Their Doula Disappointment
Recently these two news stories came across my desktop. “My Doula Disappointment” outlines one woman’s story with her birth and postpartum doulas. The second is a petition which is a response to North Florida Regional Medical Center’s recent move to create a registry of birth doulas who are “allowed” to attend women in labor at their hospital. What do these stories have to do with the current discussion of certification? Plenty.
In the first issue, the woman noted that the doula she hired had twenty years experience and was highly recommended but not certified. The mother disregarded the doula’s lack of certification, remarking that since she came highly recommended, certification was not necessary. Now that she is not satisfied with her experience, she realizes that there is no one to complain to nor to mediate her dispute (or even to listen to her feelings). While I know nothing about the circumstances or doula’s perception of what happened, that isn’t relevant. My point is that the mother bemoans the fact that there is no one with any authority who will listen to her concerns, so she is forced to air her concerns on the internet – for all to read. If there was a certifying body, the story she shares might be different.
In the second instance, NFRMC is reportedly instituting a doula registry in order to clear doulas who will be allowed into the hospital in a doula role. [This is unverified as the only mention I have found online is the petition.] Undoubtedly, they have encountered unprofessional behavior and are doing what they can to provide a “reasonable” working environment for their staff and providers. Part of the problem is that doctors and nurses deal with novice doulas, hobby doulas, friends of mothers calling themselves doulas, and rogue doulas*. Very few of these people feel any allegiance to other doulas or the professional standards most of us hold dear. They can’t tell them apart from the professional doulas – we’re all the same to them. We use the same title and there is no visual distinction between us. Every doula gets blamed when one person calling herself a doula acts in a way that medical professionals do not care for.
Even though we are not part of the medical culture, it behooves us to structure our profession in a way that garners their respect. We can either control and patrol ourselves or hospitals will do it for us. As someone who has consulted with hospitals regarding their conflicts with birth doulas, I am not surprised by NFRMC’s purported action. It makes perfect sense to me when I consider the bigger picture of their possible doula experiences.
On the other hand I hear doulas rejecting certification because it interferes with their freedom to offer services to their client. What is it you want to do for your client that is outside the doula’s scope of practice as defined by DONA, CAPPA, and similar standards? This “I want to follow my own conscience” does NOT work for doctors, accountants, or even personal trainers. No one is protected by an “anything goes” attitude. According to DONA and CAPPA SOPs you are welcome to use aromatherapy, therapeutic touch, even massage, homeopathy, and herbal remedies IF you have additional education or certification. Counseling that these alternatives are available is certainly within your SOP. Giving your mom a recipe for an herbal tea to start labor is too IF you are a trained herbalist and her MCP of choice is consulted. Herbs, homeopathy, and essential oils are drugs! They have effects on the body; that is why we use them. The same goes for acupressure. To think that these effects are always benevolent is deluding yourself. States and provinces even require massage therapists to be licensed. But many alternative remedies have been classified as supplements which means they are available over the counter. But OTC does not = benign. Both of these SOPs state that if the mother is considering doing something to her body that may have a deleterious effect, even if it is a rare occurrence, that she discuss it with her care provider of choice first. Some doulas interpret this as asking for permission; I see it as consulting. The mother hired her MCP for their expertise on her physical health. If she is considering taking a drug or having a treatment that may affect her health, it is important for her to get their opinion and for her medical record to be complete. It is the mother’s choice to make; we only counsel her to do so.
We live in a society where few people take personal responsibility. You may think your client will never blame you or a technique you recommended for a poor outcome. Just ask the doula who has had 100 clients – she’ll set you straight. According to my own research participants and the hundreds of doulas I’ve known over the years, scapegoating occurs in both small and large ways. The limits for the doula’s standards of practice and condition that the client consult her medical care provider PROTECT you and your client. If you really want to prescribe rather than support (or in addition to it), get the education and credentials to do so. No one is stopping you.
But remember that the doula’s magic is her ability to support unconditionally and be present with a woman when she is vulnerable, uncertain, and challenged on every level. It is believing in her ability to find her own voice. It is not being another voice telling her what to do. That is what the research evidence supports. If prescribing, diagnosing, and treating are important to you, then perhaps your path is not to be a doula. There are many other roles where these desires can be accommodated – just don’t do them and call yourself a doula. Be fair to the rest of us – the choices you make individually do not end with you – they affect all doulas.
*rogue doulas: A doula who willfully behaves in a way that is dishonest, unethical or against established standards for doula behavior.