ICAN of Huntsville crucifies a physician ally

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It started with a sign.

Please let us know if you hire a doula during your pregnancy as Dr. Aguayo has decided not to collaborate with doulas or other lay support people… Please feel free to discuss any questions or concerns at your appointment.

It has escalated to a full fledged attack on a doctor orchestrated by Huntsville Alabama ICAN (International Cesarean Awareness Network). At this point, ICAN’s followers are jamming the phone lines and patients cannot get through to speak with the doctor or staff.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]ICAN Huntsville doesn’t understand that it might not have been Dr. Aguayo’s choice or they don’t care.[/pullquote]

When I first saw discussion of the sign on Facebook, I assumed (incorrectly) that the doctor was an older, man who got fed up with doulas acting outside their scope of practice by giving medical advice to patients.

But that’s not the case as a variety of testimonials on Facebook make clear:

Dr. Aguayo is wonderful and very pro patient choice. With both of my pregnancies she has been very kind to listen to my concerns and open to my choices, never once saying no to any of my requests. I chose to use a doula with my first birth and she was very encouraging and supportive of that. She even made recommendations when I brought the subject up. All I can say is something big must have happened to come to this point for her. Love her so much and I’m so glad she’s the one delivering my children!!

And from the page of Huntsville ICAN itself:

I love Dr Aguayo she is one of the kindest most patient providers Ive ever met…She has always been very welcoming to Doulas and has always encouraged natural child birth and wasn’t very invasive at all…I can’t imagine what would have happened to make her take this stand…There has to be more to this story…One of my best friends delivered with her just 2 months ago with a doula and it was a wonderful experience…‍♀️I think something had to have happened to make her take this stance.

It does not take a rocket scientist to figure out that Dr. Aguayo, apparently a staunch supporter of both natural childbirth and doulas, was probably forced into taking this action.

How might that have happened? It could have been precipitated by a dreadful outcome — a brain injured or dead baby — whose care was compromised by a doula operating outside her scope of practice. It may not have even involved Dr. Aguayo herself.

Nonetheless, Dr. Aguayo’s malpractice insurer might have told her that her insurance would be invalid if doulas were involved in patient care.

Dr. Aguayo’s hospital might have told her that doulas were not longer welcome in the wake of bad outcomes.

Dr. Aguayo herself might have come to the conclusion that certain doulas in her area were actively harming patients or interfering with the doctor patient relationship.

One thing seems certain, however; Dr. Aguayo is not personally opposed to doulas.

That didn’t stop ICAN of Huntsville from naming and shaming her. It resulted in a story on AL.com, Alabama OBGYN refuses to work with birth doulas, causing online uproar.

A local birth advocacy group, ICAN of Huntsville, posted the photo Tuesday morning. By Thursday afternoon it had been shared more than 1,500 times and had more than a thousand comments.

But for ICAN and many of the commenters, the online uproar over Aguayo’s policy isn’t just about the ability to use doulas with one doctor. It’s a natural outgrowth of changing cultural expectations for how childbirth is supposed to go. Doulas are often seen as patient advocates and witnesses in a setting that favors the needs of hospitals and doctors of those of laboring women.

“Birth culture is changing among consumers,” said Brianna Barker of ICAN of Huntsville. “We are realizing we do have the ability to take hold of our rights.”

They were especially angry that an ally had let them down:

The post also gained steam on Facebook because it was about Aguayo, said Barker.

“Anybody else in town would have been less shocking,” she said. Aguayo is well-known in the Huntsville area for her welcoming attitude toward birth plans, natural birth, and her willingness to work with doulas.

“That’s why I chose her,” said Lowder. “I have very natural views on childbirth and wanted to have a doctor that supported that. And she did.”

Without bothering to consider that Dr. Aguayo might have been forced to stop working with doulas, they crucified her.

The online anger was swift. Negative reviews popped up on Google. Barker said she and Justen Alexander, also of ICAN, spent hours deleting inappropriate comments on the post and banning commenters who stepped out of bounds, including those who shared links to Aguayo’s personal information.

At All Women’s OBGYN, the phone lines have been so backed up that patients have had a hard time getting through, Janah Baker, the office manager, told AL.com.

