Scope of Practice

Last night at the meeting of our local doula collective, (which I love and depend on a great deal and will talk about more in another post) we talked about the importance of doulas working within their scope of practice. Like many other professions, especially health care professions, doulas have a very important code of ethics and scope of practice. Basically, they outline things that a doula should and shouldn’t do. It’s so important for doulas to follow these guidelines.

Sometimes as doulas we come across with doctors and nurses who are very wary about working with us.  When you start to dig deeper into why you often discover they have had encounters with doulas who have been working outside of scope.  Sometimes, it’s just seemingly little things where the doula is often appearing to be speaking for the client or where the doctor feels the client is constantly turning to the doula for answers to medical questions.  While some people might not feel this a big deal they can interfere with the doctor patient relationship. If a patient doesn’t trust their doctor, they need to deal with it long before the labour room. I have heard of much more blatant things too of course.  Doulas un-strapping their clients from the fetal monitors, wearing the blood pressure cuff so it would give better readings (which is so dangerous) Shushing a doctor abruptly with a hand as she walked into the room because the client was in the middle of a contraction.

I get it.  It’s hard.  We love our clients and we hate to see what we might consider or deem un-necessary interventions during labour.  HOWEVER, most of us do not have much, if any, medical training so we don’t have the qualifications to say what is and isn’t necessary.  I believe in education, information, and knowing your rights.  I like to give my clients access to evidence based information on what interventions they may encounter and how they might impact their body their baby and their labor.  Then it is their prerogative to make decisions based on this, THEIR decisions.  If they want to refuse procedures and interventions that are routine, then we talk about informed consent and the importance of a written birth plan and talking things over with your doctor ahead of time.

Whatever decisions they make, whatever they chose, I support them in those choices, 100%. Complete, unbiased, no judgement. Your Body, Your Baby, Your Birth.

Each different doula regulating organization will have a its own scope of practice although most of them are similar.

Here are the standards of practice that a doula in our collective must sign and abide by when she joins.

I also have included some explanations where is thought appropriate.

STANDARDS OF PRACTICE

Services Rendered

The Doula:

  • Strives to provide continuous support for the length of time that her client requires it.

Continuous support is important and yet hard to get in the hospital setting.  Nurses work 12 hour days so of course they need to go home at the end of their shift even if they have been a vital part of your support team. And Doctors are often only there for the last hurrah! Unless you are like myself who birthed my last 2 so quickly the doc never made it.  Our nurses are great at catching babies though.  All this to say that having a doula should guarantee you continuous support for as long as you need it.  Most doulas do reserve the right to call in back up after 24+ hours, even just to get some sleep. I personally have never had to use this clause in my contract. I usually want to see it through.

  • Accompanies the woman in labour, provides emotional and physical support, suggests comfort measures, and provides support and suggestions for the partner. 

I think this is self-explanatory.

  • Does not displace existing support persons, but rather facilitates their full participation in supporting the client.

This is so important, especially when it comes to dads.  As a doula, I never want Dad to feel that I am there to replace him or because he is lacking in any way.  I always strive to work with dads to help them support mom in whatever way they feel most comfortable.  I will never force a dad to do something he isn’t comfortable with either.  I want this to be special experience for both of them.

  • Respects the client’s right to self determination by not speaking for her, nor making decisions for her. She helps the mother incorporate changes to her birth plan if and when the need arises and enhances communication between the client and the care giver.

This particular point can be difficult if the client is quiet or doesn’t want to “rock the boat” with the medical staff.  It also can be tricky if you arrive at the hospital when she is has nearing or in transition and finding it more difficult to talk.  Good communication before labour begins, having a written birth plan, and having dad speak up for mom are just some of the tools you can use to head off these potential issues.

  • Works as a member of the larger birth team.

One of the most important things in labour is keeping the labour room as calm and tension free as possible and one of the fastest ways to raise tension in the delivery room is for there to be issues between the doula and the hospital staff.  It is vital that the doula keep her ego out of things and think about her client first.  It doesn’t mean she should put up with abuse or that if something inappropriate happens she can’t deal with it later, perhaps by going and speaking to someone after the birth is over. But it is vital that the tension be kept out of the birthing room as possible.

  • Does not perform medical or nursing tasks such as taking blood pressure or temperature, fetal heart tone checks, vaginal exams, or postpartum clinical care.

You would think this would be a given, considering how most doulas don’t have any medical training but the stories you hear…

  • Does not attend planned unassisted home births.

Unassisted or free birthing refers to situations where a woman has chosen to give birth without the assistance of a doctor or midwife.  Some argue that when you use the word unassisted it means she should be birthing alone or only with their partners there. however, some women who plan to birth unassisted still want a doula there. Sometimes they genuinely want doula support, sometimes they are looking for a cheaper, more available substitute for a midwife.  At any rate doulas in our collective do not attend unassisted homebirths.  There are a plethora of reasons but the biggest one is that if things go wrong you as the doula suddenly become the person with the most medical experience. I have attended many births and have seen how fast things can go sideways.   I NEVER want to be the person who is making decisions in those life and death situations.

  • Makes back-up arrangements with another doula to ensure services to the client if the doula is sick or unable to be reached. Should any doula feel the need to discontinue service to an established client, it is the doula’s responsibility to notify the client in writing.

Once again, I will sing the praises of the collective.  I love knowing that if some disaster happens and I can’t make it to a birth for some reason I have many wonderful women I can call on.  I had a period when I ran without backup and it was scary.  Love my collective ladies!

  • Will make referrals to appropriate resources should the client’s needs be beyond the scope of the doula’s training.

For me this primarily is about things like lactation consultants.  And we have two fabulous ones in town and I will list their info below. I nursed 5 kids but there is a huge difference between nursing your own baby and helping someone else nurse. These ladies have so much training and have helped so many families. If I feel a client is having issues I will refer to them in a heartbeat.

So there you have it. The scope of practice that I follow and what makesme a more effective doula.

Registered Lactation Consultants                           

Milky way Lactation Services        

Tara-Jean Thiessen

BScN, IBCLC, RLC,

Ph/txt: 780-380-9891

milkywaylactationservices@gmail

facebook.com/milkywaylactationservices

Nourished by Nature

Lorna Hillier

IBCLC, RLC

PH/txt: 780-832-5371

nourishedbynaturelc@gmail.com

facebook.com/nourishedbynaturelactationservices

 

 

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