As I was doing a pre-natal visit with a client this weekend I realized I was covering a lot of what happens in a childbirth education class. So then I got to thinking about my scope of practice and trying to figure out where the line is between informing clients as a doula about medical procedures and giving my clients a one-on-one childbirth education class outside of my scope of practice. I don't want to cross the line but I want them to be well informed.

Can anyone explain to me where the difference really lies? Thanks!

This is exactly why I don't do prenatal "lesson plans". My only goal with prenatals is to get to know each other. Mine are very informal, usually held at Starbucks or my favorite pedicure place. I don't limit the number of prenatal meetings. I have never had a problem of going into birth education during a prenatal because my clients know that it's not what it is about. I want to know who they are, what they like, what their hopes and dreams are, what their family dynamic is, etc. I try not to become the fount from which all birth knowledge flows because it's not about me... it's all about her. Now do I occasionally answer questions like "how will I know I'm in labor?" or "what kind of procedures are standard at my hospital?"... sure! Another way I minimize the whole scenario is requiring (well unless they are 2nd+ timers) my clients to take childbirth education classes.

I do the same thing, Wendy. And it REALLY hit me just how much educating I do when I observed my CBE series for my certification last summer. I sat there thinking, "My clients get MORE than this from me in our 2 prenatals!" Ack!

I've discovered, though, that I am really into the education part of it (more than I thought I would be, as a few years ago I wasn't sure if doing CBE would be "enough" for me...I still don't think it would be "enough," but it's now definitely something I want to do in addition to doula-ing!), and so far, my clients have been really receptive to it (actually have encouraged it) and appreciative. I really do follow their lead for the most part, so the ones who aren't as chatty don't get as much of the education stuff...but so much of it seems to just naturally flow out through conversation and questions. I ask them at our first visit (or sometimes before the first visit) to fill out a sheet on what they would like more information on...and I'm happy to help with resources or simply explaining certain terms or procedures, etc.

I have wondered from time to time if I should just add another prenatal visit for the "education" part as an "optional" visit, and charge for it, for the clients who are not otherwise going to take CBE classes (and most of them, if not all, have not so far because there just aren't good options around here at all, unless they want to drive an hour + each way ~ and that just hasn't been feasible for most of them).

I am really anxious to be able to offer actual CBE classes myself, though.

I used to teach 4 private classes with each client but once I became Lamaze certified I stuck with group classes (which my clients are encouraged to take but it's by no means required)

Now I find myself doing only 1 prenatal visit, which covers:
-Her priorities for her birth (it's a worksheet)
-When to call me and how to reach me (brief review of signs of labor)
-An early labor "plan" (a list of suggested ways to spend early labor according to time of day/night)
-Her birth plan (if she has one)
-How I can best support her (a worksheet of things I offer/bring with me)

I describe the content of this meeting ahead of time so they know what to expect. If there's a lot of gaps they feel like they need to fill in, I'll offer 1 extra class for an additional fee.

I actually think it is better if the childbirth education comes from me, and I let my clients know that they won't need to take supplemental classes because of all that we cover, unless they are looking for specialized classes like hypnobirthing or BFW. Unfortunately, the vast majority hospital classes around here teach "how to behave in the hospital and when to get your epidural" as their main focus. My clients generally are looking for a natural birth, though, so I emphasize that information.

This is exactly what I do as well.

Of course I direct them to great prenatal childbirth classes and not the one given at local hospital or public health.

Since I've been in St Louis this is what I've experienced. Very few mama's I've encountered take anything other than a "How to be a good patient" (we have a similar term for them) in-hospital class.
I found myself initially going over a lot of questions that I thought CBE classes should have covered.
So I adjusted myself to the needs of my clients, which usually means prenatal #1 is spent "how to write a birth plan" and what are your choices in childbirth and answereing questions that the class left unanswered. My 2nd prenatal is ALL about comfort techniques. I ask dads to get their hands dirty and practice with us, I really want my families to have the confidence that IF they ever had to do this without me they totally could! This is something our in-hospital CBE classes just lightly brush on and its usually 'sit on a birth ball' and 3-4 lamaze style breathing techniques. But many of our in-hospital CBE classes are taught by doulas, so the knowledge is there to be able to teach.

I lay out my prenatal's to be slightly 'structured' in terms of what we cover, but leave a lot of other time to chit chat. (and a huge difference between me and emmabella, I hate meeting at Starbucks and similar places. I find that mamas don't open up to me as much in public places and meeting in their homes always leads to a random conversation that wouldn't have if we were somewhere else)

We also have to be mindful that CBEs spend a lot of time preparing quality programming to offer to expectant couples and that as Doulas it is our job to "inform" not neccesarily "educate". I think there is a huge difference between those 2 words. If you are a CBE then by all means create a package that will incoorporate childbirth education, however if your skill-set is only that of a Doula I would help a client seek out educational avenues in their area.

