Working with Doulas

  1. I'm just wondering what the general consensus of nurses is when working with doulas. I'm a doula in private practice and I'm looking forward to starting school this spring to get my RN. I'm currently working as a volunteer doula in part of a hospital program.

    If you have had the chance to work with a doula on your foor, what are your feelings? Do you view doulas as an affront to your job? Or an asset making your job a little easier (not having to answer as many call lights).

    I'd really love to know the good, bad, and the ugly of anyone who has worked with a doula.

    If you don't know what a doula is, visit www.dona.org. This is the website of Doulas of North America, it provides information on the role of the doula and certification.

    Thank you!
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  2. 17 Comments

  3. by   Baby Catcher
    We don't have doulas where I work but I would love it. I had a pt. who's sister was a massage therapist and she acted as her doula and it was great. It's nice to know when I'm not in the labor room a supportive person is in there. Sometimes the RN is so busy getting everything ready that we can't be in the room the entire time. What I don't like is a failed home birth and the LAY midwive tries to tell us (including the MD) what to do. We only have lay midwives in this area. No formal training but learned from other lay midwives. That's a whole other thread.
  4. by   JaneyW
    I have only worked with a doula one time. She was very humble and helpful and it was fine. Just don't try to be the nurse--you aren't responsible for the patient, we are. We are required to chart quite often and have to assess our patients regularly. This doesn't mean we aren't sensitive to their needs for quiet or privacy. Be prepared for your client to change their minds about pain relief when they are in active labor and don't make them feel guilty for it. It is their pain--not yours.

    Good luck. You will have a realistic view of what you will be getting into as a nurse!
  5. by   rpbear
    We have a doula group that is on call for our hospital, I think they are great. I alos agree witht the other poster that your job is different than ours. We try as hard as we can to stay within the birht plan, but sometimes it is medically impossible.
  6. by   BabyRN2Be
    Quote from rpbear
    We have a doula group that is on call for our hospital, I think they are great. I alos agree witht the other poster that your job is different than ours. We try as hard as we can to stay within the birht plan, but sometimes it is medically impossible.
    I guess that I'm very different that other doulas. I'm totally understanding of the nurse's job. My mom was a nurse for many years and before I got into the doula aspect, I had a degree in speech language pathology (well, still do).

    We are there for NON-medical comfort, something that the nurses can't do because a) they don't have time or b) SOME won't. I understand that job and since we are working as a team to help the mom, I won't interfere with the nurses. I've already come away from some doula meetings disgusted by some comment, a doula who was "bragging" that she didn't pass on a request for pain meds... I was angry. This was the mom's birth, NOT the doula's birth.

    That's another way I differ from most doulas: I don't offer my opinions regarding pain meds. I support any way the mother choses to go.. pain meds, no pain meds, or wait 'n see. I don't go into every birth with the preconceived notion that she won't have meds, or with my own agenda in mind (i.e. - she's stated that she wants meds, but when she's in labor I'll do everything in my power to be sure she doesn't get them or I've failed as a doula - there are some who do this). Since I've been in the medical field and seen a lot of hospital births, I do know that when things in birth go wrong, they REALLY go wrong, and FAST... there's no time to argue a point on a birth plan when a life is potentially at risk.

    That's another way I differ: birth plans. I remind my clients that they can chart out their wishes in the birth plan, but keep in mind that they might not go according to plan. Be flexible. And the saying that "the longer and more complex the birth plan, the greater the chance of the birth ending in a c/s" - I've found that to be more true than not.

    I know that I'm not the perfect doula, but I just wanted to clear up a few misconceptions about doulas. There are several that play wannabe midwife/RN, do more harm than good and then the rest of us who aren't really that way, who understand the medical profession have a lot of "clean up" to do. We are there to help the patient, and in some ways, to help the nursing staff by answering/helping the patient - therefore diminishing the amount of call lights to the desk. In our hospital where I work as a volunteer, we are taught how to undo the monitors so the pt can go to the bathroom, walk around, etc. and then hook them up to the monitor again. We have been trained by the RN to do this, not doing this ourselves.

