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Doulas and Nurses – You Need Them Both!

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Recently, I attended a birth at a local hospital. When my clients and I arrived at the hospital, our nurse greeted us and did all the right things: she asked for all our names and roles, she asked about the couple’s birth plan and she warmly told my clients that everything on their birth plan looked great and doable. She ended up being a fantastic nurse for this couple, and they did go on to have the natural birth they were preparing for many hours later.

As shift change, the nurse was saying goodbye and she mentioned that she was excited to have seen a natural delivery. She said she had only seen ONE other natural birth in the SIX years she had been working as a a nurse in labor and delivery. I was stunned by her comment and I wonder if her experience is reflective of all nurses who work in with laboring women in the hospital setting. However, the fact is that it is not a nurse’s primary job nor the focus of her training to help families have a natural birth.

Everyone birthing at a hospital will be assigned a nurse (maybe several depending on how long labor lasts) and I am frequently asked why a couple would need a doula since they will have this nurse to help them while they are laboring at the hospital. It’s a great question! I believe that Labor and Delivery nurses are a wonderful resource and usually kind people, however their role is primarily focused on the clinical duties of monitoring baby and mom, charting and also juggle a few patients – how many other patients will depend on the time, day and how a particular hospital manages staffing.

Both Roles Are Important, But Different

These other duties that nurses manage can limit the amount of time she has to spend taking care of the physical and emotional needs of the laboring family, but more importantly, most nurses are simply not trained to help women who are planning a natural birth and, as demonstrated in the previous story, many don’t experience natural births all that often. When one sees medicated births day in and day out, that becomes the norm and a couple planning a natural birth will seem unusual.

In a study examining pregnant women’s expectations, women giving birth for the first time anticipated that their nurse would spend 53% of her time offering physical comfort measures, emotional support, information, and advocacy. However studies have shown that the actual amount of time an obstetrical nurse spends doing all of these things combined is closer to 6%*. With hospital interventions at an all-time high, nurses may wish to provide those services, but their reality is that they have to spend most of their time managing clinical concerns and hospital policies.

In common practice, until a women starts to push, nurses do not usually spend time in the labor room but instead monitor remotely at the nurses’ station. In my experience doula-ing with laboring families, it is not unusual to attend a whole labor and never see the nurse touch mom in a manner that is not clinically related. The nurse may move fetal monitors, take a woman’s temperature or feel her cervix by placing her fingers inside mom’s vagina but never touch the mom outside of these clinical activities.

A Doula Focuses on the Family

The doula on the other hand, has the primary focus of supporting and being with the laboring couple. The continuous care of a doula allows her to respond quickly, make recommendations based on how labor is unfolding and provide immediate emotional and physical support and that is her main job.

A doula sees natural birth all the time. She is familiar with the sights and sounds of normal labor and may even be able to anticipate what a woman will needs as she labors. She is also trained to suggest position changes, comfort measures and relaxation methods that have been proven helpful. If a couple has prepared for birth, they will probably have confidence and information, but neither confidence nor information replaces having someone there to answer questions and provide ongoing encouragement. As a doula does not have to analyze a fetal heart tones, run IVs or enforce hospital policies she can simply focus on being what the family needs.

Another large different between an expectant couple’s relationship with their doula vs. their nurse is that in most cases the family has chosen and met with their doula. Their doula has likely been working with them prenatally and many times labored at home with the family prior to arriving at the hospital. The doula will know the couple’s wishes, worries and even the dynamics of the couple’s relationship. She knows if the mother in law is someone that should be in the labor room or if the woman wants to have the cute nursing bra on for pictures – even if she says she doesn’t care at the time. A doula is there through as many shift changes as the baby takes to arrive a doula will stay in the room while the partner grabs a cup of coffee, checks on older children or gets a meal. In the weeks after the baby’s arrival, the doula will call/text to check in, to answer questions, and to process concerns.

Nurses Do A Lot Too

Despite all the things that were just listed that doulas do, a nurse’s role is important in many other ways. The labor nurse is the primary liaison between a couple and their care provider. She will be the one calling the OB or midwife and she is in charge of updating them with the details of labor. She is also the one that will making the ongoing analysis of baby’s well being. In the event that either you or your baby something needs immediate medical attention, it might seem as if the OB is swooping in to save the day,¦but it will have been the nurse that called him and brought the issue to their attention.

A big part of a nurse’s training is being a patient advocate. Nurses can advocate for a couple’s expressed plan treatment in a way that is very distinct and different than what a doula does. Doulas can help couples express their preferences, help them consider their options and facilitate communication, but nurses can actually advocate for a couple or act as their liaison.

I recall working with an excellent nurse at a birth where the OB and the couple were not on the same page concerning the use of a routine intervention that happened to be standard hospital policy. After a discussion with the couple that clearly indicated their concerns, this nurse pulled up a chair to the hospital bed and looked the couple in the eye and told them exactly what their options were, what might happen with each of these options and how to say no in a manner that would be most respected and accepted. Then the nurse took it one step further. She told the couple that she would speak to the care provider and that she would let him know that they had declined. While this may not be a common scenario, a nurse can choose to do this as part of her job; a doula cannot.

Doulas and Nurses – Better Together

The role of doulas and nurses will overlap sometimes but very few families will complain about extra support. Ideally the role of the doula and  the role of the nurse should complement each other – which is why laboring couples need both. With a great nurse and a great doula on their side,  a couple can expect to have an amazing birth!

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