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Old 11-10-2012, 01:56 PM   #11
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Re: Tell Me About Doulas

I totally agree with JenntheMomma's post.

As far as not speaking to the nurses as a doula ever, this is something that I think I don't agree with. There is a way to communicate without being argumentative or making decisions for the mother. It's just weird being a person in the room that is not "allowed" to talk to the nursing staff. I think I mentioned in another thread that at a recent birth the mom desperately wanted the monitors off, and it had been as long as the nurses said was necessary. I offered to go ask the nurses if we could take the monitors off. Maybe some would think that I shouldn't have gone to the nurse's station, but why not?
Also at that birth the nurse repeated over and over to the mother just coming into the hospital that we had to "make sure" that she was "really in labor" because you know, most moms just don't know and they would probably be sending her home. I had been with her at her home for 5 hours and I knew that she was "really in labor", so I just said (really to encourage the mom) "oh, she's in labor". Not in a mean way, just in a definite manner so that mom would feel better about what was going on. The nurse gave me a very mean look and asked me if I had checked her cervix, as if that was the ONLY way that I would know. Of course I hadn't done that, but it really irritated me.

Being a doula is a VERY tough position to be in if the hospital isn't friendly to them or generally has procedures that fascilitate natural birth. It's like a constant balancing act of trying to make sure that mom feels good and knows all of her options, without alienating the staff or putting them on the defensive. Every time I do it I wonder why I'm putting myself in that position, but it's like I forget that feeling and want to do it again the next week! Kind of like my own births, I suppose.
The other part of a doula's job that can be very important is making sure that the parents know their rights. If mom really doesn't want to have a vaginal exam or CFM, she has the right to know that she has the right to refuse. Generally the staff will not inform the mother of this, but will use all kinds of tactics to reinforce what they want to do until the mom caves and does it. But a doula can tell the mother (not in front of the nurses, preferrably,) that she has the right to refuse if that is what she would really like to do.

Case in point- one mother had picked out a dress that she wanted to labor in. As soon as arriving, even though the hospital had said that she could wear what she wanted, she was told by the nurse to put on a hospital gown. Mom insisted that she wanted to wear the dress, but there were all kinds of reasons given to why she should wear the gown. The mother was very reluctant to put on the gown, as it wasn't what she wanted. I told her that she had a right to wear what she wanted to wear, but her mother told her that she should really just listen to the nurse and put on the gown. Eventually the nurse backpedaled and "insisted" that she wear her dress after all. But if she hadn't had me there as her doula, she probably would have put on the gown and already felt defeated in the first 10 minutes. I would never interfere with a medical emergency, but most procedures that are normal in the hospital just aren't that important but can make a huge difference to the mother.

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Old 11-10-2012, 02:22 PM   #12
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Re: Tell Me About Doulas

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Husbands can sometimes get nervous or scared because they are so emotionally invested in you and the baby. A doula is there as a calm person who cares but won't lose her cool easily.
I really like this.

husbands and family members cannot think clearly in these situations. That's why doctors don't treat their own kids, etc. Another party with your best interests in mind is such a great addition to a labor experience.
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Old 11-10-2012, 08:41 PM   #13
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I think a doula who knows her role and abides by it is an awesome thing for a laboring mother. Unfortunately it seems 75% of my experience with doulas has been negative. I think L&D nurses and OBs are seen as these 'evil' people by the 'crunchy' community. We want you to sit down, shut up, and have a baby, preferably by c-section. I have had arguments with doulas who seem to think they know better than me, about a patients medical care. That really rubs me the wrong way. I have worked LONG and hard to have the knowledge I have, as well as the years of experience. Doulas do not have the same knowledge. But most that I have worked with seem to think they know best.

Sorry if I sound bitter, I have not had good experiences with doulas. To me the 'idea' of a doula is a great thing. I just haven't witnessed it yet myself. I'm sure there are FANTASTIC ones out there, don't get me wrong. But at the end of the day I want to go home with the memory of a mom and dad smiling over there brand new newborn baby. Sometimes interventions are the ONLY way to make that happen. And when it's an emergency situation I don't need someone with no medical background telling my patient what is best.

