L&D RN's opinions on doulas?

klone, MSN, RN · Feb 6, 2011

Some nurses dislike all doulas. I LOVE a good doula! It really helps take the burden off me as the nurse, especially if I have two labor patients, and especially if the woman is wanting to go med-free.

The key with a good doula with regards to how the nursing staff will accept her is knowing her professional boundaries and not overstepping them. There is one particular doula that I've worked with a few times who is OBNOXIOUS. She is a midwife-wannabe, regards hospital staff as The Enemy, and doesn't make that opinion a secret to her staff. I think she preps them ahead of time that we're going to be rude and overbearing and try to trample all over the patient's rights, because that's kind of the attitude many of her clients have when they come in, and I think she fosters that atttitude with them. She also fosters/encourages a codependent relationship to her, to the point where her clients are afraid to make any decisions without talking to her first and seeing what she thinks. She has given downright DANGEROUS information to her clients about breastfeeding, and one of her patients left our facility AMA because *her* information was conflicting with our information as far as the baby needing to eat.

Sorry, I'm still really ****** off about this woman, as you can see.

On the other hand, there's another doula I work with regularly who is absolutely LOVELY and I adore her and get really happy when I get to work with her. SHe's amazingly wonderful with her clients and is truly gifted at what she does.

As far as the doula's role - she is there to provide support to the mom in labor. Whether that's verbal/moral support, or physical support in the form of massage, accupressure, etc. She also helps coach the mom through contractions with breathing, helping her to focus, etc. She is not there to offer medical advice.

ShiphrahPuah · Feb 6, 2011

Completely agree with Klone. I have worked with a few doulas who were amazing and provided great support to the patients and worked WITH the nurse to make laobr the most positive experience possible for the pt. These doulas were a blessing and made my job easier when I was juggling multiple labor patients. However, there are other doulas who make everyone who works for the hospital out to be an enemy so there is constant conflict and the pt does not trust anything the nurse tries to do. Labor and delivery is one of the places where lawsuits are most common. So, yes, my hospital had pretty strict rules about the certain things we had to do (i.e. continuous fetal monitoring with some breaks allowed under specific circumstances). Some doulas can be very obnoxious and leave the hospital staff wishing the pt and the doula just stayed home for the birth.

There is huge potential for a doula to be a great asset to the team. And to be honest, I do think due to liability, hospitals can have sort of a factory approach to laboring women, and this is where a doula can really be a great help to the pt. Plenty of L&D nurses WISH they could spend more time with their pts but are unable to due to pt load, and this is where the doula is a great team member.

tablefor9, RN · Feb 7, 2011

Like they said, it's dependent on the doula, and either the best thing or...not.

I love a great doula, because then I know that our patient is going to get the very best support and care, good information, and hey, it says alot about the birthing family that they were educated and invested enough to read/learn about all the options available to them.

I don't love the natural birth dictator type, because I am a huge advocate for the rights of a birthing family. Trading one type of paternalism for another just annoys me.

OldNurseEducator · Feb 7, 2011

Good posts! There are good and bad in every profession!! (Doulas aren't really

"professionals". I don't think doulas need college degrees.) Just my :twocents: !!

klone, MSN, RN · Feb 7, 2011

A doula is a professional, IMO, if she has a business and gets paid for her services.

ebphillips · Feb 7, 2011

I am a doula, currently a CNA, looking to get into RN program and eventually work in L&D. I always had the attitude that we are all there to work as a team. I am not against you (the RN, or OB for that matter) and I hope you don't have preconceived notions about what I do. I actually had a very hostile OB go "what do you think of that belly?", as in what point in progress is she in... knowing full well that I couldn't answer because I am not allowed to by the Scope of Practice (organizational policies, DONA specifically).

I believe that a laboring mother should make her decision based on fair information. If you decide after educating yourself about an epi, then do it- I support you. I had a mother that stalled (truly) at 6cm and decided to go for a c-section. She asked for all information from her (perturbed) OB, and after many huffy answers, decided to go for the section. I said nothing to the Dr, in fact, I encouraged her to go with what she was feeling, and if it was right for her, I applaud her. I went over all the information I had about sections, and asked her to question the OB on whatever she wanted more info on, to be truly informed.