“It’s been disheartening and frustrating,” said Baker.

Huntsville ICAN and its followers were so drunk on self-righteous rage that they never stopped to analyze the situation or consider the impact of their actions. They’ve been backpedaling ever since.

If you feel strongly about this policy, writing a letter may be the best way to share your concerns without disrupting the patient care. Do not post links to Dr. Aguayo’s personal profile – these comments will be deleted. Please do not leave reviews on her page unless you have been her patient. This is about her policy, not about her as a person. Please do not call her office unless you are a patient.

But they still don’t get it.

ICAN does not support maternity care providers dictating who a patient can privately contract for services. The abuse of power dynamic is outlined in ACOG’s Committee Opinion of refusal of medical recommendations.

They either don’t understand that it might not have been Dr. Aguayo’s choice or they don’t care; they crucified her anyway.

With friends like Huntsville ICAN, who needs enemies.

  • siliso

    Imagine an “ICU doula” with a weekend training course trying to argue with the doctor/RN/RT about vent settings and pressors while the patient is tanking. Shudder. I’m sure there’s a backstory to this decision, and I bet it involves someone trying to play doctor/nurse in a critical situation. If all doulas stayed in their lane of nonmedical support (and nonmedical support is a great thing for patients and families in times of stress), there should be no conflict. If some don’t, you might see this response for good reason.

  • The Bofa on the Sofa

    OT but not really for this blog:

    At least six infants and one mother have died in planned out-of-hospital births with midwives since October in Florida, according to new state reports obtained by GateHouse Media.

    An additional three infants and two mothers suffered catastrophic or potentially life-threatening injuries.

    https://www.heraldtribune.com/news/20190817/new-florida-out-of-hospital-birth-reports-highlight-risk

    • MaineJen

      Good god. How is this allowed to continue??

  • MaineJen

    I’ve already been in one facebook skirmish over this post. I wish the default assumption wasn’t “Of COURSE you want a doula!! Don’t you want someone to advocate for you??” What I hear is: Don’t you want someone to deny your request for pain relief on your behalf, because you told them once six months ago that you might want to try all natural, low intervention birth?

    Why no, no I don’t. A lot of us have NO INTEREST in trying all natural, low intervention birth. It sounds horrible. Give me all the interventions, please and thank you.

    • tariqata

      And even for those like me, who did prefer to try a low/no intervention birth*, I really don’t understand exactly what value a doula provides when it comes to “advocacy”. If women are supposed to be empowered to speak up for themselves and what they want and need, what can a lay person add?

      *assuming a low risk profile. 20-odd days past a planned c-section to deliver my second child, who had her head stick up under my ribs for the last 9 weeks of the pregnancy, I never doubted the decision to go ahead with all the interventions, and am grateful to be in a system where my midwives a) did NOT “advocate” for anything other than the safest option to get her out and b) could smoothly collaborate with an OB and the L&D nurses to care for me and the baby before, during and after.

      • Shawna Mathieu

        I remember looking into the doula program at the hospital where I delivered my son. and their sole qualification was having gave birth. I mean, that’s great and all, but what if my birth experience was totally alien to her?

        Most of the women who sign up to be doulas likely went for natural childbirth. My son was breech, and they couldn’t flip him without abrupting my placenta, potentially killing one or both of us, so I had a C-section.

        They say over and over that doulas don’t give medical advice. But I clearly remember one of the examples, in I think Sears’ birth book, was a doula who told the doctor the laboring woman asked for pain relief, BUT then told the doctor to told off for awhile they tried more non-drug stuff.

        How the hell isn’t that medical advice? Not to mention, isn’t the very thing the NC crowd complains about hospital births is that medical personnel ignore the woman’s wishes? This is the same thing, just wrapped in hemp cloth and covered with essential oils.

    • Mel

      Plus, some people are plenty comfortable advocating for themselves. Advocating for myself has been excellent practice for advocating for my son as well.

      In terms of the nuts and bolts of labor and delivery, I was the second generation to deliver a few days prior to my planned childbirth class. Interesting fact: L&D nurses are really good at explaining what to expect if you ask. I’ll never forget at around 4am the morning my son was born looking at my high-risk L&D nurse and saying, “Um…yeah. This is my first pregnancy and my childbirth class is next Tuesday, but my son is going to be born today. What should I expect during a C-section? Any tips?”

