Birth Doulas

[pamela100]

I was an L&D nurse for 2 years but left the field 10 years ago when I was having my children and didn't want to work the shifts and holidays. I did become a Childbirth Educator and kept busy. I am a Birth Doula and will begin serving as a "Volunteer" Doula in a large, inner-city hospital. I'll work 1 or 2 shifts a week.

My question is for the L&D nurses. How open are you to having Birth Doulas on the floor? Any pointers both positive and negative for me to consider?

Thanks for your help. Pam

[CEG]

I've never had experience with Doulas, but I didn't think that they have the education or authority to be teaching people about medical treatment. Therefore, I wouldn't think that they would influence parents on what is best for their child. They are not midwives, NP's, or nurses... AND I am a L&D RN. We are 1:1 and I do provide 100% of the labour support. I certainly do know how to do this, it IS my job to do this and I think that myself and most of my colleagues do a great job!

No doubt then with your attitude you are one of the ones who can and do give labor support. I have never had the privilege of 1:1, where I work it was "officially" 1:2 and in reality 1:3 or more. Even with 1:2 I obviously have to see my other patient so when I am in her room or even charting on my other patient's strip in the room of the patient I am supporting I am not giving her full support. Charting is a huge distraction.

The fact of the matter is many women do not get the education from their provider. How many doctors discuss the risks and benefits of vitamin K, erythromicin, or hep b vaccine prior to delivery? Next to none if not none. The parents have the option of having no education at all or getting their education from a doula, who if certified does have a fair amount of background and knowledge.

I think the real issues people have with doulas educating clients is that the results of that so frequently go against standard procedure. If there were doulas who talked people into continuous fetal monitoring, AROM, and pitocin then hospitals would be jumping over each other to hire them.

[bmcm2girls]

No doubt then with your attitude you are one of the ones who can and do give labor support. I have never had the privilege of 1:1, where I work it was "officially" 1:2 and in reality 1:3 or more. Even with 1:2 I obviously have to see my other patient so when I am in her room or even charting on my other patient's strip in the room of the patient I am supporting I am not giving her full support. Charting is a huge distraction.

The fact of the matter is many women do not get the education from their provider. How many doctors discuss the risks and benefits of vitamin K, erythromicin, or hep b vaccine prior to delivery? Next to none if not none. The parents have the option of having no education at all or getting their education from a doula, who if certified does have a fair amount of background and knowledge.

I think the real issues people have with doulas educating clients is that the results of that so frequently go against standard procedure. If there were doulas who talked people into continuous fetal monitoring, AROM, and pitocin then hospitals would be jumping over each other to hire them.

We have a standard of 1:1 most times. Exceptions are if it is early labor cervidil type inductions. Even then, we try to keep 1:1 if staffing allows. Of course, there are always emergencies and things come up so we aren't always 1:1...but it is a goal that we do fairly well with. Even with that and even with me loving natural labors I still LOVE doula's MOST times. I recommend them highly to friends/family when possible. They are one more person that a laboring woman can draw support from and, yes, when I am worried about charting and updating the doc, it is nice that there is still someone with the patient who is totally commited to that patient. That being said, as with everything else, there are good ones and not so good ones. We have a handful that come around occasionally that make us all groan b/c we know it will make for a long night. And it isn't that they are talking pt's out of cont EFM, AROM, or Pit. B/c to be perfectly honest, in normal labor circumstances, *I* am rooting for the patient to decline those things as well if they aren't necessary. But those handful that we groan about, we do so b/c they are, to be perfectly honest, unsafe. They are the ones that will tell a febrile patient that antibiotics are not necessary and just another intervention we are pushing on them. Or the ones who will break down a bed and instruct a primip to start pushing at 4 cm b/c she feels pressure. Or the ones that will take a patient off the monitors even though they are having lates and min variability (yes, it is one thing to not want cont EFM and an entirely different one to not want it even if the baby is showing signs of stress). I have seen one too many negative outcomes when those handful are giving advise to women that isn't safe. Like I said, most of them are great. Most of them have listened to what the patient wants and communicates it to the medical staff so we can all be on the same page. SOME of them come in with their own issues and feelings and they want the labor to go the way THEY want rather then how the patient wants at all costs.

[DoulaJane]

I think I might have a different perspective as someone who is a former doula. I think doulas are wonderful. In my experience most nurses do not have time to provide true labor support, very few know how to do it, and very few even want to try.

As for "talking patients into things" a doula is not acting ethically if she talks someone into doing something. She should only discuss risk vs benefits and let the patient make the decision. For instance eyes/thighs mentioned earlier- if mom/dad are STD free and baby has had a nontraumatic delivery it really isn't a risky decision to skip them. A doula who pushes her clients one way or another is not a good doula. .

In Illinois, eye med is law.

[CEG]

In Illinois, eye med is law.

There is a religious exemption. Often, people who object to the test on philosophical grounds use the religious exemption when no other one is available.

The law does not preclude informed consent and parents have the right to refuse, although they may be reported to DHS. Rarely does this result in anything other than a report.

I can't find a legitimate source at the moment, but I will link to a natural birth website that cites the regulation.

[Doulatron]

We like them except if they try to prevent us doing our thing.

We have one in our town, and she is great helping laboring women. I haven't worked with her, but the other nurses like her because she makes their job easier.

We have a lay midwife here who has been barred from the hospital because she would do things we consider unsafe, like unhook moms from monitors even though baby was clearly in distress. She also encourages moms not to have their babies get eye meds or vit K shots. (Not doing hep B, I understand and can support, but the others are important.)

I am a baby nurse planning on learning labor soon. I was thinking of taking a doula class, just so I can be better supporting the natural labor moms.

I know quite a few nurses (worked with one just yesterday in fact) who have also taken this route and have really liked the different skills they learned.

It's true that there are a real range of skills, approaches and attitudes amongst doulas; it's great to see someone affirming this. I think it is helpful to others who might have had a few "bad apples" to know that this is not representative of the whole bushel basket.

I haven't looked at too much of this site, but I hope it is all as candid and respectful as what I've seen so far.

[rbytsdy]

I've never had experience with Doulas, but I didn't think that they have the education or authority to be teaching people about medical treatment. Therefore, I wouldn't think that they would influence parents on what is best for their child. They are not midwives, NP's, or nurses... AND I am a L&D RN. We are 1:1 and I do provide 100% of the labour support. I certainly do know how to do this, it IS my job to do this and I think that myself and most of my colleagues do a great job!

Hopefully you will get to experience a client who has a doula sometime soon. Many doulas are also childbirth educators and are clear that they do NOT give medical advice. However, they can make sure their clients receive information to make an informed decision. No one ever even told me what the purpose of the eye treatment was. My first baby was a c-section and I was free of STDs; what was the point? My L&D nurse was really wonderful! But she didn't provide the same type of labor support I had from my doula. I really believe you need to experience doula support before you can make a judgment of labor support from a doula vs labor support from a nurse. It's a different world! Doulas aren't concerned about charting, meds, etc. A doula is only focused on the mom and her needs. Doulas don't leave at the end of their shift. They provide consistent one-on-one care for mom. My doula also arrived at my house before I left for the hospital so provide support at home. :)