L&D RN's opinions on doulas?

[mskate]

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. :)

[obrn2]

I love GOOD doulas. The best doulas help with position changes, encouragement, getting my patients to the bathroom with the IV poles, feeding ice chips and MY FAVORITE, help with changing out dirty chux. OMG. That's the best. I can feel comfortable that my patient gets that "extra" bit of care...holding her hand during a tough contraction or counter pressure during back labor, that's what a good doula can provide. She can also calm an anxious partner and give guidance on what the partner can do to be part of the labor process. Those doulas are invaluable.

A bad doula makes the entire experience awful for mother and staff. My worst experiences are when doulas speak for the patient. Hey, they can be an emotional and physical support all day long, but when they start refusing medical interventions they are NOT qualified to advise, you're going to get on my bad side. Speaking FOR the patient is not in the scope of practice and it's going to piss off the medical staff. And if on top of that, they sit on their ass not helping as I'm trying to get the patient to the bathroom or moving them in bed, then it's going to be a bad day for all.

By the way, doulas DO have a scope of practice. Not all are certified, but should follow some basic "rules." Here is the scope from DONA International, one of the certifying organizations: DONA International – Standards of Practice for Birth Doulas and another from CAPPA Certified Labor Doula (CLD) - CAPPA

Also, I'm not shy asking them if they're trained, with whom, how many birth's they've attended, etc. I do that to try and find some common ground so that the entire room begins to believe we're on the same team.

Overall, I'm happy to work with them because I try to stay positive!

[DreamerMW]

Not an RN yet, but on ob rotation at the moment. Just a few days ago a GBS+ woman came in mi-morning, claiming that her water broke about 6 hours ago. Why didn't she come in right away? Her doula said that she could take her time. At the time of admission, she was already mildly febrile. Fast forward 6 hours, the woman has a temp of 103, baby's HR in the 180-90's with minimal variability. Needless to say, her doc and the L&D RNs were NOT happy. She ended up with a cesarean, a nasty uterine infection and a baby in the NICU.

[Mr Midwife, BSN, RN]

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

All this means is that she is a business person. If you look at the standard criteria for the defination of a professional it needs both a form of regulation (such as medical or nursing boards) which ensure a standardised knowledge of a "unique body of knowledge". As such I wouldn't consider a doula to be a professional.

By all means the good ones take the pressure off me when it comes to dealing with normal labour and birth but when there is deviation from the normal the they can be the biggest hinderance which they are still blindly holding onto ideas of normality when there is clearly an abnormal situation.

[Race Mom, ASN, RN]

Visiting the newborn in L&D, as the nursery nurse, I was happy to comply with the family's request of waiting 2 hours from birth for bonding. I arrived a few minutes prior to 2 hours (parents were accepting of vitK but not erythromycin) to give the VitK in our standard 2 hour time frame, as well as newborn assessment/Ballard/etc. I had prepped the VitK, ready to give, and the doula walked in between me and the infant (on the warmer) and coo'd over the infant for at least 2 mintues while I stood there with an exposed needle. The warmer is in a confined area in the room, so I could only feel that it was intentional. The rest of the family did the same thing repeatedly during my assessment. I was hoping to get it all done quickly so they could continue with the bonding, but my assessment ended up taking about 45 minutes with all the "stand in front of the RN while she is working". It was frustrating. In the end, the family thanked me for not taking the baby off the breast and allowing for bonding. No harm, no foul, but my interest is that the baby is transitioning well and I need to assess that. That is what we do in a hospital environment. The baby is just as important as the mother.

[DWelly14]

It is also a misconception that Doulas have no medical training.

