What's your experience with doulas? - page 3

I'm an RN who has had plenty of experience in post-partum, L&D recovery, nursery, and in the wellness area in general, (plus other nursing experience.) I am curious to see a surge (can I use that... Read More

  1. by   Belinda-wales
    I think that there are no hard and fast rules every labour is different and every labouring woman is different. I have loads of stories for and against epidurals. All I got to say is that I belive that the epidural rate is much higher in the states than the UK BUT the cs rate is about the same between the two UK may be 1% lower so if the labouring woman wants an epidural why not - ok it might not be what she hoped for but it has a good chance of helping. We should not dictate just support and inform.
    Last edit by Belinda-wales on Jan 30, '07
  2. by   Belinda-wales
    ]
    Quote from Belinda-wales
    I think that there are no hard and fast rules every labour is different and every labouring woman is different. I have loads of stories for and against epidurals. All I got to say is that I belive that the epidural rate is much higher in the states than the UK BUT the cs rate is about the same between the two UK may be 1% lower so if the labouring woman wants an epidural why not - ok it might not be what she hoped for but it has a good chance of helping. We should not dictate just support and inform.
    I am going to give myself a Off topic
  3. by   Mrs.S
    Quote from KellNY
    You know what upsets me? When a woman plans on having an epidural, and therefore learns NO OTHER COPING TECHNIQUES.

    This is such a bad idea for 4 major reasons:

    #1-Labor usually hurts. In the begining it is uncomfortable at the least. These women are mistaken to think that they can have their epidural after the 1st twinge of pain. Even if you get an epidural, there will be pain involved. Doctors have to write orders, nurses have to bolus, EFM and follow other protocol, anesthesia has to prep, etc.

    #2-In many hospitals (including our large teaching hospital if you're a private pt) you can't get your epidural until your doctor (or someone from the group) writes for it. So if Dr.Abcd is out to dinner with his wife and takes a while to return page, to finish up, and to arrive an hour and a half later...well, the woman suffers for that time

    #3 You might be promised an epidural as soon as you ask, but what if there's an emergency c/s going on and anesthesia can't leave the OR? Or there are 3 women that are having one placed before you (not uncommon in a large hospital with 7, 8 or more laboring moms at once)

    #4 Epidurals don't always work. Whether it's pt's anatomy, drug (non)reactions, practitioner inexperience, a fluke, whatever--I've had one mom give up after 3 failed placements. I've had more than a few pt's with "windows". And to be honest-most of my epidural pts do c/o "pain" during the pushing stage. Now-pain or pressure--not up to me to decide, but I've hard lots of "Owww! Owww! It hurts! I thought I was gonna be numb!" or similar.

    Sorry...just my little pet peeve...

    Oh my gosh, I love this post! You said it so well!! I wish the OB's would be more honest about epidurals instead of letting patients believe they are all wonderful and the pt can get one whenever she wants and will have a perfect pain-free labor. it's so frustrating that this seems to be the expectation lately!

    Back to the original question about doulas, I think the idea of having doula support in labor is awesome. unfortunately the only doula that we usually see in our hospital is not very pleasant to work with. she is an L&D nurse from a different local hospital and regularly way oversteps her role in our hospital as a doula (messes with the equipment, lingers at the desk listening in on conversations about other patients, etc) plus she's rude and condescending to the nurses.
    We did see a different doula last year for a few births, but then she had a baby and we haven't seen her since. I never met her but I heard she was wonderful to work with.
  4. by   CEG
    Quote from KellNY
    You know what upsets me? When a woman plans on having an epidural, and therefore learns NO OTHER COPING TECHNIQUES.

    This is such a bad idea for 4 major reasons:

    #1-Labor usually hurts. In the begining it is uncomfortable at the least. These women are mistaken to think that they can have their epidural after the 1st twinge of pain. Even if you get an epidural, there will be pain involved. Doctors have to write orders, nurses have to bolus, EFM and follow other protocol, anesthesia has to prep, etc.

    #2-In many hospitals (including our large teaching hospital if you're a private pt) you can't get your epidural until your doctor (or someone from the group) writes for it. So if Dr.Abcd is out to dinner with his wife and takes a while to return page, to finish up, and to arrive an hour and a half later...well, the woman suffers for that time

    #3 You might be promised an epidural as soon as you ask, but what if there's an emergency c/s going on and anesthesia can't leave the OR? Or there are 3 women that are having one placed before you (not uncommon in a large hospital with 7, 8 or more laboring moms at once)

    #4 Epidurals don't always work. Whether it's pt's anatomy, drug (non)reactions, practitioner inexperience, a fluke, whatever--I've had one mom give up after 3 failed placements. I've had more than a few pt's with "windows". And to be honest-most of my epidural pts do c/o "pain" during the pushing stage. Now-pain or pressure--not up to me to decide, but I've hard lots of "Owww! Owww! It hurts! I thought I was gonna be numb!" or similar.

