What Doulas DO NOT DO

You need not be certified to be a doula. But if you are certified, then the organization has what is called the “Scope of Practice.” Here is what DONA considers the scope of practice:

A. Services Rendered
The doula accompanies the woman in labor, provides emotional and physical support, suggests comfort measures, and provides support and suggestions for the partner. Whenever possible, the doula provides pre- and post-partum emotional support, including explanation and discussion of practices and procedures, and assistance in acquiring the knowledge necessary to make informed decisions about her care. Additionally, as doulas do not “prescribe” treatment, any suggestions or information provided within the role of the doula must be done with the proviso that the doula advise her client to check with her primary care provider before using any application.

B. Limits to Practice

DONA International Standards and Certification apply to emotional and physical support only. The DONA International certified doula does not perform clinical or medical tasks such as taking blood pressure or temperature, fetal heart tone checks, vaginal examinations, or postpartum clinical care. If doulas who are also health care professionals choose to provide services for a client that are outside the doula’s scope of practice, they should not describe themselves as doulas to their client or to others. In such cases they should describe themselves by a name other than “doula” and provide services according to the scopes of practice and the standards of their health care profession. On the other hand, if a health care professional chooses to limit her services to those provided by doulas, it is acceptable according to DONA International’s standards for her to describe herself as a doula.

CAPPA’s scope of practice is very similar.

Doulas are sometimes confused with folks who act as doulas but are not acting like doulas should… so I wanted to clarify. A few months ago I entered a hospital with a client and the nurse asked me how far dilated she was. I told her based on how she was acting I would guess 6 to 7 cm. She asked me didn’t I check my clients. I told her of course not I was a doula, not a monitrice. Seems a doula recently who was acting as a monitrice had recently attended a birth there and had been checking the mom at home. I clarified that we did not do that.

This past week I received a call from a mom who was 38 weeks pregnant. She asked if I was available to be her doula. When I asked where she was birthing, she told me at home. I said great, who is your midwife. She told me she only had a clinical midwife who would not be attending her birth. I explained that we do not attend births without a care provider present. I believe women should be able to choose to birth anywhere and any how they choose, but the doulas in my group do not attend a planned unassisted birth. We are not trained to do so nor do we have the necessary equipment to do so.

  • Doulas do not suggest a mom stays home when she is ready to go to the hospital. It is up to the parents to decide when to leave to go to the hospital. The doula should not be encouraging the couple to not go- nor should she be demanding that they go- it is their responsibility to make that decision. 
  • Doulas do not encourage a mom to stay home when she is obviously in active labor if she plans a hospital birth. As a doula we can suggest that labor is progressing and let the client know that they may want to consider moving to their birth location. 
  • Doulas do not diminish the importance of having a midwife or doctor present at a birth. Sometimes having great confidence in the doula makes clients feel she is more than capable of catching their baby. It is not her role to do so, she has not been trained as a doula to do so.
  • Doulas do not bring a doppler to a birth- she is not trained as a doula to use this piece of equipment. Sometimes having tools that are used by medical providers makes folks think that the doula has medical skills. It is best to leave medical equipment to medical personnel.
  • Doulas do not take your blood pressure. See the previous statement.
  • Doulas do not take your temperature. If your water has been broken for a while or you show signs of a fever, she may suggest you take your own temperature.
  • Doulas do not do vaginal exams. This is way outside of our scope of practice. If you are a doula and doing this I hope you are calling yourself a monitrice instead. 
  • Doulas do not catch babies intentionally. If no one else is around, and the labor moves quickly, we may assist the partner in doing so or even catch the baby ourselves. But we are adopting a policy that all labors that are precipitous in the future will also have a call to 911 in case it is needed.

I have personally caught two babies at home in precipitous births- where the mom was pushing when I arrived. I offered to help them possibly make it to a hospital. I called their midwives to alert them. I got a midwife to come but they arrived only after the birth. I suggested calling 911 both times but it was declined. In the future I will make that call and they can then decline going with the emergency folks if they choose to do so. 

As per our agreeement:

” Doulas DO NOT: perform tasks such as blood pressure, fetal heart checks, or vaginal exams.  Our role is one of nonintervention and is non-medical.  We are there to provide physical comfort, emotional support, and advocacy.  Doulas do not make decisions for you.  We will help you get the information necessary to make an informed decision.  We will also remind you if there is a change in your birth ideals that you have shared with us.  We will discuss your concerns with you and suggest options, but you and your partner will speak on your behalf to the clinical staff.  We will only act as a liaison between you and the staff if you ask us to do so and when it is appropriate.”

Labor of Love doulas do not attend planned “unassisted births.” There needs to be midwifery care for us to attend a home birth. We understand that sometimes births happen quickly, but the plan always needs to be one in which a midwife plans to be in attendance for us to be in attendance.

If you have any questions about our services, please contact us at info@alaboroflove.org. Thanks!