This profession has become necessary for a couple of important reasons, in my opinion. First and foremost, we don't often live in the same area as our immediate or extended families. Once upon a time, not too long ago, women were surrounded by immediate and extended family and the women in a family or community would provide this service much of the time. Mother's, Aunts, Grandmother's, even daughters or niece's may have been a part of a laboring woman's circle. Midwives moving into the modern era and being licensed has significantly increased the numbers of practicing midwives, both in and out of hospital, which is wonderful. Along with this privilege to practice, came the need for rigorous documentation which requires more of their time spent charting if compared to the constantly attentive homebirth days of midwifery care. A small price to pay to have the option. Additionally, in hospital, the role of the nurse has significantly changed in scope. Hospital budget cuts and misappropriated funding have altered the nurse to patient ratio, lawsuits have increased the need for constant documentation and data entry, policy has created monotonous and incessant repeated questioning of the patient, doctors delegate more and more clinical tasks, often leaving the true definition of "nurse" in the dust. Synonyms listed on Merriam Webster:
So, not all women will need all of these things, and some women will need things that I couldn't imagine in a million years. We learn over time not to judge...but to be discerning. If there is ANYTHING that comes up that I feel falls into the category of "medical", there will be a communication between my client and her medical team. This means reporting a broken bag of fluid, any amount of blood that meets or exceeds their directive to make contact, changes in consciousness, anything that the care provider has asked specifically to be notified about, etc. I am not medical professional, and take a great deal of pride in that, actually, but I will pay attention to the requests of their care provider and additionally, will likely notice if anything is happening that I understand the doc or midwife would want to know about. This is not my responsibility, but I'm happy to be a second, and slightly more experienced pair of eyes and ears.
There is a new breed of doula out there that significantly blurs the line between doula and medical care provider and I want to go on record saying that if a doula is offering any degree of clinical evaluation...know that she is not acting as your doula. Most of the time I consider it part of my job to assist in helping women to avoid nonessential intervention, so why on earth would I be offering it myself? Some examples of things I consider medical are:
- Anything involving the physical well being of the baby or mother, above and beyond what a couple would be asked to monitor independently. For example, families are often asked to track fetal movement, so even though I don't use the data to diagnose or treat anything, I will jot it down if mom mentions baby kicking to help the family communicate with the care team accurately. I feel comfortable assisting in timing contractions because families would be asked to do that with or without me. I don't evaluate fetal position, I don't offer sterile water injections, I don't listen to fetal heart tones, I don't check maternal vitals, I don't use a Rebozo for fetal positioning...this is an odd cross over, I think. Why would a doula make any attempt to manipulate or reposition the baby? I don't know what position the baby is in and it is not my role to assess. Definitely medical, even though the rebozo looks like a little swath of fabric, a scarf, really, its use for anything other than comfort (hip squeeze, gentle hip support, etc.) by a doula is reckless endangerment in my opinion. To be manipulating the belly IN ANY WAY is irresponsible. If the medical team wants it done, they should do it themselves.
- Vaginal exams...Seriously! There are Doula's out there, usually falling into the category of either a "Montrice" (A birthy person trained to perform some clinical tasks), or a midwifery student or midwife who also moonlights as a doula. One of my main objectives is to help my clients limit cervical exams as much as possible, not performing them myself. One component of the art of being a doula is to learn to ascertain (using external signs: words, behaviors, discomfort, positions, needs, appearance) the approximate stage of labor and provide appropriate care and comfort based on the needs of the laboring woman in that stage. I'm a big believer in the sphincter law that Ina May Gaskin talks about in her book "Ina May's Guide to Childbirth" and I am also very aware of the fact that if I had done an exam on a woman and determined that it was time to go to the birth place, my examination will NEVER prevent another exam from being done upon arriving at the birth center or hospital, they will want to assess her cervix themselves and therefore I would just be yet another person violating her sphincter, causing her stress, and potentially introducing bacteria. No thank you.
- Giving her (even if requested) herbs, supplements, pills, or tinctures without consulting with her as well as her care provider first. This does not mean that I won't hand her or bring her any medicinals that she researched, discussed with her care team, and brought for herself. If her mother was there, or her grandmother, they would meet that need, and so then will I.
I hope this article will be helpful, to families who are considering hiring a doula, as well as lending my 2 cents to the discussion of what the role of the doula includes and what it doesn't. If you are in need of some education prior to interviewing doula's and you are unable to attend my classes (I'd rather deliver the information in person!), please consider purchasing my textbook/workbook. It is a concise 192 page workbook that will educate you about preparation for birth, provide a thorough account of the labor and birth process, it will assist you in the creation of a your birth plan because the truth is, that barring overstepping my boundaries into medicine, or not meeting the parameters of the contract we have agreed upon, my job description is the birth plan as written. It will additionally inform you about common practices in and out of the hospital, offer a variety of relaxation and support techniques for you to try out, which will be a big asset to anyone serving in the "doula" role, whether it's your husband/ boyfriend/spouse/partner, you mom, a friend or relative, or a professional doula. Knowing what comforts you and providing it at the right moment is an elemental part of this caring profession.
Here is a link to find it on Amazon:
Expecting Kindness by Kristin Dibeh