Something to consider; childbirth education is not just about the learning but about the community building as well. Living in Toronto, it is a very transplanted society where many live a great distance from family and close friends. A prenatal class offers couples a chance to build community with people of similar standing ... everyone (god willing) will end up with a baby at the end and it helps form bonds and they can help eachother out through the good times and bad. One of my HypnoBirthing classes, the couples spent 7months trying to get together ... to me that spoke volumes as to how connected they were after their intensive 5weeks together with us. I think that is the piece some couples may miss on just sitting in their home. Also questions, suggestions, and comments may come out in a class setting that would probably not develop in a singular setting. They also push eachother to practice and acheive their goals.

A little more food for thought; there is often slams against the hospital based programs. The reality is these women (as it often is) as educators have their hands tied. They are told by the hospitals what to cover, what to say and how to teach. I know many a hospital based educator that has gotten their wrists slapped for talking too much about natural birth and the alternative pain management techniques. So before we sit their and say "oh the hospital programs here are -----", we need to think about the environment in which it is set.

As Doulas I think that you are right to inform, provide information through referrals and handouts but to offer prenatal education with little background of study to me (personally) it is stepping outside of your scope of practice.

By "background of study," do you mean a *formal* CBE training program?

I understand what you're saying about the hospital-based classes, even when the educators would like to offer more and better material, but to be clear about what I personally said above, my clients have all come to ME saying that they don't want to take the hospital-based classes. It hasn't been something I've told THEM they shouldn't do.

I offer 1-2 prenatal visits. The first visit is going over their (already prepared) birth plan. If there is a second it is often comfort measures and whatever else is pertinent to the family's situation. I am not a CBE. I am not trained, beyond my self-directed education, in teaching all that goes into a well thought out childbirth preparation class. Can I punt? Absolutely. But, I am not billing my prenatal as a mini-CBE class.

Amanda brings up an excellent point (one that I've heard for the second time this week), We should inform not advise. Pointing a woman toward excellent resources that she can peruse and digest is empowering to her. Advising her is a trap. Either she will ravenously eat up what we give and then we risk becoming the one to go to for EVERYTHING. Or, she will dismiss our advice and then be reticent to accept other things we may have to say.

Sorry if this is a huge tangent. This topic is an excellent one.

To that I would say yes. Many programs; ICEA, Lamaze, Bradley's and even HypnoBirthing have been around for a great number of years and have all the cred to back-up their information as well as their CBEs providing said information. I think for Doulas to borrow material and tout themselves as a one-stop shop (and no I am not speaking of anyone personally) is watering down and possibly doing their clients a great disservice if education is not their "fortay" or a primary modality.



I was never insinuating such. Even as a HBCE I often inform my students that if they still would like to take a hospital-based program to take the short*est one possible because they do not want to inject themselves into a situation that is often fear-based as I have spend 5 weeks de-programming them of such beliefs.

Education is truly my passion and if Doulas find that education is their passion then they should consider investing and researching avenues that will get them there.

I have been thinking of this also. I am persuing certification as a childbirth educator. I have a ways to go. In the meantime, a couple of my clients have wanted some natural childbirth education. The only option in my area is a pretty basic, free class that is offered. Not suitible for those pursuing a natural birth, which most of my clients have come to me have wanted. There are some great options avalible in the city, over an hour away. I have not met anyone willing to drive that distance once a week to attend a class; on top of their regular visits with their health care provider which is usually in the city also.




This is what I have been thinking also. I didn't think this would be out of my scope of practice, as I it is still more information than advise. I find that some clients are more prone to wanting advise, or sometimes ask "well, what would you do in such n such situation?" , no matter how much information has been given. And some women are very good at researching on their own. I do not want an important piece of info left out just because someone doesn't know how to research well. I actually do advise women to check out different resources and evidence. I don't know though.... I guess I need to think of this more.

I agree... good topic!!

I personally don't know the difference.

My clients DO get private CBE classes as their "prenatals". I actually thought my doula training mimiced what I do in CBE classes for the dads/partners.

IMO its the only way I can feel secure that they do have all information and are making fully informed choices in all circumstances.

I don't belive most doula trainings prepare you for teaching more then a very general CBE course, in most cases. CBE course is a year of study and then some, doula training is a 3 day workshop.

Very interesting. I find that many of my clients need information more than education. I don't go over things like the physiology of labor/delivery at all, unless they ask. We more go over choices they'll need to make, and why.For example, when looking over birth plans, if they don't know the side effects to a certain procedure, I'm going to tell them.
In a way, that makes my "informing" them also "educating" them. But, I really don't feel like I am a CBE, but perhaps, I'm confused.

For those of you who do CBE during prenatals... what about the time restrictions? I teach a 14 hour CB class series at a community center and I feel like I *barely* cover everything they need. I don't know how I could possibly feel like I conveyed all the necessary info for true CB prep in two prenatals. I guess if there weren't any good options near me I might consider doing more CBE during prenatals but, for me, I'm glad that I don't have to. It does feel outside of the scope for my own doula practice. I just enjoy the relaxation of a mutual conversation during prenatals instead of being in teaching mode.