    We would really like to be seen as a help to the nurses, not a hindrance, not competing for the job, etc. I know my place, however, there apparently are some who do not.

    I know this is long, but I wanted to type out some of my feelings. FWIW, I'm not totally accepted in our doula group because I have an extensive medical background, and I don't buy into the "you really haven't given birth until you've given birth w/o an epidural", etc. And this is even moreso since I've told them that I'm going into nursing. You all should have heard the silence after I told them I was going into nursing.

    Now, I just hope that I'm accepted by the nurses after I graduate when they hear that I have a doula background. :chuckle

    Katherine
  7. by   SepiaRNC
    Quote from BabyRN2Be
    I guess that I'm very different that other doulas. I'm totally understanding of the nurse's job. My mom was a nurse for many years and before I got into the doula aspect, I had a degree in speech language pathology (well, still do).

    We are there for NON-medical comfort, something that the nurses can't do because a) they don't have time or b) SOME won't. I understand that job and since we are working as a team to help the mom, I won't interfere with the nurses. I've already come away from some doula meetings disgusted by some comment, a doula who was "bragging" that she didn't pass on a request for pain meds... I was angry. This was the mom's birth, NOT the doula's birth.

    That's another way I differ from most doulas: I don't offer my opinions regarding pain meds. I support any way the mother choses to go.. pain meds, no pain meds, or wait 'n see. I don't go into every birth with the preconceived notion that she won't have meds, or with my own agenda in mind (i.e. - she's stated that she wants meds, but when she's in labor I'll do everything in my power to be sure she doesn't get them or I've failed as a doula - there are some who do this). Since I've been in the medical field and seen a lot of hospital births, I do know that when things in birth go wrong, they REALLY go wrong, and FAST... there's no time to argue a point on a birth plan when a life is potentially at risk.

    That's another way I differ: birth plans. I remind my clients that they can chart out their wishes in the birth plan, but keep in mind that they might not go according to plan. Be flexible. And the saying that "the longer and more complex the birth plan, the greater the chance of the birth ending in a c/s" - I've found that to be more true than not.

    I know that I'm not the perfect doula, but I just wanted to clear up a few misconceptions about doulas. There are several that play wannabe midwife/RN, do more harm than good and then the rest of us who aren't really that way, who understand the medical profession have a lot of "clean up" to do. We are there to help the patient, and in some ways, to help the nursing staff by answering/helping the patient - therefore diminishing the amount of call lights to the desk. In our hospital where I work as a volunteer, we are taught how to undo the monitors so the pt can go to the bathroom, walk around, etc. and then hook them up to the monitor again. We have been trained by the RN to do this, not doing this ourselves.

    We would really like to be seen as a help to the nurses, not a hindrance, not competing for the job, etc. I know my place, however, there apparently are some who do not.

    I know this is long, but I wanted to type out some of my feelings. FWIW, I'm not totally accepted in our doula group because I have an extensive medical background, and I don't buy into the "you really haven't given birth until you've given birth w/o an epidural", etc. And this is even moreso since I've told them that I'm going into nursing. You all should have heard the silence after I told them I was going into nursing.

    Now, I just hope that I'm accepted by the nurses after I graduate when they hear that I have a doula background. :chuckle

    Katherine
    I think you will do just fine and you will make a great RN. I have worked with doulas, I've served as a doula on several occasions, free of charge for several church members. Some are overbearing and I feel they get in the way. Some are doing what the husbands should be doing. My biggest frustration is when they answer for the patient. I want to yell "I wasn't talking to you!" I would by fine with them as long as they don't tell me how to do my job. I believe they are needed. I encourage all laboring women to have someone who can fill that roll. The problem is, in my area, only the affluent have them. That's why I didn't charge for my services.
  8. by   JaneyW
    Sepia-

