Friday, August 13, 2010

What's a Doula to Do?

Whats it like for a doula in the hospital setting? What does she have to deal with, exactly? What should she be doing or not doing? The answer will vary depending upon which L&D nurse you ask and at which hospital. It will vary depending on their experience with doulas and what their current moods are.

I know I've been told that I haven't been doing enough simply because I was 'holding the space' and also looked at like I should just keep my mouth shut if I spoke for a mom who was in the middle of a contraction. Its tough to please both the staff and the client, but the focus should always be the client!

This "Montreal Doula" describes how it feels to juggle things in the Labor and Delivery room, and gives some great doula advice!

The "Can do no Right" Doula Blues
If I try to respect a nurse's job by getting out of her way, I can be asked huffily, "Why aren't you helping me?" If I jump in and try to help (change bedding, soiled gowns, etc.) I am often criticized for not doing it properly, or told altogether to not interfere.

I have been told, "I know what I'm doing!" when I remind a resident of the fact that a mother has unusual bleeding during labour when they tell her she can go off the monitor for an hour, and also been told, "If you KNOW she has unusual bleeding, why were you going to let me take her off the monitor? I have visited 6 patients in 15 minutes...if you KNOW the drill, speak up!"

When I've removed a bloody pad from the bathroom floor so as to keep the environment clean, I have been told, "You can't move that! I need to measure the blood loss!" When the next time the situation has arisen and I have left it there for the nurse to assess, I have been told, "Why would you leave that there?! It gets germs all over the place! I thought you liked to keep the environment clean? Jeesh!"

When I have placed a towel under a standing, nude, extremely actively labouring lady to protect the floor from slippery amniotic fluid, it has been yelled at me, "she's going to trip on that's a hazard!" When I have not placed that towel down, I am yelled at, "What are you thinking not putting a towel under her? Don't you know that amniotic fluid on the floor is a hazard?!"

When I have been buzzing for a nurse in a busy hospital to help a 1 hour postpartum lady up to the bathroom to have a much needed pee, I can be asked with scathing indignation, "why wouldn't you just bring her yourself? Isn't your job to tend to her?" And, when I have taken the initiative and just brought the full bladdered lady to the bathroom myself, I have been been told, "You can't take her to the bathroom! What if she faints? I'm responsible!"

If I have shown as much respect for boundaries as possible and asked first before doing anything, I have been advised to stop pestering, to take initiative, and just DO what needs to be done (barring anything considered medical). When I have taken the initiative, I have been told to do nothing without permission.

A doula can be a scapegoat for staff members' frustrations. When things are busy, we can be damned if we do, and damned if we don't. Let the attitude roll off you like water. Don't take it personally. Sense the tone, and do what you think will cause the least tension. If you're wrong, you can rest assured you at least respected your scope of practice, respected your client, and did your best to respect the staff.

I personally have some boundaries I don't cross, even when asked. I will not "just put the lady on the monitor for me..I have another lady about to deliver and don't have time." I will not start "coaching" and counting during the second stage of labour, unless this is what the mother wants. If a staff member wants to assume I'm lazy or don't know what I'm doing because I don't engage in the Purple Pushing Circus, that's fine. I will not "make" my client stop vocalizing and "get control of herself". If she is releasing tension by using her voice and is obviously progressing beautifully, there is no need to change anything. I will continue to just be quietly present if that is what the feel of the labour dictates, not worrying about the whispered comments I hear, "why isn't she DOING anything, like telling her to breathe or anything? Why did they hire her?" I will not be over solicitous to please nurses when I know it's going to get on my client's nerves. I will also not answer, for example, if my client is going to take postpartum Synto by IV or injection, as this is not a call a doula should ever be asked to make. Yet we're asked to speak for our non-communicative clients all the time. I will communicate preferences the client has discussed with me, but I will never speak for her her concerning a split second medical decision!

And yes, sometimes I get eyeballs rolled at me when I gently say, "I'm sorry, but I can't speak for my client." Just like I get eyeballs rolled at me when I offer important information about my client that was not asked by the staff, because I'm not supposed to "speak for" my client (ex. "Mrs. P had a double mastectomy 4 years ago..she has asked me to communicate that she wishes not to be asked if she will be breastfeeding").

I just continue to smile and be kind, not getting caught up in the criticisms and comments. When my clients hold their babies in their arms with huge smiles on their faces and tears in their eyes, shining with gratitude for my having been there for them how they needed me to be, this is all the "reward" for my efforts I need. I have surrendered the need to please everyone on a hospital staff and invest huge efforts in having them like me and approve of my work. You can't please everyone. I serve my clients, and am confident I do nothing inappropriate to endanger them. I respect all boundaries to the best of my abilities, and do my best to reduce tension.

If I am at a birth with a student doula or another colleague and someone takes us aside and says, "why aren't you letting this mother get an epidural? Can't you see she's suffering enough?" we just smile and explain that an epidural is a mother's choice, not ours to make for her, and that she will most certainly have our support if she asks for one. Then when we're alone my student or colleague and I will have a giggle. It's pretty crazy, really. At the same time as being thought of as puppet masters who have omnipotent powers to pull all the strings and have all control over a woman's attitude, sounds, movements, breathing, requests, bodily functions and choices, we are often not thought of as smart enough to even hold a vomit bowl "competently".

Someone needs to make a decision. Is it our "power over our clients" and our seeming omnicience that is perceived as dangerous, or is it our stupidity and ineptitude that endgangers? Better yet, why doesn't someone debunk these misperceptions altogether? We should put up a summary of Klaus and Kennel's studies on the amazing results of having a doula present at a birth on the walls of every hospital room, providing evidence that IN FACT good doulas (not those few doulas actually behaving badly...most that are perceived as behaving badly are in fact not) are the opposite of dangerous. Perhaps this fear of us having the potential to make everything SNAFU in the hospital maternity ward is not actually a testament to our dangerous, witchy natures, but simply a fundamental resistance to the uncharted waters of that unfamiliar, radical thing our clients often want and we support called normal physiological birth! Why not realize that trying to "put us in our places", or sabotage us doesn't hurt doulas (we're used to it, and have thick skin), but the birthing women themselves? They will remember.

1 comment:

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