?A Hypothetical Question?

[SarahMcKay]

Let's say you know a certified doula who you feel has done or is doing things with her clients that are totally out of her organization's Scope of Practice. Do you report her? Let me add a few variables: What if you've met her and could potentially acquire clients from her referrals?
What if she hasn't done anything harmful to her clients, per se, but harmful to our profession?
What if she's a very well established and respected doula in your community?
If you choose to report her, do you do it anonymously?
Does it matter if you are certified through the same organization?
Would it make a difference if you had personally witnessed the questionable behavior, or if you had only heard about it from others?
Let's hear what you ladies think.

[doula Michele]

Yikes..i am not sure, it would depend what was going on.
If its out of scope, i may say something to her. I did question a doula who had never even been to a birth, but she was describing how she planned on using a rebozo to turn babies...I did question her as to whether she felt this was within scope. Thats as far as I went, becasue I think she attended on birth, it didn't go so well, and she just had to many other issues in her life that she decided maybe doulaing was not for her.

[AussieDoula]

Quote:

Originally Posted by SarahMcKay Let's say you know a certified doula who you feel has done or is doing things with her clients that are totally out of her organization's Scope of Practice. Do you report her? Let me add a few variables: What if you've met her and could potentially acquire clients from her referrals? What if she hasn't done anything harmful to her clients, per se, but harmful to our profession? What if she's a very well established and respected doula in your community? If you choose to report her, do you do it anonymously? Does it matter if you are certified through the same organization? Would it make a difference if you had personally witnessed the questionable behavior, or if you had only heard about it from others? Let's hear what you ladies think.

I put these into a numbered list so it is easier for me to respond, LOL! Don't mind me, hehe...

1. Somewhere down the line, going outside your Scope of Practice catches up with you. Even if there were potential referrals for me involved, I don't think I would knowingly associate with a Doula I knew was deliberately practicing outside her certifying organisation's Scope.
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2. I think this all goes back to the need for specific universal guidelines and procedures for when Doulas stray from their Scope of Practice. Spreading negative associations about Doulas through actions outside of your Scope is potentially damaging for all Doulas, and only adds to the confusion others have about the Doula's role.
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3. It doesn't matter who you are, you are still accountable for your own actions. Knowingly going beyond the Doula's limits as outlined by your certifying organisation is a big no-no and these guidelines are in place for a reason.
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4. This is a personal choice... Reporting someone annonymously is no guarantee that people won't just go ahead and make their own assumptions anyway. If you feel like this may damage your own reputation or hurt your business, then annonymous action may be best to help protect yourself.
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5. I don't think it matters whether you're from the same organisation, from different organisations, or if you aren't even certified but she is. When she signed on to certify through her organisation, she agreed to their standards of practice. We have to watch out for each other and be aware of what is happening within the Doula world - regardless of who you chose to be affiliated with through certification. The general public isn't going to categorise Doulas into their respective organisations - they will just lump Doulas into the same group, and this isn't good news when someone is leaving a bad impression about Doulas by the way they choose to practice.
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6. If I had not personally witnessed specific behaviour, it would definately leave me questioning how much of what I had heard was true. The grapevine can be fickle and less than accurate at the best of times. Hearsay really isn't enough for me to take action and report someone.

Protocols for investigation and reporting Doulas who are going outside their Scope of Practice are there so we can weed out the Doulas giving everyone else a bad rap. Use them! If I had been witness to someone repeatedly going otuside their Scope of Practice, I would definately take measures to gather information and report them to their certifying body.

Good luck!

[doula Michele]

Aussie, you always write such awesome responses!

You are obviously a writer. My answers are never as thought provoking or as intersting as yours even if I am thinking the same thing.

[AussieDoula]

Quote:

Originally Posted by doula Michele My answers are never as thought provoking or as intersting as yours even if I am thinking the same thing.

Don't sell yourself short! There are times in those responses that you hit the nail right on the head - without all the flowery pomp.

[motherwise]

It would depend on what it was, but ultimately I believe in protecting parent choice. If a parent chooses someone as their doula, it is really between the two of them what goes on. If it was a dangerous practice and completely out of line, that may be different. I would definitely speak to her personally (or write an email expressing my concerns) before I talked to her organization.

I personally believe making sure all doulas 'behave' the way an institution thinks they should ultimately is limiting to parent choice. I understand what Aussie is saying about certain doula's actions potentially being damaging to all doulas, but I really think that only applies in cases of gross negligence where boundries (E.G. a doula performing actual medical tasks) are concerned and I also think that problem will be there regardless since there are alot of midwifery students etc who practice as doulas that bring their extra skills with them and perform duties that would be technically out of a normal doula's 'scope of practice'. Does this cause confusion? Probably. Does it mean that parents don't have a right to choose someone who practices as a monitrice? No, I don't think so.

