The Ordinary Doula Podcast
Welcome to The Ordinary Doula Podcast with Angie Rosier, hosted by Birth Learning. We help folks prepare for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.
The Ordinary Doula Podcast
E89: Doula Do's & Doula Don'ts
Angie Rosier shares insights on doula guidelines at hospitals, exploring the delicate balance between supporting clients and collaborating with medical staff.
• Hospitals will sometimes provide doula guidelines that outline appropriate roles and boundaries
• Doulas are welcome additions who provide emotional support, comfort measures, and improved communication
• Doulas should not perform clinical tasks like checking vital signs, doing vaginal exams, or administering medications
• Gray areas exist where doulas may assist with monitors or participate in brainstorming strategies
• Hospital policies typically restrict electrical items, open flames, and items requiring heating for safety reasons
• Creating a collaborative team atmosphere is essential for positive birth experiences
• The primary goal shared by everyone is a healthy mother and healthy baby
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Show Credits
Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker
Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.
Speaker 2:Hello and welcome to the Ordinary Doula Podcast. My name is Angie Rozier, I'm your host and I appreciate you spending this time with us. So today I want to share a little something that I was given a few weeks ago as I was at a birth at a hospital. A hospital I've been to many, many, many times before and this time they handed me a little doula guidelines sheet when I went in and they don't always do this I think it depends on who's at the desk and stuff. But as I've worked at different hospitals I've kind of seen policies ebb and flow around how hospitals are going to handle and manage doulas who come in Some of them. I've been at some hospitals that have you sign something they might give the patients that are going to use a doula something that the doula needs to look at ahead of time. They'll promise to do this and promise not to do that and stuff. So today we're going to talk about doula do's and doula don'ts. This particular sheet was kind of cool Overall. It talks about what a doula is and it says I love it, but it starts off that your doula is welcome to join you, which I absolutely love. It says let me just I'm going to read a little bit from it. Here and there, studies show that having a trained birth attendant to provide emotional support and labor coaching can help you have the birth experience you desire. So, first paragraph, they say that, which is awesome. They also state that they are kind of taking their guidelines for practice and scope of practice from Donut International, which is a really great standard for what the role of doulas is and what they're expected to do and what they're expected not to do, and in bold it says please share this with your doula and any other person who intends to support you during labor and delivery. Talks about how important these guidelines are. Doulas work for you and is not an employee of the hospital, which I love that they highlight that, because the doula does work just for the patient. But the guidelines help us all foster a safe and supportive environment. Also, which I agree with, they make sure everyone works well together to nurture you and your baby and, as a doula joins a hospital team and her client at the hospital, they should make a collaborative team.
Speaker 2:It's not great to go in with your dukes up and, you know, be ready to pick a fight or an argument with anyone and everyone, and some doulas do have that kind of that persona that they're going to go in and protect, protect, protect, you know, like protect your client from the big bad hospital, the big bad medical system, the medical system does you know? They're not out there, they're not there to get everyone right, they're not the big bad guy. But there is gaps, right, there's, as we've spoken about many times on this podcast. There are those gaps where what the hospital wants to do and the patient wants to do are slightly, a little bit different. So they have a list here of do-la-do's and do-la-don'ts and I think it's interesting, I think a lot of times where the lines can be blurred, because I really like what they've stated here. Overall, I really totally agree with how they've stated it.
Speaker 2:But I think where we get into a little bit of trouble is where someone who's not really a doula comes in saying they're a doula and they may step outside of scope of practice and definitely out of these guidelines that this hospital is encouraging, and sometimes that person who's not a trained doula might be a sister or a friend, a cousin, a neighbor, someone who wants to just go in and offer labor support, but maybe they don't have the nuances, um, how to do that? Also, sometimes I think and you'll kind of see as we go through this so this might be a home birth midwife in a transfer situation, somebody who doesn't more clinical skills than doulas usually do. So let's start with the do list. So this is what this particular hospital says. What doulas do? They offer guidance, help you with your comfort during labor Perfect, that is absolutely awesome. It says they may help you with breathing, relaxation, movement, positioning and visualization exercises. That, in a nutshell, is a lot of what doulas do. They say fosters a positive environment and supports good communication between you and your healthcare team. Absolutely love that too. They're not using the word advocate in there, because that's kind of a strong word, but that's exactly what doulas are doing.
