Friday, June 18, 2010

Doula Training for Nurses

I am so very excited. An amazing nurse who works at a hospital I do a lot of doula gigs at used to be a doula student of mine. We have been discussing my giving a doula training to obstetric nurses for years. Finally, it seems to be about to happen. The hospital is financially swamped, as is often the case in Canada, and the training is not in the budget. But I don't care. I'm doing it for free. To have the opportunity to show new OB nurses a different paradigm of birth, and to provide them with some tools to help them feel comfortable with natural labour and capable of supporting it is just too important to make money a concern.

First the nurses, then hopefully soon the med students and residents. I had a really sweet resident the other day try so hard to make my client happy. The resident wanted my client to have the birth of her dreams, but was so worried about her being disappointed, she told her that her birth would not be natural, that it would be long, that it would require an epidural, etc, and that whatever information she was getting contrary to what she was saying (from me, I guess she meant, meaning I was telling her patient natural birth was indeed possible and reasonable to hope for) was suspect. The resident explained that in her medical experience, and in her friends' experience, this was what would more closely match reality. And I understand her intentions, I truly do. But tension and lack of hope don't lend well to an efficient labour. Nor, perhaps, was she aware of the fact that continual emotional support throughout labour can be a powerful aid.

I had worked with this resident before at an extremely long birth in which the mother refused much of the recommended medical intervention and she sadly ended up with a C-section at the end (though not because of refusing intervention, as far as I know). Perhaps this resident believed I put that other woman up to those choices (as is often believed of doulas) and was concerned I was misleading her patient. I don't know for sure. I do know her heart was in the right place, and she was doing her best to protect her patient's interest.

I reassured my client that truly, nobody could be sure of how long her labour would be, and to just take it one contraction at a time. From the time contractions got strong enough to breathe through until birth took only 2 hours. No epidural. Labour begin in earnest as soon as the resident went off call and my client was introduced to the new doctor on call who is always a lovely, positive, supportive presence. Instead of feeling defensive of her desires, my client visibly relaxed and felt like she could trust. Coincidence? Perhaps. But there is a LOT to be said about a gentle, supportive environment making the cervix that much more yielding. As Ina May says, it is a sphincter, after all. If you are trying to go to the bathroom, someone telling you you'll need all kinds of interventions and medications you don't want in case you end up being constipated will probably make the anal sphincter a little shy, perhaps even creating a self fulfilling prophesy. But say, "okay, you go do your thing..your body is well designed to do this..we won't bother you unless there's a need," well, then you may just go with more confidence and comfort. Sorry for the poo analogy, but there you go.

Obviously, birth it too complex to make it as black and white as that, but keeping the birth environment more nourishing than frightening is never a bad thing.