Doula Scope of Practice:
Prior to birth, a doula provides information to her clients about the birth process in general, a variety of comfort measures and coping skills, and common procedures. The doula should offer evidence-based information in a manner as unbiased as possible. Referring the client to reliable sources so that she can make her own decisions imparts confidence that she can draw upon during labor.
As a doula accompanies the birthing person in labor, her primary responsibility is to be present in every sense. A doula provides continuous care from early or active labor until the postpartum period. She should have reliable alternative arrangements to provide for her client’s care in case she is unable to attend the birth.
A doula provides culturally appropriate emotional support to the laboring person, helping them to cope with labor in their own way. The doula, as a servant, lays aside any preconceived ideas she may have and supports the client in the way that the client chooses to labor.
A doula also supports the partner and others who are present, helping them to participate in the birth experience to the extent that they are comfortable.
A doula physically supports the birthing person in a variety of ways. She will suggest alternative (upright and gravity positive) positions for the client, remind her to maintain her fluid intake, make sure she goes to the bathroom frequently, or offer the use of heat/cold therapy for stress and pain relief. A doula may help with coping skills such as breathing techniques, relaxing touch or visualization. She may suggest dimming the lights or playing music – whatever creates a soothing environment for the client. A doula offers comfort support.
There is a misconception that doulas only provide care for those interested in natural childbirth/unmedicated births. Doulas provide care for people with and without pain medication, unaccompanied teen parents, clients who have little or no social support, clients who have disabilities, clients who plan cesarean sections, clients who have unplanned cesarean sections or people who are planning a TOLAC (trial of labor after cesarean) or VBAC (vaginal birth after cesarean). Since the core of the doula’s belief is to make this the very best birth experience for her client, the doula can be a benefit regardless of the particular circumstances surrounding a birth.
Limitations of a Doula’s Scope of Practice:
A doula does not give medical advice or perform any medical tasks! While it is beneficial for a doula to be knowledgeable about medical procedures, her job is not to make decisions for the client or offer to perform any procedures. She may describe a procedure, explain why it is done, clarify the procedure’s risks and benefits, and explain any alternatives. In many cases, when clients have questions about medical issues, the doula can consider it an opportunity to facilitate communication between the client and her caregivers. When the client and her family speak directly with their healthcare providers, it reduces risk of miscommunication and increases shared decision making and a great birth outcome both physically and emotionally.
Doulas do not ever suggest supplement protocols when clients have a midwife who is helping tailor that guidance based on what she is seeing. Doulas do not palpate for fetal position when the client has a midwife that is doing this. Doulas do not take the role of their midwife. Doulas do not contradict health care providers. The woman and her family have chosen a provider they presumably trust. Entering into an adversarial relationship with that provider undermines the client’s ability to make her own choices. An adversarial relationship may also affect her emotional health and her feelings about her birth, as well as making her doula and doula colleagues appear reckless in the community.
DOULA AT AN UNASSISTED BIRTH:
This is an ethically questionable practice- as people choosing to birth unassisted are relying on their own instincts. If they are asking for a doula present, they might already be hoping for guidance, which a doula should never do in this birth setting.
If a doula is comfortable attending an unassisted birth - the birthing person is technically their own provider and a doula should only offer comfort support, without any guidance or opinions offered. They should make their scope very CLEAR – attending only in the role of a quiet friend.
If the doula - in any way insinuates that she can help in an emergency during an unassisted birth, brings in any equipment/ supplies, or guides/ assesses client or baby, this is an unethical representation of her skill set. If the birthing person accepts this, they are looking for midwifery care, which a doula is not able to provide. The doula should never be assessing vitals for client or baby. She should never be offering any clinical advice. This could create an unnecessary transfer, or FAR WORSE, not transferring when necessary - because the ambitious doula suggests something is okay when it’s not, which is unfortunately likely to happen.
An unassisted birth is planned with the premise that the birthing mother is being guided by her own intuition and will seek outside help if something feels off to her. Adding the doula’s thoughts in to the space interferes with the mother-baby dyad.
Unfortunately, there have been more and more ambitious doulas who are willing to take advantage of people who want a homebirth, but feel like they can’t hire a midwife. They blur the lines of their scope which could put the birthing person and their baby at risk.
If a doula agrees to attend an unassisted birth and hints that she can potentially offer anything more than to be a babysitter, a photographer, and a cleanup crew, be extremely cautious!
If someone is planning an unassisted birth and the doula comes in with anything other than her self, it would be wise for the laboring person to send her home immediately. An ambitious doula like this can absolutely disrupt her own logic and instincts and should never be welcomed into a birth space.
https://www.facebook.com/103912865037948/posts/109198794509355/
https://icea.org/wp-content/uploads/2016/01/Role_Scope_Doula_PP.pdf