    I love your Snoopy. I have it on my car. I also feel that the doula is often doing what the husband should be and either won't or can't. A lot of my patients are hispanic/Mexican and are most often tended to by their mothers and aunts and sisters. Quite often too many cooks in the kitchen, but I am usually thankful for their help and distraction. I had a dad the other night that stayed behind the curtain during the birth while the grandma was at the mother's side. It was their fourth child, but he just wasn't comfortable with the legs spread bleeding part. Glad to have the grandma there. Would have been a good doula moment.
  9. by   BabyRN2Be
    Quote from SepiaRNC
    I think you will do just fine and you will make a great RN. I have worked with doulas, I've served as a doula on several occasions, free of charge for several church members. Some are overbearing and I feel they get in the way. Some are doing what the husbands should be doing. My biggest frustration is when they answer for the patient. I want to yell "I wasn't talking to you!" I would by fine with them as long as they don't tell me how to do my job. I believe they are needed. I encourage all laboring women to have someone who can fill that roll. The problem is, in my area, only the affluent have them. That's why I didn't charge for my services.
    Thank you, Sepia!

    On answering for the patient, I tell them that I'll advocate for them to a certain extent. However, all requests, especially for pain peds must come from them. I fully support their decisions, but since I've heard of doulas not passing requests for meds to the nurses, I never want to be accused of that.

    I tell them that when they're ready for meds, I'll ring the nurse, but the request must come from their own mouths. I feel that's the best policy to protect them and myself.

    Thank you all for the replies, I do appreciate it.

    Katherine
  10. by   fergus51
    You're the kind of doula I love. I have been lucky enough to generally only work where I would have one woman in labour, so I have the time to support them like a doula, but having a doula they already know and are comfortable with is just great for them. I do agree there are some doulas out there that I do NOT like working with (the ones who are still ragging about having a vag birth when the baby's heart rate is in the 80s.....), but the good ones are worth their weight in gold. If I ever have a baby, I am asking for a doula gift certificate for my baby shower!
  11. by   Energizer Bunny
    Quote from BabyRN2Be
    I guess that I'm very different that other doulas. I'm totally understanding of the nurse's job. My mom was a nurse for many years and before I got into the doula aspect, I had a degree in speech language pathology (well, still do).

    We are there for NON-medical comfort, something that the nurses can't do because a) they don't have time or b) SOME won't. I understand that job and since we are working as a team to help the mom, I won't interfere with the nurses. I've already come away from some doula meetings disgusted by some comment, a doula who was "bragging" that she didn't pass on a request for pain meds... I was angry. This was the mom's birth, NOT the doula's birth.

    That's another way I differ from most doulas: I don't offer my opinions regarding pain meds. I support any way the mother choses to go.. pain meds, no pain meds, or wait 'n see. I don't go into every birth with the preconceived notion that she won't have meds, or with my own agenda in mind (i.e. - she's stated that she wants meds, but when she's in labor I'll do everything in my power to be sure she doesn't get them or I've failed as a doula - there are some who do this). Since I've been in the medical field and seen a lot of hospital births, I do know that when things in birth go wrong, they REALLY go wrong, and FAST... there's no time to argue a point on a birth plan when a life is potentially at risk.

    That's another way I differ: birth plans. I remind my clients that they can chart out their wishes in the birth plan, but keep in mind that they might not go according to plan. Be flexible. And the saying that "the longer and more complex the birth plan, the greater the chance of the birth ending in a c/s" - I've found that to be more true than not.

    I know that I'm not the perfect doula, but I just wanted to clear up a few misconceptions about doulas. There are several that play wannabe midwife/RN, do more harm than good and then the rest of us who aren't really that way, who understand the medical profession have a lot of "clean up" to do. We are there to help the patient, and in some ways, to help the nursing staff by answering/helping the patient - therefore diminishing the amount of call lights to the desk. In our hospital where I work as a volunteer, we are taught how to undo the monitors so the pt can go to the bathroom, walk around, etc. and then hook them up to the monitor again. We have been trained by the RN to do this, not doing this ourselves.

