Doulas: love them or hate them.

Specialties Ob/Gyn

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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.

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I think there are a lot of expecting moms who like the idea of a birthing plan, and a doula can be instrumental in helping with that. However, I have known many a mother (myself included) who once everything gets going, welll....to heck with the birthing plan. (and birth in itself is not a known typical situation) I think a strong partner of any sort can talk with the mom prior to the birth about "worst case scenario" cause when a mom has had enough, and wants pain relief, then she should get it. And right or wrong, I would not want anyone to try and change my mind. I know my pain threshold. Period. Just my 2 cents worth....

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

I haven't read more than the title of this thread so far, but just had to post, and then I'll go back and read everything.

Doulas: LOVE a good one.

LOVE to make fun of the bad ones.

Sorry, that's probably not very nice, but the bad ones I've encountered have been so ridiculous that it's impossible not to just shake your head and wonder "What the F?"

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Specializes in Med/Surg.

I do not work in L&D but to me this post might as well be about family members. There are some we love. They help and comfort the patient and assist in things like walking them, fetching water/blankets, etc. And some we hate...the ones that try to pretend they know how to do your job better than you do, ask a zillion questions that you've already answered, crowd the patient when you are trying to do an assessment, etc. In the end though good, bad, indifferent if the patient wants them there you do your job and that's it. I do agree with you that its common courtesy to acknowledge anyone in the room with the patient and offer them a drink/blankets/something to eat.

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Specializes in Anesthesia.

I don't think there is anything wrong with the idea of doulas, but the majority of doulas I have met/worked with don't have a clue about anesthesia or IMO about the physiology/medical indications for many of the things done in L&D.

I only let one visitor in during C-sections. I have never been in an OR where it was big enough that people weren't practically tripping over each other as is, and one other person just gets in the way.

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I love them but as a nurse midwife they generally make my life easier so why wouldn't I :) At my facility they are few and far between but I encourage my patients who desire a natural delivery to have one. I think it is a control issue for most.

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I've been a doula for a number of years. I think sometimes staff can encounter a doula with a "strong personality" and form a negative impression, and that impression about doulas in general gets spread amongst the staff. Nurses at one hospital will greet me warmly (and some have even stopped to talk to me in the halls and given me a hug) while at another hospital I barely get acknowledged and you can practically see the mental eye rolling when they find out I'm their patient's doula - and it's not like I do anything differently!

Doula training is usually very minimal. How good a doula is will often depend on how much extra effort she is willing to put into learning about all aspects of birth, using critical thinking skills to overcome their own biases. It also doesn't help that anyone can call themselves a doula, so you get some untrained friend attending the birth that is calling herself a doula, and acting in ways that aren't in line with our standards of practice/code of ethics.

For the record, a doula should NEVER persuade her client to not take pain meds (or force their opinion about any other intervention for that matter). In the case of pain meds, think there is an assumption that we interfere because we often end up with clients who are strongly against using pain meds of any kind. I discuss preferences with my clients well before the birth, and if I have anyone who is either thinking they will get an epidural at the first sign of discomfort, or conversely, think that nothing short of a section will convince them to use pain meds, then I discuss with them the realities of needing to wait until labour is established or that a long difficult birth can also be detrimental if there is no strength left for pushing. My goal for them is a positive birth experience - however the baby actually gets here.

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We don't get a lot of private patients who can afford doulas but our unit is pretty accepting. Many of the L&D nurses where I work are former doulas and aspiring midwives. The doulas I have worked with have been pretty low key and unobtrusive, there to comfort the mother. I was working with one laboring patient and her doula. I suggested that the patient get OOB and I showed her how to rock her hips and hum. The doula was surprised and said so. I guess many doulas think L&D nurses are the enemy.

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Specializes in NICU.

I've only had experience with three doulas, because where I work, moms don't seem to use them often. One was great--very supportive to mother, baby, and the family. They did not cause problems with staff either, they simply made themselves available and backed down when it was appropriate. They simply supported the mother through labor and delivery and helped her to relax.

The second one was supportive to the mother during labor, but VERY rude and pushy and badgered the staff CONSTANTLY. She was like a bad mother-in-law. Nothing made her happy. When the baby came to the nursery for it's bath and assessment, she was at the window beating on it the whole time, informing the staff that skin to skin was best for the baby's warmth and to bring it back to the room NOW even though after 45 minutes of skin to skin with mom in L&D, the baby had a low temp on arrival to the nursery. I came in when it was time to take the baby out (shift change) and understanding that the doula was there to help mom, I went over the safety guidelines and newborn instructions with mom, then left her to bond and the doula to assist her with breastfeeding. I asked her to call me when they were ready so that I could document the baby's latch--which is required by my facility that a RN has to observe and document at least two breastfeeding sessions. Of course, I never got a call, and every time I went in there, she had "just finished" breastfeeding and the doula didn't feel it necessary for me to see because SHE was a breastfeeding expert. I bent over backwards to be nice to this lady, and she was rude and dismissive. She also refused to let any of the family in to see the baby when I brought it out from the nursery because the mother needed quiet time alone with the baby. So as I am leaving the room, a lady asked if she could go in and see mom and baby. I told her that they didn't want visitors for an hour, and the lady started to cry and asked me if I could just tell her she had to leave and she would be back in the morning. I asked her name so I could tell the mother who she was, and the woman replied "I am just her mother." I told her to wait just a second and not to go anywhere, I knocked on the door and then went in and the doula SCREAMED at me I SAID NO VISITORS!! I totally ignored her, addressed the mother and said, your mom is out in the hall and has to leave now, do you mind if she comes in for a moment and sees you before she has to go?? Of COURSE the mother was fine with that. Doula was TICKED though.