Anyway sorry for what turned in to be a rant. I think if you ask a doula how they feel about us L&D nurses it wouldn't be rainbows and sunshine either lol.
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Old 11-10-2012, 08:49 PM   #14
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Quote:
Originally Posted by z2akids

For L&D people - if a doula came out and told you mom wanted x treatment done or stopped, would you? I see this from my hospital view and cannot imagine altering treatment of an A&O competent adult based on what a "friend" told me. If a friend/family member/paid support person came to the nurses' station and told me that the patient wanted X, I would head to the room and talk to the patient, but I would do the same thing if the patient hit the call button. Unless the individual is the POA, I take treatment decisions from my patients, not other individuals. Granted, my patients are sick, so perhaps there is a big difference there. I cannot tell you how many times I've been admitting an 80+ year old COPD patient and asked them about a flu shot and their 50/60 year old child tells them - oh, you don't want that, everyone I know gets the flu after the shot. They wind up throwing up for weeks. I just keep my mouth shut and move on and discuss with with the patient when visiting hours are over.

Do doulas take courses on reading strips and are they competent to read the monitors and what is going on with baby? Do you become certified/licensed for that sort of thing? As a doula, do you advise your client on what a decel (for example) means in terms of what the nurse/doctor wants to do?
In order to actually answer your questions.... Lol

If a doula came to my desk and said for example, the pt wants the monitor off. I have no problem with that. I would go into the pts room and either take her off or explain why I can't or am uncomfortable with doing so. What I have a problem with is then if the doula decides to tell her patient it's fine, it's your right, just take the monitor off. Meanwhile baby is having late decels to the 80's. Doulas are not trained to read strips. So how can she with no training, tell the pt it's ok? I can't answer your question about if a doula advises her client about what the nurse/dr will do in the event of a decel, but without that training they shouldn't. Some decels are perfectly ok and even normal. So why get a mom all worried and wonder why we aren't doing anything when really there is nothing that can be done, for example with an early decel.
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Old 11-11-2012, 07:07 AM   #15
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Re: Tell Me About Doulas

I forgot to answer the part about reading the monitor, etc. No, I do not care to read the monitor at all. I would much rather focus on the mother. But I don't always think that when something is recommended, like a c-section, that the medical personnel knows best. Case in point; I was texting a friend who I wanted to be with during her birth, but couldn't. Another friend went who isn't a doula, but she was communicating with me and I was offering suggestions. The doctor recommended a c-section after she was "stuck" at 9.5 cm for 3 hours. Via cellphone I told them that if there was no concern with the baby's heartrate or mom's temperature, etc, that it was not riskier to continue trying for a vaginal birth. I repeated this many times, as the mother repeatedly got pressure to just have a c-section because "FTP", "baby was probably too big", "her pelvis was probably too small," and "we don't have any other options from here". During the 8 HOURS that she was waiting to be fully dilated, there was no problem with the baby's heartrate or mom, yet she was still pressured with a c-section. I advised her that studies have shown that up to 50% of women will go on to deliver vaginally if given just a few more hours to labor. In the meantime I suggested position changes and encouragement. She did give birth vaginally, much to her doctor's surprise, 10 hours after she was 9.5cm. Even the doctor told her that she was glad that her patient decided to wait and wait. And my friend says that she almost certainly would have had a c-section if I hadn't encouraged her to wait longer. If I had been at the hospital, maybe the nurses would have labelled me as a "problem" doula, simply because I was encouraging the mother to trust her body as long as there were no other problems.

MelDM- I'm sorry that you have had bad experiences with doulas, but I also think that sometimes hospitals/nurses/doctors and doulas have different agendas, and therefore some toes will be stepped on. I try very hard to maintain a good relationship with the nursing staff and doctors, but when a nurse or doctor wants to rigidly abide by hospital policy on something that is really not that big of a deal, and isn't what the mom wants (I think this is more common than a doula saying something during a true medical emergency that is out-of-place), then I think it's inevitable that feathers will be ruffled. I just hope that everyone can get along a little as doulas become more common, if that becomes the case.
I also wish that some of the nurses would consider how difficult it is to be a doula, to be supporting the mother even when she wishes things that are against hospital policy. Let's be honest. All of those policies are NOT for patient safety/ comfort. Many are because of liability and convenience. If the mom doesn't want to jump through all of the hoops and has a doula, don't blame the doula. Mom has a right to make those decisions. Sometimes it's easier for her to stand up for what she wants because the doula can remind her of what she really wanted, but that doesn't change that it's coming from the mother, not the doula.
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Old 11-11-2012, 07:19 AM   #16
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Re: Tell Me About Doulas

I have heard that in Europe the hospitals are set up very differently than here for people having babies. If the expectant mother is low risk, she would go to a part of the hospital where midwives basically take care of the birth. Those with any problems/issues would go to a different part of the hospital where they can be more closely monitored and have surgery, if necessary. This seems like a much better system to me. I don't think nurses would be as irritated because they could focus on the expectant mothers that actually need medical intervention. And mothers would get better care. I think it's true that in the US, care providers don't work as a team enough and people take sides. It's sad.
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Old 11-11-2012, 07:45 AM   #17
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Re: Tell Me About Doulas

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Originally Posted by songbird516 View Post
I totally agree with JenntheMomma's post.

