January 20th, 2006

Stewart Not Your Monkey

Doulas offer NON-MEDICAL labor support!

Ok, folks, seems like this is just my day for rants.

I am SO sick of doulas fighting amongst each other and perpetuating miseducation! It is just NOT RIGHT to say "I'm a doula. I didn't certify, I didn't sign a Scope of Practice, so I can do anything I choose in my practice. DOULAS have no definition or Scope of Practice. If I want to perform medical procedures, I can! You can't stop me! DONA, CAPPA, ALACE - keep your hands off my practice!" Meanwhile, doulas everywhere are finding that doctors and hospitals are increasingly refusing to work with ANY doulas.

With that in mind, here is an answer I posted to a doula yahoo group (after all the quiet folks were urged to speak up...I'm not usually the confrontational type - oh, and minus morning-induced typos). I'm posting it here because I believe people - and especially doulas - should be educated about what a doula is and their role in the labor room:

I'm here. I personally agree that we need to self-regulate ourselves as a profession before the government decides to get involved and do it for us. I agree that we need to keep our scope of practice to non-medical care, and that others who choose not to should call themselves 'monitrices' ,or 'nurses', 'midwife's assistant', etc. - if you're so trained. I didn't feel the need to speak up because it has been said so many times, why keep repeating? Especially since those people who disagree seem adamant about their perspectives. However, since asked....

While some people argue that doulas have no real definition, I've read many, many childbirth books that define doulas as 'non-medical labor support'. Also,

DONA says: "The doula’s role is to provide physical and emotional support and assistance in gathering information for women and their partners during labor and birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement, and positioning. She also assists the woman and her partner to become informed about the course of their labor and their options. Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort.

Doulas specialize in non-medical skills and do not perform clinical tasks,
such as vaginal exams or fetal heart rate monitoring. Doulas do not diagnose medical conditions, offer second opinions, or give medical advice. Most importantly, doulas do not make decisions for their clients; they do not project their own values and goals onto the laboring woman."

CAPPA says:
"Today, labor doulas continue this tradition of providing support, information, and non-medical comfort measures to assist the laboring mother. Labor doulas are professionals, trained and experienced in childbirth. The labor doula provides physical, emotional, and informational support to the mother and others who are attending her.....A labor doula will not perform any medical tasks, such as fetal or maternal monitoring or vaginal exams. A labor doula will not give medical advice or second opinions, and will not project her own goals onto a laboring woman."

ALACE says: "ALACE certification does not cover clinical or assessment skills such as palpation, fetal heart tones, or vaginal examination. All ALACE labor assistants/birth doulas are required to sign the ALACE Scope of Practice Statement, which states that ALACE provides only an introdution to these skills.

ALACE supports the right of labor assistants/birth doulas to perform
assessments if they are already a midwife, physician, or labor and delivery nurse or have received further training. However, we discourage routine or frequent vaginal exams in any setting, and by any caregiver. Labor support professionals should never offer assessments while in a hospital or birth center, unless it is at the request of the mother's primary caregiver and with the permission of the mother."
(Emphasis mine)

Wikipedia says: "Labor support doulas are trained and experienced labor support persons who attend to the emotional and physical comfort needs of laboring women to smooth the labor process. They do not do clinical tasks such as heart rate checks, or vaginal exams but rather use massage, aromatherapy, positioning suggestions, etc., to help labor progress normally."

(And I've heard that even aromatherapy is a hot topic....)

Whether we like it or not, NON-MEDICAL labor support is the popularly
accepted definition of a doula. Doulas who perform medical tasks are having grievances brought against them from hospitals. It is beginning to interfere with many doulas' practices, and I don't believe that's right when there's no harm in calling yourself a "monitrice" or even "professional labor support".

I am a Reiki Master and a Chaplain Emeritus. I offer spiritual support - Reiki (energy healing) and prayer - if my clients are interested. In my prenatals, I am VERY clear that this is NOT covered in a doula scope of practice, most doulas DO NOT provide these services, and that if they want these services, I am acting either as a Reiki Master or as a Chaplain at that time. Some people have chosen not to use those services, and some people have. It has not hurt my practice in the least, being honest about what is commonly accepted in our field.

There's no way to say this part without sounding smart-assed, but that's not my intention. It's only a simplistic example. The definition of an artist is 'One who creates art'. I can sit around all day farting and call myself an artist, but most people would agree that farting is not in any way encompassed in the definition of 'art'. Now, for sure, if I held an exhibit, some folks would pay to come see and talk about how very cutting edge it is. But most artists would be upset - and rightly so. No organization would be able to insist that I take 'Artist' off of my business cards, and I could argue all day that it is truly art and no one could prove otherwise. I could complain loudly when museums quit allowing me to show my work. That doesn't make it any more acceptable.

Ok, so I spoke my piece. I didn't want to fight with anyone, which is why I remained silent to begin with. This may just be a topic we must all maturely and respectfully agree to disagree on - until we are legally unable to do so anymore.