Tell Me About Doulas

[BeccaSueCongdon]

Originally Posted by MelDM 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.

This is a good clarification - it's within a doulas role to ask a question for mom like this, but not to provide the answer for her in place of the provider, if that makes sense.

Regarding decels: I've read as extensively as I could (as extensively as I think a layperson CAN) and I feel like I have a good grasp on them. But I also understand that I did that reading over the course of a few months on te Internet, and not in medical school. I would never dream of interpreting that info for a mom. The appropriate way to address stuff like that is to ask the nurse how things are going and if she has a moment to explain it to mama and educate us.

[BeccaSueCongdon]

Originally Posted by BeccaSueCongdon This is a good clarification - it's within a doulas role to ask a question for mom like this, but not to provide the answer for her in place of the provider, if that makes sense. Regarding decels: I've read as extensively as I could (as extensively as I think a layperson CAN) and I feel like I have a good grasp on them. But I also understand that I did that reading over the course of a few months on te Internet, and not in medical school. I would never dream of interpreting that info for a mom. The appropriate way to address stuff like that is to ask the nurse how things are going and if she has a moment to explain it to mama and educate us.

Also, to add to what I was saying, I think asking questions for mom like "how would it be if she did x/y/z now?" Instead of posing it as a demand. That approach of fighting for moms rights really hurts mom in the long run, I think. And it disrespects the birth team. The nurses and midwives/doctors involved in her care are real people with their own experiences and backgrounds that shape how they approach birth, mom and the doula. And starting out with a demanding and defensive stance disrespects not only their contribution to the birth but also lays the foundation for a negative view of doulas in the future and creates barriers for the profession and for moms who want their support.

[RunawayBunny]

I read most the responses and realize the conversation has gone more to doulas and nurses, but I figured I would add another mom perspective. My DH will be out of town for my birth. I will most likely be with my mom, but she kind of freaked out at my son's birth. So I have decided to hire a doula. I want someone to help me breath, someone to say "you are doing great, you dont need to give in to that epidural yet". My mom cant do that and really my dh didnt do great either. When I told my l&d nurse I was thinking about an epidural she said, "good idea, no need to be a hero."

I have found a great provider that knows my desires, but I trust his medical opinion. When I told him I would be hiring a doula he told me that was a great idea and gave me a few business cards with ones he has worked with recently. Now I would not at all say he or my hospital is "crunchy". The cs rate is close to 30%, midwives are illegal, and bfing is the lowest in the nation. So there is a doc who can see the value and appreciate that sometimes a mom needs to bring her own support.

[MyLovely]

I think the problem is that there is a divide between what doulas are supposed to do and what they actually do. I was with my sister for her last birth, and her doula was awesome. Never offered medical advice, just told her she was doing well and helped her cope with pain. However, she seems to be the rarity. I don't think a lot of doulas realize the toes they may be stepping on in certain situations, because so much of it comes down to wording and vocal inflections. For instance, if a doula politely says "My client would like to be taken off her her monitor, as it's been 45 minutes and all is looking good," I'm sure that the majority of nurses and doctors wouldn't think twice. However, if that doula is thinking "geez, I can't believe the unnecessary procedures this poor woman has already been subjugated to," that same phrase will come off very differently...sarcastic and know-it-ally, and she won't even realize.

Anyhow, this topic is something I feel conflicted about. I do have a lot of problems with the way that the maternity system is run in the US for low-risk women, and I think that, in theory, doulas could help. However, at present, all it ends up doing in a lot of instances is pissing off doctors and nurses even more, which certainly isn't going to motivate them to let the next woman in labor step outside of the box.

I feel pretty fortunate in that it's not something I worry about (doula versus non-doula). I have no reason to plan on anything other than low-risk pregnancy/birth, in which case I would birth either at home or in a birth center with a CNM team, and a doula wouldn't be necessary. If I required interventions, I would obviously be happy to be in a hospital and would fully trust my doctor and nurse team to take care of me, rendering a doula unnecessary.