As far as not speaking to the nurses as a doula ever, this is something that I think I don't agree with. There is a way to communicate without being argumentative or making decisions for the mother. It's just weird being a person in the room that is not "allowed" to talk to the nursing staff. I think I mentioned in another thread that at a recent birth the mom desperately wanted the monitors off, and it had been as long as the nurses said was necessary. I offered to go ask the nurses if we could take the monitors off. Maybe some would think that I shouldn't have gone to the nurse's station, but why not?
Also at that birth the nurse repeated over and over to the mother just coming into the hospital that we had to "make sure" that she was "really in labor" because you know, most moms just don't know and they would probably be sending her home. I had been with her at her home for 5 hours and I knew that she was "really in labor", so I just said (really to encourage the mom) "oh, she's in labor". Not in a mean way, just in a definite manner so that mom would feel better about what was going on. The nurse gave me a very mean look and asked me if I had checked her cervix, as if that was the ONLY way that I would know. Of course I hadn't done that, but it really irritated me.

Being a doula is a VERY tough position to be in if the hospital isn't friendly to them or generally has procedures that fascilitate natural birth. It's like a constant balancing act of trying to make sure that mom feels good and knows all of her options, without alienating the staff or putting them on the defensive. Every time I do it I wonder why I'm putting myself in that position, but it's like I forget that feeling and want to do it again the next week! Kind of like my own births, I suppose.
The other part of a doula's job that can be very important is making sure that the parents know their rights. If mom really doesn't want to have a vaginal exam or CFM, she has the right to know that she has the right to refuse. Generally the staff will not inform the mother of this, but will use all kinds of tactics to reinforce what they want to do until the mom caves and does it. But a doula can tell the mother (not in front of the nurses, preferrably,) that she has the right to refuse if that is what she would really like to do.

Case in point- one mother had picked out a dress that she wanted to labor in. As soon as arriving, even though the hospital had said that she could wear what she wanted, she was told by the nurse to put on a hospital gown. Mom insisted that she wanted to wear the dress, but there were all kinds of reasons given to why she should wear the gown. The mother was very reluctant to put on the gown, as it wasn't what she wanted. I told her that she had a right to wear what she wanted to wear, but her mother told her that she should really just listen to the nurse and put on the gown. Eventually the nurse backpedaled and "insisted" that she wear her dress after all. But if she hadn't had me there as her doula, she probably would have put on the gown and already felt defeated in the first 10 minutes. I would never interfere with a medical emergency, but most procedures that are normal in the hospital just aren't that important but can make a huge difference to the mother.
I don't understand why it would be weird not to be "allowed" to talk to the staff. I mean, I don't think that a doula shouldn't be allowed to converse with the staff, but I don't see why they should be allowed to provide treatment decisions. While I will happily grab a cup of tea for a patient when her family member comes out and asks (and she's allowed to have it), unless the individual is the POA, they don't count in terms of treatment decisions from my end. Just last night, I had a husband clock watching and paging me the minute it had been 3 hours since his wife's last pain meds. He wanted me to give her more immediately. Well, IMO it wasn't safe (she was snowed from the last round of pain meds, her resps were low and she hadn't woken up enough to ask for them). He was very unhappy, but he wasn't my patient. His wife, who was competent and did not have any advanced directives was my responsibility.

It sounds from your post like your type of doula is different than several of the other doulas who posted or were discussed. Does that vary on whether you participate in a particular organization? Where do doulas get their education that gives them the information to be able to provide their clients with all of their options? Are you talking about treatment at tht point? If you are offering medical advice (and your later post about telling your friend to refuse a c-section over the phone sure sounds like you are offering medical advice), I am interested in understanding where doulas gain the education to do so. Do you worry that doulas will become regulated? Do you carry malpractice insurance in case a client takes your advice and something goes wrong? Do you worry about liability?

