Physicians and Labor Support

[May_baby]

A friend of mine in a nearby state was recently told at 36wks by her OB that if she and her husband hired a Doula the Physician would not attend her delivery.

I am nursing student and also have extensive experience (200+ births) as a hospital-based doula. I have never encountered a provider who made it a rule that clients could not seek out a professional support person during labor.

I should add that the physician did not reject me in particular, but Doulas in general.

I would love to help this friend during labor, and be present only as a friend that just happens to have some undisclosed doula training... But on the flip side I know the Physician might be suspicious and this could create tension.

What is your take on a friend serving as a Doula in a situation like this?

I would hate to cause tension with the Physician or hospital staff.

*Clarification*

I am the Doula/Friend.

My friend is the one expecting.

[gdelrosa]

wow... why would the physician feel threatened by the doula? I think your friend should ask her OB why he/she isn't wanting a doula at the delivery. It's kinda suspicious...

[Elvish, BSN, DNP, RN, NP]

I'd be finding me another doc lickety-split.

[nj1grlcrus]

new doctor for me, too. I had one hospital birth, and then went to midwives for the next three, no way I would let a doctor prohibit a doula. Wow, we are really going backwards as far as birthing is concerned.

[grandee3]

How does one become a doula? The Doc is wrong period.....

[shortstuff31117]

Switch doctors ASAP...better yet, tell her to find a midwife...

[BabyRN2Be]

For more information on becoming a doula, go to www.dona.org. I've been a doula for the last 9 years and it's been very rewarding. I work as a volunteer doula as well as free-lance, and the experience has been wonderful.

DONA is not the only certifying organization, but this is the one I'm most familiar with.

FWIW, I'd be looking for another doctor also. A doctor provides the medical services, but does not provide emotional and physical support during the entire labor. I would ask him why he doesn't allow doulas, and as a tongue in cheek question, I'd ask him if he's willing to perform the tasks of doula (supporting you while vomiting, changing positions, massage, general encouragement). If the answer is not acceptable or has an "off" view of doulas, it sort of shows two things:

1. Lack of knowledge of what a doula does.

2. Bad experience with a doula. In this case you have to demonstrate that not all doulas are like this (depending on what happened).

It's very telling if a doctor doesn't want a doula present. It says to me that the doctor does not want to be challenged in the smallest decisions, and is afraid of someone who helps the parents make decisions for themselves.

This is just my opinion on the matter.

[Selke]

The doc can't tell you who you can and can't have in the labor room! Against the law and hospital policy! Just be there and do your doula thing, don't tell anybody that you are a doula, tell them you're her cousin or best friend, and just do your labor support. Don't challenge the staff or question anything; talk to your friend when they're not in the room.

And change providers, needless to say. This OB sounds like an idiot. If you can't change providers this late in the game, why not tell the office secretary to give you copies of your prenatals, then find the local hospital with midwives on staff, and just show up there when you go into labor?

[OC_An Khe]

Actually my understanding of the OP was the MD wasn't banning the doula from the labor room, he was stating his position on who he would accept as a patient. He just wouldn't accept a patient who wanted a doula. His right to do so but not choice I would agree with. Any idea as to why he has objections?

[Elvish, BSN, DNP, RN, NP]

When some OBs & RNs hear 'doula' they hear someone who will be a Nazi about breastfeeding, who will try to interfere with their job. Probably from a bad experience, but sometimes just from misinformation. Some folks have the misperception that doulas are like lay midwives.

Probably, due to the misinformation or bad experience previously mentioned, he feels threatened by her presence. This is just a guess, of course. I would definitely ask him what his objections are to a doula's presence.

The doulas I've seen at our hospital have been wonderful, to the tune of pushing out a >9lb baby with no meds, very small 1st degree tear, and a very nice birth.

[Jolie, BSN]

While your doctor's comments about having a doula certainly raise some red flags, I would talk with him further before running off to find another provider. If he is opposed to ALL doulas, then I would be concerned that he may be inflexible, overly controlling, and insecure in his own practice, not good qualities in an OB. However, if he is referring to one particular doula with whom he has had bad experiences, then you may be able to come to some kind of agreeable arrangement.

I used to work in a birth center with a great group of MDs and CNMs. Most of our patients had detailed birth plans, and we were usually able to accomodate their wishes. One local childbirth educator was so militant and over-the-top that her patients came in to deliver with the (incorrect) impression that we were there to ruin their plans and destroy their birth experiences. It was impossible to provide safe care for some of these patients due to the "brainwashing" they received from this woman. Our manager tried to reach out to this educator to work out a teaching curriculum that was more realistic, and offered to have one of our nurses co-teach with her. She refused, and subsequently some of our MDs and CNMs began to refuse this "educator's" clients as patients, citing their inability to practice safe medicine.

It is one thing for a doctor, nurse or CNM to have to work out differences of opinion regarding treatment with the patient and her partner. That is our job. But it becomes impossible when an "third party", especially one without detailed medical/nursing knowledge, is pressuring a patient to go against medical advice. Due to the litigous nature of OB, many providers are just not willing to deal with this type of situation.

Of course I don't know for sure that this is why your doctor reacted the way he did. It's just a possibility that may be worth checking into.

I agree with the above posters who stated it is not up to your physician to decide who is present during your labor. So, if you can't come to an agreement with him, I would encourage you to start looking for a new provider.

[BabyRN2Be]

As with the CBE example above, there are "bad" doulas out there. Some very militant, midwife wannabes can ruin it for those who understand that we are there, working as a team, for a healthy mom and baby.

In my area, there have been some doulas who are not welcome at certain hospitals and are asked to leave if discovered on premises. Well, L&D at least.