“Doula” Shouldn’t be a Dirty Word

December 17, 2018

“Doula” Shouldn’t be a Dirty Word

It’s no secret that doulas are not well received in certain communities or with specific care providers. Why is that? Why is “Doula” considered a dirty word for some medical professionals? Birth Boot Camp Doula Trainer, Alexa Gumm, has some thoughts on this. Alexa is passionate about training new doulas to understand what it means to stay within a professional Scope of Practice.

I’m a birth doula, and I don’t perform cervical exams. This is often a misconception about what doulas do and do not do. I’ve been asked in the past by some (very unprofessional) care providers if I would check a client for them. My reply has been, “No, we will wait for you to do it.” The fact that they were asking told me they were used to or had heard that area doulas were doing cervical checks. Perhaps they were uninformed as to what the role of a doula actually was and had been influenced by its misrepresentation.

Doulas should NEVER check cervixes and here are a few reasons:

1. Performing cervical exams are the role of the healthcare provider. A cervical exam, or sometimes referred to as a vaginal exam, is the manual examination of the cervix to determine its dilation (opening) and effacement (softening/shortening) and to determine how the labor is progressing. The doula’s role is to provide physical and emotional support, as well as information. It is not to perform the job of the provider. Cervical exams cross the line into healthcare.

2. Inaccuracy of the exam. A non-medical professional, like a doula, does not have the appropriate knowledge or skills to accurately assess the cervix.  What would happen if the client was told she was 9 cm, only to arrive and find out she’s 4 cm? Complete emotional breakdown. Or, the opposite, being told by a doula the cervix is 3 cm, only to arrive at the hospital at 9cm and no time for appropriate antibiotics for being GBS+.

3. Risk of infection. If a woman experiences PROM (prolonged rupture of membranes) and her doula examines her and later develops an infection, this can be a problem.  It might not have been her fault, but who may be blamed? You guessed it – the doula. Multiple exams increase risk of infection. Many clients don’t realize it, but a certified doula should know this fact. If the woman’s water is broken for an extended period of time, we often see more infections or fever, in part, due to multiple vaginal exams.

4. We can often determine labor progress by how we sense a client is coping rather than through a cervical check. How covered is she? If she is fully clothed, she’s in very early labor. As the cervix opens and thins and the baby moves lower into the pelvis, most moms will shed clothing or blankets. It’s usually very clear, in an unmedicated birth, when a woman is ready to start pushing without a vaginal exam.

Doctors and nurses have shared with me they have caught a doula performing an exam on a patient. This does a disservice to all doulas, making them look unprofessional and irresponsible. Some hospitals do not allow doulas because of such experiences. It’s a shame how some misguided doulas represent the profession. These behaviors harm everyone.

Birth Boot Camp Doulas are specifically trained in knowing appropriate scope and how to behave as professionals. In fact, it is so important to our Birth Boot Camp Advisory Board, we have included this statement in our Training Manual regarding scope of practice.

“Birth Boot Camp Doulas are not birth advocates and do not speak to a client’s healthcare provider on behalf of the client. Birth Boot Camp Doulas are not medical professionals and do not provide medical treatment or diagnosis. Diagnosis, treatment, and medical monitoring including, but not limited to, body temperature, blood pressure, heart rate and cervical dilation, etc. are outside of a doula’s scope of practice.” All of our doulas have agreed, and violation of this requirement is reason to have certification revoked.

We believe all families can have an amazing birth with education and well-trained support to help them along their birth journey. The best birth teams are comprised of professionals who respect one another and their dedication to staying within their respective Scope of Practice. Birth Boot Camp Doulas are trained to do just that! To find a doula in your area, click here.


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