In a medical setting, I have told my patients that they have the right to refuse treatment. However, that doesn't mean that I won't discuss the matter extensively if they want to refuse a treatment that I believe to be important. There are certainly some things that may be standing orders that aren't all that important for some patients. For instance, my patient who was walking the halls last night who had acute (not chronic) condition really didn't need the heparin shot that was on her med list. But, the majority of my patients really need it. Does your doula education help you discriminate between patients for whom an intervention (non-emergency) may well be indicated versus a patient who perhaps can get away without the same intervention?


Quote:
Originally Posted by songbird516 View Post
I forgot to answer the part about reading the monitor, etc. No, I do not care to read the monitor at all. I would much rather focus on the mother. But I don't always think that when something is recommended, like a c-section, that the medical personnel knows best. Case in point; I was texting a friend who I wanted to be with during her birth, but couldn't. Another friend went who isn't a doula, but she was communicating with me and I was offering suggestions. The doctor recommended a c-section after she was "stuck" at 9.5 cm for 3 hours. Via cellphone I told them that if there was no concern with the baby's heartrate or mom's temperature, etc, that it was not riskier to continue trying for a vaginal birth. I repeated this many times, as the mother repeatedly got pressure to just have a c-section because "FTP", "baby was probably too big", "her pelvis was probably too small," and "we don't have any other options from here". During the 8 HOURS that she was waiting to be fully dilated, there was no problem with the baby's heartrate or mom, yet she was still pressured with a c-section. I advised her that studies have shown that up to 50% of women will go on to deliver vaginally if given just a few more hours to labor. In the meantime I suggested position changes and encouragement. She did give birth vaginally, much to her doctor's surprise, 10 hours after she was 9.5cm. Even the doctor told her that she was glad that her patient decided to wait and wait. And my friend says that she almost certainly would have had a c-section if I hadn't encouraged her to wait longer. If I had been at the hospital, maybe the nurses would have labelled me as a "problem" doula, simply because I was encouraging the mother to trust her body as long as there were no other problems.

MelDM- I'm sorry that you have had bad experiences with doulas, but I also think that sometimes hospitals/nurses/doctors and doulas have different agendas, and therefore some toes will be stepped on. I try very hard to maintain a good relationship with the nursing staff and doctors, but when a nurse or doctor wants to rigidly abide by hospital policy on something that is really not that big of a deal, and isn't what the mom wants (I think this is more common than a doula saying something during a true medical emergency that is out-of-place), then I think it's inevitable that feathers will be ruffled. I just hope that everyone can get along a little as doulas become more common, if that becomes the case.
I also wish that some of the nurses would consider how difficult it is to be a doula, to be supporting the mother even when she wishes things that are against hospital policy. Let's be honest. All of those policies are NOT for patient safety/ comfort. Many are because of liability and convenience. If the mom doesn't want to jump through all of the hoops and has a doula, don't blame the doula. Mom has a right to make those decisions. Sometimes it's easier for her to stand up for what she wants because the doula can remind her of what she really wanted, but that doesn't change that it's coming from the mother, not the doula.
So, I guess the question is who does know best when it comes to deciding whether or not to go ahead with a c-section, if it isn't the doctor? I don't mean to be contrary or pick on you, but I have a difficult time believing that the person best suited to make that decision is the friend on the other end of a telephone who isn't even there.

I can get the end of this post - about reminding the mother of what she really wants. I can see how having someone there who is not emotionally conntected to the events may be very helpful in that way for some women and that seems to be the gist of what several other posters have mentioned.
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Old 11-11-2012, 08:25 AM   #18
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Re: Tell Me About Doulas

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I think a doula who knows her role and abides by it is an awesome thing for a laboring mother. Unfortunately it seems 75% of my experience with doulas has been negative. I think L&D nurses and OBs are seen as these 'evil' people by the 'crunchy' community. We want you to sit down, shut up, and have a baby, preferably by c-section. I have had arguments with doulas who seem to think they know better than me, about a patients medical care. That really rubs me the wrong way. I have worked LONG and hard to have the knowledge I have, as well as the years of experience. Doulas do not have the same knowledge. But most that I have worked with seem to think they know best.

Sorry if I sound bitter, I have not had good experiences with doulas. To me the 'idea' of a doula is a great thing. I just haven't witnessed it yet myself. I'm sure there are FANTASTIC ones out there, don't get me wrong. But at the end of the day I want to go home with the memory of a mom and dad smiling over there brand new newborn baby. Sometimes interventions are the ONLY way to make that happen. And when it's an emergency situation I don't need someone with no medical background telling my patient what is best.

