How doulas can build positive relationships with hospital staff and why they should

doula holding patient hand at hospital birth

One of the things I am most proud of as a doula is the relationships I've built over my career with nurses, midwives and doctors. I felt intimidated my first few births at the hospital afraid of not being accepted as a valuable member of my client's care team. I had read stories online of conflicts between doulas and hospital staff or of individual doulas or doulas in general not being welcome in some hospitals. I didn't identify myself as a doula while I was feeling out the birth scene initially but I quickly gained confidence and felt welcomed at the births I was attending.

I'm not going to say I've never had a stressful or uncomfortable exchange with a member of the medical team or that I've liked and respected everyone I've worked with and the ways that they have provided care, but my positive experiences have far, far outnumbered the few hard ones.

Over time it was my experience that many nurses wanted to work the births I was at. They enjoyed having me in the room with them. Whether it was because I made their job easier, or because they liked the kinds of births that happen with doulas, because we learned from each other or maybe we just enjoyed each others company - being a good team member only benefits our clients.

So how did I do it? How did I nurture so many positive relationships with the hospital staff?

I recognized their expertise.

Even at the busiest times of my career I could never have attended as many births as hospital and delivery nurses, midwives and obstetricians do. Medical care providers have seen a lot. They have extensive training. I approach my relationships with these care providers with a lot of humility. When there is an opportunity for me to ask a question about something they are doing, I approach them with genuine curiousity. My clients often prioritize my information and opinions and I'll offer what I know about a certain medical intervention, what the benefits and risks are etc. and then I'll also encourage dialogue with their medical care provider too. I might share the information I have in front of a nurse and then invite my client to ask the nurse for her expertise and opinion as well. Going into a birth with a lot of confidence as well as humility and appreciation for the different knowledge and perspectives of medical care providers really brings the defenses down. I have found that it also creates an environment where nurses or other care providers can learn from me too. Let's face it - doulas can come into a birth with some odd or unfamiliar tricks and techniques, but isn't it great when a nurse feels safe enough to also ask "what are you doing?" with genuine curiousity?

Recognizing the wealth of knowledge, expertise and skills of the medical team members also benefits clients by building trust between client and their care providers. When people feel defensive, egos take over. Decisions and care made from a place of ego is where power struggles are born and that leads to negative birth experiences. Clients can still advocate for themselves and break the mould of the hospital care model when they want or need to. It will be even more well received when the relationships between patient, doula and care providers feel safe, have mutual respect and a lot of understanding. The reality is, many doula clients will choose medical intervention like induction, epidural, rupture of membranes etc. when given the benefits and risks. I always say "I want for my clients what they want, as bad as they want it." It doesn't matter what I would choose for myself or what my beliefs and biases are. Empowered and informed clients who felt in charge of their births with a team that was cohesive and supportive of their choices feel positive about their birth, even if it didn't go the way they planned and wanted. When I go to a birth with a client who is more opposed to interventions and push the boundaries of what the medical team are comfortable with, the medical care team knows its genuinely coming from the client because I have built that foundation of trust with them. I can help my clients navigate a medical system in a diplomatic way so they feel safe to say no and still receive care and support. I can teach my clients how to word their birth plan in a strong, confident and non-combative way. We take things out of the birth plan that our local hospital already practices (eg. delayed cord clamping) and leave in only those things that are not normal practice (like eating during labour or refusal of continuous fetal monitoring). A birth plan that recognizes and asks for the knowledge and support of their care providers while also advocating for non conventional options is more likely to be supported in a way that minimizes conflict.

The bottom line is, when we have our defenses up and see the medical team members as "other", we will be met with defensiveness and ego. When we approach these relationships with humility and mutual respect, we can get a lot more for our clients when they do want to push the limits. I've watched doctors and nurses evolve over many births where I was present. One particular doctor shot daggers at me with her eyes when I quickly said to my client "Do you understand the intervention that is about to be done or do you have any questions for the doctor?!" as the doctor picked up the amnio hook. However, at future births I observed that same doctor pulling a stool up in front of my clients to get to know them better and ask them what they wanted for their births and why they wanted it. We have a lot to learn from each other. Sometimes doulas want to change birth by jerking the rope as hard and fast as they can but real progress is made with steady and consistent pressure in the direction things need to g

o. Ultimately, we all want the same things. We want our clients and patients to have positive birth experiences. We all want healthy and happy clients/patients and babies. We want to be liked. And we want to be successful in our birth support careers.

By the Moon offers Holistic Full Spectrum Doula training and Holistic Reproductive Practitioner training. Michelle Stroud has two decades of experiences offering reproductive health and advocacy support in her community and has also trained doulas and holistic health practitioners from all over North America and abroad. Learn more about our online and in person training programs: Holistic Full Spectrum Doula

Holistic Reproductive Practitioner (doula training + reflexology + energy healing)