When I was a new doula, I remember being excited to apply everything I learned in training to support my clients in different 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 is one thing allowed at Hospital A while the complete opposite is the policy at Hospital B? Aside from the confusion, I was also embarrassed to think that my clients didn’t know what I was doing. Some examples of the differences I have seen are as follows:
- Is an IV needed?
- Is eating and drinking allowed throughout childbirth?
- Is hydrotherapy possible after rupture of the amniotic sac?
- Can position changes be used after an epidural is placed?
In my community, doulas can support families at six “metro” hospitals and at least five “rural” hospitals within a short drive. We also have a free-standing birth center as well as many 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 made me frustrated with various policies.
The US is also seeing a surge in traveling nurses who may or may not be familiar with birth location policies or even childbirth. Helping your client know their options before birth and supporting them during birth will help them have a more positive birth experience overall. We know that this type of informational doula support has been shown in studies to help improve birth outcomes for people in labor. (Cochrane Review)
Here are some things I learned during my time as a labor doula.
Before Birth
Work with your clients to develop a birth wish list (birth plan) so they can begin communicating with their providers before labor begins.
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 BRAIN Informed Decision Making steps with your clients. Remind your clients of their reproductive rights.
Meet 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 helpful for me before attending my first home birth.)
Familiarize yourself with the ACOG 2019 Committee Update. It lists the recommendations of the American College of Obstetricians and Gynecologists. 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 on Babies Are Not Pizzas: They Are Born, Not Delivered! by Rebecca Dekker. This book discusses how hospital culture differs from one location to the next.
During Birth
Check-in regularly with your client (and their support partner). Remind them that they can always ask for time alone to talk about anything.
Build bridges with the health care team. Begin by introducing yourself and sharing your business card and/or CAPPA Scope of Practice card. Try to create a positive team approach whenever possible.
Remind your client to share their Birth Preferences with their providers.
Contact the nurse/provider/midwife. To learn more about hospital policies and procedures, I use phrases like, “My client is excited to spend time working with your amazing tubs. Can I start filling that in for them?” or “My client discussed their birth plan with their provider who is on board with changing positions throughout labor. I’d be happy to suggest a few, or do you have favorite positions at work?” or “When I was at Hospital A, my previous client was able to ____ and I hope the same is true here.”
Give Your Clients. If there are any discrepancies between your client’s wishes and birth location/provider policies, help them advocate for themselves. Remind them to look for information using BRAIN questions. Your client has the right to accept or refuse any treatment for themselves or their baby. Hospital policies are not law.
Encourage your client to seek a second opinion. If the nurse is not supportive of your client’s wishes, remind your client that they can ask to speak directly with their doctor or midwife. This is especially effective if your client has already shared their preferences with their provider during prenatal appointments.
Provide evidence-based information in the moment. The more you know, the easier it becomes to communicate during labor.
Remember the Purpose
Our goal as labor doulas is to help our clients have a positive experience and healthy outcome. Sometimes we can be frustrated knowing that if our client were in a different setting, they would have a different experience. Remember, our goal is to help them achieve their goals—in any setting and with any provider they have.
As you gain experience, you will find that helping your client prepare for a positive birth experience and advocating for their birth preferences becomes easier. As you help your clients find their confidence, you will gain yours too!
Sources
- Strategies to limit intervention during labor and delivery. ACOG. (n.d.). Retrieved March 1, 2022, from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth
- Dekker, R. (2019). Babies are not pizza: They are born, not delivered! Evidence Based Birth.
- Gruber, KJ, Cupito, SH, & Dobson, CF (2013). Impact of doulas on Healthy Birth Outcomes. The Journal of perinatal education. Retrieved March 1, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/
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 does not support new mothers enough and she has mission to help provide 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 moms through her role as a Postpartum Doula Trainer. Katie is a frequent speaker for mothers, families, and health care providers in Iowa. She was featured in a doula magazine, Parents Magazineand on his local television station.