    Sorry...just my little pet peeve...
    This is exactly what I was trying to say... just didn't say it as well. I had two epidural patients today. One c/o severe pain with placement. The other c/o of pain not relieved with contractions and a window. It hadn't occured to either one of them to investigate the other options available.

    On the flip side, had a doc made a bad remark about doulas. "Patient doesn't want the epidural. She has some doula in there or something. Well, let me know when she's ready for the epidural." When patient was already at 6cm with a pit induction from 0. Way to be supportive.
  5. by   SmilingBluEyes
    Most of these patients you speak of however, are NOT your typical doula/natural birth people; those who have doulas tend to HAVE investigated and shown interest in laboring naturally or coping in ways that don't include asking for anesthesia early-on. I have learned, you are not gonna change minds in the middle of labor either. So if a lady has her mind made up and wants an epidural in active labor, I just get ready and let her have it.

    If it's early and not time, I do my best to support her as she naturally copes with the discomforts of prodromal/early labor. That is what we are there for in the end.

    If an OB acts like the above, I tend to ignore him or her totally and continue my support of the naturally-laboring mom. That, also, is what I am there for .
    Last edit by SmilingBluEyes on Jan 31, '07
  6. by   KellNY
    Quote from SmilingBluEyes
    Most of these patients you speak of however, are NOT your typical doula/natural birth people; those who have doulas tend to HAVE investigated and shown interest in laboring naturally or coping in ways that don't include asking for anesthesia early-on.
    Oh, I think you may have misunderstood me. I was responding to one of the attitudes I hate most which is of the "I don't need a doula or to worry about any of those things, I'm getting my epidural" or even worse (in some ways) the doctor's "What do I think of doulas? Well, you're going to get the epidural, right? So, no need to waste your money. ::insert chuckle or general smugness::"

    I have had a few clients who did want the epidural right away but wanted a doula as well. Some know that there will be pain before and want me for that, some want to stay home as long as they can and just get the epidural for the pushing, some just want me there for the emotional support and education and breastfeeding assistance. (I've also have a few scheduled c/s clients)

    I honestly think that most people could benefit from a good doula--epidural, c/s, natural, whatever.
    Last edit by KellNY on Jan 31, '07
  7. by   SmilingBluEyes
    I agree, a good doula is a great thing!
  8. by   eden
    It depends on the doula. There are a couple of fantastic doulas who work out of our center, who are very supportive of their client and who do not interfer when there are medical decisions to be made between the pt and dr. They do not pretend to have medical training and all that it entails and if the birth is not going according to plan they do their best to help mom cope with the change in plans.

    OTOH, there are a couple of doulas who drive me insane, who are petending to know how to interpret the whole clinical picture and who argue with the dr./nurse in front of the mom, because they have seen a few births and it then qualifies them as expert:icon_roll . They also leave in the middle of things if the plan needs to be altered or mom wants to change her own plans. Now that is unprofessional.

    So to sum it up, it depends on the doula. If I could find a good, supportive doula who knows what her role is then I would use one for my delivery.
  9. by   BonnieSc
    (It's funny, everyone says they've worked with doulas like that... but every single doula on every doula mailing list / message board / whatever claims they're NOT that kind of doula... my guess is that a few doulas are perceived as interfering when they're not, and then some doulas perceive themselves as being non-interfering when they ARE.)
  10. by   tinyscrafts
    Quote from Wendy79
    (It's funny, everyone says they've worked with doulas like that... but every single doula on every doula mailing list / message board / whatever claims they're NOT that kind of doula... my guess is that a few doulas are perceived as interfering when they're not, and then some doulas perceive themselves as being non-interfering when they ARE.)

    THat's exactly what I was alluding to when I said
    I will admit that on a few occasions i got the stink eye from a nurse because i was carrying out moms very clear instructions to me to suggest/encourage other comfort techniques when she started to ask for pain meds.

    So tell me what would be percieved as interfering? Give me the subtle stuff. I bet we can all agree on the obvious things.
  11. by   BonnieSc
    I think those standard doula phrases "Can you tell us more about that?" and "Did you have any questions [for the doctor] about that?" can come off as the doula "pushing" the mother.
  12. by   beanie29
    I think doulas are wonderful (I'm sure there are exceptions, but I haven't met any exceptions yet ). I'm starting nursing school in the fall and I am taking my labor doula training this summer (through CAPPA) and plan to be certified before I finish nursing school. I think just to have that background as a doula will be helpful as a RN in L&D.
  13. by   beanie29
    Quote from Wendy79
    I think those standard doula phrases "Can you tell us more about that?" and "Did you have any questions [for the doctor] about that?" can come off as the doula "pushing" the mother.
    That's really too bad if some people interpret that as 'pushing' the mother. I think it's just helping the mother to have the opportunity to ask for more information. To find out about side effects, other alternatives, etc. that routinely aren't mentioned.
    If I had an advocate like that with my first, I'm sure that I wouldn't have ended up with a c-section.
    Having an advocate and an amazing midwife contibuted to my natural VBAC the second time around.

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