I guess, in short, I'd love to see more cooperation between doulas and hospital staff. I do not deny that there are a few militant poo-poo heads on both sides of the fence, but for the most part, we work together well for the laboring mother...

Irishobrn · Feb 18, 2011

I'm not a fan of doulas in general because most of them get in the way of what I'm trying to do. I haven't encounterd any that are dangerous though...although sometimes I've had to point out what their roles really are so they know not to interfere with monitoring or positioning. I think in the absence of a supportive partner they can be helpful, but in our hospital they are usually in addition to the spouse/FOB or family member so it's just too much to deal with.

tablefor9, RN · Feb 19, 2011

I'm not a fan of doulas in general because most of them get in the way of what I'm trying to do. I haven't encounterd any that are dangerous though...although sometimes I've had to point out what their roles really are so they know not to interfere with monitoring or positioning. I think in the absence of a supportive partner they can be helpful, but in our hospital they are usually in addition to the spouse/FOB or family member so it's just too much to deal with.

WOW. :eek: I thought assisting with positioning WAS a doula's "place", and certainly encourage that practice with both my epidural pts & my natural pts.

Doulas aren't the enemy. Sure there are a few that are somewhat over the top (come to think of it, I know some RNs that are, too...another post for another day). However, the good doulas can help a ton with giving our pts the very best care & labor support. Spouse/FOB are clueless, many times, and Mama/Grandmama can be, too. SO nice to have someone who has a common goal of supporting mom & support people.

If I remember a delivery, it was exceptionally beautiful or sucked in ways I never want to see repeated. The family, however, should remember it forever. Bottom line is that it's about them, not me, and a good doula helps make that happen.

bagladyrn, RN · Feb 19, 2011

WOW. I thought assisting with positioning WAS a doula's "place", and certainly encourage that practice with both my epidural pts & my natural pts.
Doulas aren't the enemy. Sure there are a few that are somewhat over the top (come to think of it, I know some RNs that are, too...another post for another day). However, the good doulas can help a ton with giving our pts the very best care & labor support. Spouse/FOB are clueless, many times, and Mama/Grandmama can be, too. SO nice to have someone who has a common goal of supporting mom & support people.
If I remember a delivery, it was exceptionally beautiful or sucked in ways I never want to see repeated. The family, however, should remember it forever. Bottom line is that it's about them, not me, and a good doula helps make that happen.

Actually the biggest problem I have is with those doulas who view and encourage the patient to think of the staff as the "enemy", placing themselves in the role of "protector" running interference between the staff and the patient. Those I have experienced who act in this way have made a bad name for those doulas who act appropriately in supporting the patient, her family AND the staff.

In some cases those doulas (not all) seem to be acting for their own agenda. A case in point being the one I experienced who walked out and left a patient when the patient decided that she needed pain medicine after demanding that I lie to the patient and tell her she was more dilated than was the case and that she couldn't have meds! Left me with the task of repairing the damage done to the patient's emotional well being at a critical time.

tntrn, ASN, RN · Feb 19, 2011

Our labor patients are one-to-ones practically from the time they walk in the door until after they are recovered, so truly, the doula IS in the way. And any "information" the patient and family can seek is available from the RN who is in the room.

When it comes time to push, the doula is certainly welcome to help hold one of those anesthesized legs, though. I am not going to be doing that anymore. My back and shoulders just can't tolerate it.

Irishobrn · Feb 19, 2011

Positioning for comfort is the doula's job...but when that position interfere's with my ability to monitor the baby or when the position isn't comfortable for the patient during a decel I have to object. So as long as they don't get in the way of my job I don't mind them being there, but some of them do and I don't like that. I don't know what their education is, and I'm sure it differs from each one, but I do think that if the birth is planned in the hospital they should defer to the hospitals policies and protocols and work with in them. If not then they should labor their clients at home where they can be in charge.