Hospital Doula programs versus private practice

[helpinghands]

Hey Doulas,

I am not wanting to start a debate about good vs. bad or anything, but I was wondering if we could start a discussion on private practice doulas versus hospital based programs? I know that there is a huge range of what is practiced among private practice doulas and also among the hospital programs.. but maybe we can share what our experiences have been. Maybe some of us have been on both sides of the fence and can share what you chose and why you made that decision?

I will be back to post later..gotta get the toddler down for her afternoon nap but I saw that Yvette had posted in the Introduction section with this question and I wanted to get a thread started in General Discussion. (I am thinking maybe we have discussed it here before but a fresh discussion is always good too!)

[sacredma]

thanks for posting this. i am very interested in what doulas do who work in hospital based programs. i am currently working private practice in partnership with another doula. sometimes we go to births together if the mom is in agreement. there is one hospital around here that is rather difficult, so the more support the better.

[helpinghands]

I also am private practice. I was briefly with a hospital based doula program but I found it very confining. I wasn't able to meet with families at home (prenatally or in labor). I felt like a lot of the personal connection was lost. Perhaps it was because I had worked independantly for a few years and then tried the hospital thing I was too set in my feminist ways?? Of course, I knew the restrictions before I tried it out.. I figured that it would be nice to have back up, quartly support meetings, etc.. but it didn't meet my expectations. I found that most of the other "doulas" weren't as proactive in their education and advocacy as I was and I found that frustrating, personally and professionally. I also found that I missed meeting families in their element (at home)..a lot of the personal connection was missing and meeting in a hospital room for 1 hr. prenatals when privately I was used to 3 hr prenatals at their home.. just a huge difference. I also felt like I was expected to "tow the line" more for the good of the collective business and that is NOT what I am willing to do at all. I really liked the woman who was one of the founders of the hospital doula program though, I just think that they are in a tough position with the hospital, professionally..and I understand that..but I tried and I just can not be a part of it, professionally. I do refer women there when I am not available (I am the only other option locally), and I also ask prospective clients if they have considered all doula options for their birth. I believe that for some women, these doulas would be a very good fit; however, I have met other women who wanted a bit more from their doulas..with regards to prenatal education, option of meeting locations and labor locations, etc. and that is okay. A doula for every woman, right? On their side, the women who started the hospital program are physical therapists, so they have establish professional relationships with phyicians and may have more sway with getting "favors" for a woman in labor.. if they are willing to advocate and/or they are the ones at the birth. I don't know if insurance would be more likely to cover their services since they are license health care professionals.. and the women they hand pick and hire from the community work for them..so possibly they have an easier time with that..I don't know. I just felt for the amount of work and passion I put into serving the women who seek me out in my community.. I don't need any strings attatched. I have my scope of practice with DONA and what not.. I am secure in who I am professionally and I without a doubt, am serving first and foremost ..the interests of my clients; period. I am nice to docs and nurses.. but really, I have no professional reprucussions if I am doing my job, ya know? It sucks that I am not allowed to sit in on their Doula support meetings. (I was told..it would be bad for busienss and I may use their ideas to further my own agenda.. whatever.. I think that was a lame a$$ excuse and I believe I could have brought a LOT to the table to share in a professional and educating manner; sucks that I am such a "renegade" that they won't let me play.. ) Oh well.. I always encourage women who seem interested in birth work to consider Doula work.. I would LOVE back up. The area needs more Doulas who work independantly..I strongly believe that it benefits everyone..most of all the families. I plant seeds where I can and I hope to have some back up soon but I am also willing to continue to practice solo ..cause, well,.. .I don't have a choice.

[1stimestar]

Jenni, you should host a traning. More later as I have henna on so can't type much now.

[helpinghands]

A training?? Yeah.. I would have to find women willing to shell out the money though Maybe I am cycnical.. but hopeful.. maybe a few diamonds in the rough

applevalleychick.. that is cool that you can do both. With some hospital doula programs, you have to sign a form that you won't take any private clients while working for them. (I had to do this). It sucked. It was a financial loss (because they took a large portion of the fee compared to when you work independantly you keep the entire fee..and many times, you EARN it, LOL) It also felt like a loss of freedom to not be contractually able to work with a client who would want to hire you privately..so great that you have the option. Did you have to sign any sort of contract?

[helpinghands]

Quote:

Originally Posted by 1stimestar Jenni, you should host a traning. More later as I have henna on so can't type much now.

P.S... Henna schmena.. I have a bowl full of Girl Scout cookie ice cream and I am able to type just fine...even with the spoon. Hmph.

[tlcdoula]

I have done both myself, but am now back to private practice. Honestly I can see pluses and minuses on both sides, and I think the biggest determining factor has to do with the work environment and your boss, scope, etc.

