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What is the purpose of a doula?  Scope of Practice

purpose of a doula

Editor’s Note: Jessica Cartwright is one of our incoming students to recently be awarded a merit-based scholarship. As a part of the scholarship application process, we request that candidates complete two interviews with local birth professionals. In the interview process, professionals are asked questions pertaining to their previous experiences with doulas and how to improve relationships between doulas and medical professionals. Jessica’s interviews illustrate the tension and the harmony that can exist, and the proper role of a doula in the birthing experience.  We are reproducing her interviews here with Jessica’s permission.  Check out Jessica’s mom and baby yoga website at JessicaEnergy.com.


Stacey​ ​was​ ​one​ ​of​ ​my​ ​midwives​ ​and​ ​is​ ​an​ ​invaluable​ ​resource​ ​in​ ​our​ ​community.​ ​She​ ​is​ ​a member​ ​of​ ​the​ ​Montana​ ​Midwives​ ​Association,​ ​Midwives​ ​Alliance​ ​of​ ​North​ ​America,​ ​the​ ​National Association​ ​of​ ​Certified​ ​Professional​ ​Midwives,​ ​and​ ​Citizens​ ​for​ ​Midwifery.​ ​She​ ​is​ ​on​ ​the​ ​faculty of​ ​several​ ​midwifery​ ​schools​ ​where​ ​she​ ​serves​ ​as​ ​a​ ​clinical​ ​preceptor​ ​for​ ​aspiring​ ​midwives.​ ​She often​ ​does​ ​training​ ​for​ ​hospital​ ​staff,​ ​teaching​ ​them​ ​how​ ​to​ ​become​ ​involved​ ​in​ ​natural​ ​births​ ​and healthy,​ ​happy​ ​moms.​ ​She​ ​has​ ​been​ ​a​ ​midwife​ ​for​ ​20+​ ​years.

1. What​ ​experiences​ ​have​ ​you​ ​had​ ​with​ ​doulas?​ ​If​ ​negative,​ ​please​ ​describe​ ​what​ ​made them​ ​negative​ ​for​ ​you.

“I’ve​ ​​ worked​ ​with​ ​a​ ​lot​ ​of​ ​doulas.​ ​My​ ​biggest​ ​concern​ ​is​ ​that​ ​people​ ​don’t​ ​know​ ​their scope​ ​of​ ​practice.​ ​I’ve​ ​received​ ​calls​ ​from​ ​doulas​ ​asking:​ ​’how​ ​can​ ​we​ ​get​ ​labor​ ​going, my​ ​clients​ ​water​ ​broke​ ​3​ ​days​ ​ago’;​ ​‘my​ ​patient​ ​is​ ​laboring​ ​at​ ​home,​ ​had​ ​a​ ​baby,​ ​now how​ ​do​ ​I​ ​deliver​ ​a​ ​placenta?’;​ ​and​ ​‘I’m​ ​telling​ ​my​ ​client​ ​not​ ​to​ ​take​ ​antibiotics,​ ​what​ ​do you​ ​think​ ​is​ ​the​ ​best​ ​herb​ ​for​ ​this​ ​treatment?’ Stacey​ ​believes​ ​that​ ​doulas​ ​understanding​ ​their​ ​scope​ ​of​ ​practice​ ​is​ ​critical.​ ​They​ ​need to​ ​know​ ​they​ ​are​ ​not​ ​here​ ​to​ ​save​ ​people​ ​from​ ​unnecessary​ ​medical​ ​treatment.​ ​Doulas are​ ​here​ ​for​ ​support​ ​and​ ​confidence,​ ​not​ ​for​ ​medical​ ​advice.

2. What​ ​value​ ​do​ ​you​ ​feel​ ​doulas​ ​have?

Doulas​ ​provide​ ​good​ ​support,​ ​someone​ ​that​ ​is​ ​consistent​ ​in​ ​their​ ​labor​ ​and​ ​pregnancy.

3. In​ ​what​ ​ways​ ​could​ ​doulas​ ​and​ ​medical​ ​professionals​ ​work​ ​better​ ​together​ ​to​ ​serve​ ​a birthing​ ​woman?

