Thursday, April 5, 2012

"Sometimes we just like to let our clients BE"

A snippet of a blog post from MotherWit Doula called "Where the Magic of Doula Care Lies" in which she explains why "the magic of doula care lies in the relationship between the doula and her clients."
In my years working as a doula, I've come to understand that sometimes it can look to an unsuspecting nurse or doctor that we don't know our doula skills because we're not doing the general things they've learned about to support their patient. For example, sometimes, even though moms "should" be upright a lot through labour and "should" use the bath or shower in active labour to relax and reduce pain, it's important for caregivers not to assume we're ignorant of the application of these comfort measures simply because we're not suggesting them. My way of being a doula is to NOT be over-solicitous, meaning I don't with every contraction ask Mom to get up, change positions, haul out a ball or massage oil, or suggest things. Why? Because after a while it becomes a pain to hear the mosquito buzz of questions in your ear in labour. Sometimes we like to just let our clients BE. It's also important for caregivers to realize that our client has already probably pretty strongly let us know what she needs. Perhaps she's lying on her side because this is her "happy place" and is indeed progressing just great as she is. We can be trusted to ensure she's getting up to pee once in a while and in the process shaking her pelvis around a little. Unless a mom is clearly trying to avoid the hard work of active labour and needs a little energy reversal to shake things up, leaving her to it is often a wise choice.

I've heard doulas have encounters with nurses who thought the doula was acting very strangely, even ignorantly, by fully supporting the mother's insistence upon a seemingly early epidural, and were chided by the nurse who wanted to give them a crash course in comfort techniques. When (with the clients' knowledge and permission of course) the doula took the nurse outside the room and explained the mother was a survivor of sexual abuse and that they had in advance of the labour come up with a plan to demand an epidural when the pain started triggering feelings of emotional instability, the nurses immediately did what was asked, recognizing the value of the doula/client relationship. I remember walking the hall of a hospital and the mom stopped for a contraction, leaned over, and I rubbed her back in the way we had discussed, due to an issue with her sacrum. A nursing student ran up, and said, "Let me," and proudly "showed" me how to do a sacral press because I guess she had learned it was better, even though it was wildly inappropriate for this particular mom. I've had a couple of students chewed out by hospital staff for looking like they weren't doing anything for a mom who had just clearly told them she wanted to rest quietly for a while.

Doulas craft their relationships with their clients painstakingly and lovingly. We find out what coping skills they have to weather the sensations of labour, find out whether or not they prefer fancier breathing techniques, what kind of essential oils they like, and what scares them.

I particularly like this excerpt because I have had been in similar situations, where the hospital personnel seemed to imply that I wasn't doing enough. The reason for this is exactly as explained here above. 

Doulas, have you ever had this experience?  

"It may surprise some to know that our magic may run just a little deeper than double hip squeezes and lavender spritz."


  1. I haven't been chewed out or anything, but this is why I hate having to get questionnaires from the doctors and nurses for my DONA certification. I can feel like I did a great job for the mom, and she can say so, and we did everything exactly how SHE wanted it done, and then some doctor or nurse can say that I need to suggest more position changes, etc and then it makes me feel like poo. Even though we did everything the way the MOM wants and that's what counts, it really feels bad when the nurses think you're just a dumb doula in training afterwards.

  2. hmm... I wrote a comment in response to this a couple days ago, but it seems that blogger decided not to post it!

    I believe what I wrote was that I had a similar experience when I was getting my certification evaluation forms signed... Doctors would tell me that I could be more vocal during pushing. But I HATE directed/purple pushing, and just because that's the norm in the hospital, doesn't mean that's what the mother wants!

  3. I think the biggest downfall for a doula is to be in a hospital setting and doula run program. The doula is on call waiting to arrive at the hospital and has no opportunity to meet and greet the mom, couple, or family prior to the birth call. There is no pre-established visit and when one does get there and has done a monumental job for the mom and family one never knows how they were treated and felt. I am really frustrated and feel like I was taken advantage of 2 out of 3 births at GBMC. I now find out many doulas have started there and feel similarly. Still knowing I am not alone I take this personally.

  4. I have had a similar experience as Kristi. I brought a book along and the couple wanted time alone as I sat outside their room. The nursing staff reported I was not with the couple and felt I did not wipe her butt enough without them eyeballing me!!! One hospital that I became certified through will not allow us to do anything medically or be in the area of delivery but this hosptial through orientation practice insist it is protocal. I asked the mom first if I could clean her up several times she said "She was good!"

    I not only agree with Kristi and the same situation happened to me but 2-out-3 births were 19 and 29 hours!!! The fee paid to the doula was only $300.00 no matter how long the event took.
    I did sign up for the program but now see the lack of concern for the doula is less important than the PR for the hospital.


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