I Refuse To Practice Outside the Scope of a Doula | #safebirth #birth #pregnancy #doula
I am an asset to the women in my community. I am a doula. I am a great doula.
Five years ago, when I decided to become a doula, I’m not sure if I was under a false illusion about what the role of a doula is, or if things have just changed so much in the past five years that I’m behind the times.
When I became pregnant with Jett, I decided to continue to be involved in the birthing and natural parenting community, however, I chose not to attend any births because I did not feel that I would be able to be there emotionally and (mainly) physically for any mom in labor. I did not want any women hurt by birth because of my inability to be there, full circle, in my role as a doula. If there are victims of medical malpractice during childbirth, they should consider taking legal action with the help of a brachial plexus birth injury attorney.
Now that Jett is 8 months old, I have began taking clients again and getting more involved in the birth community.
I am looking forward to, once again, helping women feel empowered by childbirth through my support and love as a doula.
However…
I’m concerned.
Better yet, I am terrified.
Not terrified for myself, but for moms and other doulas.
To me, the role of a doula should be simple to put into words.
A doula is a non-medical assistant who provides informed support to women during pregnancy, labor, and postpartum (if she so chooses).
So why is it that I’m finding that more and more birth/labor doulas, these days, are dabbling in murky waters and becoming complacent with giving medical advice or even practicing hands on procedures that should be left to the trained midwife, apprentice, or medical professional (and in some cases, a trained monitrice)?
Because you are not actually required to have a certification to be a doula or a monitrice, there is a fine line when it comes to accountability.
Not only is it not in the scope of a doula to check cervical dilation, fetal heart tones, positioning, blood pressure, etc., but it’s a huge liability to do these things with the proper training and credentials.
It’s also shaky ground when a doula offers medical advice based on the fact that they’ve been there and done that. Just because a doula has had a section or complications during pregnancy, it doesn’t mean that they’ve earned a medical degree for advice in the process.
Is this becoming a new trend? Is this becoming the norm for doulas?
I refuse to practice outside of what I know a true doula to be, even if it’s going to keep me from getting clients in the future.
I will not hurt the women that I vow to help keep safe through support and nurturing. There is enough of that going on in doctor’s offices and hospitals.
A doula is supposed to be an advocate for what a women wants for her pregnancy and birthing experience, not to show off the life altering tricks and tips they’ve picked up from midwives and doctors here and there.
The more that doulas practice as mini-midwives, the more moms will be hurt by birth. The more doulas who practice outside of what they’re professionally trained for, the more that doulas, like me, will find it harder and harder to find clients, because let’s face it, who wouldn’t want an all-in-one doula?
If you hire a doula who does more than what a typical doula should, I dare to say… beware.
We are TTC again, and would love to have you as a doula, but I can promise you friend, I would NOT allow to check my cervix! My MIL tried that once during kiddo numeral solo, and although she is a registered labor nurse, we were NOT going there.
this post struck me in a few different ways. Immediately I was a little mad because I felt like you were calling me a mini midwife because I listen to heart tones. But I really only do thst if directed to by a midwife. I have only ever done pelvic exams when directed by a midwife as well, but that has been very few and far between. I also know some Doulas that do these things, but I still think they are good doulas. BUT then I started thinking more and I realized that I was a little mad because you were challenging me in my ways. So then I decided to look into monitrice programs, and I am happy to say that ultimately, between your post and the birth I went to this weekend, that its time for me to move on and you inspired me to move forward with a monitrice training program. I will be starting in the next 2 weeks. So am I a mini midwife? No I dont believe so. BUT I do believe that I might have been heading in that direction as I get more experience as a doula because I am finding myself more and more frstrated with showing up at the hospital too early with some of my clients. So thanks for this!
Lisa,
I feel so very proud of you for posting this. We would all be wise to be circumspect in what we do and do not do. You do great work for women AND doulas! (And thanks for calling me your fantastic doula!).
Debbie
I have been mulling over this post since you posted it, not quite understanding my thoughts on it. Like Nicole, it struck me in several different ways. At first I thought, “Oh boy, this is going to get interesting.” I was a little aggravated I think, actually not quite sure what the emotion was, but I was thinking about the great doulas that are working as midwives assistants and act as monitrices sometimes. Sometimes I feel like as some of my colleagues move on and develop these extra skills, there will be little need for someone like me. At this time, I do not ever see myself having the desire or feeling comfortable performing cervical checks and taking fetal heart tones, etc. I plan on just being a plain ole doula and practicing within the scope of practice DONA has set forth. This is also one of the reasons I appreciate that certification exists (not looking for a debate on whether certified vs. uncertified is better/more skilled) because it sets forth a clear line of what that particular doula’s scope of practice and MINIMUM training has been. Unfortunately there are friends of mine that say, “Oh, my sister was my doula.” Um, no. Your sister may have supported you and did lots of stuff that a doula does, but unless she’s been trained as a doula, she’s not a doula. But this kind of stuff runs rampant so that it’s very unclear to many people as to what a doula is supposed to do. There are plenty of great doulas that know so much and know all kinds of tricks, but honestly, they do stuff that would be considered outside of the scope of practice I have chosen to follow. And this is one of the reasons that those doulas have chosen NOT to certify. They want to be able to serve without those restrictions. And there are moms out there who WANT a doula that can serve without those restrictions. Lucky for them, they exist. Can some doulas go too far and end up harming moms? Certainly. But so do some doctors and midwives. I guess my final conclusion with all of this thinking I’ve been doing since you wrote this, is that ultimately, it boils down to the moms. There really is a doula for every woman. Does she really want a monitrice? Well, there are several around. Does she want a certified doula who follows the scope of practice of her certifying body very carefully? Well, there are several around. And finally, although I sometimes do get discouraged that I will never have these extra skills (cervical exams, fetal heart tones, etc) and therefore not as much work as some of the other doulas who can do these extra things, I have to keep hope that the moms that I NEED to meet and am meant to help will be the ones that find me. The moms that hire me to attend them at their births will hire me because I was the exact type of doula they were looking for.
I read Nicole’s comment and thoroughly agreed. At first I was a little upset, like ‘she is telling people to beware of ‘me”… but then I thought, “wait, you’re being moody and a little arrogant. This isn’t an attack against you, she has a point”.
I have been training as an apprentice midwife for a few years now and fully feel able to provide monitrice services to the clients who might want them.
But then again, when people hire me as a doula – I ONLY doula, unless I have accountability: a midwife asks me to for some reason (i.e. can’t reach a cervix (small hands)), etc…
Doulas should doula when they are doulas. If they are trained for more, then they should call themselves monitrices, not doulas. And, likewise (and perhaps another post for you Lisa) midwives shouldn’t be expected to doula, because they are midwives. 🙂