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changes in obstetrical careFrom: Cbcnm@aol.comTue Jul 23 18:56:59 1996
The conversation regarding the use of doula's was interesting, but I think the real issue was overlooked. The administrator never would have called the practitioner into his office if the RN(s) at the birth had not been unhappy/uncomfortable with the situation. SOMEONE complained to her/him!! I think that doulas fulfill at least some of the role that labor and delivery nurses have traditionally filled as labor support people. Is is possible that the nursing staff in your hospital are feeling threatened by the presence of the doula? The person who initiates change into an old fashioned Ob system becomes a target very ,very quickly. People are threatened and unhappy with change, especially if they have not been prepared for it by the hospital or if it changes their role. Remember, many nurses go into the field of Ob because they like babies. When they no longer get to be the maternal figure for newborns, when the hospital does not "own" the baby , when the MOTHER and family "own" the baby, it creates a lot of hostility. The change toward Family Centered Maternity Care is easiest and quickest where there is competition for patients. Women and Families want rooming in, want support people present etc. To keep market share, Hospitals who compete for business MUST change. In rural areas where people have literally no choice of place of birth, Hospitals have not had to change. They have a captive audience. For those who work in rural areas ( as clinicians) , it is very challenging to implement Family Centered Care. The process is s-l-o-w, but it can happen with patience and a thick skin. Just my thoughts after 3+ years in a 26 bed rural Hospital with 500 births per year. Chris Beard CNM Washington State/Oregon
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