There’s no need to mince words on this topic. When it comes to births in the hospital setting, many doulas are met with opposition and even flat-out lack of acknowledgement where RNs are concerned. There’s beef in these streets and it’s largely on the part of the nurses. Who better to address it than someone that exists in both realms and refuses to choose between the two?
I’m a nurse at my core. I was raised by a veteran nurse, which makes me hardcore. I was the kid going to my mom telling her what the game plan was after I was injured/ sick 😂. As a doula, I bring my nursing skills to my practice. Now that wasn’t easy at first, I too was viewing the roles as totally different, but my mentor (shout out Michelle) helped me see the value in my previous experiences. The reality is that when executed properly, the two specialties can work together synergistically!
Here’s the crux of the problem, the word doula scares practitioners that operate under the western medicine model. Doulas are seen as a catalyst to bucking the system. We’re largely viewed as granola toting (and I do keep my granola on deck), tonic makers, who are present to interfere with the nice little cookie cutter lit’s of policies and procedures that govern nursing practice. Nurse’s often feel like doulas are going to complicate their workload.
To the nurses' credit, we can only operate on the doctors’ order and follow the hospital’s policies. The hierarchy literally ties our hands at times. Now advocacy isn’t just a doula’s job, it’s at the heart of nursing practice as well; but it’s dependent on an individual’s personality as to how comfortable they are exercising this skill. As a floor nurse, I challenged doctor's orders all the time because I felt it very important to be a voice for my patients. Add to the mix of pre-existing rules- high patient acuity, low staffing and rude doctors and that often sets the stage for a hostile environment.
I’m very solution oriented though, so let’s switch gears. Here are a few ways that I level the playing ground. I encourage my clients to mention to their nurse that they have a doula upon arrival. I show up at the hospital with a copy of my certification, mask on, recent COVID test, my ID badge on and the love of Jesus in my heart. I introduce myself to the nurses when I walk in and I offer my help with patient care. I show them my knowledge base with confidence not cockiness. My goal is to foster an atmosphere where the nurse sees that I’m an ally not an adversary. These steps have proven to be beneficial in most cases. In the rare instance when the nurse is still not taking the bait, they may just need a gentle(ish) reminder that my client wants me here and I’m going to do the job that I was paid to do! Professionalism is key but respect is non-negotiable.
There is much work to be done to bridge the gap and I believe that labor and delivery/ nursery nurses need in-services on working with doulas. Communication is key. While attending births, I talk to the nurses and get a feel for the hospital’s culture around doulas. Perhaps the most influential way to foster change is to simply let our gifts speak for themselves. The research on continuous support in labor is readily available but seeing it in action is magic! Often times, our clients will hear our voices when they aren’t willing to listen to anyone else’s. We are invaluable members of the birth team!