Monday, August 6, 2007

Doulas and Scope of Practice

I will try to be careful with this post. I am just a new doula. I don’t know what it’s like to be in the delivery room, yet. So, I will attempt to tread carefully while talking about something that I know very little about first-hand but still have strong opinions about.

I think that all doulas should be as well-trained and well-informed as possible. However, I am concerned by some of the language that gets thrown around by people when talking about training. It seems like doulas are looking for information for their clients that go beyond their scope of practice.

Doulas should be models of resourcefulness. If a mother has a question that reaches beyond the scope of practice of a doula (Should I get a cesarean? The baby hasn’t moved today, should I be concerned?) then the doula shouldn’t go and find that information for her, she should encourage the mother to talk to her doctor or refer her to a specialist who is qualified to answer questions and offer advice. This is not only good for the mother because it opens them to a world of resources, it also protects the doula. It just makes professional sense to work within your expertise and avoid opening yourself up to trouble by going beyond your scope of practice.

I am not a nurse. I cannot offer medical advice and while I may have opinions regarding certain medical procedures it is not my place for me to share these opinions with my clients. It would also be completely inappropriate for me to force my ideals on my clients or try to argue with a doctor.

For example, if a mother were to come to me and say that because of certain factors or based on certain concerns that the doctor has, they have decided to pick a date to induce. I may talk to the client about their concerns and help them to find the resources and information to decide how they feel about that decision. If they have concerns, I might encourage them to talk to their doctor after doing their own research. I should not and would not tell the person that I think induction is a bad or good idea and that she should argue or agree with the doctor. I am there to offer information and support to my clients, not opinions.

If as a doula, you feel like you would like to perform tasks that go beyond your scope of practice, there are a variety of other professions to consider. You could become an RN, you could become a montrice, you could even become a midwife (I am currently considering midwifery). However, if you are going to be a doula then you have to embrace and learn to work within your scope of practice.

Bottom line, my philosophy is that it’s your birth your way. If you want to schedule a cesarean and you want me to come to the hospital with you, then that’s exactly what I’ll do. If you want to swim out into the ocean and give birth with the dolphins “nature’s midwife”… Well, I might recommend a doula with better swimming skills but I’ll get the water wings and swim out into the big blue with you. Okay, maybe I wouldn’t attend your dolphin birth, I think that’s way beyond my abilities. I’m kind of afraid of the ocean and you might have trouble finding a human midwife who’s willing to share her duties with the dolphin midwives. Unless one of the dolphins has learned to speak or your human midwife once worked at seaworld and knows how to communicate with the dolphins. Also, being in the water that long would make my fingers and toes all pruney, I hate it when that happens. But I digress…

My knowledge is important, but in the end, my opinion doesn’t matter.


Grits said...

Hi Peggy!
Having you as a friend has helped make the thought of childbirth less scary for me. wink wink

doulicia said...

Sorry to hijack the comments here -- I couldn't find an e-mail address for you. Anyway, thanks for your yarn suggestions. I have thought of alpaca as soft in the past but I just finished knitting with an alpaca merino blend that, though soft to the touch, was still itchy on my neck. It made me realize I couldn't have a sweater from it...but perhaps not all alpacas are created equally?

As for your doula practice, let's keep in touch. One of my favorite former doula clients recently relocated to the L.A. area. She wants another child in a year or so but is worried about finding the right doula in the area.