Over the course of the past few months, I’ve read numerous things from various sources — emails, L&D nurse blogs, links to nurse things — that touch on the topic of “being an advocate for the patient.” One nurse forum had the line, “Be nice to your nurse — we keep your doctor from killing you,” or something similar. Humorous, but probably with a nugget of truth.
One of the links was to a nurse’s forum and a discussion on how much Pitocin the nurse should give the patient — the original question was from a nurse who was given orders by a doctor to give Pitocin in a large dose to start with, and/or increasing it by too large an increment or too close together — whatever it was, it was so egregious that several nurses expressed shock that the doctor would even order it, and strongly recommended that she document everything (to cover her own butt), and other nurses said they would usually say, “Yes, doctor,” and then ignore the order if it was something they were uncomfortable with. (Need I elaborate on how distressed I was to read this thread?)
Some nurses might get a little edgy or “territorial” over things like the woman having a doula, saying things like, “She doesn’t need a doula to advocate for her — that’s part of my job description!” To which I say, that’s pretty good proof, then, that the average woman does need a doula in a hospital. My line of reasoning is this — why do laboring women (and other people in the hospital) need patient advocates in the first place? It’s because sometimes their wishes are not honored or respected, or perhaps the doctor screws up (either due to being only human, or because he’s acting rashly, trying to speed up a birth and not caring if the woman has a C-section or not due to fetal distress from too much Pit), or some other reason. The nurses can be a buffer between the doctor and the patient. So can a doula. While some nurses may be able to fulfill that role, other nurses can’t, won’t, or don’t, and the pregnant woman will have no idea which kind of nurse she will be assigned to prior to going into labor. Having a doula can be a safety net in this area.
If the hospital system were “ideal,” nobody would need anyone else as an advocate, because the doctors would do just what they were supposed to do, and would explain things like they ought, and practice evidence-based medicine, and have a good bed-side manner and all that jazz. But sometimes they don’t; and that’s where a patient advocate comes in. But what if the nurse assigned to the patient isn’t a good advocate either? Where does that leave the patient? The very reason that the nurse needs to advocate for her patient is the very reason why she should have a doula. A doula can’t countermand idiotic medical orders, but she can suggest things that can minimize risk — such as, if the contractions are already in a good pattern, could the pitocin be turned down or off, to see if labor continues? can we try X before we have to do Y? is there any reason why she can’t go to the bathroom herself, rather than get a catheter? — that sort of thing. Being familiar with various medical and labor/birth terms, a doula can also explain things to a laboring woman or her family if the doctor or nurse can’t or won’t.
Patient advocacy is just one aspect of what a doula can do — even if you have a great doctor and/or nurse so don’t need a patient advocate as such, you may still want a doula to help you through labor, because very few medical staff will have the time, desire, or ability to really be with you during labor the way a doula can.