I am trying to get a better understanding on why my co-workers hate doulas and I am pretty sure it comes down to control. There are 2 local hospitals with L&D and one welcomes doulas and mine hates doulas. The other hospital knows some doulas by name and greets them warmly. If a patient is sent for a section, the doula almost always accompanies the mother (along with the FOB or main support person) to the OR.
It's very different where I work. I hired a doula and sensed the hostility towards them at my hospital. My co-workers didn't know prior that I was going to have one there. I knew I had a strong possibility of a section and I wanted emotional support to avoid medication in hopes to avoid a c-section. I did end up with a section... because I work there my doula came to the OR with me. But, NEVER have I seen another doula go back there. My doula does not want to take patient delivering at my hospital anymore. She has been treated so poorly. I am now friends with a few doulas in the area and they all say the same thing about my hospital.
I took care of a woman with a doula a few months ago. I did not know this doula at all. I smiled at her, addressed her by name and when ambulating the mother, I accepted her assistance when she offered it. At one point I offered to get the mother and doula a water. She followed me out of the room and told me that no one at this hospital has even been this nice to her. I'm not surprised to hear her say this. The sad part is that I didn't give her special treatment, I just acknowledged her as a human being.
When I ask my fellow co-workers, they have said, "I just don't see the point of a doula/Why not just have your mother there?" (This is when I mention that studies have shown that doula support can increase your chances of an unmediated birth as well decrease your chances of c-section. I can give many more reasons for a doula vs. mother/sister/friend.) And they have told me that doulas give their patients medical advice and they don't like that. Or that doulas are pushy and always suggesting position changes or decreased monitoring.
One of my doula friend knows a charge nurse. We have all suggested having a "meet the doulas" day. This way the nurses can ask questions or even create boundaries on what is considered medical advise and maybe we can all work together without tension in the future. This ended up fizzling out. I know the only nurses who would come are the very few that like doulas. One of the other nurses confided in me that she was a doula prior to becoming an OB nurse, but she didn't want anyone else to know.
Thank you if you took the time to read all of this. I would love to hear some of your perspectives.
Specializes in Nurse Leader specializing in Labor & Delivery.
I agree with you - the only one who should be giving R/B of anesthesia is the anesthesiologist (or CRNA :)).
I definitely think it's in the purview of the doula to remind the woman that if she has an epidural, she will not be able to move about, change positions easily, labor in the shower or tub, and that it may affect the effectiveness of her pushing. Of course, these are all things that the mom and partner already know and have likely already discussed with the doula antenatally. But being brought to the present and reminded of what she already knows is always helpful, and I'm sure is one of the reasons why they hired her in the first place.
only if we are comparing birth and outcomes in developed countries. Then its more apples to apples, or as close as we can get.
and while I'd love to pull up even more articles, football starts here soon :-P But going completely off the top of my head of research I have read over the years is that the rest of the developed world has a much lower rate of maternal and infant morbidity and mortality than the U.S. They also have a much lower rate of medical intervention and birth happens by and large outside the hospital and/or with midwives with minimal to none medical intervention. OB typically attend the high risk births only (and this is where you see your analgesia and instrumental and surgical births). I mean if we want to logically think about this.....I think its safe to conclude that the more medicalized birth is, the riskier it is, and the greater morbidity and mortality.
The point is our medical intervention rate is extremely high, but compared to developing countries our percentage of safe deliveries is also extremely high.
In this country I think our medical intervention rate in L&D has more to do with perceived liability and increased malpractice rates than any other thing.
I would venture to guess that women who have an epidural would get more instrument deliveries because obstetricians aren't worried about the pain it will cause the mothers. OBs are more likely to try other things before going to instrument delivery with a woman who does not have epidural/neuraxial anesthesia. A small percentage of these women with epidurals may have increased chance of instrument delivery, but as far as I know that small percentage does not equate to a significant increase in adverse outcomes.
FYI: Epidurals adverse reactions are extremely rare. You are more likely to see problems with IVs. Chances of back pain after laboring epidural are statistically the same for patients that go natural or have an epidural. Serious life-threatening reactions reactions to epidurals are around 1:200,000. The most serious complication that is not directly related to actual epidural site is when someone hooks the epidural up accidentally to the IV site.
Specializes in Nurse Leader specializing in Labor & Delivery.
In this country I think our medical intervention rate in L&D has more to do with perceived liability and increased malpractice rates than any other thing. .
I totally agree. I've heard it said that an OB is never sued for jumping to a C/S too quickly, but is certainly going to be sued for not doing one soon enough. Right or wrong, that's how it is, and many/most OBs practice with that in the back of their mind.
The point is our medical intervention rate is extremely high, but compared to developing countries our percentage of safe deliveries is also extremely high.
In this country I think our medical intervention rate in L&D has more to do with perceived liability and increased malpractice rates than any other thing.
oh absolutely. Defensive medicine at its finest. Totally sad though IMO.
I would venture to guess that women who have an epidural would get more instrument deliveries because obstetricians aren't worried about the pain it will cause the mothers. OBs are more likely to try other things before going to instrument delivery with a woman who does not have epidural/neuraxial anesthesia. A small percentage of these women with epidurals may have increased chance of instrument delivery, but as far as I know that small percentage does not equate to a significant increase in adverse outcomes.
perhaps. Though even the woman with analgesia during labor who has had an instrumental delivery suffers damage to her perineum. So while the pain felt might not be immediate, there is pain associated with such interventions that last weeks and sometimes months and years after the fact.
One thing I have noticed when a doula is present is that the male partner of the laboring woman seems to be more passive/less directly involved with the woman. I often note them seeming to be kind of back in the corner.
