By Sharon Muza, BS, CD(DONA), BDT(DONA), LCCE, FACCE, CLE
Today is the fifth post in the occasional series, “Doula Me This!” Each post in the series provides a common scenario that a birth or postpartum (or both) doula may face. The “correct” answer (if there is one) requires some synthesis of the situation and at times consideration of the DONA International’s Standards of Practice and Code of Ethics. Today’s dilemma is based on an often confusing topic that may not be common but could feel quite sticky for a birth doula faced with this situation. How would you handle this in your own practice? Read through the scenario and let me know what you would do.
Doula Me This!
You have been hired by a family who was planning a home birth with a local midwife. Six weeks prior to their due date, they announce to you that they have decided to have an unassisted home birth, without having a health care provider present. They are still planning to have your birth doula support at the birth.
The Details
You were rehired by Natalie and Jonah to be the birth doula for the birth of their second child. You were their doula at the birth of their first child, who was born at home three years earlier with a local midwife. That birth was uneventful and without complications. At your first prenatal at 34 weeks for this second pregnancy, they inform you that after much consideration, they have decided to birth their second child unassisted in their home. They will continue to see their midwife for prenatal and postpartum care, but will not have the midwife attend their birth. They calmly explain their reasoning behind this change in plans and discuss how they are preparing for this unattended birth. They state that they are planning for you to support them again, in the birth doula role, as you did for their first birth and how they recognize how much help you were to both of them during the labor and birth.
The Dilemma
You are surprised by this unexpected change of plans. As you sit listening to them explain this shift in their thinking, you are wondering what really has caused this shift, and what your responsibility is both now and in the future. You have not been in this situation before, nor do you have any colleagues who have, to the best of your knowledge. You feel confused about how you should respond and a bit floored by this information. Your clients are looking at you excitedly, after sharing their plans, awaiting a response.
What would you do?
Do you attend this birth? Are you comfortable attending an unassisted birth? Are there any ethical ramifications? Do you have any legal exposure? Are you fully aware of any potential repercussions if there is no midwife present during the labor and birth? Should you study up on emergency childbirth procedures just in case? Do you decline to attend, despite having a signed contract and paid retainer? What are your obligations if you do not attend? What would you say at the moment when you first hear this news? So many things to consider, as you absorb what you are hearing and your thoughts after the prenatal is over and you alone. Please share what you would do in the comments below. Let me know your thought process and what you are basing your decisions and plan of action on.
I am in Canada and the legal ramifications for myself are likely very different than in the US. If a transfer was required to the hospital in an unassisted birth it would be accepted.
I would really ask a lot of questions to find out why they were creating this choice.To truly understand. I would then see if they had considered all of the options and “what ifs”.If they were still determined to have an unassisted birth I would explain that this puts me in an awkward position and that I personally would not be able to attend. Depending on our financial arrangement, I would likely return all but a small fee ($200-300) for the work we had done thus far.
I am in this exact situation right now. I have accepted the role of Doula to the home birth of their 5th child. I have had them to sign my usual contract which states that they understand and acknowledge that I am not medical support… that i am nonmedical support and what that entails. I will not catch their baby, nor will I check her. We have agreed that if the situation requires we will diall 911 and transfer to the hospital. They were determined to do this whether I stayed or not. I chose to stay to help in whatever way I can within the scope of practice as Doula.
I will never put myself in this situation, to guide them without any medical (midwife, OB) around. If something will go wrong, even I have a trauma for life. Besides that I bring myself in a dangerous situation regarding insurance. I will listen to them, will ask questions and I hope they will change their opinion regarding no midwife in the room to bring mom and baby at risk. I will explain them scenario’s what can possibly happen without a medical expert around.
And also explain to them that in my scope of practise i am not doing any medical intervention. So definitely a NO from my site.
I would attempt to redirect their thinking. For baby and mom safety it would be important to have a healthcare professional present during birth. As a doula it would be out of my scope of practice. If they insisted then I would have them sign a contract relieving me off any backlash that may result.
thank you for this very interesting scenario… i definitely understand the discomfort a doula would have with it and i feel it puts undo hardship on the doula for a client to expect this… it is a scope of practice issue… i would have a long discussion with them and if the framework doesn’t change politely decline…
I would ask a lot of questions surrounding their decision. I would make sure that they understand that I am unable to provide any medical support at all, that I am not considered a medical provider and that, I would not be able to assist in any kind of medical care other than helping physically as any other family member or friend would do.
