Wednesday, December 1, 2010

Won't My L&D Nurse Do That?

...yet another post on why to bring a doula with you to birth!

Before having heard of a doula, or even stopping to consider hiring one, women believe that their nurse in labor and delivery will be able to provide all of the support during labor that they might need. They ask "Why should I bring another support person with me?  Can't the nurse help with informational/physical/emotional support?"

A study published in the journal Birth took a look at women's perceptions during their last trimester of the type of support they would receive from their labor and delivery nurses during childbirth.

The question “What do you think your nurse's role will be during labor and delivery? You may list as many things as you wish.” was asked of women who were pregnant for the first time at their childbirth education class.

Approximately 29 percent of the nursing tasks listed by the nulliparous women were related to providing them with physical comfort and emotional support, 24 percent related to providing informational support, almost 21 percent were related to providing technical nursing care, and 21 percent related to monitoring of the baby, mother, or labor progress; approximately 5 percent related to indirect care (outside the room).

In contrast with the expectations of mothers reported in this study, two work sampling studies indicated that nurses spend little time giving women physical comfort and information support during labor. One study indicated that the proportion of time that nurses spent in supportive versus all other activities was 9.9 percent, and another study showed 6.1 percent was spent in supportive care. This supports the suggestion that women's expectations of care and their actual care might not agree.

Doulas frequently inform women that they will probably see very little of their nurse, who has many patients to tend to and a lot of paperwork, tech equipment, and other responsibilities that keep them from providing continuous emotional and physical support to the laboring woman. A limited number of available nurses and financial resources are barriers to availability of nurse bedside care. Additionally, nurses are frequently not educated in non-pharmacological forms of coping techniques.

touching the computer, but not the mom...

Labor and delivery nurses are compassionate, hardworking individuals who desire to provide quality support and care to their patients. This study showed that although the women valued technical help during labor, they also have a strong desire for “high-touch,” personalized care. Meeting women's expectations during labor can increase their satisfaction with the overall birth experiences. This, in turn, can help them gain confidence to be strong parents who will provide nurturing care to their infants, thereby creating stronger families.

So, if women have a strong desire for high-touch, personalized care, which in turn creates better births and stronger families, but the nurses aren't going to give it to them, what to do?

This is the point in the post when I say... HIRE A DOULA!  



  1. This comment has been removed by the author.

  2. Interesting and informative post. Having a doula present is important for women who want to have continuous emotional and informational support.

    What I might add to this is that many nurses wish that they could give that level of support. For a lot of nurses, this is one of the main reasons they became nurses. Also, nursing education about non-pharmacologic pain relief is in every nursing text book I've read in nursing school nowadays. In my nursing school experience, these techniques were very much emphasized. However, the culture of certain L&D units may not support nurses in using these techniques to their full advantages. I think that it is advantageous for nurses and doulas to be on the same team and learn from each other.

  3. Excellent! Thank you for commenting! :)

  4. Great post!

    I agree with Christine--in my experience with L&D nurses, many of them wishh they could provide more one-on-one and hands-on support during labor, but the culture of many L&D units makes this nearly impossible. And yes, this makes room for doulas and nurses to learn from one another and to "work on the same team!"

    I do wonder, however, how often non-pharmacologic comfort measures are taught when nurses are learning on the job or in their L&D rotation. Reading about these comfort measures in a textbook is one thing, but experiencing them firsthand is quite another.

  5. Hello, Emily. I am a new Doula and I'm putting together an information package for new clients. I would love to include this blog post! May I have permission to use it? I would reference you and your site, of course!

    You can email me at cassandrarjenkins AT Thank you so much!


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