The role of a doula

Doulas, although not considered healthcare providers, are proven to act as a beneficial addition to the maternity process for many. A Dona International Data Project (DIDP) study found that using third-party obstetrical support improves outcomes such as prematurity and cesarian surgery, dropping from 5% below the national average. With undeniable statistics backing the use of doulas, it's essential to understand how they fit into a healthcare setting. 

Doulas and their role in the maternity process

The types of doulas

1. Birth doulas (Labor support): Birth doulas offer support during pregnancy, labor, and the immediate postpartum period. They provide emotional support, physical comfort measures, and informational support about the birthing process. 
2. Postpartum doulas: Postpartum doulas focus on the mother's recovery after birth and the baby's transition into the world. They offer support with infant feeding, emotional and physical recovery from childbirth, infant soothing, and light household tasks.
3. Antepartum doulas: Antepartum doulas specialize in supporting families experiencing a high-risk pregnancy that may require bed rest or have other complications. They provide emotional support, help with household tasks, and can offer information and resources related to the pregnancy.
4. End-of-life doulas: Although not directly related to maternity care, end-of-life doulas provide support and comfort to individuals and families during the dying process.
   
   

The role of the doula

A study by the program DREAM mirrors some aspects of doula support by training preclinical medical students to provide prenatal, labor, and postpartum support to underserved women. This initiative helped students gain obstetric and gynecological knowledge and improved communication, advocacy, and support skills. This also focused on how continuous support during childbirth improves health outcomes and satisfaction for birthing individuals. A summary of the doula's training includes: 

1. Before birth: Doulas provide education and resources on childbirth and postpartum care, help families develop birth plans, and offer emotional support to reduce anxiety and fear associated with childbirth.
2. During labor and delivery: They offer continuous emotional support, employ techniques for physical comfort, and facilitate communication between the birthing person, their family, and the medical staff. Doulas can help create a more positive and empowering birth experience by advocating for the mother's wishes.
3. After birth: In the immediate postpartum period, doulas can offer support with breastfeeding, newborn care, and adjustment to new family dynamics. They also provide emotional support to help reduce the risk of postpartum depression and anxiety.

See also: Reproductive health: Rules, rights and compliance

Benefits of using a doula 

1. Increased knowledge and confidence: Participants in the DREAM program, which modeled doula-like support, demonstrated increased obstetric and gynecological knowledge and confidence in communication, advocacy, and support. Similarly, doulas educate and empower parents about the childbirth process, leading to increased confidence in making informed decisions about their care.
2. Enhanced communication and advocacy: Doulas enhance communication between the birthing person and healthcare providers, ensuring that their wishes are heard and respected. They advocate for the birthing person’s preferences, which can lead to a more satisfying birth experience.
3. Emotional and physical support: Continuous emotional and physical support provided by doulas during labor has been associated with improved outcomes. This support includes comfort measures like massage, guidance on breathing techniques, and emotional reassurance.
4. Lower rates of medical interventions: Studies show that doula support is associated with lower rates of cesarean sections (one study showed a reduction of 7.8% from the national average within the study group). There was also a reduced use of epidurals and fewer instrumental deliveries.
5. Shorter labor duration: A doula is associated with shorter labor durations. Their support can help the birthing person feel more relaxed and progress more smoothly through labor. For example, in a dataset examining the length of labor and doula support, the median length of labor from admission to birth for spontaneous labors that did not have pharmacological augmentation was 8.0 hours (interquartile range, IQR, 5.0–12.0 hours). 
6. Improved maternal and infant health outcomes: Continuous support during childbirth has been linked to better health outcomes, including higher rates of spontaneous vaginal birth, reduced risk of newborns being admitted to a neonatal intensive care unit, and lower rates of reported dissatisfaction with the birth experience.
7. Reduced risk of postpartum depression: Emotional support from a doula during and after childbirth can help reduce the incidence of postpartum depression and anxiety by providing reassurance, listening to the mother’s concerns, and offering guidance and resources for coping with the challenges of new parenthood.
8. Assistance with breastfeeding: Postpartum doulas can offer valuable support and information on breastfeeding, helping to establish a successful breastfeeding relationship from the start.
   
