Agreeing to hospital standards does not prevent me from providing physical, educational and emotional support to women and their partners during labor, birth and the postpartum period.

In recent birth news…

Lakeview Regional Medical Center in Covington, LA is planning to implement a policy that would require doulas to be “credentialed” through the hospital in order to provide labor/birth support to families choosing to birth in their facility.

So what? What’s the big deal?

Any professional who provides care in a hospital setting will likely need to be “vetted” by the hospital, no?

The good news is, hospitals are seeing doulas as professionals. Isn’t that what we have been rallying for?

Here’s how I see it…

Many doulas are working to elevate the role of doulas in the eyes of expectant parents, medical professionals and doulas themselves.

Expectant parents, seem to get it!

Medical professionals are starting to get it!

Doulas themselves? Well… doulas get it.

Activists that refer to themselves as doulas? A whole different story…

They want to fight.

They want to advocate.

They are not looking to unify and work together with hospitals to make birth more peaceful for families and respectful of women. They are worried about being removed from hospitals for advocating for others or for fighting with medical professionals.

But, we are already in that position. When you are in a hospital, you are a guest of the hospital. Whether you fill out a form in order to be there or not. If you behave inappropriately, you will be asked to leave. If you do not leave, you will be removed.

I had the opportunity to speak with the Director of Provider Relations at Lakeview Regional Medical Center and am confident that what they are seeking is safety and professionalism.

Doulas that certify, agree to a certain scope of practice based on the requirements of the organization that they certify with. For some, it is a short but specific list. For ProDoula, the scope of practice is taught through a standardized curriculum. Doulas are taught what is acceptable and what is not.

When a doula practices outside of scope, a grievance may be filed. Depending on the organization, they may or may not take action. For obvious reasons, hospitals must protect themselves from anyone “working” in their facility that could cause a difficult or dangerous circumstance.

Asking doulas to agree to their scope of service and job description… simply makes sense.

There is accountability in that. Agree to this scope of service. Sign the document saying you agree and if you practice out of scope, you don’t come back. Easy, right?

The best part of the whole thing is that the hospital has reached out to doula certification organizations like ProDoula and asked specifically about scope of practice. They want to know exactly what a doula should and shouldn’t do. They want to know how a doula becomes certified. They want to know how much time it takes to become a certified doula. They want to collaborate with us in order to be sure that doulas are able to do what the profession describes; provide physical, educational and emotional support to women and their partners during pregnancy, birth and the postpartum period.

Hospitals are not trying to dictate what doulas do. They are committed to learning what doulas do and holding doulas accountable to exactly what doulas do.

The following is the job description of Doula, as outlined by the hospital.

Duties and responsibilities:

  • The Doula will provide culturally sensitive support and serve as a role model in general, also will be a member of the team and work in a context of supervision and support.

  • Initiate contact with women as early in pregnancy as possible.

  • Seek to establish a trusting relationship with the women, provide comprehensive education.

  • Assist in labor and delivery. Attend and support women through labor and delivery and in initial hours postpartum.

  • Visit pregnant and parenting moms in their homes.

  • Provide individual education related to prenatal and postpartum health.

  • Maintain postpartum contact for a predetermined time period, maintain confidentiality of clients.

  • Work cooperatively with other staff and serve as a resource to them.

  • Support the birthing women in labor by offering alternative comfort measures and options including but not limited to positions, relaxations, essential oils, affirmations, massage and other techniques.

  • Perform other related tasks as needed or requested.

 Job Requirements

  • Must have completed a certified Doula Training program or apprenticeship.

  •  Experience in developing trusting relationships with clients and working with team members.

The following is the “scope of service” they will hold doulas to, as outlined by the hospital.

Scope of Service may include:

  • Non-biased emotional, physical and informational support during pregnancy, labor and the birth process, and the immediate postpartum period.

  • Working closely with the birthing woman and her family as she explores her values and needs surrounding birth.

  • Encourages 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.

  • Provide information on birth options and resources

  • Provide the woman with non-medical comfort techniques and alternatives for labor, including but not limited to positions and movement, comforting touch, visualization, breathing techniques, essential oils, rebozo and affirmation.

  • Provide support and assist with 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.

Limits to Services: Doula’s provide emotional, physical and information support only. The 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

  • Attend births that are intentionally unassisted by qualified medical professionals.

  • Have access to the patient’s medical record

If what we are all hoping to do is elevate the role of doulas and leave birth better than we found it, let’s build some bridges and work collaboratively with other professionals to make that happen. No one is the enemy here. Signing this paper doesn’t give your power away. Instead, it creates a more powerful force for generating positive change for birthing families.

What one can’t do alone, many can do together…