[JennTheMomma]

Originally Posted by MyLovely I think the problem is that there is a divide between what doulas are supposed to do and what they actually do. I was with my sister for her last birth, and her doula was awesome. Never offered medical advice, just told her she was doing well and helped her cope with pain. However, she seems to be the rarity. I don't think a lot of doulas realize the toes they may be stepping on in certain situations, because so much of it comes down to wording and vocal inflections. For instance, if a doula politely says "My client would like to be taken off her her monitor, as it's been 45 minutes and all is looking good," I'm sure that the majority of nurses and doctors wouldn't think twice. However, if that doula is thinking "geez, I can't believe the unnecessary procedures this poor woman has already been subjugated to," that same phrase will come off very differently...sarcastic and know-it-ally, and she won't even realize. Anyhow, this topic is something I feel conflicted about. I do have a lot of problems with the way that the maternity system is run in the US for low-risk women, and I think that, in theory, doulas could help. However, at present, all it ends up doing in a lot of instances is pissing off doctors and nurses even more, which certainly isn't going to motivate them to let the next woman in labor step outside of the box. I feel pretty fortunate in that it's not something I worry about (doula versus non-doula). I have no reason to plan on anything other than low-risk pregnancy/birth, in which case I would birth either at home or in a birth center with a CNM team, and a doula wouldn't be necessary. If I required interventions, I would obviously be happy to be in a hospital and would fully trust my doctor and nurse team to take care of me, rendering a doula unnecessary.

I truly think it's where you live and the birth culture in your state/area. The doula you described in which you say is a rarity, is actually normal here. It would be rare for a doula to be in the way of the nurse/Doctor etc. Doulas are very welcome here.

To the bolded, I've never heard a Doula say something like that. All the ones I know (I'm in a group of over 20 Doulas) are very respectful of the hospital/birth staff and wouldn't dream of saying something like that.

To the second bolded. That doesn't happen here. Doctors/nurses/birth staff are not pissed off or annoyed with Doulas, and they are encouraged in the hositals I have been in. In fact, the nurses usually just let the doulas, mom and dad be alone and come in every so often. If mom needs something dad or doula can go to the station and ask for the nurse. Doctors don't normally come in until the end and the doula is then at mom's head/side to support her.

[MyLovely]

Originally Posted by JennTheMomma I truly think it's where you live and the birth culture in your state/area. The doula you described in which you say is a rarity, is actually normal here. It would be rare for a doula to be in the way of the nurse/Doctor etc. Doulas are very welcome here. To the bolded, I've never heard a Doula say something like that. All the ones I know (I'm in a group of over 20 Doulas) are very respectful of the hospital/birth staff and wouldn't dream of saying something like that. To the second bolded. That doesn't happen here. Doctors/nurses/birth staff are not pissed off or annoyed with Doulas, and they are encouraged in the hositals I have been in. In fact, the nurses usually just let the doulas, mom and dad be alone and come in every so often. If mom needs something dad or doula can go to the station and ask for the nurse. Doctors don't normally come in until the end and the doula is then at mom's head/side to support her.

I'm sure it does vary from place to place. I would imagine that certified baby-friendly hospitals are a lot more open to doulas, and I know that many of them actually employ doulas. However, at the same time, we can't really ignore the actual medical professionals (midwives, nurses and doctors) who regularly see doulas overstepping their boundaries.

I used to feel very strongly about being a doula. In reference to the first thing of mine you bolded, the hypothetical doula wasn't saying it, she was thinking it Doulas are very sympathetic (it's necessary for the job, after all) and are invested in their clients having the birth they desire. If things start to happen that the doula knows her client doesn't want, it makes sense that she will be upset on behalf of her client. A good doula (which it sounds like you are) will use those feelings as motivation to help her client. A bad doula, the type that give the rest a bad name, will let it get to them and will leave a bad impression on the medical staff.

[melilo]

This is getting to be quite the interesting discussion.

I must add, please do not bash all of Ohio. Here in my area we have some of the best doulas. Most of them are DONA trained and abide by that code if ethics and conduct. The current president of DONA lives here in Ohio.

As to the comment about completely trusting the staff to take care of you, many mamas including myself simply cannot. The section rates are very high here and having the knowledge that I do, I know that I may need to disagree about my care at some point. I also know that I don't know everything and in a situation where I don't feel properly educated I would trust a doctor or nurse.