   

What to look for in a doula 

1. Experience and training: Check their background in doula training and how many births they've supported.
2. Certification: Some doulas are certified by organizations. While not always necessary, it can indicate a commitment to their profession.
3. Availability: Make sure they're available around your due date and can commit enough time to support you before, during, and after birth.
4. Compatibility: You should feel comfortable and connected with your doula. They should respect your choices and support your birth plan.
5. References: Ask for and check references to hear about other families' experiences with the doula.
6. Cost and services: Understand what services they offer, how many visits you'll get, and how they handle the birth. Make sure you're clear on the cost and what it covers.
7. Emergency plan: Ask about their plan if they can't make it to your birth. Do they have a backup doula?

Doulas and HIPAA compliance 

Doulas do not have to comply with HIPAA, mainly because of the nature of their services and the specific definitions of entities covered by HIPAA. HIPAA applies specifically to healthcare providers, health plans, and healthcare clearinghouses. These entities provide medical services, engage in billing and other electronic transactions involving protected health information (PHI), or process health information into a standardized format. 

Doulas provide emotional, physical, and educational support during childbirth and the postpartum period, rather than medical services. They typically do not engage in electronic transactions involving PHI that HIPAA covers, such as billing. Furthermore, doulas are not classified as healthcare providers in the traditional sense covered by HIPAA, meaning they don't perform clinical tasks or handle PHI in a manner that requires HIPAA compliance. 

See also: Does HIPAA apply to doulas?

Doula certification

Despite not being covered under HIPAA, doulas often follow ethical guidelines that include respecting client confidentiality and privacy, as set by their professional certifying organizations. Doulas, specifically in the United States, operate under a framework accentuating training and certification rather than formal governmental regulation. Various organizations, such as DONA International, CAPPA (Childbirth and Postpartum Professional Association), and Lamaze International, offer certification programs for doulas. 

These programs typically include training in childbirth support, ethics, and sometimes practical experience. Certification processes may involve attending workshops, supporting a certain number of births, completing written examinations, and adhering to a code of ethics. Although no law mandates doulas to be certified, obtaining certification from recognized organizations can enhance a doula's credibility and demonstrate their commitment to adhering to professional standards of care and support for birthing individuals.

The integration of doulas in a healthcare setting

Healthcare organizations can integrate the use of doulas or prepare to accommodate patients who bring their doulas through several specific strategies. These inlcude: 

1. Establish clear policies and guidelines: Develop clear policies that outline the role of doulas within the healthcare setting, including their responsibilities, limitations, and how they can collaborate with medical staff. These policies should be communicated to both staff and patients.
2. Educate staff: Train doctors, nurses, and other healthcare staff about the benefits of doula support and how to effectively collaborate with doulas. Understanding the non-medical support doulas provide can enhance teamwork and improve patient care.
3. Create a welcoming environment for doulas: Ensure that the hospital or birthing center environment is welcoming to doulas, recognizing them as valuable members of the birthing person's support team. This includes offering them access to necessary facilities and including them in discussions about the birthing person's care plan.
4. Offer doula services as part of maternity care packages: Healthcare organizations can partner with local doula agencies or certified doulas to offer doula services directly to patients as part of their maternity care packages. This can help make doula support more accessible to a broader range of families.
5. Facilitate communication: Implement a system that allows for smooth communication between doulas, patients, and healthcare providers. This could include pre-birth meetings to discuss the birth plan and any specific wishes or concerns the birthing person might have.
6. Respect and support the birthing person's choices: Recognize the need for the birthing person's autonomy in making decisions about their care and the role of the doula in supporting these choices. Healthcare providers should respect the support and decisions made by the birthing person and their doula, as long as they do not interfere with medical necessities.

See also: HIPAA Compliant Email: The Definitive Guide

FAQs

What is the difference between a doula and a midwife?

The difference between a doula and a midwife is that a doula provides emotional, physical, and informational support during childbirth without performing medical tasks, while a midwife offers medical care and support throughout pregnancy, labor, delivery, and postpartum.

What does a doula do?

A doula provides continuous support to the birthing person and their family through emotional encouragement, physical comfort measures, and informational assistance to navigate the birthing process and make informed decisions.

What is another name for doula?

Another name for a doula is a birth coach or labor support professional.