    • Cristina B

      I’m Canadian and where I live, if you give birth in the hospital, you have an L&D nurse, plus your GP or OB. However, if you use a midwife, you don’t get any nurse support, which is probably why, here at least, midwives and doulas go hand in hand. I think a doula is paid for out of pocket though, versus free with a nurse. The really weird thing is that it isn’t like you’re limited on who you can have in your L&D suite, so I don’t get why people would pay for a support person who isn’t even medically trained. To me it always just sounded like they were there to suggest different positions or give you a massage, as well as cockblock the epidural. Plus they do the plaster belly cast when you’re pregnant, which you probably also have to pay for.

      • AnnaPDE

        I think there are many people who are looking for a supportive person who is close enough to provide comfort, distant enough to stay calm when the parents to be are a bit freaked out by the intensity of the experience, to do things like attend to non-medical requests (like getting ice chips and back rubs). And a certain amount of experience can also help.
        Traditionally women would have a close friend or relative around who already had kids, but there are people who don’t have this as a good option, and for them a paid doula can be helpful.

  • Alia

    BTW, I decided to check ICAN and the name is pretty Orwellian. “Cesarean Awareness” means here “we think C-sections are wrong and will do everything in our power to convince women they do not need them, even if they do”.

    • rosalie

      The Vaccine Awareness Center is there to provide people a way to file complaints and “get help” after vaccine injuries. It’s an anti-vaxxer group with a misleading name. There seem to be lots of these in medicine.

  • rational thinker

    “Please let us know if you hire a doula during your pregnancy as Dr.
    Aguayo has decided not to collaborate with doulas or other lay support
    people… Please feel free to discuss any questions or concerns at your
    appointment.” The way the sign is worded reads to me that yes you may have a doula at your birth but the Dr will not speak to the doula at all during delivery as part of the patient care team. Maybe they are not banned it is just that she will have no medical conversations with the doula.

    • EmbraceYourInnerCrone

      Which makes perfect sense to me because a doula is not a health care provider and should not be making health care decisions. A doula is not required to have any medical training what so ever as far as I know. S0 they are not qualified to give medical advice.

  • PeggySue

    You would think that the adult thing to do, if a doctor sets a policy that seems baffling and unlikable, would be to ask the doctor directly if there was anything she or he could say about why the policy was set. No one from the “natural birth” community appears to have been willing to take this course. Sad.

  • Lee McCain MD

    You are completely right in you intuition on Dr. Aguayo. I am on staff with her at Huntsville Hospital and she is well known for welcoming alternative birthing plans. Dr Aguayo is also one of the nicest people on staff and has never had a negative thing to say in staff meetings. Like you I have no doubt there is an underlying issue here that forced her to make such a blanket assertion. And like you me and my partners are in disbelief at the tragedy and pain this has brought for Dr. Aguayo and her practice.

    • mabelcruet

      One of my neonatal colleagues found himself in a very difficult position on social media-there was a woman pregnant with a baby who had major anomalies incompatible with life, and she had decided to continue the pregnancy and let nature take its course. He met with her and her mother (she was very young), and the grandmother brought along a ‘support worker’ who turned out to be a anti-abortion campaigner. He was talking about the various possibilities, and whether she wanted the baby resuscitated, and if so what level of intervention-intubation and ventilation, or comfort care and palliation, or if she wanted paediatric staff present at delivery or not and so on. Perfectly normal discussion common for anyone facing this sort of thing. But the ‘support worker’ launched into an attack accusing him of planning on murdering the child, or euthanising him, getting rid of him because he couldn’t be bothered looking after the baby. She then ‘exposed’ him all over Facebook as a baby murderer, and left reviews everywhere about him, which took him ages to get removed. Since then he has been very wary allowing anyone else in the room other than immediate family, which is a shame because some people might need additional support, but seeing this recent attack on Dr Aguayo, I think its wholly unfair and uncalled for to attack a doctor who is attempting to practise ethically and holistically, especially when the full background of the decision making isn’t known.

