Birth doulas can be an extremely valuable source of support to mothers before, during and just after childbirth, as they are specially trained to provide physical, emotional and informational support. Doulas, however, are not trained medical providers, and thus, there are limits on what they can and cannot do.
Unlike physicians or nurse midwives, doulas are not required to obtain and maintain licenses or certifications in order to practice. Various doula organizations train and certify doulas, such as DONA International, Childbirth International and CAPPA. However, as certification is not mandatory, it is up to each individual doula if she wants to affiliate herself with a professional organization and their particular scope of practice. Thus, it is always important to ask a doula about whether she adheres to the guidelines of a particular certifying organization during your initial interview.
Even though each doula certification organization has different certification guidelines and is built on slightly different philosophies, all of them agree that the role of a doula is solely non-medical and that certain things are out of every doula’s scope of practice. Below are four things that doulas cannot do.
- Perform any clinical tasks. This includes vaginal exams, taking vital signs, or monitoring the baby’s heart rate. This is number one on the list of doula no-no’s and is clearly outlined in most doula’s contracts. Even presumably simple tasks such as readjusting fetal monitors during labor or taking them off to allow mom to use the bathroom or walk around should not be done by a doula without explicit permission from the nurse or care provider, as this can be seen as a medical task.
- Speak on your behalf to your care providers. While a doula is there to help you know your options and formulate questions to ask of your care provider during labor, all final decisions must come from you.
- Carry and administer aromatherapy scents, essential oils or herbs. This is a currently a very controversial topic within the doula community, and the question of whether or not it is appropriate for a doula to utilize these tools sparks heated debate. However, DONA International, one of the major doula certifying organizations, has recently declared it outside of a doula’s scope of practice. Since aromatherapy scents, essential oils and herbs can have potentially harmful side effects and requires special training to administer correctly, I do not believe that it is appropriate for a doula to use them. In your search for a doula, consider asking her if she uses any of these products and if so, what her training is with them.