Hiring A Doula? Watch For These Three Red Flags
I was recently contacted by someone who wanted to alert me to a podcast they were on that addressed their recent experience with a doula and their pregnancy loss. Admittedly I did not listen to the entire podcast. There were some red flags right from the beginning that I wasn't comfortable with. However it made me think about how hiring a doula, which is an unregulated health profession, is really a buyer beware situation. So as a doula for over 17 years, I thought I would offer some red flags for people to watch for when hiring a doula.
So let's start with what a doula is. A doula is an unregulated professional, trained in physical, emotional and informational support during birth and in the postpartum period. They are not medical and will not replace a midwife or an obstetrician during your pregnancy or birth.
Red Flag #1
As a non-medical support, the doula will not and should not be discussing your prenatal blood tests, checking your blood pressure or palpating your belly to determine baby's size or position. They will not and should not be doing vaginal exams either to determine dilation. As an old school doula, who has been around before doulas became uber popular, my training (CAPPA.net) emphasized the physical and emotional comfort during labour and postpartum.
Recently I have seen several situations where doulas have been charged criminally with "working as a midwife, without a license" for doing medical care during pregnancy and birth. Doing medical care, as stated above, is outside the scope of a labour/birth doula. However, if that is the support you are looking for, I suggest seeking out the services of midwifery care. If you are looking to free birth, please remember that doulas should not be attending a free birth with the idea that they will be a medical expert. Someone asked in an interview once, what I would do if they stayed home too long and baby was coming and there was no time to get to the hospital. I explained that I would call 911 to help and support them in hospital after they are transferred because that was what my training and scope of practice requires of me. Also that was where my comfort level was too. They didn't like that answer and it was clear they were wrangling for someone to support them during a free birth. I didn't feel comfortable with this couple as they weren't being honest with me and I was glad when they didn't hire me.
Doulas are also informational support, but will not speak for you, and will not and should not tell you to ignore your care providers suggestions or advice.
Red Flag #2
Many people will hire a doula because they have had a past traumatic experience with birth or they are fearful of the birthing process. I was once hired because the pregnancy had become very medicalized and the couple, being from my prenatal class, were looking for a calming presence during the final weeks of pregnancy and birth. As the pregnancy continued and became more medicalized, they needed someone to talk to. Whenever they called about something the doctor said my first question was always, "How do you feel about that?" Depending on their answer I would offer up evidence based information including links for their own research and help them form questions to ask their care provider so they can have an open and honest conversation with them. I also encourage the partner to be there for the discussion so they won't feel pushed around by a care provider who has an agenda. (Not all care providers have agendas, but some do.).
Telling my client what to do, telling them to ignore medical advice or giving my opinion on things is no better than care providers with an agenda. And I feel like when I speak for my clients or tell them what to do, I'm disempowering them. My job is to empower them to speak for themselves, this will give them the strength they will need to manage their own care and their baby's care once the doula is gone from the picture.
Red Flag #3
In the past few years, there have been clauses added to doula contracts where the doula will charge you, over and above their standard fee, if the labour goes longer than x number of hours, or they will call in a back up. It was never something I did, but I completely get this, labours can often go extremely long and that is very hard on the doula's body and their family. But a doula should never leave you high and dry if things don't go as planned.
Many years ago, there was a doula working in Toronto who stated, up front, that if the birthing parent got an epidural they would leave. She felt that once an epidural came into play she was no longer needed. This is patently untrue. Just because you have pain medication doesn't mean you don't still need emotional, informational and yes, physical support. How that support happens is just different. It becomes more emotional and informational, and likely less physical.
Particularly after the birth when you need help with feeding baby for the first time. Leaving the birthing parent because you don't feel you are needed is, in my opinion, wrong. It also adds pressure to the birthing parent to make decisions not based on their current need but whether they will lose support if they make a decision against their doula's beliefs. This is also wrong. So make sure you check with your potential doula any limitations they may have about your support and the timing of that support.
Other Factors To Consider
Other factors that aren't necessarily red flags, but should be considered before hiring a doula include, asking questions about the refund policy and is it laid out completely in the contract.
Also, ask the doula what their birth philosophy is and does this philosophy line up with your thoughts and feelings on birth. If not, then this doula may not be right for you. Even if they come highly recommended.
Also, consider interviewing 2-3 different doulas from different companies to get a feel for the type of support you are looking for. Interviewing more than three can get confusing and overwhelming, but 3 I feel is the perfect amount.
Make sure your partner is on board or at least open to having this extra support. Having a doula without the buy in from others on your support team can be uncomfortable for everyone and make your birth a stressful battle field you don't need.
Hiring a doula to support you during your pregnancy, birth and the postpartum period can be empowering and make your experience better over all. But before you hire one, make sure you are doing your research to find the best fit for you.