L&D RN's opinions on doulas?

Specialties Ob/Gyn

Published

So, more and more of people that I have known in my life talk about using a doula in the hospital. I am very curious what the doula's role is, how that effects the nurse/patient relationship, if it is disruptive and how the nurses REALLY feel about it?

I mean, I'm coming from an ICU perspective and if the family of a patient wanted to bring in someone to my bedside, more than likely - I'd show that person the door! haha but the L&D environment is sooo different - I'm just genuinely curious. :)

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.

Our hospital has banned us from holding legs anymore...too many nurses have gotten hurt that way. Now we are to position them in stirrups or ask that they pull their own legs into position. The docs are not happy with it but I have to say my shoulders and arms are. :)

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Specializes in Community, OB, Nursery.
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.

Ahhh, if only home birth were as accepted and legislated in every state as it apparently is in yours. In my state of about 10-12 million, there are exactly two CNMs who will deliver a home birth, and it is illegal for CPMs to do it. (Doulas shouldn't be 'laboring' people at home. Doulas should be supporting women while they labor with their birth attendant of choice.) So it's easy to say, if you want a doula you should be laboring at home, but the reality is that at least in several states, that's not really an option. People should still get to decide what people they want in the room and how they want to be supported in labor, whether they're in the hospital or not.

As with any line of work there are good and bad. I've seen some fantastic doulas and some not-so-fantastic ones, but on the balance I'd say they're a great asset.

About doula education/certification: http://www.dona.org/

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
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.

I disagree with this (a lot).

So many hospital policies are so much politics and provider preference.

As long as I'm not jeopardizing the mother's health and the baby's health, I'm willing to work with pretty much anything the mother and her partner want.

Have I mentioned recently that I LOVE a good doula?

Even when I'm 1:1, I still have to do things like chart, pee, eat. If a woman is wanting to go med-free and is having a hard time with it, a good doula is priceless. She is there, 150%, for the mother, and nobody else.

And hell, I've even LEARNED a thing or two about labor support from some of the doulas I've worked with! Crazy.

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Specializes in ICU, Home Health, Camp, Travel, L&D.
I disagree with this (a lot).

So many hospital policies are so much politics and provider preference.

As long as I'm not jeopardizing the mother's health and the baby's health, I'm willing to work with pretty much anything the mother and her partner want.

Have I mentioned recently that I LOVE a good doula?

Even when I'm 1:1, I still have to do things like chart, pee, eat. If a woman is wanting to go med-free and is having a hard time with it, a good doula is priceless. She is there, 150%, for the mother, and nobody else.

And hell, I've even LEARNED a thing or two about labor support from some of the doulas I've worked with! Crazy.

I say it all the time...birth & death aren't about us. I'm not so laissezfaire that I'll neglect interuterine resuscitation standards for the sake of a Mom directed labor & delivery, but IF I can let Mom drive the train, baby that's how it's happening, with intervention that is as minimal as the situation can stand. NO RN spends 100% of her time all abt the family. We CAN'T, too many misc tasks to count.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

I remember a particular situation (thankfully I was 1:1 and could do this) where the mom was having a such a hard time getting comfortable, and the only position she was comfortable in was one where the EFM wouldn't trace FHTs except at a really crazy angle. I spent TWO HOURS in there, HOLDING the EFM at the weird angle so she could be in the position she was most comfortable. Thank goodness there was a doula there, helping out, giving her sips of water, doing sacral massage, because I was pretty useless, in spite of being at the bedside.

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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.

Even if you are 1:1, like some others have said, you still have things to do other than support mom. Charting, getting supplies, dealing with Dr.'s, etc. Also, generally a the doula has gotten to know the mom over the course of a few months so they are better able to offer comfort to her since she knows her.

I had a doula at my daughters birth and it was wonderful. The nurse that was there really appreciated my doula as well. I had been working with her since I was 4 months pregnant, so she knew how to help me and was able to do little things like give me sips of water, put a cool cloth on my head, talk quietly in my ear while I was pushing.

I didn't want any "information" from my doula I wanted to emotional support. Lastly, she was able to offer support to my husband so that he could support me more effectively.

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I had a doula at my first birth and she was wonderful. I wanted a doula to help me with a natural birth, but she attended all kinds of births with epidurals and C-sections and the like (and had had all kinds of births herself). I am certain she is why I DIDN'T end up with a C-section. She reminded me when I had been pushing for three hours that I had said I WANTED her to make me get upright if I was having trouble and got me one of those portable toilets to sit on where I could grip the handles and that is what finally got my daughter to move down. I had intermittent monitoring and no IV access and ate and drank lightly (all of which I wanted as long as things were going okay) and none of the nurses had any problems with this. I did have a CNM who was supportive of everything I wanted even if I "broke some rules" so I didn't really have a fight on my hands beforehand. I would have stayed home to have my daughter had we not been living overseas on a small military base. I did go on to have the next four at home and was happy to get a good hospital experience the first time around and she was definitely a part of me getting that. The ONLY problem with nurses that I had and this is WHY I hired a doula was because you have good ones and bad ones for natural birth and you really do not have any control over who you are going to get the day you go in to have the baby. Some nurses support natural birth and are absolutely wonderful with everything you want (and mine were, really) but some are not. As a first-time mother I had heard stories from other moms who had attempted natural births who had had less than stellar nursing care; I recall one mother telling me that when she checked in to have her son she had planned on a natural birth and refused the IV since she wasn't getting medication and the nurse rolled her eyes and said "You first timers always think you can do it without drugs. Just get it because when you see how horrible this is you WILL change your mind". I was appalled, and yes, I had heard more than one tale like this and actually could not find a single soul who intended to birth naturally in the hospital that was successful. I was very happy I was taking someone with me to remind me of what I wanted in the event that I got someone who thought I was just one of those "silly first-timers who only THINKS she can go without drugs". If the nurses thought that (and I really don't believe they did) they were kind enough to not express it to my face in the birthing room at least (and I really didn't think it was all that horrible, nor did this silly first-timer "change her mind" ;)) I knew I'd at least have someone there who believed in me and would tell me that I COULD do it and do everything in her power to help me get what I wanted, provided me and my daughter were okay.

