Birth, doula

Doulas and the Medical team… Bridging the Gap

I am a Labor & Delivery nurse in Mississippi and I am also a DTI(Doula Trainings International) trained doula. I woke up with a strong desire to help bridge the gap between nurses and doulas! In fact… the whole birth team.

Doulas, by name, have been used since the 1960’s. Blah blah…There is no secret that doulas can be extremely necessary in SO many ways; from decreasing cesarean rates, decreasing medical interventions, and so much more. I wont list the facts. Advantages of doula use has been proven by research and we talk about the advantages of having a doula a ton, so I’ll spare you this time.

As a Labor & Delivery nurse, I am honored that I get to view both sides. As a nurse, it’s so easy & useful to transform into doula mode and utilize my trained skills to care for my patients. I’m that nurse that’s in my patients’ rooms giving hip squeezes, teaching the husbands and boyfriends how to perform a hip squeeze or perineal massages and teaching him how to be there for her when I’m away. I will massage the feet, play music, make sure the birthing person is staying hydrated, etc… I utilize birthing balls and peanut balls with my patients even as a L&D nurse ( birthing balls are my fav). My roles connect so well because at the end of the day, both the nurse and doula in me has ONE GOAL, to make the birthing person’s birth experience comfortable, beautiful, and memorable…. thus, ultimately having a healthy mom and safe delivery.

The gap I’ve noticed in care is that medical teams are not too fond of doulas. Some love them, some hate to see them coming. Doulas can be so helpful that some nurses hardly ever have to go in the room outside of their normal rounds because the doula has a handle on the non medical parts of care. On the other hand, there are doulas that, plain and simple, CROSS THE LINE! Understanding each team member’s role and setting boundaries are the way we will see improvement in care and bridge the gap. When doulas start respecting the boundaries of the medical team and the medical team respect doulas for their part on the team as well, we will help bridge the gap! Some of you medical professionals have NO IDEA how useful doulas are or what we do… doulas are in those rooms putting in WORK (muscle , tears and sweat)!!! How about stop by sometimes and just watch a doula in action or ask a doula what she or he does and ask the patient how the doula is impacting their birth experience.

Let’s talk BOUNDARIES!

  • Doulas, don’t unplug medical equipment without asking first.
  • If monitors are hooked up, don’t just unplug the monitor parts to help the patient to the restroom unless the nurse has given you permission to do so.
    • Do not put lights, oil diffusers, or other objects on the nurse’s work area. You can have the rest of the room, give the nurse her/his space.
    • Doulas, do NOT argue with the medical staff. Communicate with your client that if at any point there’s question in care, if the family doesn’t understand something or if they need to make a decision, to ask for time to think about it. Ask if mom and baby are okay. Then, discuss procedures, interventions, pros and cons, etc…in private.
    • Doulas, you are there to advocate! Yes…do it and do it well. However, there is a right way to be an advocate without getting into an uproar with the staff. Without insulting them and without making them feel like they aren’t in charge(I know, it’s a team effort but some doctors don’t always get that). Stay polite! Ask for understanding.
  • As a nurse and as a doula, I tell my clients and patients, when in doubt or you’re confused, first and foremost, ask if baby is safe and if mom is safe. Then, ask if you have time to think about it or for further explanation.
  • We are NOT on a battlefield fighting one another people! We should all be working together for that birthing person!

    My doula trainer said something that stuck with me and I remember this every time I work. We have to understand, people do their jobs the way they know how and sometimes when someone is out of their comfort zone, it can bring tension and anxiety. Mostly, it may bring a sense of lost control. Us nurses and doctors like to be in control and that’s not always possible with “Birth Plan Patients”, “doula patients”, “crunchy mommas”, you know what that call us(me included, I was a home birth momma). My trainer told me, “Doctors & nurses don’t come in on their shifts and say, “I’m going to ruin this patient’s birth experience today”. No, they are simply doing what the know how to do, sometimes in too big of a rush, but they are just doing what they know.

    Medical staff, Doulas don’t come in saying we want to make the patients give the staff hell. No! Doulas are there to give those birthing persons mental and physical support. We are there to empower them, to tell them they are safe and capable, to help with position changes to help decrease labor intensity and hopefully assume the optimal position of baby. We are there at the birthing persons’ every need because everyone needs somebody! We remind dad to take breaks & eat and tell mom to rest between contractions. If necessary, we have grandmother run to the store to grab lunch, allowing mom and dad to have some alone time and get oxytocin flowing. (Don’t we love that happy hormone, oxytocin?) We try to keep our clients and family calm when an emergency arises and stay with them throughout anything and any decision they make.

    Medical staff, I get it, sometimes we(medical side) ask questions and the patient looks to the doula. Haha. Boy, this eats some medical staff up. Hear me out though, it’s not like that. The thing is, doulas give birth education and we establish a rapport with our clients. Doulas don’t know everything, but we know a good bit. We’ve been working closely with a client for at least 4 months and they’ve gained a relationship and trust their doula. It’s not that they don’t trust you or want to make you feel like crap because they look to the doula for advice, that’s just who they trust. Most women have been scarred from birth and have heard traumatizing stories. Birthing persons come in scared, y’all. All physicians don’t have the best interest of patients…we all know this. The patients just want help from where they know someone has their best interest.

    In my doula role, I personally do not give ANY medical advice. What I will do is give the pros and cons of whatever decision is on the table.

    My point here is that there are boundaries!!! BOUNDARIES need to be respected by doulas, and the medical staff need to start respecting and appreciating doulas because WE ARE A TEAM!! We are all here for a patient and the family! I wish immensely that the animosity, anger, bad talk, disrespect about doulas and medical teams stop and that we could all learn to work collaboratively, for the benefit of everyone!

    Peace & Love,

    Raquel Scott, BSN, RN, Doula