Not everywhere. I know where I work there is a vast array of doulas, from the ones that do have medical training and can be very helpful, to the ones that just decided they wanted to call themselves doulas and can at times give very dangerous advice to patients. Perhaps it's just the hospital that I work at, but there is no investigation into the doulas that come in with our patients. It's usually the patient says "this is my doula" and that's it. If there was some way to know what training the doulas I work with had, I think I'd have a lot more trust in them and be less annoyed when my patients bring new ones in. Yes, there are a few that I've worked with many times and LOVE! But there are many that I dread seeing in my patients' rooms. I've had a doula tell my patients "oh the baby's heart rate is in the yellow so it's fine" even though the baby's baseline had been in the 150s and had been having recurrent late decelerations to the 120s but based on the doula's advice, the patient did not want to reposition or take any other resuscitation interventions. I've had a doula demand to be allowed to go into a c-section with a patient even though the spouse was going and our hospital policy is that only 1 support person is allowed in the OR with the patient, due to space constraints, to the point that security had to be called. I've had a doula tell a patient that my only goal was to make her baby "tank" so the OB could cut her (while I was standing right there assisting with many position changes, applying counter pressure to the patient's back to help with back labor, and doing everything in my power to help the patient have the natural delivery she desired). So yes, some doulas are great and have excellent medical training. But some doulas are not and have no training other than experiential, the internet, and possibly their own deliveries. I feel that doulas are not well regulated at least where I am. So to answer the OPs question, once a doula has proven herself to me and we can work as a team, I LOVE doulas. But I'm always skeptical when I work with a new one. When my friends ask me about doulas, I always encourage them to do their research, and I provide the names of the ones I know and trust. Good support for laboring women is essential and can't always be provided by the RN. However, doula and good support are not always synonymous.

[Surfandnurse]

This is a great thread!mi absolutely love everyone's honesty regarding doulas! I've been an LDRP RN for 3 years and have also had the wonderful opportunity of being close friends and family members "support person." It is absolutely refreshing to attend a birth NOT on the nurses side of the room! It is absolutely enjoyable and just writing this makes me want to attend more births as the laboring woman's support, not the RN.

Of course I could've been doing SVExams and worrying about the heart tones, but instead I shut my brain off and supported the woman who wanted a non-medicated birth; beautiful! The research for doulas is astounding! It can greatly reduce a woman's chance of being cut, and also increases her satisfaction, feeling in control etc.

I completely agree with the other commenters here... Some DOULAS need to step the f&$k back and realize they are NOT TRAINED MEDICAL PROFESSIONALS! Google does not give out degrees. And holy Hannah I would conquer, the thought has crossed my mind so many times, "why didn't you just stay home and deliver if you know everything already?"

take home message: doulas serve a great purpose, please continue to support women in labor, but please let me do the teaching (unless of course your nurse is "the enemy"....)

2nd take home message: LDRP RN's: attend a birth of a friend/family member who wishes for some kick orifice support, you will enjoy it to no end!

[KRVRN, BSN, RN]

I don't encounter doulas much in the NICU, but the one that stands out to me was not good. I ended up arguing that yes, I know newborns can be maintained just fine eating small amounts breastfeeding, even if the latch isn't perfect each time and/or it's a first time mom.

My argument was that the newborn in question was 35wks, s/p respiratory distress, jaundiced and sleepy. Mom's milk was delayed from blood loss, pain, first baby and separation from baby. Once her doula came to visit, everything was a debate. She insisted Mom not consider a nipple shield, SNS with formula, NG feeding or bottlefeeding. She talked a lot about excessive medical interventions and told me we should just stop the IVFs and let baby nurse in her own time because that's what is normal.

I felt like she really had no experience or knowledge of premature babies. They aren't trustworthy and need monitoring. All I was going to do was force her into using bottles and formula. She was very confrontational and it was very uncomfortable. No, I just don't want to see the baby stay longer for phototherapy.

[PNCC2001]

They aren't required to have college degrees; but many in fact do have them and are professionals in other fields as well as, their Doula work.

[BRing914]

The technical job of a doula is to provide comfort measures and emotional support to a laboring couple. They are there to help you get any information you require in order to make an informed decision about your labor, suggest different positions that might help with progression, encourage mom when she hits a wall. Most doula work with mom for at the very least a month or two prior to deliver so there is a level of trust and understanding there. Things doulas are not supposed to do is anything medical. I always told my clients if a dr or a nurse did it it was out of my scope. Doulas should not be monitoring heart rates, blood pressure, checking dilation. Doulas are not there to take the place of a meidcal professional.

However, like in most professions, you will have your good doulas and your bad doulas. Where I live we have some amazing women that I wish I had met prior to getting my trining because I feel I would have benefited from being under their wigs while learn the business. Theres several doulas here that I wouldn't get near with a 50 foot pole and would not recommend to anyone because they often over step scope. They give the rest of the doulas here a very bad name.

Doulas can be invaluble, and studies have found they help reduce the risk of the need for interventions. Women should have the right to one, if they want one, and hopefully one day our system will find a good balance of doulas working along side nurses and drs for the best out come possible.