Updated: Jan 10
As a volunteer doula, and in my own business, I spend lots of time working directly with labor and delivery nurses. When I say L&D nurses are absolutely amazing, I am making no understatment. They are the ones who admit you when you arrive to the hospital, monitor your progress, check you and baby's vital signs, administer most intravenous medications, input your charts, bring you any hospital equiptment you need.
I've had a few conversations about how doulas fit in to a hospital birth when there are already nurses there to provide care.
Unfortunately nurses often are not able to provide constant, continous care during the duration of your labor. Nurses are often stretched thin, and may have other patients to tend to on the delivery floor, as well as a plethora of other responsibilites to attend to during their shifts. They also undergo shift changes and go on their breaks, where another nurse will fill in during that time.
According to a study reviewed by Evidence Based Birth (see podcast episode 106) nurses spent about 30% of their time in the actual labor room, where most time is spent on direct clinical care, managing equipment or monitors, or charting. Only 6-12% of their time is spent directly assiting patients with non-medical care, such as labor coping measures, emotional support and encouragement, helping patients stay informed and answering questions, etc, and often there was an overlap with the that and the time spent on clinical tasks and responsibilities. The study also noted that even on a quiet floor, nurses still spent the same amount of time in the patient's rooms. The fact is there are many barriers preventing nurses from spending more time with their patients, including the hospital’s culture and expectation of nursing roles.
This is where doulas come in. Doulas fill in the gaps that are unreasonable for nurses to consistently fill. Doulas provide continous care throughout the whole pregnancy, labor, birth, and postpartum time, and are directly available during labor to assist with comfort measures, providing continous encouragement, assisting the birthing person with whatever they need, and helping their client understand their options in the delivery room and how to advocate for the birth experience they want.
Ideally, nurses and doulas work together to provide a full spectrum of care during labor- nurses from the medical side, and doulas from the non-medical, supportive side. Both help to provide the best possible care for the laboring person possible.