The mother was nice, but under the impression--from her doula--that we were all incapable of anything. She got a clue later in the night when she could not get the baby to latch and doula had left to go home, and I had to help her. I guess I did a fine job because the baby nursed, mom was happy, and she told me later she wished she hadn't gotten the doula because all she had done all day was aggravate her and make her anxious because she was pushy.

The third one I dealt with mostly by phone, because the mother in this case was from out of town, and the doula refused to come to the hospital because she didn't want to drive an hour. She was rude, demanding, and had NO IDEA what she was talking about. The mother was GBS positive and had gotten no antibiotics because she delivered quickly, so our neonatologists like to do a CBC and a CRP at 6 hours of age just to make sure that there are no signs of infection. Mom had also ran a fever, and so did baby, so the doctor had discussed this with the mother and she agreed to the screening. When I went to get the baby for the bloodwork, she refused the labs and told me her doula didn't feel it was necessary so she didn't want it done. Then she refused to breastfeed because the baby didn't seem hungry to her (even though he was sucking his fist down his little throat) and her DOULA told her it was okay for newborns to go 3-5 days without eating because they are made that way. She refused pretty much everything because "Her doula said so." I finally got the kid to latch to the breast--when she FINALLY allowed me to help her--and she FINALLY agreed to the bloodwork--but only after the Neo threatened to call DCF on her. Good lord, I was a MESS at the end of that shift having to be the go between for the neo, the doula, and the mother. Mom and I got along great, but I spent MOST of my time in that room (and I had 5 other patients) because of an ignorant doula who couldn't even come to the hospital.

So I get why staff can hate doulas. I totally get it. Out of 3 that I have met, 2 were BAD. Doulas are supposed to be there to support mom through labor and delivery--not give medical advice and make things chaotic.

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Specializes in Labor and Delivery, Medical, Oncology.

I took a DONA doula workshop last spring to sweeten my resume for L&D (hurray!! it worked!) and learn some labor support skills. I also learned lots about the role of a doula as well as the tension that happens between doulas and nurses. In a nutshell, here's "doula 101":

1)Doulas do not give medical direction to their clients. Their role is strictly supportive. Any advice should be qualified with, "but check with you ob/midwife first".

2) Research shows that access to a doula does decrease need for pain medication, instrumental delivery, and c-section.

3) "Why doesn't she just have her mother be her support person?" Doulas have the advantage of being able to provide caring support while being able to maintain a healthy emotional distance that a mother or husband couldn't.

4) Doulas help their clients make informed decisions by reviewing with them the risks, benefits, and alternatives of various interventions. As nurses I think we might interpret this as the doula "butting in" or "standing in our way" or "contradicting the doctor". That's not it at all. She's trying to make sure the client has all the info she needs to make a good decision.

All of this is to say here's what a doula should be. There are bad eggs in every profession and it sounds like we've met a few already. As nurses, I think we should try make doulas our partners. Our job is to make sure the labor is going well from a medical standpoint and (sigh) document the whole thing. Doulas are free to be at the bedside constantly with their focus on the patient. How often have any of us wished for an extra pair of eyes or hands?

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Specializes in Anesthesia.

4) Doulas help their clients make informed decisions by reviewing with them the risks, benefits, and alternatives of various interventions. As nurses I think we might interpret this as the doula "butting in" or "standing in our way" or "contradicting the doctor". That's not it at all. She's trying to make sure the client has all the info she needs to make a good decision.

That is problem as I see it right there. How can someone with very minimal medical training hope to ever be able to competently explain the risks, benefits, and options to a patient? There is no way someone with no medical background aside from a short Doula course is going to be able to explain the R/B/O of epidurals, instrument delivery, and/or c-sections.

According to the website I looked at it only takes a minimum 16hrs of formal instruction to become a Doula. http://www.dona.org/develop/birth_cert_faqs.php#4 IMO a Doula should never be explaining R/B/O to a patient. They don't have the background/education for it.

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That is problem as I see it right there. How can someone with very minimal medical training hope to ever be able to competently explain the risks, benefits, and options to a patient? There is no way someone with no medical background aside from a short Doula course is going to be able to explain the R/B/O of epidurals, instrument delivery, and/or c-sections.

According to the website I looked at it only takes a minimum 16hrs of formal instruction to become a Doula. http://www.dona.org/develop/birth_cert_faqs.php#4 IMO a Doula should never be explaining R/B/O to a patient. They don't have the background/education for it.

Look a little closer... for that organization to certify a doula it is the hours of instruction, attendance at childbirth classes, completion of a reading list, attendance at births with evaluations filled out by the provider, and a test.

The healthcare provider should be the one explaining the r/b/a to a patient, not the doula. The doula may help the patient decide based on the healthcare provider's information. A doula is generally more qualified than the average person to make those decisions, why wouldn't that be helpful?

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