    We would really like to be seen as a help to the nurses, not a hindrance, not competing for the job, etc. I know my place, however, there apparently are some who do not.

    I know this is long, but I wanted to type out some of my feelings. FWIW, I'm not totally accepted in our doula group because I have an extensive medical background, and I don't buy into the "you really haven't given birth until you've given birth w/o an epidural", etc. And this is even moreso since I've told them that I'm going into nursing. You all should have heard the silence after I told them I was going into nursing.

    Now, I just hope that I'm accepted by the nurses after I graduate when they hear that I have a doula background. :chuckle

    Katherine
    I personally think that your attitude as a doula is fabulous, especially about the pain meds and birth plans. I have that attitude and hopefully will continue to do so when I finally become a CNM. My midwives with my last two children were just like that and I can only hope to be as great as they were.
  12. by   Dayray
    I've seen awesome duals and terrible dula's. sure there are a few that fall somewhere in-between but most fall in at either end of the extreme.

    Good dula's. Support the patient, ask questions, discuss medical issues with patient doctor, nurse. By listening to them I can tell that they are advocating for the patient by making sure the patient receives all the facts to make an informed decision. They don't try to force there own idea's of what birth is on the patient only make sure that the patient is given the options and offer their techniques rather then force them. They never leave the patients side they do as much or as little as the patient requires. They realize that there are good nurse and bad nurses and don't assume that we are the enemy.

    Bad dula's, refuse to come to the hospital until the patient is declared officially in labor, they sleep on the couch while the patient labors. OR they fight with staff, accuse us of terrible things, talk over me when I'm talking with the patient, try to make it seem they know more then anyone else. They smother the patient with unwanted activity's or conversations. They scold the patient if they ask for pain medicine and insist that the pateint not ver from the birthplan.

    The bad dula's are easy to handle, give them enough rope and they will hang themselves and the patients end up throwing them out.

    I see good duals as a great help to patient and my only regret is that I don't get to do much of the support type stuff when they are there.
  13. by   BabyRN2Be
    Quote from CNM2B
    I personally think that your attitude as a doula is fabulous, especially about the pain meds and birth plans. I have that attitude and hopefully will continue to do so when I finally become a CNM. My midwives with my last two children were just like that and I can only hope to be as great as they were.
    Actually, I broke my own rule regarding pain meds the other day. As I said in another post, I have my clients ask for their own meds. But since we were fairly sure that this was headed towards a c-section (80-90% chance), I asked the mom if she was opposed to trying IV Stadol. She was doing a GREAT job with cxns, but labor was really getting rough and baby was starting not to tolerate labor well.

    Since I work at this hospital as a volunteer doula and had a great rapport with the nurse, I could go behind the desk and ask her about meds for my client. They wanted to try a half dose of Stadol and that's what I asked for. They ended up giving her a full dose and she got rather loopy. I surely wasn't upset that this happened (she was REALLY getting to the point of needing medication), but this illustrates my reasons for them asking for their own pain meds. For all they know, I went up to the desk and said, "Hey, my lady in there isn't tolerating anything well anymore and hey, could we give her as much Stadol as we can?" - or something to that effect.

    In the end, the parents weren't upset with me. But I'm sure that if they weren't so understanding, I could have been in trouble with them.

    I think I might post about that birth, because it was so wonderful. I do have their permission to share what went on, but I will not give their names or anything like that.
  14. by   BETSRN
    I love doulas, and am sorry we don't encounter more of them. We only have them occasionally. I wish we had a doula program. I am alwayas happy to ahve a patient who brings a sould with her because usually they are such a wonderful addition top the patient's overall experience.

    It's the occasional doula who has her own agenda that makes it difficult for all doulas, if you know what I mean.

    Good luck in your RN endeavors. Your doula skills will be such an asset if you become an L&D nurse at some point.

    Betsy

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