I'm sorry to anyone who has had poor experiences with doulas, but it is certainly not the norm everywhere. It is bad apples like that that give all doulas a bad name. Just like one bad nurse can spoil someone's opinion of all nurses.

[nettepoet]

the book, <i>Birthing From Within</i> has some awesome stats on doula assisted labor on page 209. it is taken from a study of 412 women who were randomly assigned to two groups...one group with an active doula (in other words, a normal doula who provides support and encouragement verbally and physically), and the other group with an observing doula, who simply sat in the room taking notes. then there was the control group.

the results were pretty amazing, with better outcomes for reduction of length of labor, epidural use, pitocin to augment labor, c-sections (no doula group had 18% rate vs. 8% rate in the active doula group), and forcep use. also, in the no doula group only 12% delivered without meds, epidural, forceps, vs 55% in the active doula group delivering with no needed interventions of any kind.

[z2akids]

Originally Posted by JennTheMomma 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.

While I would agree that Ohio isn't a role model for "crunchiness," I birthed all 3 of my children at a hospital that 12 years ago had labor/deliver/recover/stay rooms. Babies roomed in. They had one with a deep tub. And, the '08 (I use those because I found them quickly) c-section rates were 16%. My first time around, I was GBS+, my membranes ruptured 12 days early and I did not go into labor on my own. Would up in extended labor and exhausted. I wound up with a bunch of interventions as a result. However, I did not have nurses and a doctor who rushed me off for surgery. I did wind up delivering with a bunch of surgical interns in the room, because we were heading in that direction. However, my doctor was ancient and my first was vacuum delivered. Anyway, I just think it's unfair to bash an entire state.

Even in this thread, I see very differing opinions from doulas as to what their role is. That was my question and ultimately is my concern. I think that it may be an excellent option for people who need an extra support person focused on making sure that they remain focused - encouraging, reminding them that it won't last forever, relieving dad or grandma, etc. As I said, it is not something I would have any desire for for myself. DH and I were happy to be left entirely alone for the majority of my labors with nurses in only intermittently. But, my lack of desire isn't because I think that they wouldn't be useful support people for others. It is simply my personality and my relationship with DH.

But, even on this thread, this isn't the only view of a role of doula that I read. The idea that it is the doula's job to give mom options seems a bit scary to me. I am trying to figure out exacty where the doula gets the education to be qualified to determine and discuss options. I have read that some L&D nurses doula in their spare time, etc. I an see them having the education to present options. However, I wonder how a mom knows if their doula is qualified to offer what appears to be medical advice.

Unfortunately, I think a mom comes in set up for a difficult time when the nurse says let's check to see if you're in labor and the doula replies - she is in labor. Sure, the doula may well be right, but right then she's pitting herself and by extension, her client, against that nurse. Certainly, it isn't a foregone conclusion that things will go downhill, but I can just see that nurse's mind jumping to the conclusion that it's going to be one of those kind of days where everything (even things that don't need to be) is going to be a fight.

Again, I do come at this from the POV of a nurse in a medical setting. All of my patients are sick. I understand that low risk laboring women are a different patient entirely. So, I know that I come to this with the bias of how I feel when a random person tells my patient with serious clots that they shouldn't take the thinner that we wanted her on because it interferes with the high doses of vitamin K that his "natural" remedies company made. I still wonder from time to time if that woman is dead yet from that advice.

[JennTheMomma]

Originally Posted by melilo This is getting to be quite the interesting discussion. I must add, please do not bash all of Ohio. Here in my area we have some of the best doulas. Most of them are DONA trained and abide by that code if ethics and conduct. The current president of DONA lives here in Ohio. As to the comment about completely trusting the staff to take care of you, many mamas including myself simply cannot. The section rates are very high here and having the knowledge that I do, I know that I may need to disagree about my care at some point. I also know that I don't know everything and in a situation where I don't feel properly educated I would trust a doctor or nurse. I'm sorry to anyone who has had poor experiences with doulas, but it is certainly not the norm everywhere. It is bad apples like that that give all doulas a bad name. Just like one bad nurse can spoil someone's opinion of all nurses.

I wasn't bashing Ohio. Ohio is a lovely state, I have friends and family there, and we had thought about moving there before. I was simply saying they aren't the friendliest of places to birth at.