“We​ ​could​ ​work​ ​together​ ​to​ ​overthrow​ ​the​ ​entire​ ​medical​ ​system​ ​and​ ​put​ ​in​ ​a​ ​good​ ​one.​ ​If OB​ ​practices​ ​had​ ​on​ ​staff​ ​doulas​ ​for​ ​labor​ ​care,​ ​on​ ​site​ ​child​ ​education,​ ​and​ ​motherhood support​ ​groups,​ ​we​ ​could​ ​improve​ ​the​ ​birthing​ ​experience​ ​and​ ​the​ ​outcomes​ ​would​ ​be magical.”


Jazmin​ ​was​ ​also​ ​one​ ​of​ ​my​ ​midwives.​ ​She​ ​has​ ​6​ ​children​ ​of​ ​her​ ​own,​ ​and​ ​is​ ​the​ ​most​ ​educated midwife​ ​in​ ​the​ ​state​ ​of​ ​Montana.​ ​In​ ​2015​ ​she​ ​graduated​ ​with​ ​a​ ​MEAC​ ​accredited​ ​BS​ ​in​ ​Midwifery from​ ​the​ ​Midwives​ ​College​ ​of​ ​Utah​ ​where​ ​currently​ ​she​ ​is​ ​a​ ​remote​ ​Teacher’s​ ​Assistant.

1. What​ ​experiences​ ​have​ ​you​ ​had​ ​with​ ​doulas?​ ​If​ ​negative,​ ​please​ ​describe​ ​what​ ​made them​ ​negative​ ​for​ ​you.

“I​ ​have​ ​had​ ​both​ ​positive​ ​and​ ​negative​ ​experiences,​ ​more​ ​negative​ ​than​ ​positive.​ ​I​ ​find that​ ​some​ ​doulas​ ​are​ ​there​ ​to​ ​fulfill​ ​their​ ​own​ ​emotional​ ​stuff​ ​or​ ​to​ ​process​ ​their​ ​own births​ ​instead​ ​of​ ​bringing​ ​in​ ​great​ ​energy,​ ​and​ ​a​ ​willingness​ ​to​ ​see​ ​this​ ​mom​ ​through​ ​this birth.​ ​They’re​ ​draining​ ​the​ ​energy​ ​by​ ​processing​ ​and​ ​repairing​ ​themselves. In​ ​my​ ​field​ ​(because​ ​I​ ​work​ ​out​ ​of​ ​hospital),​ ​they​ ​get​ ​in​ ​my​ ​way​ ​a​ ​little​ ​bit.​ ​They’re​ ​used​ ​to running​ ​interference​ ​between​ ​client​ ​and​ ​care​ ​provider,​ ​because​ ​the​ ​trust​ ​hasn’t​ ​been established.​ ​I​ ​have​ ​their​ ​best​ ​interests​ ​in​ ​mind,​ ​they​ ​don’t​ ​have​ ​to​ ​run​ ​interference.​ ​She’s forgetting​ ​she​ ​doesn’t​ ​have​ ​to​ ​protect​ ​the​ ​client​ ​from​ ​me. Sometimes​ ​they​ ​get​ ​in​ ​the​ ​way​ ​when​ ​I’m​ ​doing​ ​things.​ ​They​ ​need​ ​to​ ​be​ ​really​ ​helping​ ​out and​ ​sometimes​ ​they’re​ ​just​ ​not​ ​doing​ ​enough. Often​ ​I​ ​find​ ​the​ ​best​ ​doulas​ ​come​ ​in​ ​and​ ​fulfill​ ​needs,​ ​without​ ​having​ ​tons​ ​of​ ​experience. They’re​ ​more​ ​common​ ​sense​ ​based​ ​than​ ​training​ ​based.”

2. What​ ​value​ ​do​ ​you​ ​feel​ ​doulas​ ​have?

“Doulas​ ​are​ ​an​ ​amazing​ ​asset,​ ​they​ ​provide​ ​clients​ ​with​ ​physical​ ​support.​ ​They​ ​support the​ ​husband,​ ​so​ ​that​ ​they​ ​husband​ ​can​ ​support​ ​the​ ​partner.​ ​A​ ​good​ ​doula​ ​really​ ​saves me.​ ​I​ ​can​ ​focus​ ​on​ ​just​ ​midwifery​ ​and​ ​what​ ​I​ ​need​ ​to​ ​do.​ ​There’s​ ​a​ ​second​ ​set​ ​of​ ​hands. If​ ​a​ ​moms​ ​needs​ ​her​ ​back​ ​rubbed​ ​or​ ​someone​ ​needs​ ​water,​ ​the​ ​doula​ ​can​ ​do​ ​that,​ ​so​ ​in between​ ​monitoring,​ ​I​ ​can​ ​take​ ​a​ ​nap​ ​or​ ​catch​ ​up​ ​on​ ​charts.”