It's hard to answer your question without knowing what exactly you would be talking about. I recently had a doula be very upset with a friend (also a doula) of mine because she brought essential oils (lavander and peppermint) to a birth, saying it was 'out of her scope'. To me, that is just ridiculous. If you have heard that she is recommending herbs or homeopathics, she may just be providing the information to her clients, letting them borrow books on the subject etc and her clients may be choosing to use these remedies. Not 'out of scope' IMO, unless she is prescribing remedies. Or, if she is doing VEs at a birth, she may have extra skills that lend itself to that. We have several doulas in my area who are/were assistant or apprentice midwives who *can* and occasionally do offer this to clients. Just my , but you may want to give her the benefit of the doubt unless it is something more serious.

[AussieDoula]

Quote:

Originally Posted by motherwise I personally believe making sure all doulas 'behave' the way an institution thinks they should ultimately is limiting to parent choice.

Parents do have the right to choose. They can choose to have no Doula, a certified Doula (bound and held accountable to Scopes of Practice), an uncertified Doula (not bound by anything other than personal philosophy), or a monitrice (entirely different to a Doula).
If parents want some variation in between, maybe a midwifery student is a good choice - but again, not the same as a Doula.

Quote:

Originally Posted by motherwise I also think that problem will be there regardless since there are alot of midwifery students etc who practice as doulas that bring their extra skills with them and perform duties that would be technically out of a normal doula's 'scope of practice'.

I have no objection to these types of labour support, as long as those offering it are clear that they are not performing merely in a Doula's capacity. Additonal services need to be labelled under a different title if those services go outside of or contradict your organisation's Scope.

Quote:

Originally Posted by motherwise Does this cause confusion? Probably. Does it mean that parents don't have a right to choose someone who practices as a monitrice? No, I don't think so.

My opinion is that if parents prefer someone who provides the services of a monitrice, they need to contract with a monitrice - not a Doula. This is why we have differing levels of clinical involvement separated by different titles for those roles; the Doula performs at the bottom of that spectrum - no clinical tasks.

[b'earth angel]

If you are a doula, then act like a doula.
You said it right Aussie!

[doula Michele]

Quote:

Originally Posted by b'earth angel If you are a doula, then act like a doula. You said it right Aussie!

Agree.
And if you are certified with an org. then you do have to follow a code of conduct. If you are not certified, I guess you are free to do what you want. Unfortunatly thats where the waters get muddy and doulas may get a bad rap. I am sure there are lots of doulas who may do crazy things way out of scope of practice for an actual 'doula'.

[RosyDoula]

I think if you haven't seen it first-hand it wouldn't be fair to report it based on what someone else has said. That person could be totally wrong.

[motherwise]

Quote:

Originally Posted by AussieDoula Parents do have the right to choose. They can choose to have no Doula, a certified Doula (bound and held accountable to Scopes of Practice), an uncertified Doula (not bound by anything other than personal philosophy), or a monitrice (entirely different to a Doula). If parents want some variation in between, maybe a midwifery student is a good choice - but again, not the same as a Doula. I have no objection to these types of labour support, as long as those offering it are clear that they are not performing merely in a Doula's capacity. Additonal services need to be labelled under a different title if those services go outside of or contradict your organisation's Scope. My opinion is that if parents prefer someone who provides the services of a monitrice, they need to contract with a monitrice - not a Doula. This is why we have differing levels of clinical involvement separated by different titles for those roles; the Doula performs at the bottom of that spectrum - no clinical tasks.

I actually do agree with you Aussie, but I think the term 'Doula' is often used in a broader way than you are speaking of (it is, after all a recently made up term! and actually was originally only used to refer to PP doulas untill Penny Simkin and other DONA founders adapted it), whether that is or isn't ideal, it is how things are at the moment. My point was just that in this particular instance the doula in question may have some other skills that make her comfortable operating outside of her 'scope' and I don't think that is cause for reporting. I hope that makes sense...blech, I have a head cold (aka fuzzy brain)

[1stimestar]

I would address your concerns to the doula in question. You did not see the actions in question and hearsay can really not be relied on. There may be many factors involved. Then if she tells you "yes I normally DO do XYZ," and you know that XYZ is outside of the doula's scope of practice, then yes, send a letter to her certifing organization asking them to look into it. Good luck and let me know if I can help. doula1@alaska.net

[loveslabor]

I don't think I would report the doula if there was no harm to the clients. I might talk to doula about my concerns, if I had any.