As a doula, it is vital we use evidenced based birth information as we provide education and support for our clients. However, it is equally important that we also stay within our doula scope of practice. This means using evidenced based information to help us share options with our clients but never providing medical advice.
It is important we always remember we are not medical providers. Even if you are also a licensed medical provider, you cannot act as that medical professional while providing doula services.
Understanding evidenced based birth information and doula scope of practice is vital for providing the best and safest support for our clients.
What is the Birth Doula Scope of Practice?
During your birth doula training, you will learn all about your scope of practice. You will also learn how to apply that understanding in different circumstances. There are times clients will ask you medical related questions you know the answer to. However, it is important you do not provide direct medical advice.
In these situations, you provide general information and education, point them to evidenced based birth resources, and remind them to check with their medical provider.
The birth doula scope of practice is:
- Evidenced based birth education during pregnancy
- Being On-Call
- Continuous Attendance at the Birth
- Comfort Measures During Childbirth
- Relaxation Techniques
- Touch Techniques
- Positions
- Warm and Cold (heating pad or cold pack)
- Emotional Support during Pregnancy and Childbirth
- Advocate (Assisting in facilitating fluid communication between birth facility staff and the birthing family – we do not speak for our clients, rather we support them in self-advocacy)
While doulas are trained in evidenced based birth, pregnancy, and postpartum, we remain completely non clinical. Having knowledge is not equivalent to having clinical skills nor the ability to safely diagnose, treat, or recommend anything medical.
Doulas are not:
- A birth doula is not a medical professional.
- A birth doula is not a psychologist or mental health professional.
- A birth doula does not perform clinical tasks.
- Clinical tasks that a doula would NOT perform would include checking fetal heart tones, checking a mom’s cervix, taking blood pressure, suggesting medications including over the counter, prescription or herbal medications, vitamins or offering any other medical advice.
- A birth doula will not provide abdominal massage to help turn a breech baby.
- A birth doula will not contradict the healthcare provider’s advice.
Again, even if you hold a clinical license, when acting as a birth doula you do not perform any clinical tasks nor diagnose or treat anything.
Why Must Doulas Use Evidenced Based Birth Information?
As doulas, it is important we provide our clients with evidenced based information. There are endless sources of information, myths, and opinions floating around regarding birth. As professionals, we are obligated to provide our clients with accurate information to help them make informed decisions.
By providing clients with evidenced base information, we are giving them the tools to make safe choices about birth. With many myths, half-truths, and opinions around, it is easy for clients to inadvertently make choices which are not always safest.
It is also important that we only provide evidenced-based information to ensure we are not putting clients at risk. It is perfectly acceptable to share opinions with clients, but it is vital our clients can easily decipher between our opinion and actual evidence we are sharing.
For example, if a client asks about when inductions are medically necessary, we can provide them with the most recent information from ACOG, WHO, ACNM, etc. We can also share when we would personally opt for an induction versus waiting. However, we need to be sure they understand which information is from the reputable sources and which are our personal opinions.
Always Refer Back to Healthcare Provider
It is also important to redirect clients back to their provider for more information about their questions. For example, if a client is simply asking about inductions, you may not know why their provider has recommended one. By redirecting them to their provider, they might find out they are showing signs of hypertension and it is an evidenced-based recommendation. Or they might find out their provider offered it as he does all clients, and it is truly up to the client’s personal preferences.
However, if you simply provide information about induction without redirecting to the provider, and the client declines an induction, they could be at risk if it was medically indicated. As a doula, we need to ensure we never give medical advice and put our clients at risk and ourselves at risk for liability.
Evidenced-based information is vital for our clients being able to make informed decisions. Practicing within our scope of practice is vital for ensuring the safety of our clients and protecting our liability.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...