      • Alia

        This must have been one really devoted anti-abortion campaigner, as even the RC church oficially states that while abortion and euthanasia are evil per se, “persistent therapy” (I’m not really sure what the right English collocation is) is not necessarily good and in the case of serious, terminal illness providing palliation is enough.

        • Mel

          The RC church in the US uses the term “extraordinary efforts” to describe medical treatments that go beyond attempting to correct a fixable issue which would be an “ordinary effort”.

          The phrase is based in theology because theologians express the normal + important duties of a Catholic as “ordinary” while saving the term “extraordinary” for allowed duties that should not interfere with ordinary duties. The example I can think of is that offering a Mass in any living language on Sunday is an ordinary duty of a priest. Offering a Mass in Latin is extraordinary; a priest is allowed to do that if and only if it does not interfere with offering the Mass in a living language for his congregants.

          One problem, though, is that a lot of Catholics don’t have the grounding in the theological difference between ordinary and extraordinary and so mistakenly believe that extraordinary means “better or best” rather than “allowed in a secondary function”.

          The benefit of that system is it allows medical decisions to be made on a very individual level. So, on an otherwise healthy baby, fixing a heart defect would be viewed as an ordinary effort that treats a treatable issue. On the other hand, the same surgery would be viewed as an extraordinary effort on a baby with Trisomy 13 who has major defects in multiple organ systems that make survival of surgery questionable.

          The drawback is that you end up with screamers (who are almost never directly involved in either medical care OR working with people with medical disabilities) who claim that you are denying a child ordinary medical treatment against the wishes of their child. I suspect requiring the screamers to live at the hospital with the infant they are recommending multiple invasive treatments on is the best solution – but a girl can dream.

          • mabelcruet

            The attorney general in Northern Ireland is currently taking a case against a woman who is sueing the department of health for not allowing her to have a termination of pregnancy in Northern Ireland and forcing her to go to England. The UN CEDAW committee has declared that Northern Ireland legislation is evidence of wholesale state sanctioned discrimination against women. The high court has ruled that it contravenes human rights law, as has the European court on human rights.

            The fetus had anencephaly (no brain), a condition that is obviously lethal. Her argument is that forcing her to go to another country comprised cruel and unusual punishment. The attorney general’s defence of the current legislation banning termination is that if it was changed to allow termination for lethal anomalies, that would constitute discrination against handicapped people. According to him, anencephaly is a handicap, and should be treated exactly the same as discriminating against someone who was vision impaired, or who used a wheelchair. It’s a ludicrous argument.

          • mabelcruet

            It wasn’t so long ago that it was routine to not operate on congenital heart disease in a baby with trisomy 21, but nowadays they would be actively corrected. However, I think that the general public sometimes have difficulty with the understanding that although something can done, it, doesn’t necessary mean it should be done. Kids with Downs are very different from those with tri 13 or 18.

          • PeggySue

            When I was a hospice chaplain (in the US) I spent a lot of time with the Catholic Ethical and Religious Directives for end-of-life care (ERDs). The entity where I worked was owned by a Catholic health care system and thus was required to operate under those ERDs. I learned that even some Catholic clergy had poor understanding of what was/was not required, and that medical professionals, who think about quality of life, needed help to think about burden vs. benefit of each treatment being offered. Quality of life is not a Catholic concept, but treatment can be declined if the patient or patient’s decision maker determines that the burden of a proposed treatment exceeds the benefit the treatment would provide. But the “burden” cannot be “continued life in a disabled state.” It has to be something like, specific side effects in a treatment that has no chance of being curative.

        • mabelcruet

          She’s well known in my region-she was charged with harassment and made the subject of a restraining order to stop her following and harassing the director of a local Marie Stopes clinic. She is a rabid forced-birther and spews a lot of vicious malignant rhetoric, very unpleasant individual. No idea what her religion is though.

          • rational thinker

            Sounds like maybe born again evangelical christian.