Speaker 2:For example, your doula may help you communicate your wishes for your medical care and, as recorded in your birth plan, if you like, she may also help the medical team explain some of your care options to you, and I find that all the time, a lot of times, if, like, the care team comes in and presents something or explain something to my client, so often they look at me right there like all right, what do you think? Or you know, as we have a history here and we've talked about this, what you know, explain this more. And so many times, after that explanation or those options are offered, the team leaves, or the provider or whoever the medical professional is, and we have another talk about it. Right? We're like, all right, let's discuss this further. So I love that they are talking about the communication point. And then it continues to say most helpfully, your doula can encourage you to ask questions and speak for yourself. You are your own best advocate.
Speaker 2:So they did use the word advocate, but for you know, having the patient be their own advocate, which is true. But, however, when you're contracting, when you're in labor, when you're in an unfamiliar setting and maybe you have some extra fears around that, when your partner has a different expertise in life and childbirth and all the nuances around labor and delivery of the strategy um involved there, they may not know so, um. So I think the doulas they're they're not using a very strong advocate role here, but doulas definitely are advocates and very kind of quiet advocates, kind of subtle advocates, um, in really diplomatic and amicable ways. Of course we want to be an advocate. It goes on to say, on the do list, the doulas do? They provide physical and emotional support for you and your partner during labor and birth. Very true, love it. So I think they've highlighted pretty well what doulas do during labor and delivery.
Speaker 2:It can get a lot more complex, of course, as we have, you know. You bring in the emotions of this and the physicality of the exhaustion for clients and some people come into this with a lot of fears, right, some pre previously experienced medical trauma or birth trauma or life trauma. This gets in pretty deep and the medical staff is usually not in a place to a be aware of that or be be able to cautiously, compassionately handle that Um. So doulas wear that hat pretty heavy. The last thing they say here and this one's kind of interesting a doula well, and I agree with it, a doula protects your privacy. Just as a medical team adheres to health insurance, the portability account, which is HIPAA right Accountability Act, your doula should also respect patient confidentiality and while doulas are not as tied to HIPAA as medical professionals are, right, the training and the attestations and things aren't as strong for doulas. However, doulas do need to be very respectful and cautious about their clients' information and their experiences and how they choose to share that? Um, all right, and of course it's, you know. Just with no um identifiers, right? That's uh, and you'd be surprised. What can be an identifier when we're sharing information, health information. All right, let's go to the do not list. Here's what doulas do not do during labor. So, as we go through this list, this is where like yeah, this is, they may be speaking a little bit to someone else A supportive and well-trained doula does not perform clinical or medical tasks.
Speaker 2:Your healthcare team provides these services. This means your doula cannot do any or other clinical tasks such as take blood pressure or temperature, check fetal heart tones or adjust monitors, do vaginal exams, rupture membranes, which is breaking your water, do perennial massage, give or adjust medicine, including homeopathic or herbal remedies. So all of those things are very clinical. I will say that over the years I have sort of done some of those for sure.
Speaker 2:As far as adjust monitors, like I do that quite frequently and sometimes I'll sit and hold a monitor in a finicky situation, just if it. You know, sometimes it needs to be held just right to pick up, and I've honestly found that nurses appreciate that they are coming in the room less if somebody else was like, oh, let's just, you know, put a finger on that and hold it. And now I don't put monitors like on or I'm not taking them off If somebody's going to the bathroom, um, take blood pressure. I don't take blood. I mean, some nurses, honestly, have asked me to do that, um, but maybe I'll take a blood pressure cuff off if somebody's going to the bathroom or something like that, or help it, put it back on if it's slid down or something.
