Any nurses also doulas?

BabyRN2Be · Jul 17, 2007

Hi Almabella,

I've been a doula for the last 9 years, and I was considered a PP doula before becoming certified as a birth doula. I will answer your questions as best as I can as I am not a nurse but I work closely with them in a volunteer capacity.

I just wanted to say that becoming a doula would be a big asset to your nursing skills. Some may disagree with me, but being an RN would boost the patient's confidence. Although the two roles are different, there are benefits to doula training. You become more involved with the patient on a different level than what you would normally in the nurse/patient relationship.

how do you balance your doula schedule with work and family?

As a doula working PP, you can pretty much set your own schedule, decide on a caseload which would be right for you. It's easier to work with your families needs working PP as opposed to being a birth doula, because when you are a birth doula, if you don't have backup, you are pretty much on call for 24 hours. When you work as a PP doula, you can set up appointments which will be easier on your family life.

do you ever feel like your role as a nurse and as a doula are blurred? (my fear is that if there were ever a bad health outcome for a mom/baby that I had visited as a doula my nursing license would be at risk)

I believe that the two roles are different as you are dealing with more subjective than objective information. In this case, you have to seriously define your role with your client and spell out what you will and will not do. Get it in writing. It's totally up to you what you decide the tasks that you are willing to do PP. As a nurse, you are trained and licensed to do more tasks than what a non-RN doula can do. For example, I know that this is the birth side of doula'ing, but some nurses who are doulas are willing to do SVE's during labor. Some are not due to the reasons you listed above. It's up to you to decide what you will and won't do as a nurse/doula and how much you are willing to risk. As an aside, there is malpractice insurance available for doulas which would cover you if something went wrong and it wouldn't need to go on your RN coverage.

is there any third party reimbursement or mainly out of pocket for patients?

It does happen, but very rarely. I've heard of Blue Cross/Blue Shield covering doula services, but as you can imagine, it's very time consuming. Personally, I've never received 3rd party reimbursement. I've been paid directly by the client.

You mentioned becoming an LC. I'd like to recommend a stepping stone for that goal, that is becoming a Certified Breastfeeding Educator. There is an excellent nurse out of Mercy Hospital in Oklahoma City who presents 3 day conferences. She was so helpful and is a great instructor. Her first name is Debbie and she has a PhD. If you google Certified Breastfeeding Educator and Mercy Hospital in OKC you may get more information. I learned so much from that conference. I missed the one in Oklahoma City and had to drive +500 miles to Des Moines, Iowa to catch it, but it was so well worth the time. It would be a great step towards becoming a IBCLC.

If you have any more questions, I'd be glad to help you. Feel free to PM me anytime! :)

Selke · Jul 17, 2007

Doula skills -- labor support -- are invaluable and every L&D nurse should have them. The labor support approach to IP care is spotty and inconsistent, SO dependent on the culture of your hospital ... so the more RNs who know this stuff, the better. That said, it is tough to be both doula and RN. Your doula part should inform and guide the kind of care you give your patient, but as a nurse you have many more responsibilities, and most likely more than one patient, which makes continuous presence at the bedside for the entire labor pretty much impossible, unless you happen to have a lady who comes in and births on your shift and you don't have to pick up another patient. On the contrary, the doula is dedicated to supporting that mom, stays through many changes of shift, and maintains a relationship with her once she's discharged. If you are in the role of a doula you CANNOT legally perform nursing functions. You can't touch the monitor, get FHTs, do vag exams, assist with the birth, &c. You can just be a doula. Otherwise you will get into very, very, very big trouble with the hospital and will probably get escorted out by security. Even if you are a nurse at the hospital you are being a doula at, you cannot perform as a nurse -- you are not on the clock, she isn't your "patient". Postpartum doula-ing might work very well to combine with a nursing work schedule. You can schedule your home visits on your days off and do the lactation consultant thing. Adding LC to your skills is a very smart move. You could become a resource for your hospital as well as your private clients!

Almabella · Jul 17, 2007

Becoming a Cert BF Educator....that is a great idea! I hadn't even thought about that. I will definitely look into that!

I also completely agree with what you said, selke, about the limits to your function as a birth doula and this is one big reason why I am not interested in working as one. But mainly it's also because I do not want to be "on call" 24-7.

Maybe I'm just paranoid, but we live in such a litigious society and I don't want to put my license at risk (worked so dang hard for that thing!). Maybe I will just look into the BF educator and ultimately LC certification as that would be more of an asset to my career as a nurse.

Anyway, if there are any nurses out there actually working as doulas I'd love to here from you!

CEG · Jul 17, 2007

You can also become a certified lactation educator through CAPPA (www.cappa.net). I am working on that right now. It's a great stepping stone to LC in my opinion. I am hoping to get there someday.

I was a doula before I was a nurse. I recently graduated from nursing school and took a job in L& D. I haven't started working yet but during my nursing clinicals I had a hard time with how the women were treated/manipulated by the MD/staff with my doula training and belief in respecting and empowering women.

I think I was a good resource during clinical for several women who desired a natural childbirth. None of the other nurses had any experience with labor support and I was able to help those women be succesful. I am working towards CNM and I believe my doula experience will help with that. I also think doula trianing is so valuable for nurses and everyone who works in L & D should be required to be doula trained. There is just so much valuable information even if you have mostly epidural patients.

I am not taking any doula clients now because I couldn't miss work for a birth. I did find a job at the hospital that has the most mother/baby friendly practice policies. Unfortunately birth centers are not legal in my state

Selke · Jul 17, 2007

I should have added that perhaps you could get permission to hold inservices on your L&D floor to teach the other RNs about doulas, and actual hands-on doula skills. I worked at a hospital once, where I initially learned about labor support, where several RNs were doulas prior to becoming RNs and they set this up as a part of the new nurse training program. It has actually enhanced the reputation of the L&D nurses at this hospital. You could tell your boss that doula skills enhance customer satisfaction. I don't know of any RN who continued as a birth doula because of time constraints. I have a good friend who works a weekend program and sometimes still does doula work during the week, but that's it. Unless you can work part time, it can be tough. I just attended Penny Simkin's 32 hour doula training workshop in Seattle and they brought up the liability issue and not crossing nursing/doula boundaries, and talked about how difficult it is to combine being an actual doula and being the care provider for the patient - I never thought about the legal issues until then. I think there's always a need for lactation consultants; those skills will always be a feather in your cap.