What A Doula Does Not Do

Let me first say, this is what a professional doula does not do. There are folks out there who call themselves doulas who have never had training or have trained but chosen to not certify. That is fine. It is not a requirement to be trained or certified to call yourself a doula. But please act professional. When a doula steps outside of the protocols of a professional doula, she risks the reputation of all doulas. So, this is about what I personally feel a doula should not do.

A certified doula signs a code of ethics and practices within her scope of practice. I have been a certified doula for a long time- with DONA and with CAPPA. I am currently certified with CAPPA.  Here is the scope of practice I follow- CAPPA SCOPE OF PRACTICE.

 

  1. The labor doula assists the woman and her family before, during, and after birth by providing emotional, physical, and informational support. It is not within the labor doula’s scope of practice to offer medical advice or perform any medical or clinical procedure.
  2. During pregnancy, the labor doula’s role is to assist families in preparing a birth plan, to provide information about birth options and resources, and to provide emotional support.
  3. During labor and birth, the labor doula facilitates communication between the family and the caregivers. She supports the mother and her partner with the use of physical, emotional, and informational support.
  4. During the postpartum period, the doula assists the mother in talking through her birth experience, answering questions about newborn care and breastfeeding within our scope of practice, and referring the family to appropriate resources as needed.

So doing vaginal exams is not what a doula does. Have I, yes twice when a mom was birthing at home unexpected and I arrived to find her pushing. I called her midwife both times to let her know that yes the baby’s head was right there! I did check so I could let them mom know my opinion on whether she should get in the car or call 911. Both times the mom asked me to confirm what she was feeling- and it was a small internal finger hitting a head check!  Is that me acting as a doula….NO! It is me acting as a good samaritan person who had the most birth knowledge in the room at the time. Did it feel scary and weird- YES! But did I feel it was needed- YES! Both moms birthed within minutes safely and had a midwife there moments after the birth to provide medical assessment.

So, when a doula says she can offer a vaginal exam – then she is acting like a monitrice- not a doula. She should have learned these skills from a midwife. If she says she does this, you need to ask where she got her experience. And also you need to  think about how important is it to have a vaginal exam performed on you in a normal, non emergent situation. Rarely is a vaginal exam needed in labor at home if you are planning on going to the hospital. Trusting your care provider to send you home if you are not dilated enough, trusting them to not interfere in ways you do not desire, are imperative.

Information gathering is wonderful. Even providing information that is something they did not know is even better. But the role of the doula is not to require a mom to have the birth that the doula wants- but the one that the mom wants. Making sure she has information to make an informed decision is most important. I wear the hat of childbirth and parenting educator- so often I provide a plethora of information. When a mom tells me about the birth ideals she has and I realize the provider or the place she has chosen may not provide what she is looking for, I often tell her about other resources. But whether she chooses those options are up to her. I support what she decides once she has the information.

A doula remains with the mom or couple during the labor. I do not think a professional doula leaves a mom in labor unattended. If the labor is too long, she can certainly call in a back up, but she remains with the mom until her back up arrives. There will be times for bathroom breaks, quick meals and even a nap if the mom is walking the halls with her partner or resting herself. But she does not leave the mom unless the mom dismisses her. If a mom chooses medication, a professional doula does not decide she is no longer needed and leave just because the mom is medicated. I love what Persis Bristol says, “just because the mom’s body is numb does not mean her mind is numb!

Our company provides a postnatal meeting to review the birth and see any pictures that were taken. We love this time. Some moms drop by on the way home from the hospital to get breastfeeding assistance and the postnatal is done then. Others may wait a few weeks, some months and some just ask for me to send the pictures and notes due to hectic schedules and returning to work. But I have to say I miss seeing the new family if this is the case. I have some moms who text, email and call frequently to chat about baby and parenting concerns. We welcome this.

This week four things came up. 1. One was a potential client who asked if we required her to have to be committed to a natural birth. I discussed options, informed decisions and how this was her birth. Sometimes doulas project their own bad birth baggage onto their clients. They also feel the need to “save” their clients. And sometimes they feel compelled to force their birth dreams on others.   2. The other thing that was shared with me was how a doula had some issue with having to pick up her child and left the mom who had gotten an epidural, and then never ever returned to the mom during the labor and birth.   3. I had a strange question asked of me by a nurse.  It made me curious when a nurse asked me if I did vaginal exams on the mom prior to her arrival. I explained that I did not do vaginal exams. Then the attending midwife shared how a doula who says she is a monitrice had a mom arrive and proclaimed her to be in very active labor- 7cm dilated, only to be 2 centimeters. This was making the nurses misunderstand the role of a doula.   4.  I had a mom recently ask if she ended up with good biophysicals from her perinatologist and was like her mom and went to 43 weeks, would I still be her doula since our agreement says 42 weeks. I assured her I was her labor doula until she gave birth!

I think it is important to know all doulas don’t follow the same rules or scope of practice. All doulas don’t provide the same services.You may want to ask a lot of questions. Perhaps you should ask where she received her training. Ask if she is certified and if she is not, ask why. Ask about her scope of practice. Ask about her experience (there are doulas in my area who are just starting out and charge more than very experienced doulas in the same area). Ask away- you may find some of the answers are exactly what you are looking for, or not.