Navigating Differing Hospital Cultures as a Labor Doula

When I was a new doula, I remember being excited to apply all that I learned in training to support my clients in various birth settings. What I wasn’t prepared for was dealing with differences in birth location policies and working with different providers, who all seemed to have different policies as well. Why was one thing allowed in Hospital A while the complete opposite was the policy in Hospital B? In addition to feeling confused, I was also embarrassed thinking my clients didn’t know what I was doing. Some examples of the differences I saw were the following: 

  • Is an IV required? 
  • Is eating and drinking permitted throughout labor? 
  • Is hydrotherapy possible after the amniotic sac has ruptured? 
  • Can position changes be utilized after an epidural has been placed? 

In my community, doulas can support families in six “metro” hospitals and at least five “rural” hospitals all within a short drive. We also have one free-standing birth center as well as numerous home birth midwives. Each of these places/providers has similar but not identical policies and procedures. As a new doula, I didn’t realize that not all birth providers practice evidence-based care. This caused me to grow frustrated by the different policies. 

The US is also seeing a surge in traveling nurses who may or may not be familiar with the birth location policies or even childbirth as well. Helping your client know their options prior to birth and supporting them during the birth can help them have a more positive birth experience overall. We know this type of informational doula support is shown in studies to help improve birth outcomes for birthing people. (Cochrane Review) 

Here are some things I’ve learned in my time as a labor doula. 

Before the Birth 

Work with your clients to develop a birth preferences list (birth plan) so they can start communicating with their providers prior to labor beginning. 

Encourage your clients to take an out-of-hospital birth class to learn what evidence-based options may be available to them in their area. 

Review the B.R.A.I.N. Informed Decision-Making steps with your clients. Remind your clients of their birthing rights. 

Get to know other doulas in your area. Ask about their experience with different providers and different birth locations. 

Attend a prenatal appointment with your client if allowed. (This was especially beneficial for me before attending my first home birth.)  

Be familiar with the ACOG 2019 Committee Update. This lists the American College of Obstetricians and Gynecologists recommendations. If you are looking for up-to-date Evidence-Based Information, visit the Evidence Based Birth website. You can also do a “Google Scholar Search for any birth option” to find current research available. 

Read Babies Are Not Pizzas: They are Born, Not Delivered! by Rebecca Dekker. This book talks about how hospital culture is different from one location to the next. 

During the Birth 

Check-in with your client (and their support partner) regularly. Remind them that they can always ask for time alone to discuss anything. 

Build bridges with the health care team. Start by introducing yourself and sharing your business card and/or CAPPA Scope of Practice card. Strive to create a positive team approach whenever possible. 

Remind your client to share their Birth Preferences with their providers. 

Communicate with the nurse/provider/midwife. To learn more about hospital policies and procedures, I use phrases like, “My client has been so excited to spend time laboring in your fabulous tubs. Can I get started filling that up for them?” or “My client discussed their birth plan with their provider who was on-board with changing positions throughout labor. I am happy to suggest some, or do you have any favorite go-to labor positions?” or “When I was at Hospital A, my previous client was able to ____ and I’m hoping that is the same here as well.” 

Empower Your Clients. If there are any discrepancies between your client’s wishes and the birth location/provider policies, help them advocate for themselves. Remind them to seek information using the B.R.A.I.N. questions. Your client has the right to accept or refuse any treatment for themselves or their baby. Hospital policies are not laws. 

Encourage your client to seek second opinions. If the nurse is not being supportive of your client’s wishes, remind your client they can ask to speak directly to their doctor or midwife. This is especially effective if your client has already shared their wishes with their provider during prenatal appointments. 

Provide evidence-based information in the moment. The more you know, the more easily communicating during a birth becomes. 

Remember the Goal 

Our goal as labor doulas is to help our clients have a positive experience and healthy outcome. Sometimes we can get frustrated knowing that if our client was in a different setting, they would have a different experience. Remember, our goal is to help them achieve their goals—in whatever setting and with whatever provider they have. 

As you gain experience, you will find that helping your client prepare for a positive birth experience and advocate for their birth preferences gets easier. As you help your clients find their confidence, you’ll gain your confidence too! 


About the Author

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.

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