I have had the wonderful opportunity to work with hundreds of nurses during my career as a labor doula. Whenever we have a blend of professions like Labor & Delivery Nurses and Labor Doulas, it can be a tricky situation to navigate. I truly believe everyone has the client’s best interests in mind, however sometimes the professionals will have different educational experiences, professional experiences, and oftentimes, philosophies. I recently had a few opportunities to chat with nurses from three of our largest hospital systems in Iowa about their experiences with labor doulas. I wanted to know the “insider secrets” about labors with doulas present, birth plans, and anything they were willing to share with doulas.
Before I share the tips, I want to offer a few disclaimers.
First, this is intended to be a positive article written to help doulas feel more comfortable in the birth room. Oftentimes, this is the first interaction a nurse may have with a doula and we want to make a positive experience for everyone.
Second, it is important to remember that we work for our clients and not the hospital. I will do my best to create a positive environment for everyone, but my clients always have the final say in their decisions and choices. My job is not to make the nurse comfortable, but we all know that people (our clients, doulas, nurses, health care professionals) work better together in a positive atmosphere. We can help with that!
Third, these tips are from 20+ nurses who took the time to share this information in person with me. They had some crazy stories about doulas to share! After further questioning from me, they did not know whether these were trained/certified doulas or just people calling themselves doulas. If you are certified, please share this with the medical staff during your introductions! Nurses and healthcare providers are starting to realize that not all doulas have the same training and scope of practice. Be a proud representative of CAPPA! It is a very well-respected organization.
So, how to do we all work together to improve the birth experience for our clients? Here are the top tips some nurses shared to help us Build Bridges in the birthing room!
- Make yourself at home. A good way to get a feel for the nurse’s preferences are to ask whether it’s ok for the doula to open cupboards to find things like pillows, pillowcases, and wash clothes.
- Help your client change into the hospital gown or labor clothes.
- Doulas are awesome at helping with position changes. This is where our expertise will allow us to really shine as CAPPA doulas! The nurses I spoke with know that position changes are very beneficial, but they do not have a lot of training in this area.
- Help the birthing person remember to use the restroom regularly. Full bladders can impact labor progress.
- Provide the emotional and physical support while nurses are taking temperatures, watching the strip, and keeping an eye on the monitors. Many nurses want to do the emotional and physical support, however they are responsible for so many aspects of the person birthing and baby’s overall health monitoring.
- Encourage your client to use low, primal voices.
- Dirty linens can be tossed into the blue bags or linen carts. If you are unsure, ask a nurse where those items should go so the room stays clean and safe.
- Understand when to support with natural techniques and understand there is a time for medical interventions (high risk clients, complications, etc.) This can be a tricky situation for doulas to be in because sometimes we hear information that is biased or not evidence based. Our best plan of action is to encourage our clients to ask questions and make a decision that feels best to them.
- Nurses will likely not having training in natural births. I was so surprised that the nurses I talked with had ZERO training in natural birth unless they happened to attend births with a midwife during their schooling. Even then it was less education on specifics and more witnessing.
- Nurses do not like when doulas or family members stand between the monitors and the hospital bed. They fear having to get to their patient quickly and having someone physically in their way. Don’t be afraid to ask nurses where you should stand.
- Do not speak on client’s behalf or “boss around” the nurses.
- Nurses do not like to be contradicted on medical processes or recommendations. (Again, encourage your clients to seek more information instead of speaking on their behalf.)
- Support the client’s choices, even when it goes against their original birth plan. One topic I always cover during prenatal appointments with my clients is what happens when they receive “curveballs” in labor meaning something unexpected has just come up. I ask open ended questions like, “What are your feelings if a curveball makes you deviate from your birth plan?”
- Birth plans help the NURSES advocate to doctors about patient’s wishes.
- Birth plans under one page are ideal.
- Medical terms should be spelled correctly on birth plans. (ex. Clients use “aversion” or “inversion” instead of “version”.)
- Clients can request a nurse who is more comfortable with natural births, high risk, etc. at shift changes. It is more difficult to fulfill this request when client arrives at hospital. This is also true of larger hospital systems and not smaller hospitals.
- Nurses want parents to attend childbirth classes and to do the hospital tours.
Pushing and Postpartum
- Keep cold wash clothes and ice ready for your client during pushing. This is something that everyone seems to like during pushing and a great way for doulas to provide some additional comfort during pushing.
- Help hold legs during pushing. Follow the health care provider’s lead if they ask you to hold a leg—and be sure to put your gloves on!
- Stay close during postpartum. A few of the nurses were surprised that doula(s) would sit on the couch right after the birth. I personally know that standing in one spot for hours during pushing is physically demanding, however our clients still need us close.
- Place the order for food service for the family after the birth and offer to feed client while they are breastfeeding.
- Nurses are required to stay with a pushing person. A nice touch is when the doula also brings the nurse a drink or snack when they grab something for their client.
- Do not sit on the couch during pushing. (Again, couch sitting doesn’t have the best perception with others in the room, including your clients.)
- Assume nurses want the absolute best outcomes for their patients!
CLD, CPD, CNPE, Faculty
Katie Nyberg has served hundreds of mothers, partners, and families through her role as a birth doula, postpartum doula, and childbirth educator since 2010. She believes that our society is not supporting new mothers enough and has made it her mission to help provide the missing care for women during their childbearing years. Katie has been a part of CAPPA since 2015. She is excited to combine her passions for teaching and for supporting new mothers through her role as Postpartum Doula Trainer. Katie is a frequent speaker for mothers, families, and health care providers in Iowa. She has been featured in a doula magazine, Parents Magazine, and on her local television station.