Speaker 2:Vaginal exams never. Rupture membranesanes nope. Perineal massage no. However, um have several times, with client permission obviously, um, and provider awareness, held warm compresses, right, like, anyone can do that, like a provider, sometimes they'll do that, dads can do that, the partners can do that, um, I've done that several times, so it's not anything clinical, but just holding that warm compress, the warm wash cloths on the perineum, give and adjust medicine yeah, never. Sometimes I'll turn off, like if the blood pressure alarm or maybe different alarms are going off. I might like hit a silence and let the nurse know that that's going off, because that's important for them to know.
Speaker 2:Other things they do not do is interfere with medical treatment or disrupt the birthing environment, and I think that's a kind of a shout out to those who are going in for a fight, right, the doulas who are going into protect, protect, protect, um, thinking that we're in enemy territory, which we're not, so disrupt positive birthing environment. I, I love that because, um, I mean sometimes, uh, you know, doulas are watchdogs I call them diplomatic watchdogs, and so sometimes there is a little bit of guard dog. You might do, but should be done, in a diplomatic way, um, but we do not want to interfere if we want to keep a positive birthing environment. In fact, it's the doula's job to create and maintain a positive birthing environment and she does that by um, using teamwork with the entire medical team.
Speaker 2:Doulas do not diagnose medical conditions or present options for medical care. Instead, she supports the communication of the medical staff. So this is a tricky spot Diagnose, no, they do not diagnose Present options. That, I think, happens quite a lot, because sometimes we're brainstorming options, honestly, like we will work as a team with the nurse, the provider. Sometimes I'll have nurses and doctors and midwives ask me like hey, what do you think? What should we do now? This could be have to do with positioning, you know, positioning of baby and mom. This could have to do with getting labor going, moving things along, searching for progress. So again, a collaborative environment. So I think sometimes doulas do present options for medical not even medical, but strategy and the what we're going to do during this process. So that one's kind of interesting.
Speaker 2:And there's definitely some gray area there, but no, not diagnosing medical conditions, right. There's definitely some gray area there, but no, not diagnosing medical conditions, right. And then a doula should not speak for you or make decisions for you. Rather, she should encourage you to ask questions about your care and treatment. True statement. But some people like, if you think about the physical, mental, emotional capacity of people deep into the labor process, it's a lot to come out of that and advocate for yourself or ask questions about your care and treatment. Sometimes you're just hanging on. So the doula again fills in some of those gaps in a real nuanced way, so that she is always pulling the her clients' opinions and desires and not imposing her own Um. So I you know, and again, another little gray area, um, but I think each team is a little bit different and as the team spends time together they kind of gel and become their own um, kind of their own entity. Each time it'll look a little bit different. The last thing do is do not do is object to the following to, I'm sorry, object to following policies of the hospital and the direction of your healthcare team. As she supports you in labor, she works at the discretion of the doctor and nurses and cooperates with their requests. I think that's true and even more than cooperate, I think collaborate, because so, so, so, so many times it is a collaboration among the team.
Speaker 2:As the doula, it's interesting every single situation you walk into, and there's hospitals I've been to dozens and dozens of times and so I know them. I know nurses, I know providers who we've worked numerous times together. We work well together. A little bit different there, but a lot of times you go in and you have to prove yourself right away. Right, you have a big job as a doula. Help that team to trust you. Your client goes in trusting you, ideally, obviously, and that team to trust you. Your client goes in trusting you, ideally, obviously and so it takes a little bit of time to kind of gel as a team. So interesting there. I like that. It does get to some sticky stuff a little bit and honestly, like I have had nurses ask me to, and this is maybe we've spent several hours together or I've worked with them many, many times over the years and they will ask me to do clinical stuff. That's way outside my scope, so that's kind of interesting. I've like helped place bladder catheters and some things that doulas typically for sure don't do, but again, you kind of earn that with the team.
