What do some L&D nurses have against doulas?

[anon456, BSN, RN]

I'm coming here as a student nurse who just spent a couple days in L&D/triage. Before nursing school I was training to be a doula and had seen and supported several births of different kinds (epidural, natural, home, etc). I am an advocate for the patient's needs and wants and I see a place for epidurals for some patients and will not pressure them one way or the other.

When I was starting my rotation the instructor said don't tell them you were a doula, that will close doors for you. Many L&D nurses do not like doulas at all.

So . . . today in triage a woman came in having cx. She had been in several times earlier and had been labeled as a "whiner", a "screamer" and a "frequent flier." She had been sent home several hours earlier and returned with very minimal changes and was not ready for admission yet. She was having cx and they were hurting her, and she was writhing around in the bed unable to get comfortable, however had not made huge progress. They said they would give her an hour and if no progress was made they would send her home again. This pt had some emotional issues going on, which was immediately evident. She was also very tired because of the cx not letting her get any sleep the last couple of days. I asked the nurse if I could spend some time with her and work with her a little bit. The nurses in the past (in other areas of the hospital) had appreciated that I had the time to work with the "high needs" patients and makes them less likely to push their call buttons every 10 minutes to get their pillows fluffed, KWIM? This nurse said sure, see if you can get her to walk.

So anyway, I asked the pt if she was willing to try some things to get her labor maybe going a little more-- and that everyone was different so it may or may not work, but did she want to try? She was interested ans receptive. I walked the halls with her and told her how to squat a little bit with contractions. Then she got tired and wanted to sit, so I showed her how she could sit and rock on the ball or the rocking chair instead of sitting in bed when she was hooked up. In that hour she made good enough progress to get admitted. :) She also started getting fllushed, sweaty, and vomiting a little bit, all signs of labor picking up. I encouraged her to keep sitting in the rocking chair next to the monitor if that was more comfortable than the bed, and to walk if she felt up to it in the time it took to get her fluids in before the epidural. She and her family thanked me so much for my support, and I patted her, said good luck and left.

However, my instructor said later that I might have crossed a line and annoyed the nurses. When the pt was transferred to L&D she asked that I stay with her until her friend arrived and the nurse in L&D was insistent that I leave (in a polite but firm way) and not follow her. I had already understood that I was not going to follow the patient past getting her and her things to the room, so that's all I did.

I don't get it-- maybe I'm just naive. I did not contradict the nurses in any way. I just spent more one on one time with the pt than they might have able to. And I feel that the pt benefited from it, which was the most important thing.

And I also don't understand in general why doulas have a bad reputation in this department. There is research showing that doulas decrease the need for interventions and they even decrease pain perception in some patients. Which leaves the nurse free to carry out the nursing side of things with caring for the pt's safety and health.

[klone, MSN, RN]

I can answer your question from my perspective, as a natural-birthing, birth plan-loving, midwife-in-training L&D nurse...

Some doulas cross the line into pushing the mom into things she may not be in agreement with, or pushing her own agenda, or offering medical opinions. I don't truck much with those types of doulas. What you describe, however, I would have no problems with, and honestly I don't get why nurses wouldn't want the labor support. Labor support is such a time consuming part of being an L&D nurse, and when you have two active pts who want to do it naturally, I gladly welcome the help of a doula!

For other nurses, I think it's a control thing. I don't know. I think some nurses take their baggage into some labors and feel threatened by the idea of natural childbirth.

[CrazierThanYou]

I can answer your question from my perspective, as a natural-birthing, birth plan-loving, midwife-in-training L&D nurse...

Some doulas cross the line into pushing the mom into things she may not be in agreement with, or pushing her own agenda, or offering medical opinions. I don't truck much with those types of doulas. What you describe, however, I would have no problems with, and honestly I don't get why nurses wouldn't want the labor support. Labor support is such a time consuming part of being an L&D nurse, and when you have two active pts who want to do it naturally, I gladly welcome the help of a doula!

For other nurses, I think it's a control thing. I don't know. I think some nurses take their baggage into some labors and feel threatened by the idea of natural childbirth.

As I was reading the OP's post, that is exactly what I was thinking...

[Nicky30, BSN, RN]

I am an Australian midwife so our system is considerably different to yours and as such doulas are only just surfacing.

To give you an example of the hospital where I work I will just describe my last shift......

I had 4 postnatals on the ward and was caring for an induction as well (we are usually the only midwife on the shift and we do everything i.e. antenatal, intrapartum and postnatal care as well). The induction was not going superbly at this point and the babe was in distress a section was being organised and at the same point in time another woman walked in the door who had ruptured membranes and was not yet contracting. Thank heavens the early shift stayed to help me out or I would have drowned.....