        • mabelcruet

          To me (knowing only what I’ve heard of her from my colleague and what I’ve seen in the local papers), I think she had absolutely no idea what palliation was and how resuscitation may not be in the baby’s best interest. It’s very like when Trump claimed that doctors and mothers waited til after the baby was born before deciding to kill it-he was confusing late termination for lethal anomalies with euthanasia, and confusing active killing with ‘comfort care’. I don’t think they understand that medical treatment also includes deciding not to treat. Withdrawal of active life support isn’t murder, even though the outcome is the same, but they don’t get that.

          • BeatriceC

            When I was having babies and struggling to stay pregnant long enough to give them a chance at life the medical team told me I could choose palliative care through 27 weeks. I don’t know if that has changed with the outcomes for micropreemies improving in the last 20 years, plus the age of viability being pushed back to 22 weeks. I’d suffered so much loss that when I did have a 24 weeker I wanted everything possible done, but I had the option to choose comfort care instead, if I so desired.

          • mabelcruet

            I’m obviously not a neonatologist, but the survival rates of premies varies depending on gestation, birth weight, maternal antenatal steroids etc. A 24 weeker weighing 500g usually doesn’t do as well as a 27 weeker weighing 400g-it all comes down to lung maturation in the end. The lungs go through a range of different developmental stages, and below 23 weeks or thereabouts, oxygen exchange can’t really take place sufficiently well enough to maintain oxygenation. But ventilation techniques are improving continuously: even so, mechanical ventilation is tough on lungs, even adults get damage from it. In the hospitals I’ve worked in, they’ve all had tertiary level NICU and I know the decision to treat an extreme premie takes place with the parents fully involved. They give the parents the up to date figures and chances of the baby surviving unscathed or surviving with neurological deficit (our royal college of paediatrics and child health has policies and guidelines so it’s fairly consistent nationwide). Generally, at 25 weeks, any liveborn baby will be actively resuscitated. At 24 weeks, resus will usually be attempted. At 23 weeks, depending on weight and the condition of the baby at delivery, they would usually attempt resus. At 22 weeks, survival is unlikely, but an attempt will be made if the family request it. But it’s an ever changing situation and the clinical picture can change by the hour, so there are lots of ongoing discussions, so a baby might be admitted to NICU initially, but end up being palliated. It must be such a hard decision for families-my neonatologist colleagues always attended the autopsy of any of their wee patients, they considered it the last service they could give the baby, so they can go back and tell the parents that we looked after them and what we found. I have the hugest respect for the neonatologists and NICU nurses, it’s not a job I could have done.

  • rational thinker

    That is just horrible. This is more evidence that these people dont care about anyone or anything else but their ideology. If any of them had half a brain after reading all the comments about how this doc supports ncb they would realize this was probably a hospital decision where the doctor has privleges or it is a malpractice insurance coverage term. Then again these are the same people who would risk their own childs life just to have a baby exit their vagina.

  • mabelcruet

    There’s a similar sort of situation in the UK. We don’t have too many homebirths and most women deliver via the NHS. But there are a few independent midwives around (mostly London and the home counties), and independent midwives can’t get insurance to cover for malpractice. In the UK, everyone is registered with a General Practitioner (family doctor), but most GPs have opted out of providing maternity cover and this is mostly done via shared care with community midwives and the local hospital. What has been happening is that private independent midwives have been found to be telling mothers that the GP is responsible for medical cover; GPs have been told by the independent midwives that they must prescribe pethidine etc for the woman and that they will be called in the event of anything happening, even though the GP doesn’t provide maternity cover at all, and even though he has nothing to do with antenatal care of the woman (beyond dealing with medical issues that she consults with him directly). These midwives are trying to use the doctor’s malpractice insurance and medical protection cover to cover for their lack of insurance and professional cover. Its been tested in court a couple of times, and the medical defence unions are very robust in their response that they aren’t responsible for covering another ‘professional’ for malpractice, and have been advising GPs to refuse to accept any responsibility. In general practice, the GP who owns the practice is responsible for the staff in his employ, so if the practice nurse does something, he might be found responsible if he didn’t check her credentials, but they have no responsibility at all for staff outside their practice, so these independent midwives are misleading mothers if they lie about medical cover. I wonder if the doctor in the story has been told by her insurance company that she needs to make it very clear that a doula or midwife is absolutely nothing to do with her?