My client was only a few hours into her induction, and she was already having unbearable contractions. I helped her in the bathtub while I was trying to monitor her baby. Then she abruptly went into transition, and I was starting an IV, calling anesthesia for her epidural, hanging an antibiotic, changing her sheets, and trying to help her focus while her family was completely overwhelmed with what was going on. I kept thinking to myself, “I need a doula in here!!!”
As a labor and delivery nurse, I provide care to help you have a meaningful birth experience. If you are thinking of hiring a doula but are questioning if you need one because you will have a nurse to help you, let me reveal how a doula and a nurse will care for you in different ways.
A doula is someone you usually have a relationship with before you give birth. You have developed trust with her and she knows your likes, fears, and preferences. I, on the other hand, meet you when you may already be 8cm dilated and not able to connect with me at that moment. When my shift ends, I will go home, but your doula is able to stay with you until you have your baby and after the birth.
While the doula is working for you, I work for the hospital. I have guidelines and protocols I must follow, and I enforce hospital policies. I am working on a team, so I may need to relieve my co-workers for breaks and answer phone calls. I am not in your room 100% of the time. Sometimes I am even caring for another laboring Mom.
One of the greatest differences between a doula and a nurse is their primary role. A doula’s main focus is you and your partner’s care and comfort. They are trained differently than nurses and know skills that are not part of a labor and delivery nurses’ orientation. I learned skills that no one had taught me before such as using a rebozo, massage techniques, and positions in labor when I attended a doula workshop for labor and delivery nurses.
Nurses are medically trained and possess nursing licenses. As a labor and delivery RN, I challenge myself to provide care and comfort to you also, but my main role is the safety of you and your baby. I am liable for my actions; therefore, I am required to document everything that happens in your labor including interpreting your fetal monitor strip, how you are coping with labor, and what your cervix is dilated to. I am the eyes of your care provider, and they rely on my documentation to help them get a picture of what is happening in your labor. They make decisions based on what I tell them.
There are many other tasks that I do that only nurses perform such as administering medications like Pitocin, placing urinary catheters, starting IV lines, and assessing you and your baby. When emergencies arise (like your baby’s heart rate decelerating or dropping), a doula makes my job easier because she is another set of hands and works with you and me.
Your doula is not the person who speaks to your doctor or midwife for you. She reminds you what you desire from your caregivers and supports you. A nurse is able to serve as your advocate. If you feel like your physician or midwife is not understanding your requests, I am able to say something like, “She would prefer not having me administer Pitocin right now. She would like to wait a few more hours.”
I think one of the most important differences between doulas and labor and delivery nurses is their skills when it comes to supporting natural labor (no epidural, no medications). Doulas are trained to give emotional and physical support during any type of labor and birth. The labor and delivery nurses in my hospital are trained more on the physiology of birth, interventions, and fetal monitoring. Most women they care for use epidurals, so they seldom witness a woman laboring naturally and might not even be comfortable caring for her! The nurse assigned to care for you when you have your baby may not be a good match for you.
I recently became a certified doula so I could be a better labor and delivery nurse. In my training I realized there were so many things doulas do that I had never thought of. Only a few RNs on my unit are dually certified, so I feel I lend a unique perspective to each person’s birth experience. When a doula is caring for my client, I know all her needs will be met.
Jen is a labor and delivery nurse, certified doula, wife and Mom to a 14 year old son and 12 year old daughter. She became a L & D nurse after the birth of her children because she wanted to give back to birthing women. She loves eating out at local restaurants, being on or around any type of water in the summer, and reading.