Speaker 2:The rest of what this there's a little other section on this and it talks about comfort aids, which I think is great, and it, you know, says here's some things you can do, but it also gives some things they don't want you doing. It says to help manage the intensity of labor, women and their doulas often bring comfort aids to the hospital True story, things like birthing balls, framed photos, massage tools. You are welcome to do this too. So they kind of touch on some things, some ideas like three, four little things there that people can bring. It says, however, as you pack your bag in preparation for labor in the hospital, keep in mind, due to safety rules, the following are not allowed at our hospitals, and this is just this system of hospitals. It said anything that needs to be plugged in, such as blenders, heating pads or crockpots. So there's some funky stories, right?
Speaker 2:Every policy has a story behind it. Can't take essential oil diffusers, it says, because that's a plug-in Candles or anything with an open flame, obviously in a hospital, and then sacks or packs that need to be microwaved. The healthcare team is not allowed to heat them for you. So I happen to know of a story with this hospital years ago where someone took a blender. It says blenders. I'm like why would you need a blender at a birth? Right? And this particular story that I heard about years ago. Someone had a baby and they wanted a piece of the placenta which had to be cut off. Um, like, the healthcare team had to cut it off and they put it into a smoothie right there in the room. So I blended it so that they had a bit of placenta that they ingested right after delivery. Interesting, um, that's a topic for another day, but something like that happens and that's where this policy came from.
Speaker 2:Right, and, of course, like heating pads, I like I don't know like the hospital will provide heating pads. I don't know like the hospital will provide heating pads. I've never known them to be very hot, but I have had lots of clients. I'm trying to think if, at this particular hospital systems take heating pads, but a lot of clients will bring a heating pad. Essential oil diffusers that's kind of a bummer but I hardly use them anyway because they, you know, acutely in one corner of the room are pretty good. But those hospital rooms can be kind of big and very drafty and so a lot of times I'll, if we're using essential oils, I'll use them more acutely on a tissue or a washcloth or something. So not a big deal for me. Candles, obviously not.
Speaker 2:Heat packs that need to be warmed, and a lot of that is with the rate of people getting epidurals in hospitals. They aren't able to feel that heat and the amount of heat that that might be on their back, and so that's, you know, kind of a blanket statement, if you will, blanket policy to prevent any burns on people who cannot totally feel what's going on on their skin because of epidurals. So that's the do's and don'ts of this particular hospital system. It says this hospital in my area has several hospitals, they don't have this out. All the do's and don'ts of this particular hospital system. It says, um, this hospital in my area has several hospitals, um, they don't have this out all the time, they don't have it out at every hospital, um, but kind of interesting to see. You know someone got together every sheet that's put out this is called a fact sheet for patients and families. Um has a team behind it, right, a team of people who go over and review it and they bring you know policy as they create policy. They somebody met about this and so they are doing their best to work with doulas. Overall, I like it a lot, but there's a few little gray areas of nuances that are kind of interesting. So if you see these in your area, make sure you know just kind of interesting to take note of them.
Speaker 2:And always, whether you have a doula coming to join you or you are the doula joining someone, make a collaborative team. Like we are all on the same team. We all have a little bit of a different role, but respect each other's roles, right? We're going to respect the role of every single person on this birth team. They all have a little bit of a different expertise and everyone is. We're striving for the best experience for the birthing person and her baby. Right, the premier goal of every single birth team is healthy mom, healthy baby. There's a lot of other goals we can get along the way and hopefully we can all strive to get those which are empowering birth experiences, positive birth experiences, collaborative birth experiences where people are made to feel good, uh, even in a hard situation, they're made to feel better, they're made to feel supported, um, and that they can feel people really, truly do care about them. I love having that role on the birth team Actually, I'm headed out to a birth in just a few minutes.
Speaker 2:I wanted to squeeze this in before I headed out Um and hopefully it will be an awesome, positive and empowering birth experience for the client I'll be joining today. Thank you so much for being with us and hope you have a great day, night, week, weekend, wherever you are, and, as always, please reach out to someone near or far and make a human connection today. Make a difference in someone else's life you never know what a difference that can make and I will hope to see you next time. Thanks so much for being here, and this is Angie Rosier signing off with the Ordinary Doula Podcast.
Speaker 1:Thank you for listening to the Ordinary Doula podcast with Angie Rosier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth. Thank you.