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This was forwarded to me on a doula list:

Nurses Who Show Negative Attitudes Toward Doula Support Diminish Patients' Birth Experience



Women who use doula services during labor and birth at a hospital may encounter negative attitudes from labor and delivery nurses, which can diminish their birth experience, says an article in The Journal of Perinatal Education.

A labor and delivery nurse typically performs several functions for a variety of patients, including performing administrative tasks and mother and baby assessments, administering medication, and providing support and guidance to laboring mothers.

Doulas, on the other hand, do not perform medical tasks, but are able to provide undivided, continuous support for women, as well as facilitate communication between the medical staff and women. A doula-the Greek word for "woman's servant"-is a non-medical birth professional. A doula offers specific, non-narcotic techniques to counteract pain and guide a woman through the stages of labor.

After witnessing an increase in doula-assisted births at hospitals, author and labor and delivery nurse Karla Papagni, BS, developed a study to determine the level of acceptance shown by labor and delivery nurses toward doulas, as perceived by the patient. She conducted her study by sending questionnaires to women who used doula services during labor and birth at a hospital in north-central Alabama.

Papagni analyzed the questionnaire responses and categorized the levels of doula acceptance into two themes: 1) acceptance and affirmation; and 2) resentment and animosity. Forty-four percent of respondents described the relationship between labor and delivery nurses and their doula as hostile, resentful and confrontational, which impacted their birth experience negatively. The remaining 56 percent of respondents reported that their doula support was met with acceptance and respect.

Nearly half of the women in Papagni's study described a negative nurse-doula relationship, suggesting nurses' lack of understanding of a doula's role. Women seek the help of a doula to increase their chance of avoiding unnecessary medical interventions, such as epidural and cesarean section, and to fill gaps in care at the hospital due to staffing shortages and the nurses' enormous amount of responsibilities. Nurses who show resentment and animosity toward doula support fail to recognize the negative impact of their attitude on the patient.

"When working together as a team, doulas and nurses can provide their patients with a positive, satisfying birth experience," Papagni says. "In order for this to happen, however, both members need to understand and respect each others' roles in the birth process."

Papagni explains that further research needs to be conducted in order to understand fully the reason behind some nurses not accepting doula support. Education is one way to clarify the doula's role, possibly leading to a more respectful relationship. She recommends that doulas make an effort to visit their clients' hospital facility, and accordingly, nurses be encouraged to attend doula workshops to better understand their training.

The Journal of Perinatal Education is the leading peer-reviewed journal for childbirth educators. The Journal is published quarterly by Lamaze International for readers who provide parent education in the areas of childbirth, pregnancy, breastfeeding, neonatal care, postpartum, early parenting and young family development.

For more information about The Journal of Perinatal Education and Lamaze International, visit Lamaze.org

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