Anyway sorry for what turned in to be a rant. I think if you ask a doula how they feel about us L&D nurses it wouldn't be rainbows and sunshine either lol.
That's a shame that you've had mostly negative experiences. I think the training in Canada is different in the US. The role of the Doula and the people who employ them may be different as well. I'm in the US and most of my clients are not crunchy, nor do they think nurses/Doctors are evil. They just want another person there to focus solely on them and not monitors or running in and out of their room to tend to other patients.

Quote:
Originally Posted by steph410 View Post
I have heard that in Europe the hospitals are set up very differently than here for people having babies. If the expectant mother is low risk, she would go to a part of the hospital where midwives basically take care of the birth. Those with any problems/issues would go to a different part of the hospital where they can be more closely monitored and have surgery, if necessary. This seems like a much better system to me. I don't think nurses would be as irritated because they could focus on the expectant mothers that actually need medical intervention. And mothers would get better care. I think it's true that in the US, care providers don't work as a team enough and people take sides. It's sad.
Yes many countries in Europe are set up very differently than in the US. Their whole maternity system is different. Midwives instead of Doctors for low risk women, encouraging being out of bed and the use of alternative pain relief and so on.

Quote:
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I don't understand why it would be weird not to be "allowed" to talk to the staff. I mean, I don't think that a doula shouldn't be allowed to converse with the staff, but I don't see why they should be allowed to provide treatment decisions. While I will happily grab a cup of tea for a patient when her family member comes out and asks (and she's allowed to have it), unless the individual is the POA, they don't count in terms of treatment decisions from my end. Just last night, I had a husband clock watching and paging me the minute it had been 3 hours since his wife's last pain meds. He wanted me to give her more immediately. Well, IMO it wasn't safe (she was snowed from the last round of pain meds, her resps were low and she hadn't woken up enough to ask for them). He was very unhappy, but he wasn't my patient. His wife, who was competent and did not have any advanced directives was my responsibility.

It sounds from your post like your type of doula is different than several of the other doulas who posted or were discussed. Does that vary on whether you participate in a particular organization? Yes, different organizations have different 'code of conduct'Where do doulas get their education that gives them the information to be able to provide their clients with all of their options? There are several different organizations that traind doulas DONA, CAPPA, ICEA, CBI, BAIAre you talking about treatment at tht point? If you are offering medical advice (and your later post about telling your friend to refuse a c-section over the phone sure sounds like you are offering medical advice), I am interested in understanding where doulas gain the education to do so. Do you worry that doulas will become regulated? Do you carry malpractice insurance in case a client takes your advice and something goes wrong? Do you worry about liability? I can't speak for her, but I give information on everything that can happen in childbirth to my clients. I get my information from medical text books, medical journals, and from the hospital that they'd be delivering at. I don't think Doulas would become regulated, maybe hospital based ones, and it wouldn't bother me if they did. You dont' carry malpractice insurance because you're not practicing medicine. You are there for support only. Most Doulas I know however do have in their contracts that if a client is unsatisfied that they get a portion of the fee back.

In a medical setting, I have told my patients that they have the right to refuse treatment. However, that doesn't mean that I won't discuss the matter extensively if they want to refuse a treatment that I believe to be important. There are certainly some things that may be standing orders that aren't all that important for some patients. For instance, my patient who was walking the halls last night who had acute (not chronic) condition really didn't need the heparin shot that was on her med list. But, the majority of my patients really need it. Does your doula education help you discriminate between patients for whom an intervention (non-emergency) may well be indicated versus a patient who perhaps can get away without the same intervention? It really depends on how extensive you've done training. Some Doulas do not discuss things like that and others do. All doulas are different. Many Doulas here are also nurses, their education is obviously different from a Doula who has no medical college background.




So, I guess the question is who does know best when it comes to deciding whether or not to go ahead with a c-section, if it isn't the doctor? I don't mean to be contrary or pick on you, but I have a difficult time believing that the person best suited to make that decision is the friend on the other end of a telephone who isn't even there.

I can get the end of this post - about reminding the mother of what she really wants. I can see how having someone there who is not emotionally conntected to the events may be very helpful in that way for some women and that seems to be the gist of what several other posters have mentioned.
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Old 11-11-2012, 08:30 AM   #19
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Re: Tell Me About Doulas

While I think it's nice you're asking questions, it does seem like you have a chip on your shoulder about anything not mainstream. You also live in Ohio, which isn't the friendliest place for Doulas and Midwives (I have several friends there as well as family and one is a Doctor). That can certainly skew your view of things. Each state is different it seems when it comes to Doulas. The people who employ them, what they want from a Doula and so on. Again, Doulas are not a new invention, they've been around for a very long time, my own mom had a Doula for her births. They are just becoming more popular which is why you hear about them more.
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Old 11-11-2012, 10:44 AM   #20
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I didn't want to continue to hijack another thread, but I am really curious what those who are doulas, have had doulas or who work in L&D think is the role and purpose of a doula.

