doula principles
respect and support: the heart of our doula practice
Doulaing The Doula - Birth Doula Code of Ethics
The goal of our Code of Ethics is to offer guidelines for situations you will face on a regular basis. We want to empower you to make the best decisions you can in any situation while observing our shared core values.
Relationships To Clients and Careproviders
The DTD birth doula is a paraprofessional and works alongside medical professionals in caring for the pregnant, birthing, and postpartum client.
The DTD birth doula strives for maximum autonomy of their client at all times.
The DTD birth doula strives to encourage communication between careprovider and client whenever possible. The doula focuses their efforts so their client’s preferences, feelings, and decisions are communicated effectively to health care providers.
The DTD birth doula strives to encourage cooperative decision-making between care provider and the birthing person or client whenever possible.
The DTD doula shall provide accurate and timely information to the pregnant and birthing client.
The DTD doula does not give medical advice or make decisions for the client.
The DTD doula seeks to maintain client and careprovider confidentiality at all times. The doula recognizes that it is the client’s major life event and it is their choice to share any information.
When seeking support from others, the DTD doula shall take time to discern what confidential details are really necessary to share and think carefully about where and whom to ask for advice.
Autonomy of the Doula’s Role
DTD doulas provide comfort measures autonomously but consult with medical professionals before doing an intervention.
DTD doulas may implement an intervention during labor after explicitly consulting with the client and a member of their health care team. The responsibility is then shared by the doula, client, and medical staff member.
Before using any comfort measure or intervention with a client, DTD doulas shall ensure they are educated about the pros and cons of the intervention and when it is recommended and when it is not recommended.
Rationale
A comfort measure is designed to lessen discomfort and enhance coping. Comfort measures are benign, only minor problems can result from using a comfort measure incorrectly. An intervention is designed to obtain a specific result. Interventions may cause unintended consequences. Intention matters, as the same strategy can sometimes be a comfort measure and at other times be an intervention. Doulas do not use clinical skills such as assessing cervical dilation or taking fetal heart tones at any time. Doulas may assist the client in taking their own blood pressure or other assessments at home.
If the doula possesses clinical skills as a midwife, nurse or student, the client and health care professional need to negotiate whether they wish the doula to utilize these skills. If they do, they are acting in the role of monitrice, not a doula. DTD doulas are aware that this practice changes the power dynamic between client and doula. Doulas who are nurses, social workers, or other skilled professionals realize those standards of practice take precedence in an emergent or urgent situation. For example, doulas are not “mandatory reporters”. However, if the doula has another profession where they are mandatory reporters, that requirement supersedes the doula’s standards of practice. It is the doula’s responsibility to make clear that they have these dual roles when the client engages their services.
Cultural Competency
DTD doulas are aware of the increased risks, barriers to care, and disparities in health outcomes faced by many marginalized communities due to systems of oppression and discrimination.
The labor of doulas is often to eliminate those obstacles. Therefore, DTD doulas need a thorough understanding of fundamental concepts related to discrimination and oppression experienced by people of color, women, individuals of diverse gender identities and sexual orientations, immigrants and refugees, and people with disabilities to provide culturally safe care.
The DTD doula is aware that all families are different. The doula is responsible for educating themselves about social and cultural differences in family customs. The DTD doula is appreciative of the diversity of individual expression and families that exist today.
When providing doula services to people of a different culture, the doula needs to understand that the client is vulnerable to unintended harm due to cultural ignorance.
Clients are the experts on their own needs, so the doula will ask pertinent, kind questions to get a better understanding of how they define support.
Where did this Code of Ethics come from?
In examining my research with doulas, I focused on what situations and circumstances got the best results all around - for the doula, birthing family, health care team, and community. Each of these ethical principles was shown to lead to better results for everyone. At this point I’ve interviewed over sixty doulas, seven nurses, and thirty parents about doula support.
Second, Janine Gardner, B.A., CBD, went over the language and helped to refine many of my ideas. Much of the ideas and language of the cultural competency section are theirs. The first two paragraphs of that section have been altered slightly from the American
College of Nurse Midwives Code of Ethics.
-Dr. Amy L. Gilliland, July 2021
Doulaing The Doula - Birth Doula Standards of Practice
The DTD birth doula’s scope of practice and role is unique. It does not overlap with any other professional role. The doula’s role is not medical. The birth doula is a highly skilled caregiver, employing sophisticated neurological processes for extended periods of time. They serve an important attachment function for the person in labor that often cannot be met reliably by loved ones or medical staff members.
The Doula’s Overall Responsibility is to:
● Provide a calm presence
● Be a knowledgeable resource about birth
● Believe in the client’s ability to birth their baby (often before they do)
● Provide individualized care in a (hospital) environment that isn’t set up for that
● Provide continuous support throughout the labor and birth
● To consider how the birthing person’s memories are affected by labor events and positively influence those memories
The Doula’s Role in Attachment and Caregiving is to:
● Provide effective and nurturing support that utilizes the neurological caregiving systems of the brain and meets the attachment needs of the birthing person and their intimate family member. The doula does this by:
○ Reading the birthing person’s cues correctly
○ Letting the client lead by following their cues
○ Accurately perceiving the birthing person’s emotional needs
○ Being continuously available to the client at the beginning of their “on call” period until several weeks after the birth
○ Being seen by the client as emotionally and physically capable
○ Being seen as effectively representing the client’s interests while they are in labor
○ Being seen as having resources that the client does not possess
○ To provide a reliable arrangement for support if the doula cannot be present
● To become a trusted person to the father/partner/grandparent/mate/loved one so they will reliably turn to you if they need help (emotional regulation) and information during the birth.
The Doula’s Role in Communication is to:
● Assist the client is discerning their preferences for the birth
● Assist the client in communicating those preferences effectively to their care team
● Provide culturally competent and congruent support through the perinatal period
The Doula’s Role in Empowerment and Advocacy is to:
● Assist the client in being involved in their care decisions as much as the client desires
● Ensure the client has the information they need to make choices. (Medical information should come from medical people as much as possible. The doula’s role is to supplement or restate information that is provided.)
● Work alongside and with the nurse, midwife assistant, midwife, physician or others to maximize positive outcomes as defined by the birthing person.
*Note: It is important to understand that it is not the “absolute truth” about the doula that matters. It is the subjective perception of the person in labor about their doula that matters. That’s why the term “being seen by the client as” is used.
Where did this Scope of Practice come from?
This scope of practice is grounded in Dr. Gilliland’s groundbreaking research on attachment support and birth doulas and interpersonal neurobiology. Her master’s thesis and dissertation are available on www.amygilliland.com. Her forthcoming article, “Human Labor and Birth as Influential Events in Adult Attachment” (working title), details the doula’s role as a unique focal person for attachment behaviors.
