The art of “Doulaing”: No two doulas are alike

​The doula profession is still rather new despite its rapid growth and popularity over the last decade or so. There are some aspects of this job that are constant throughout the professionals. We all support women in the childbearing year, either in pregnancy, in birth, or in the postpartum period. Also, professional doulas understand that they are not medical professionals, and they do not to act or practice as such. Beyond that, there are many variations in the ways that doulas practice and run their businesses.
The doula scope of practice is outlined very clearly in all of the certifying organizations and there are few variations. Here is an example of the birth doula scope of practice as outlined by CAPPA (Childbirth and Postpartum Professionals Association):

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The Certified Labor Doula

CAPPA Labor Doulas fill an important role in providing emotional, physical, and evidence-based, informational support to the birthing woman and her family before, during, and after birth.

How CAPPA Labor Doulas work with families

The Labor Doula works with families during pregnancy, during labor, and in the birth process, and in the immediate postpartum time, offering support, encouragement, information, comfort, and referrals as needed. Labor Doulas can be found working in the community in private practice, in cooperatives, as part of groups or agencies, as well as serving in various community programs

​How CAPPA Labor Doulas work within the healthcare system

Labor Doulas are skilled support persons who act as consultants and resources, not clinicians. They therefore work with the healthcare system by encouraging and promoting excellent communication between the birthing woman and the health care team, encouraging informed decision making and self-advocacy, supporting the choices of the birthing woman, providing non-clinical comfort techniques, and offering appropriate referrals when their observance or counseling uncover situations that require healthcare attention or support.

Clinical Limitations of CAPPA Labor Doulas

CAPPA Labor Doulas are nonclinical professionals. CAPPA Labor Doula courses do not qualify a professional to act as a midwife or midwifery assistant, as any alternative medicine provider, or as any medical care provider. Labor Doulas do not diagnose medical conditions, perform clinical procedures, prescribe or administer treatment for medical conditions, make medical decisions for the birthing woman, or direct families to act against medical advice.

​CAPPA Labor Doulas:

• Provide non-biased emotional, physical, and informational support during pregnancy, labor and the birth process, and the immediate postpartum period
• Work closely with the birthing woman and her family as she explores her values and needs surrounding birth
• Encourage the birthing woman to seek care and a place of birth that reflects her values and needs
• Assist in the preparation of birth preferences to facilitate communication with the birth team
• Model, teach and encourage effective communication
• Encourage informed decision making
• Provide information on birth options and resources
• Provide the woman with non-medical comfort techniques for labor, such as positions and movement, comforting touch, visualization, breathing techniques, and affirmation
• Seek to foster a cooperative, respectful, and positive atmosphere with the birth team
• Provide support to the birthing woman’s partner or family
• Support and assist initial breastfeeding
• Assist the mother in processing her birth experience
• Answer general questions about newborn care and breastfeeding
• Refer to healthcare professionals when support requires clinical assessment, a need for prescription, or medical diagnosis

The CAPPA Labor Doula is not a clinician and therefore does not:

• ​Diagnose medical conditions
• Perform clinical procedures
• Interpret medical diagnoses or clinical results
• Prescribe or administer treatment of medical conditions
• Perform clinical procedures
• Make decisions for the birthing woman
• Speak for the birthing woman
• Attend births that are intentionally unassisted by qualified medical professionals

​That about sums up the job of a doula. There are a few things, however, that all doulas do not agree on, and the discussions go on.

For instance:

• How much education is a doula to provide to a client? Where is the line between simply providing evidence based information and making medical recommendations? (Which is not within our scope of practice).
• How much talking should doulas do in the delivery room? Are doulas to be advocates or not? Is it more important to help women to find their own voice or is it better to help her speak during the intense moments where she needs guidance?
  
• ​Should doulas sign agreements with hospitals about the way that they practice or does that compromise the way we practice?
• Should we advocate for insurance to cover our services, or will that compromise the profession?
  
• What is fair to charge – and should we even do so?
  
• Should doulas attend unassisted births? It’s not unassisted unless someone else is there, and doulas can not attend as a caregiver. Is this risky?
• Should clients pay in full prior to the birth or after?
• Should doulas labor with a mother at home before she goes to the hospital? Or is that risky from a liability standpoint if the birth accidentally happens at home?
• Is it important to be insured (since we aren’t medical providers) or isn’t it?
• Is it better to work solo or with an agency or partner?
  

There are no right or wrong answers to many of these questions. In some cases, it’s a matter of personal preference on the part of the professional. Yet the discussions continue.

Why does this matter? Doesn’t every profession have areas of disagreement? Of course, they do – and that is part of what drives improvement in any industry. The doula profession is no different. They all work a little differently, with varying perspectives and philosophies.

It matters to the mothers that we work with because it’s important to know that no two doulas are the same. Make sure you hire the right one for you.

Interview a few doulas, ask them about their approach, their fee structure, their insurance, their stance on advocacy, or things that matter to you. If you want a doula that will be more available to talk with the hospital staff, make sure you ask if she will do that. If it’s important to you that your doula is insured, ask her about that. If you want a doula that will labor with you at home before you go to the hospital, make sure she does that – because they don’t all practice that way.

Doulas have the privilege of being welcomed into a sacred space. Your birth is a once in a lifetime experience – having the right one can make a huge difference in your experience.

To learn more about the work New Life Blessings does with their clients, please email us NLBlessings@gmail.com