I would probably make up a kind of add-on contract so that it is clear that I will be there only as non-medical support to the family, and have us all sign.
Other than that, I have would have no problem attending a “free birth” as a support person. As long as everyone was very clear about my scope, I don’t see an issue for myself.
I would let them know that in that case, I could be held liable for emergencies and it is against my personal policy to attend an unattended birth on purpose. I would offer them the option to use another doula in our practice that might take them on if they decide to go forward with it. I would encourage them that it is always their right to choose how they choose to birth, but it just opens me up to a liability that I cannot do. I would refund their money, except the deposit, and continue to offer prenatal support until the birth unless they are transferring care to another doula.
Hopefully they will ask me why that is my policy. As someone that had two unattended births and as someone that did attend a couple of unattended births as a doula, one with some serious repercussions, I would share how my personal experiences made this a strict policy for me.
I would love to hear more about your experiences, because this is something that scares me.
That’s awkward, but I’d attend the birth because if I didn’t the clients would probably do it anyway and be without support and therefore more at risk. Of course, I’d make it absolutely clear that I wasn’t a medical person and have my phone in hand the whole time.
As a person just beginning my study, I still have life and labour experiences. I would not feel comfortable with this scenario. I appreciate reading other people’s opinions on this dilemma. So much to learn. Thank you for your words and thoughts. Darla
It is stated in my contract that the birthing parents are required to have a licensed provider attending their birth for me to attend. I have actually had a client ask about me attending an unassisted birth. I told them I wish them luck and can provide prenatal and postpartum support but cannot attend if there is not a provider present. They decided they would rather have me there than have an unassisted birth. With the outcome of the birth I’m really glad I stuck to my guns.
I am getting ready to attend Doula Training and so I am not yet practicing. I like the idea of putting in your contract that a medical profession must be present for the doula to attend. I am a practicing RN and so this is interesting to me. Once obtaining my doula certification, I would still not consider myself a medical professional in a birth even though I am a registered nurse.
That is a fascinating scenario to consider. I’ll try to answer the questions you posed. I hope in the moment I will convey support, confidence in them and interest to learn more. It would be fair if my response also showed surprise and made space for me to ask more questions and learn more about their plans. Later, when alone I would process my feelings with a trusted doula friend and write a list of follow up questions for the couple. Questions on my list would include: do you either of you see my role any differently in light of this change? Are there any unspoken assumptions about my role? How does the husband’s role change in light of this change? What is the emergency plan for labor, for delivery and for postpartum complications if they were to arise? After learning more from these questions and others, I would re-affirm that my role is non-medical and would not include vaginal exams, etc. etc. (I would give very specific examples for labor, delivery, postpartum and infant care). I would need to re-evaluate based on our discussion and what I learned. I’m sure there’s more to consider but I would approach it from an attitude of “how can we proceed while I stay in my scope of practice.” I’m eager to read everyone else’s responses now. Thank you for posting this scenario. It’s very thought-provoking.
I recently had this happen and the clients were also friends. She was 24 weeks and said that they were consideringbunassisted. This was their fifth baby and she had had two epidurals, two completely natural, and thisbone decided to go at home, natural, unassisted. The reasoning was she gave birth so easily and “we’ll still have you there in case…”
I told them I completely respected their decision and loved them regardless, but if unassisted I could not be present at the birth with them. I explained the roles are very different and I was not a trained medical professional person. Was also working toward certification, even tho I’d attended many births prior to taking the DONA class and working on being ‘ofgicial’.
In the end they got an on and had in hospital and labored at home till she was 30 minsbout ftom pushing. Unfortunately they also chose not to call me until they left for the hospital so I was only able to be with them for 45 min total (baby was born 15 mins after I arrived) so could not count the birth toward my certification. I was very disappointed as I’d spent long hours with them prior to the birth with education and relaxation techniques
Question for DONA. What is your stand on do dalled ‘abortion doulas’ and are you supportive of this practice?
Hi Shanelle -thanks for your reply, and your question. I would ask you to reach out to our DONA President Ana Paula Markel to ask about an official DONA International opinion. She can be reached at president@dona.org. Thanks, Sharon
While a doula may not be able to attend due to certifications, having some positive support for the mom and family is still important. perhaps guide her to have like minded friends attend or other women who have done this. There are beautiful births out there to learn from and certainly books like Home Birth On Your Own Terms, a How to Guide to Birthing Unassisted. The mother is in charge, she should be educated to make her own decisions, and deal with any complications if they arise. Yes, I am a unassisted birther x4 🙂