For me, I had a great boss with great co-workers and loved doing what I was doing. I touched people's hearts who might not have had a doula under other circumstances. I touched people's hearts who had not known what a doula was but because we had the program they received one. I was allowed to do whatever was within my scope of practice as a DONA doula. The only down side to my hospital job was that I had to take on so many shifts of on call and wasn't guaranteed a paycheck. With a private client you are at least going to get paid and will attend their birth (in most cases). Another plus was that I didn't have to interview or look for clients.

Now on the flip side it is great really getting to know the couple, knowing that you are their doula because they chose you and hired you. You can do much more prenatal care with them.

Honestly I can see positives both ways!!!

[emmabella]

There is a great article in the DONA newsletter/magazine this month about hospital doula programs. It would be a really good read for you.

[helpinghands]

Quote:

Originally Posted by emmabella There is a great article in the DONA newsletter/magazine this month about hospital doula programs. It would be a really good read for you.

Just got my International Doula..reading it NOW

[Mile High Doula]

I am both as well. I have worked for 2 different hospital programs and each had a different set of rules and regulations and flowed differently.

I personally like being a private doula more. Being on-call on specific days is nice, but with all the other work I do, I find I am dreading being called in. It's usually on one of my days off with my family since that's the only time I have for regular babysitting.

The first program didn't have a class where those who want a doula can come and learn about them, so with the new program (different hospital) I proposed a class. I was turned down for what I wanted to teach so it is more of a "seminar" now on those interested in signing up for a hospital doula and for those already signed up. Instead of teaching what I teach in prenatals, I am only able to discuss the benefits of a doula, the program, how to sign up, what to expect, and payment stuff. Not much more. I have found that it's almost a conflict of interest because I can't say all that I want to since I am bound by the hospital. I also must say that I am not an employee of the hospital and my boss is contracted through the hospital so I really report to them. The curriculum I proposed was not accepted due to "the Dr's not liking it." I am sure it was because women will have a voice.

I also don't like not being able to work in the full capacity of a doula. If an OB or midwife suggested an episiotomy, I cannot look at my clients and ask them if they consent have them discuss it. That is what I miss most. Empowering the women, not just being a presence. While I fully support that the continuous presence is beneficial, it's just not how I want to practice as a doula. I have a 1 year contract. I am riding it out right now. Maybe things will change. If I had a full time job and just wanted to work as a doula on occasion, this would be perfect, but as a doula that takes on private clients as well as mentoring, webdesign, college, and being a mommy, it's ALOT.

[helpinghands]

I read the article in the International Doula. Very nice. However, I want to point out that not all hospital associated programs work that way. I liked the fact that in the article.. ANY woman who wanted a Doula could have one. That is not how our local hospital associated Doula works. I think that they charge 400 (the program takes a % and the Doula gets a %). Honestly, I am thankful that there are a variety of choices for Doula services and/but I think discussion like this is helpful and for hospital associated programs that we need to be cautious that the primary of interests always lies with the parents/laboring momma.

[birthsister]

i am fortunate in that I work at the "other" st. louis area hospital (not mentioned in the article in ID) that offers doulas for free. we have more freedom and really are able to advocate for mom. everyone understands our role, and because it's a teaching hospital, we reach med students, interns, and residents, and are able to show them the benefits of a doula before they are in an established practice.

the doulas come to the childbirth classes on 'meet the doulas' night - we introduce ourselves, we answer questions, and that way at least some of the moms have meet us before they come in. granted, we don't get to do extensive prenatals with moms, but in some ways, that's not all bad --- we don't have any preconceived notions about things before we walk in. we get really good at thinking on our feet, involving other support people who may be there, and if there's something about mom or dad that rubs us the wrong way, we know that as soon as this delivery and initial post-partum time is over, we never have to see them again.

we also have air force families, so sometimes we're the only support mom has. we also see a fair number of teen moms - i had one mom who left prom in labor. so we don't see the "typical" doula clients because most of them would not be able to afford a private doula. i feel like i get a lot of unconventional experience that i wouldn't get only taking private clients. sure, i may have 2 or 3 births on a shift, and i'm reeeeally tired by the time i go home, and there are times when i'm not called in at all (i went 5 weeks w/o a birth). but i don't do this for the money - i do it because i feel a need to be involved in birth and helping families experience birth in a positive way.

i realize i'm lucky in a lot of respects - our program is very good and extremely well-run. our coordinator is a nurse, childbirth educator, lactation counselor, and doula. she's superwoman. and because we're funded by a grant, we just have to prove our existence to get the next grant (and the next and the next). of course there are certain hospital policies we have to follow - everyone does - but as long as we don't abuse our privileges as doulas (e.g., being extremely careful with rice socks), we're able to function as we need to.