You will often hear moans and groans from many L&D nurses from coast to coast when a woman shows up with a birth plan and/or a doula. Many nurses (and doctors, even midwives…or shall I say med-wives) believe that any woman who writes out specific plans as to how her labor shall occur are subconsciously asking for a c-section. They hate the thought of someone else trying to take control of the birth. The hospital is the doctors’ and nurses’ home turf and the best results occur when the away team (aka Mom and Dad) follow the rules. Birth plans challenge this, and are quite threatening to those who like full control on their own turf.
But actually, what I meant to get into was doulas. Doulas are trained in labor support. They provide support and assistance continuously while a woman is in labor, and some may also provide help after the baby is born. Many times doulas like to meet their future mothers during the pregnancy to get to know them, and make sure that there isn’t something that would inhibit the doulas work (like the mom and doula not liking each other). Just about anyone can call themselves a doula, but don’t be fooled. Doulas must be certified by either Doulas of North America (DONA) or Childbirth and Postpartum Professional Association (CAPPA).
I personally love doulas. Unfortunately, very few women have doulas where I work, and there have even been some women who were denied their doula. Apparently there aren't many doulas in my area and the one that most go to is “not allowed” in the labor rooms per the medical staff. She was accused of interfering. My feeling is that she probably is an outspoken advocate of her clients, and therefore challenged some of our old school thinking docs.
The reason I love doulas at work is because it frees me up. Isn’t that terrible? Traditionally labor and delivery nurses were meant to provide the continuous labor support to women. However, this has historically not been the case. When childbirth was moved to the “safety” of the hospital, nurses were to assist the obstetricians. I have a nursing textbook from 1922 that gives a litany of duties the nurse was to perform.
Many of the duties have changed, but 2007 is essentially no different for a labor and delivery nurse than for the 1922 labor and delivery nurse. The difference is in what we have to do. There are monitors to maintain. Paperwork and charting to kept on top of and meticulous in case we have get deposed. Interpretation of fetal heart tones and maternal vital signs. And many times one nurse is caring for 2 or 3 woman at once. I am totally simplifying what L&D nurses do as far as our “tasks”, but my point is that very little of our time is left over for actual contact with the woman. So as you can see, doulas do what I wish I could be doing. They do what the woman deserves during her childbirth experience.
Research also shows that women who have continuous labor support have shorter labors, fewer interventions, less pain medication, to name a few. Most importantly, most women will report a greater satisfaction with their experience, even if they ended up having a c-section or epidural. I’ve done a cursory review of the literature and have come up with some titles that might be helpful. I’d link directly to the articles, but I’m told this is illegal. Find Articles might be helpful, or just google it.
Zhang, J., Bernasko, J. W., Leybovich, E., Fahs, M., & Hatch, M. C. (1996). Continuous labor support from labor attendant for primiparous women: A meta-analysis. Obstetrics and Gynecology, 88(4), 739-744.
This article is interesting for many reasons. It has a small section on continuous labor support but I think you will find other pieces of it interesting:
Leeman, L., Fontaine, P., King, V., Klein, M. C., & Ratcliffe, S. (2003). The nature and management of labor pain: part 1. Nonpharmacologic pain relief. American Family Physician, 68(6), 1109-1112.
I found this one interesting because they trained student nurses to provide doula care, and the researchers imply that institutional changes should occur to allow more nursing support of the laboring woman:
Van Zandt, S. E., Edwards, L., & Jordan, E. T. (2005). Lower epidural anesthesia use associated with labor support by student nurse doulas: Implications for intrapartal nursing practice. Complementary Therapies in Clinical Practice, 11(3), 153-160.
If you were going to read only one of these articles I list, then this is the one. It’s a case study that is discussed by several different professionals from different perspectives, while reviewing the benefits of doulas.
Stein, M. T., Kennell, J. H., & Fulcher, A. (2004). Benefits of a doula present at the birth of a child. Pediatrics supplement 3 of 3, 114, 1488-1491.
For those interested in having a doula but don’t know where to start I would suggest DONA’s website. They have a search feature to find doulas in your area. Meet with potential doulas to get a feel for her (or his) style. Also, talk with your doctor or midwife about doulas. You’ll learn a lot about his/her philosophy of birth by what they have to say about doulas.