Originally Posted by z2akids While I would agree that Ohio isn't a role model for "crunchiness," I birthed all 3 of my children at a hospital that 12 years ago had labor/deliver/recover/stay rooms. Babies roomed in. They had one with a deep tub. And, the '08 (I use those because I found them quickly) c-section rates were 16%. My first time around, I was GBS+, my membranes ruptured 12 days early and I did not go into labor on my own. Would up in extended labor and exhausted. I wound up with a bunch of interventions as a result. However, I did not have nurses and a doctor who rushed me off for surgery. I did wind up delivering with a bunch of surgical interns in the room, because we were heading in that direction. However, my doctor was ancient and my first was vacuum delivered. Anyway, I just think it's unfair to bash an entire state. Again, I wasn't bashing Ohio No where in my previous responses did I say Ohio was bad or anything. All I said was it is not the friendliest places to birth in and that may skew a view of Doulas there. I have a family member who is a Doctor there at a large hospital there, as well as friends who live there. That was one reason why we had decided not to move there. Other than that Ohio is a lovely state to live in. Even in this thread, I see very differing opinions from doulas as to what their role is. That was my question and ultimately is my concern. I think that it may be an excellent option for people who need an extra support person focused on making sure that they remain focused - encouraging, reminding them that it won't last forever, relieving dad or grandma, etc. As I said, it is not something I would have any desire for for myself. DH and I were happy to be left entirely alone for the majority of my labors with nurses in only intermittently. But, my lack of desire isn't because I think that they wouldn't be useful support people for others. It is simply my personality and my relationship with DH. But, even on this thread, this isn't the only view of a role of doula that I read. The idea that it is the doula's job to give mom options seems a bit scary to me. I am trying to figure out exacty where the doula gets the education to be qualified to determine and discuss options. I have read that some L&D nurses doula in their spare time, etc. I an see them having the education to present options. However, I wonder how a mom knows if their doula is qualified to offer what appears to be medical advice. Again, that is a hard question to ask because not all Doulas come from the same background. For a certified Doula they have to take a course which involves reading, assignments and a few births. Others will require that plus workshops and/or apprenticship with another Doula. Doulas do not give out medical advice. They can give out options for different positions, different things to help relieve pain (without medicine), etc. However, a Doula who is also a nurse may give out medical advice as she is already qualified to do so. A woman can find out what her Doula is qualified for by looking at her certification and/or prior education. If she is a nurse she can double check with the hospital she is employed with to make sure. If she's certified she can look up her Doula on the website to which she is certified with. There is also re-certification with most programs. You must be up to date in order to keep your certification. Unfortunately, I think a mom comes in set up for a difficult time when the nurse says let's check to see if you're in labor and the doula replies - she is in labor. Sure, the doula may well be right, but right then she's pitting herself and by extension, her client, against that nurse. Certainly, it isn't a foregone conclusion that things will go downhill, but I can just see that nurse's mind jumping to the conclusion that it's going to be one of those kind of days where everything (even things that don't need to be) is going to be a fight. There is a right way and a wrong way to say things. I think the woman who said that was saying it was for the mom and not really for the nurse. I wouldn't have said that however, as the mom needs to decide if she wants to be checked or not (vaginal checks upon coming to the hospital is not that common in the hospital near me however). Again, I do come at this from the POV of a nurse in a medical setting. All of my patients are sick. I understand that low risk laboring women are a different patient entirely. So, I know that I come to this with the bias of how I feel when a random person tells my patient with serious clots that they shouldn't take the thinner that we wanted her on because it interferes with the high doses of vitamin K that his "natural" remedies company made. I still wonder from time to time if that woman is dead yet from that advice.

Yes your view is going to be different because you work with sick people. I work with, mainly, healthy moms. While *I* am a more crunchy person, I am not a crunchy birth professional. And I think that is what people who don't understand doulas or midwives think, that our work is crunchy, but it's really not. All of the certifications (and I do have a medical background from college) are comprehensive so I can work in any setting with any type mom. Homebirth, hospital, unmedicated, epidural, and even with c-section moms. I think if Doulas are as bad as some think they are then hospitals wouldn't allow them nor employ them. Some hospitals don't, but its few and far between.