birth experience for all families.
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