I don't think the doulas are directly fostering this, but perhaps they are feeling unneeded. I really like to get dads involved in holding,coaching, supporting their partner.
I agree with you - the only one who should be giving R/B of anesthesia is the anesthesiologist (or CRNA :)).
I definitely think it's in the purview of the doula to remind the woman that if she has an epidural, she will not be able to move about, change positions easily, labor in the shower or tub, and that it may affect the effectiveness of her pushing. Of course, these are all things that the mom and partner already know and have likely already discussed with the doula antenatally. But being brought to the present and reminded of what she already knows is always helpful, and I'm sure is one of the reasons why they hired her in the first place.
It is also in the SOP of Doulas to educate moms regarding the "cascade of interventions" and its implications.
I am a labor and delivery nurse. I work with one doula in particular that is a pleasure to be around. She is helpful and supportive to the parents and works to accommodate the patient's birth plan. In general I think that the doula can be a great asset to the labor experience.
What is unfortunate is that many times patient's come in with the perception that the nurses are there to disrupt their birth plan and often times the doula feeds that perception ignoring the nurses recommendations. We, as nurses are not there is ruin your plan or experience. We are there to help you bring a healthy baby into the world.
To address the "Why doesn't she just have her mother be her support person?" question, some patients do not have assess to their family. The closest blood-related relatives I have live 200 miles away, including my mother. My mom is elderly and suffers from diabetes and cancer, just to name a few of her conditions. To look at her, she doesn't look that bad off, but she doesn't need to do a lot of traveling. Family and friends cannot always take off work or get away from their own family obligations to support a woman in labor. I delivered by myself 3 out of the 5 times had a baby. There were times my husband was not there because he was either stuck at work (one time at a nuclear plant) or had to stay home with our other children.
Then there are women who have no family and have not made friends that they would have in the delivery room with them. I mean, you shouldn't just have any ole kind of person as your labor/delivery support.
I wish that I could have had a good doula--not the ignorant, pushy kind that have been described here.
As a former doula and current LDRP nurse I love doulas; most of the time. The ones I dont like are the ones that THINK they are advocating for the mother but are actually being pushy, interfering, and down right dangerous (like the doula that whispered in the patients ear "remember you have choices" when the RN was trying to get a c/s consent signed because the baby was having reoccurring late decals into the 60s and we were getting ready to take her down to a crash section)
As a former doula and current LDRP nurse I love doulas; most of the time. The ones I dont like are the ones that THINK they are advocating for the mother but are actually being pushy, interfering, and down right dangerous (like the doula that whispered in the patients ear "remember you have choices" when the RN was trying to get a c/s consent signed because the baby was having reoccurring late decals into the 60s and we were getting ready to take her down to a crash section)
But Doulas have all that education that they can explain all these things to patients........ Just Kidding....
Most patients don't have good labor support. That's where a good doula comes in. A good doula empowers a woman, gives her the tools to manage labor without drugs, which is usually/often what the woman's stated goal is.
Yay, did I just bring the thread full circle?
In answer to the OP, I LOVE a good doula. Makes my job so much easier. As a natural birther, I totally respect and understand the desire a woman might have to go naturally, and while I have the tools to help her, I don't always have the time. Especially if I have two labor patients. So a consider a good doula to be an extension of the labor support that I WANT to be able to offer to my patients, but often cannot. With a good doula, I can leave the room, knowing that my patient is in good hands and that she's doing whatever she can to help my patient.
Sadly, I've worked with bad doulas, who grossly overstep the bounds of labor support and health professional. I truly believe that these women poison the minds of the couples who come in, and set them up to be on the defensive and have an us vs. them attitude towards all healthcare staff. These same doulas also set up a very unrealistic expectation of the midwives. No, this is not going to be "a homebirth in the hospital." The midwives still do have to adhere to hospital policy regarding fetal monitoring (even as liberal as it is). If you have a BP of 150/100 and your uric acid and LDH are sky-high, the midwife is NOT going to smille and say "it's okay, women have been doing this for millenia, you'll be fine" and I certainly don't appreciate when YOU say that to the patient either.
As a senior nursing student with a history as a doula, I can say that there were times when I had clients that totally behaved in an "us vs them" manner when they got to the hospital (and maybe they had that attitude before and thought a doula would somehow buffer their interactions with staff...not), but it was really embarrassing as their doula to encounter this. So in some circumstances, I think it might just be the preconceived notions and mentality of the patients, and not necessarily the doula poisoning them. On the other hand, I am sure there are bad doulas out there, just like there are some bad doctors and nurses. But I'm not about to look on all doctors and nurses with suspicion because I've seen a few bad eggs. That's all just anecdotal.
I've been a doula for about 3 years an also just finished my BSN in Oct and passed NCLEX today. Just like any profession there are crappy doulas and there are awesome doulas, it just depends on if they act in their role or not. I will say however doulas are in a hard position a lot of times. I have had clients who refuse every intervention and the nurses get ****** at me assuming I am feeding her the information when in reality it is all mom.
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Just Kidding....
klone, MSN, RN
14,857 Posts
I agree with you - the only one who should be giving R/B of anesthesia is the anesthesiologist (or CRNA :)).
I definitely think it's in the purview of the doula to remind the woman that if she has an epidural, she will not be able to move about, change positions easily, labor in the shower or tub, and that it may affect the effectiveness of her pushing. Of course, these are all things that the mom and partner already know and have likely already discussed with the doula antenatally. But being brought to the present and reminded of what she already knows is always helpful, and I'm sure is one of the reasons why they hired her in the first place.