Tuesday's Topic 8/26/08

[earthgirl]

Do you think hospital doula programs are a good idea?

And if you work as a hospital paid doula, what do you like about it, and what don't you like about it?

[Brie+3]

I answered maybe, cause I feel like it's a little of all of the above. Nothing seemed to fit exactly how I feel about it.

[DL]

I also picked "other" because I think how I think about it largely depends on how much or little restriction the hospital puts on the doulas. My favorite hospital where I attend most would probably be a great place to be a hospital doula, but I've also attended at some hospitals where the doula would probably be so restricted that it would definitely be taking some backward steps, kwim?

[Joyce in the mtns.]

Oh dang, I have to run, but I wanted to say that I voted that I felt that hospital-based doulas would be working for the hospital.

I say this because it seems to me I remember that the initial studies- (this was in a powerpoint by Debra Pascali-Bonaro at a conference years ago) about doulas showed that the fact of their NOT being part of the hospital staff was a component to the positive efficacy of the doula role.

And I do see the wisdom in that.

Sorry I have to go... later!

J.

[Close2MyHeart]

I said maybe as well. I can see both sides of it...

[doulajamie]

I think the challenge in working for the hospital is that you are required to follow their code of ethics, abide by what they define as the scope of practice, and work to the benefit of the hospital. This can create some serious ethical dilemmas for the doula. Another problem I see is that it continues the notion that the hospital can provide for all the needs of the laboring woman. It takes responsibility off the family to find a doula and make the necessary provisions to hire her. I believe that data coming from hospital doula programs will not be as positive as when a couple hires a doula parenatally, works and builds a relationship with a doula, and works towards their envisioned labor. I, personally, think programs like this could actually skew results about the benefits of doulas because the relational components and educational components are absolutely missing. In addition, I don't believe the compensation to be adequate to the work of the doula and so in some ways it demeans the value of the doula.

Jamie

[earthgirl]

Do hospital doulas provide continuous support? Do they stay the entire time, or do they leave after their shift? I think a hospital doula would be great if someone came in completely alone, and she needed someone there. But if the doula had to follow strict policies dictated by the hospital, then the act of support becomes conditional, and not as beneficial as a doula hired by the woman herself prenatally.

[JessicaE]

I think with a hospital doula program, you get about 1/4 of the benefit of a doula.

You get the physical and emotional support during labor, but not necessarily the prenatal and postpartum relationship, informational support, advocacy, etc.

I am always conscious at a birth of whom I work for -- the client, not the hospital -- and I'm sure if that role were reversed it would affect how I worked with a client.

[helpinghands]

Quote:

Originally Posted by Doula Lori I also picked "other" because I think how I think about it largely depends on how much or little restriction the hospital puts on the doulas. My favorite hospital where I attend most would probably be a great place to be a hospital doula, but I've also attended at some hospitals where the doula would probably be so restricted that it would definitely be taking some backward steps, kwim?

I agree with Lori but I picked maybe.. I guess it just depends on a variety of factors.. the doula, the woman, the hospital, etc. but even with everything working "right", I would think that there is always the understanding that the doula is working for the hospital, (that is something common I have heard from a number of doulas in hospital programs..dunno).

[helpinghands]

Quote:

Originally Posted by doulajamie I think the challenge in working for the hospital is that you are required to follow their code of ethics, abide by what they define as the scope of practice, and work to the benefit of the hospital. This can create some serious ethical dilemmas for the doula. Another problem I see is that it continues the notion that the hospital can provide for all the needs of the laboring woman. It takes responsibility off the family to find a doula and make the necessary provisions to hire her. I believe that data coming from hospital doula programs will not be as positive as when a couple hires a doula parenatally, works and builds a relationship with a doula, and works towards their envisioned labor. I, personally, think programs like this could actually skew results about the benefits of doulas because the relational components and educational components are absolutely missing. In addition, I don't believe the compensation to be adequate to the work of the doula and so in some ways it demeans the value of the doula. Jamie

great points!

[DoulaCBE]

JessicaE hit it on the head for me.

Our practice had a hospital program that allowed nurses to page us and we'd provide a doula for a patient in need. We were sub contractors, we did not work for the hospital, and they did not dictate how we practiced. The benefit of all our doulas being certified is that we already had our own SoP and CoEs to follow and the hospital didn't try to impose more.

The down side was that as a doula you could make very little impact on the outcome as the intervention train had already long left the station by the time we were called in. So it was about emotional and psychological support and ultimately patient satisfaction.

As a doula who is all about truly informed consent, this population really burned me out. We had a run of grant funding but when we reached the max # of times to be funded by the hospital's charitable org we were told we needed to become part of the operational budget and that wasn't going to happen so our program there closed its doors. We were NOT a volunteer org, our doulas were paid the same rate for practice clients as they were for hospital program clients.

[doulajamie]

Angie:

Can you tell me a little more about subcontracting? If you want to take this offlist, just send me an e-mail at doulajamie@yahoo.com and that is fine with me.

Jamie