I would have been grateful to have the help of a doula too as dad had already fainted once during labour because he saw blood. End of the story was healthy new mum and babe who had gotten themselves a bit stuck, cranky management because of the overtime and exhausted midwife at end of shift.

I am hoping that one day I will be able to work with a doula to see exactly how they can help both the mum to be and me as well. Kudos to you for assisting the woman and her family.

Nicky.

[CNM 26.2]

I agree with klone. Most of the time I love when patient's have doulas but there are those times when the doula can be very overbearing and even to the point of being rude. For the most part, nurses do a good job but no one takes kindly to someone questioning their every move or telling them they are doing things wrong. I have seen some doulas that also have an attitude that they know more than the nurses and they will even tell the patient's this. That is very frustrating. Those are, of course, the minority but sometimes it only takes a few to give the majority a bad name.

[klone, MSN, RN]

To expound on what BCNat wrote, some doulas assume that anyone who works in a hospital setting (nurses, docs, even midwives) are wanting to force the mother into interventions she doesn't want, and are going to arbitrarily take away her freedom of choice. These doulas will poison their clients' opinions of hospital staff in general, making it very adversarial from the get-go. So when a nurse hears there's a doula, she may assume it's a situation like that, and she might enter the situation with trepidation.

[chloecatrn]

I'm not an L&D nurse, but if I were, and that were my patient, you'd have been my best friend. I'd have welcomed an extra set of hands to keep the patient happy and keep her labor moving forward in a manner that was positive and patient friendly. I think you did an excellent thing for that patient, and you should definitely feel proud of what you were able to accomplish.

[HeartsOpenWide, RN]

In my hospital, we usually love the doulas. They are a big help and make our job so much easier. I work in a fairly "groovy" in hospital birth center that has won several awards for % in VBAC, and low C/S through Healthy People 2010. We do water-births and it is not uncommon for a woman to go her entire hospital stay without so much as a saline-lock. However, there are times a nurse just has to step in.

At my first L&D job I had one birth where the doula really ticked me off...ironically she was also a nurse; but did not work in L&D. This doula was pushy and defensive towards the nurses and assisted the woman to refuse treatment that was important. A woman is allowed to refuse treatment, but at the same time we all still have a license to protect.

Having been a doula before becoming an L&D nurse I can see both sides of it. Unfortunately, not too many doulas have been L&D nurses.....

[LDRNMOMMY, BSN, RN]

I gotta agree with klone. Based on what you told me, I don't see how you could have annoyed the nurses. I would have been very thankful to have you help out with and support my patient.

[SmilingBluEyes]

I think the key is cooperation and communication. I love working with the majority of doulas and think they are a wonderful asset to the unit and moms who are aspiring to achieve natural labor. I find myself at a loss when I have a naturally-laboring mom and my charting duties take time from being as supportive as I want to be. I am lucky in that, most of the time, our unit is set up for us to have only one laboring patient assigned to a nurse at a time, whenever possible. This is WONDERFUL. I love to care for all laboring moms, but working with naturally-laboring moms is a special passion of mine. I find most often, I can work beautifully with most any doula and do my best to foster trust between her, the mom/family and myself.

The only doulas I have a problem with are those who seem to overstep their role or set up an adversarial relationship with staff from the beginning. This is hard to overcome and deal with. Fortunately, this for me, is rarely the case.

So to answer your question, I have nothing against doulas. I see them as an asset and a great help to me, in the majority of cases. From what I read, I don't see you did anything wrong.

SOME nurses just have an issue with control and boundaries. That is a sad fact; I work with some of them. For some, it's a power grab. They almost want to "own" the labor experience and think others like doulas are stepping on their toes just by doing their functions. This is too bad, because in the end, we all want the same thing. The best for our moms, babies and families.

[StarrySkies]

I can answer your question from my perspective, as a natural-birthing, birth plan-loving, midwife-in-training L&D nurse...

Klone! Me too!

To the OP, I was actually a doula and a childbirth educator before entering nursing school. I went to nursing school to become a LAD nurse and eventually a CNM. I can tell you that I did NOT tell my nurse manager that I was a homebirther when she hired me, but I did tell her that I was a doula, childbirth educator, and LLL leader. I think that really helped me to get hired.

Some nurses that I work with are not receptive to doulas, but others are. It really just depends on how much the doula helps the nurse.

[klone, MSN, RN]

LLL leader

{smiles} Me too. How long? I did it for 10 years before retiring last year.