Let me preface this by saying, I'd never even heard of a doula 12 years ago when I was pg with my first. I would not have wanted anyone other than my DH in the room with us while we were having our kids. We didn't have friends or grandparents or anyone like that there. I cannot imagine having hired someone to be there in tha very intimate time with us.

That being said, when I think doula - I think basically paying someone to fill in a role as friend/family member. Someone to apply counterpressure or to supply support while you are on a birthing ball. Someone to take some pictures so that your spouse can be in them as well.

But, when I read threads here, I read things like - deal with the nurses, tell the nurses what mom wants, tell the mom the pros/cons of contemplated treatments, etc. Is this the role that doula is fulfilling generally?

For L&D people - if a doula came out and told you mom wanted x treatment done or stopped, would you? I see this from my hospital view and cannot imagine altering treatment of an A&O competent adult based on what a "friend" told me. If a friend/family member/paid support person came to the nurses' station and told me that the patient wanted X, I would head to the room and talk to the patient, but I would do the same thing if the patient hit the call button. Unless the individual is the POA, I take treatment decisions from my patients, not other individuals. Granted, my patients are sick, so perhaps there is a big difference there. I cannot tell you how many times I've been admitting an 80+ year old COPD patient and asked them about a flu shot and their 50/60 year old child tells them - oh, you don't want that, everyone I know gets the flu after the shot. They wind up throwing up for weeks. I just keep my mouth shut and move on and discuss with with the patient when visiting hours are over.

Do doulas take courses on reading strips and are they competent to read the monitors and what is going on with baby? Do you become certified/licensed for that sort of thing? As a doula, do you advise your client on what a decel (for example) means in terms of what the nurse/doctor wants to do?

Honestly, I think it I had wanted a paid person in the room with me while laboring, it would have been someone with a massage license. Perhaps I am just too much of a control freak to give up my voice to advocate for myself to someone else.
I haven't read any responses, and I may have even responded already in that other thread. But I wanted to reply here too. :-)

I'm a student doula in a DONA approved course and plan on completing the DONA certification and operating my practice under the scope of practice and ethical considerations set forth by DONA. Because the doula profession is not regulated, there will be people working as a doula who do my abide by this same scope of practice and ethical considerations. It is my personal opinion that operating outside of this scope of practice is irresponsible and endangers both the client's relationship with their provider and the reputation of doulas with the medical community.

Here is the scope of practice info;
http://www.dona.org/aboutus/standards_birth.php

http://www.dona.org/aboutus/code_of_ethics_birth.php

You can see from these that a doula is not trained to read EFM, and it is outside our scope f practice to interpet EFM. That's the nurses job.

I have gone out to communicate with the nurses " mama wants to talk about x/y/z" but I consider that as me funcioning as a call button and not as me being her mouthpiece. I still expect mama to communicate for herself and for the nurses to come in and speak with her. If things seemed to be deviating from moms original birth plan we are trained to ask mom is she feels like she has all the information she needs or if she wants time to talk/think it over with her partner. It is NOT our role to contradict the doctors recommendations or to suggest alternatives, but to remind her that she can ASK if there are any and help her process and adapt with the change in plans.

I know there are some doulas who function outside of this framework and view themselves as the guardians of unmedicated vaginal delivery, and I personally don't view that as my role. My role is to provide a constant presence of support for mom so that she has the support (in whatever form she needs) as her labor takes shape. That would potentially make me a "traitor" to the natural childbirth community bc I'm not set on advocating to protect moms birth or fighting for her rights, but I think that taking that posture actually hurts mamas and the doula profession.

As to your not feeling like you would have wanted/needed a doula - not everyone feels that need, and that's ok. :-)

Every woman has a different personality/temperament, different needs for support, different preferences for managing the challenges of labor, and different social/family dynamics. Some women feel completely satisfied with the support of their partner and the nursing staff, and some find great benefit in having someone who is trained in comfort measures and other support measures (emotional support, decision making - a non-judgemental kind, etc) who can provide a continuous presence and provide reassurance that perhaps the partner or other family members aren't able to provide or need support to provide - if that makes sense?
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