3. In​ ​what​ ​ways​ ​could​ ​doulas​ ​and​ ​medical​ ​professionals​ ​work​ ​better​ ​together​ ​to​ ​serve​ ​a birthing​ ​woman?

“I​ ​think​ ​if​ ​everyone​ ​remembers​ ​their​ ​scope​ ​of​ ​practice,​ ​that​ ​would​ ​be​ ​amazing​ ​and facilitate​ ​trust​ ​on​ ​both​ ​sides.​ ​Doulas​ ​don’t​ ​diagnose​ ​or​ ​do​ ​clinical​ ​skills,​ ​and​ ​it​ ​can​ ​be​ ​very harmful​ ​when​ ​doula​ ​is​ ​making​ ​medical​ ​recommendations.​ ​Remembering​ ​what​ ​a​ ​doula​ ​is there​ ​for​ ​and​ ​not​ ​there​ ​for​ ​would​ ​help.​ ​That’s​ ​a​ ​huge​ ​trust​ ​issue​ ​for​ ​me.”

What​ ​I’ve​ ​learned:

I​ ​learned​ ​an​ ​immense​ ​amount​ ​by​ ​talking​ ​to​ ​these​ ​healthcare​ ​professionals.​ ​I’m​ ​very​ ​grateful​ ​to have​ ​done​ ​this​ ​activity! The​ ​biggest​ ​takeaway​ ​I’ve​ ​found​ ​is​ ​to​ ​not​ ​offer​ ​medical​ ​advice.​ ​I​ ​think​ ​it’s​ ​important​ ​to recognize​ ​that​ ​I​ ​can​ ​help​ ​make​ ​sure​ ​a​ ​client​ ​understands​ ​their​ ​options,​ ​but​ ​that​ ​I​ ​will​ ​not​ ​help make​ ​or​ ​sway​ ​decisions​ ​for​ ​them.​ ​And​ ​to​ ​be​ ​clear​ ​on​ ​this​ ​from​ ​the​ ​get​ ​go. I​ ​actually​ ​find​ ​that​ ​very​ ​relieving​ ​because​ ​I​ ​am​ ​obviously​ ​not​ ​qualified​ ​to​ ​make​ ​medical​ ​decisions and​ ​would​ ​never​ ​want​ ​for​ ​a​ ​couple​ ​to​ ​put​ ​that​ ​expectation​ ​or​ ​pressure​ ​on​ ​me. Doulas​ ​are​ ​present​ ​to​ ​instill​ ​confidence,​ ​grounding​ ​energy,​ ​and​ ​to​ ​keep​ ​energy​ ​levels​ ​calm,​ ​but they​ ​are​ ​not​ ​there​ ​to​ ​get​ ​in​ ​the​ ​way​ ​or​ ​act​ ​as​ ​a​ ​medical​ ​professional. I​ ​think​ ​another​ ​takeaway​ ​is​ ​to​ ​be​ ​seamless.​ ​I​ ​am​ ​very​ ​good​ ​at​ ​holding​ ​space,​ ​and​ ​since​ ​many​ ​of my​ ​clients​ ​are​ ​my​ ​prenatal​ ​yoga​ ​students,​ ​we​ ​have​ ​a​ ​familiarity​ ​in​ ​movement​ ​and​ ​breathing​ ​and positive​ ​affirmations. I​ ​can​ ​aim​ ​to​ ​help​ ​the​ ​client,​ ​and​ ​the​ ​medical​ ​professional​ ​even,​ ​before​ ​she​ ​(or​ ​he)​ ​even​ ​knows they​ ​need​ ​it.​ ​It​ ​takes​ ​being​ ​a​ ​solid​ ​force​ ​and​ ​presence​ ​to​ ​lean​ ​on,​ ​no​ ​matter​ ​the​ ​outcome​ ​and choices​ ​that​ ​are​ ​made​ ​with​ ​the​ ​OB​ ​or​ ​midwife

Follow Rachel Leavitt:

Rachel has worked as a register nurse (BSN from University of Utah) since 2004 with a work history in Labor and Delivery, NICU and Postpartum Care. She is also the founder of New Beginnings Doula Training which she organized in 2011. When she's not busy being a mother and grandmother, she can be found reading research papers related to some aspect of childbirth.

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