Mind you, this was in 2001. I really hope things have changed since then as far as attitudes towards different kinds of births and I DO think things have changed a LOT. I am hearing from more and more mothers in the past two or three years who are more "granola" whose wishes were honored in the hospital than I did almost ten years ago when I had my first child, so that is a positive improvement and a trend that I hope to see continued (because I know not everyone can birth at home).

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Specializes in OB, Family Practice, Pediatrics.

Doulas are also trained to suggest positions to the mom which have been shown to assist with positioning and the decent of the baby. It is also a misconception that Doulas have no medical training. Their training includes labor medications, methods of induction, procedures, complications, etc. As with nursing, experienced Doulas have much more knowledge than new Doulas. Continuing education is important and helps Doulas stay current. An experienced Doula would also recognize non-reassuring decels on the monitor; and may actually start encouraging the mom to turn on her left side and handing you the oxygen mask, while you are charting what you are seeing.

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Specializes in Ortho/Neuro (2yrs); Mom/Baby (6yrs); LDRPN (4+yr).

My doula was indispensible to me with my first son. Even though the labor was super fast (he was a preemie) and she was only able to be with me for about 30-45 minutes of my labor, the support she was able to give both me and my husband really helped. I will be using her again for my 2nd, which is due in just over 5 weeks. In addition to being a doula, she's also a practicing RN now, with the additional knowledge that goes along with that.

And yes, some nurses are super supportive of natural birth and some truly aren't. Working in post-partum now, I get to see it a lot with our labor nurses. There are some that I definitely hope I don't get when I come in and some I truly hope I do. Knowing our policies, I know what I can ask for and what to expect when I do come in.

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Doulas are also trained to suggest positions to the mom which have been shown to assist with positioning and the decent of the baby. It is also a misconception that Doulas have no medical training. Their training includes labor medications, methods of induction, procedures, complications, etc. As with nursing, experienced Doulas have much more knowledge than new Doulas. Continuing education is important and helps Doulas stay current. An experienced Doula would also recognize non-reassuring decels on the monitor; and may actually start encouraging the mom to turn on her left side and handing you the oxygen mask, while you are charting what you are seeing.

I have to disagree here. The range of medical training is highly dependent on the program you attend and usually very minimal. And usually most of that is self learning and then maybe some review when attending the training. I am a DONA trained doula and I did NOT learn thoroughly about types of inductions (although we touched on pit and it's side effects) , medications (maybe just types of pain relieving meds) or complications. All of that I've learned on my own. My training focused on supporting mom, mentally, physically, emotionally. Most doulas do not have medical training. A both a doula and a doula client, many policies and procedures are in place due to the litigious nature of L&D, not for mom/baby safety. I love it when a doula and staff can work together to bypass the P&P that the MOTHER does not want.

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Specializes in OB, Family Practice, Pediatrics.

You are right; it depends on the training organization. Many other Doula trainings have developed over the years since DONA; and many Doulas are choosing the other organizations. IMO continuing education is critical regardless of who your organization is. I agree that it is wonderful when the staff and Doula can work together and respect the mother's wishes; as there are policies and procedures which have been shown not to be for mom/baby safety.

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Specializes in Reproductive & Public Health.
Our hospital has banned us from holding legs anymore...too many nurses have gotten hurt that way. Now we are to position them in stirrups or ask that they pull their own legs into position. The docs are not happy with it but I have to say my shoulders and arms are. :)

Yep, us too. Unfortunately we still end up doing it more often than not, especially since us crazy midwives don't like to break down the bed and use those damn stirrups!

I agree with previous posters that a good doula can be an indispensable part of the team during a birth. I love to labor sit and will happily spend hours at a laboring patient's bedside, but the reality is I probably have 2 postpartum patients and maybe someone in triage, plus charting, giving meds, etc etc etc. And it is nice to have someone who is familiar with mom's wishes and can help her verbalize them when she is in the midst of hard labor.

I have worked with a few doulas who clearly were mistrustful of the staff and of hospital birth in general, and who would try to talk patients out of needed interventions while we were out of the room, or who would want to try things like homeopathics for augmentation, or would focus on things like uninterrupted skin to skin when a more pressing matter (like, massive PPH) might make that impossible. I have also worked with providers who were instantly distrustful of doulas and seem to flag the patient as "one of those patients" just by virtue of their having hired a doula. Not good.

I'm not the type who would use a doula myself, despite having had my kids at home, unmedicated. I just don't like people I don't know intimately all up in my business when I am working hard! But for people who want them, they can be amazing. ESPECIALLY for things like breastfeeding support when you've got a kid who doesn't seem to quite get it, and you have a gazillion postpartum tasks to complete.

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