Hands-On L&D Nurses?

FrumDoula · Apr 6, 2005

I think the original intention of advanced technology was to free up more time for the basic care laboring patients need. Unfortunately it has simply made their care more labor intensive (pardon the pun).

My understanding was that the technology was offered not to help with basic care of laboring patients, but to increase "safety". It has done neither, and has, if anything, reduced the amount of hands on nursing that laboring mothers so desperately need. The technology that many low risk laboring women are subjected to not only do not increase safety, but increase risk, unfortunately.

I would like to correct the misconception among some nurses that doulas only work with women who desire natural birth, and that we see natural birth as the only viable option. This is incorrect. Doulas attend a wide variety of births, from planned c-sections to home births and everything in between. I've had plenty of clients who chose medication. As long as there is informed consent, along with good labor support, we're there to simply help the mother and her family in the birth process.

Now, having read research study after research study, it is not difficult to understand why so many doulas prefer low-intervention births for the low-risk mother. It's simply SAFER not to have unnecessary interventions such as mandatory IV's with no thought to patient hydration levels, continuous fetal monitoring, etc etc. Birth can be notoriously unpredictable, yes. But you can also stack the odds against a woman having a safe birth if you load her up with every intervention in the name of "safety" and prevention.

And I want to mention something else about doulas and epidurals. Penny Simkin, a very famous doula and physical therapist, has often argued that a woman who has an epidural needs MORE doula care, not less, simply because she needs to be reminded to connect emotionally and physically with her labor. She has written some very interesting articles on that subject.

Cheers,

Alison

FrumDoula · Apr 6, 2005

We even have central monitoring but my facility believes that you are better able to deal with issues at the bedside and that it enhances patient perception of their experience.

Your unit is following the current research regarding continuous labor support, and it's refreshing to see!!! Your nursing manager and medical team should be congratulated for demanding this standard of care for women.

Hey, those women who have continuous labor support not only have better memories of their experience, they also have better perception of their BABIES, even long after the birth experience.

Alison

BETSRN · Apr 6, 2005

My understanding was that the technology was offered not to help with basic care of laboring patients, but to increase "safety". It has done neither, and has, if anything, reduced the amount of hands on nursing that laboring mothers so desperately need. The technology that many low risk laboring women are subjected to not only do not increase safety, but increase risk, unfortunately.
I would like to correct the misconception among some nurses that doulas only work with women who desire natural birth, and that we see natural birth as the only viable option. This is incorrect. Doulas attend a wide variety of births, from planned c-sections to home births and everything in between. I've had plenty of clients who chose medication. As long as there is informed consent, along with good labor support, we're there to simply help the mother and her family in the birth process.
Now, having read research study after research study, it is not difficult to understand why so many doulas prefer low-intervention births for the low-risk mother. It's simply SAFER not to have unnecessary interventions such as mandatory IV's with no thought to patient hydration levels, continuous fetal monitoring, etc etc. Birth can be notoriously unpredictable, yes. But you can also stack the odds against a woman having a safe birth if you load her up with every intervention in the name of "safety" and prevention.
And I want to mention something else about doulas and epidurals. Penny Simkin, a very famous doula and physical therapist, has often argued that a woman who has an epidural needs MORE doula care, not less, simply because she needs to be reminded to connect emotionally and physically with her labor. She has written some very interesting articles on that subject.
Cheers,
Alison

ALL of what you hvae posted here is very true, Alison. I don't think any of us would disagree with you on any point.

I think, however, what we are all trying to say to you is that when you become an RN, you are going to have to put your doula skills on the back burner. Unfortunately, with the birthing climate as it is today, the legalities are going to have to come first. You will be forced to think like an RN first and as a doula second. Those hands-on skills will always be there for you to use and you will use them: hopefully in teaching other nurses less experienced in this type of labor support.

I think you misunderstood the other poster who mentioned that you would mentally have to change gears. No one says that someone with an epidural does not need labor support. Of course they do. However, you will have to incorporate all of your doula skills WITH RN skills. You will not only be protecting the mother and baby (as you always do) but you will be protecting your license and the hospital as well.

You'll be dealing with doctors in a different way and that is not always pleasant. However, it is a reality.

If, after you have been at this L&D thing a while, you are totally frustrated with it, you can still be a doula and pick another area of nursing on which to concentrate as an RN.

SmilingBluEyes · Apr 6, 2005

Indeed, I can't argue with Alison, either. I have read much of Simkin's work as well as others regarding birthing and negative trends toward high-tech, high-intervention treatment today in most hospitals. I have read extensively Ina May Gaskin's works,too. In my perfect world, birthing would be the opposite really----80% natural, 20% epidural/medical intervention situation. I prefer to work in the natural birth experience myself. But that is not how it is in most hospitals, sadly. I can understand why, also.

Unfortunately, most non-nurses are often quite unaware of the truly litigious climate of birthing today in the USA. And the liability we are subject to *is* GREAT. I would like to see a downward trend AWAY from continuous monitoring and high epidural/intervention use. It is true, continuous fetal monitoring is controversial as to whether it benefits or detracts from safety in delivery of care. I have read lots of literature that argue both sides. Still we nurses are caught in the middle of all the controversy, held liable for any negative outcomes or experiences that occur on our watch.

That interventions are so common, for me, takes a lot of the "heart" out my care. I do try to connect very personally with each birthing family I care for. I succeed most of the time. But I have to admit, the machines and epidurals do remove a lot of the desire for THEM to connect with anyone, except for Jerry Springer, Maury or Cartoon Channel on TV. Many act annoyed when I Do try to be there for them. It's disheartening.....

But Face it, we are a fast-food society in the USA. WE want what we want and we want it NOW. The increase in inductions and epidurals and even csection ON DEMAND is the TREND now. You can't blame medicine and nursing 100% for that. These couples making these decisions are at least partly to "blame" if you want to look at it that way. They want to be induced cause they are "tired of being pregnant", some as early as 32, 33 weeks. When we tell them what happens to a newborn born too soon, we get vague compliance and understanding and even some eye-rolling at times. :uhoh3:

They just want "their body back" more than they want to carry to term. The fact is, they DO pressure and pester the doctors endlessly to "get it over with" in so many cases.

They "think" once baby is here, that life will be "normal" again and they will get their full 8 hours' uninterrupted sleep and social life will resume. They can go out drinking and clubbing and have "fun" again.

Well, Seems to me, they need to be educated about the reality of life after a baby is born, as much or maybe MORE than they need to know what happens in childbirth. Really, parenting is the HUGE issue, birth, while life-altering and influencial, is not as "big", for lack of better words, in the overall life-altering situation becoming a parent is. You give birth over hours or days in your life, YOU PARENT for a LIFETIME!

*They often have NO CLUE what they are entering into in becoming parents, so focused on the passage, not the JOURNEY they are taking.*

Does that make sense?

Regardless of "who is to blame" for current trends, (lawyers, HMO's, doctors/nursing, or the consumer)---- the fact remains very simply, the minute they step through the door of the hospital, the birthing mothers' and their fetus' wellbeing becomes a LEGAL responsibility we cannot escape or remove ourselves from, period.

So yes, you will have to resolve to be RN first, and then, doula when time and situation allow for it. No one is saying lose those invaluable skills. Just be aware of your priorities and responsibilities.

One final word in this very winded post: I do recommend anyone finding this distasteful look for hospitals that boast low-intervention birth centers that feature midwifery as their hallmark of care,-----or, midwife-run practices/birthing centers. That would be MY dream one day, to work directly for and with midwifes in a midwife-run birth center.