In my last post I began exploring the piece on NPR.org about how doula care can benefit both women's care and cost savings for Medicaid programs. Since then about 4 more people have shared it with me on Facebook - how cool that it had such a wide reach!
The second question I wanted to reflect on is in regards to WHO these Medicaid reimbursed doulas are going to be. Are they certified? Do they have a scope, or standards of practice? Why does it matter?
A scope of practice is generally understood to be the guidelines and limitations of what a professional person is allowed to do. The phrase typically applies to medical professionals - physicians, midwives, nurses, etc. So in the truest sense of the definition, no, doulas do not have a scope of practice. Doulas are not medical professionals. However, understanding our limitations is very important, and so knowing, understanding, and observing Standards of Practice is a crucial part of being a doula. Doulas who buck against any outside regulation are often doulas who have an birth activism agenda that may or may not line up with yours. I have also observed that they are more likely to have negative relationships with care providers or medical facilities. Now, I don't want to have any other agenda other than ensuring my clients feel entirely supported and satisfied, and I like having good relationships with hospitals, birth centers, and care providers.
So, what Standards of Practice do I observe as a doula? I do not:
...take blood pressure readings
...take or interpret fetal heart tone readings
...do cervical exams
...use essential oils for pharmacological effect
...administer herbs or tinctures
And many other tasks that require medical training and certification to perform.
I also do not:
...interfere with care providers - obstetricians, midwives, nurses, anthesiologists, etc.
...speak for my client
...make decisions for my client
...promote any particular agenda
...take the place of the client's designated primary support person/people - husband, partner, family member or friend
...attend to the emotional and physical well-being of the pregnant or laboring mother by providing non-judgmental information, resources, hands-on comfort measures, and encouragement.
...enhance the role of the client's primary support person by relieving the pressure on that person to be a pregnancy and labor expert, freeing them to simply be present in whichever way the client and support person wishes.
...develop good professional relationships with other doulas, and medical care providers.
I would hope that Medicaid or other reimbursement programs would expect a high level of professionalism from their doulas, which means adhering to some kind of Standards of Practice.