The word “scope” is a controversial word in birthwork. At times, it has also been used to reprimand doulas. The confusion has largely come from doula organizations using the word “scope” as their perspective of how the doula of that organization should practice. While one organization says that their doula “scope” cannot use essential oils, another organization says they can.
However, doulas do not have a “scope of practice.”
A scope of practice regulates a set of standards under a license. Doulas are not licensed or regulated. This is explained by Hermine Hayes Klien (youtube video) https://www.youtube.com/watch?v=HJ6ngb4ng4I. Doulas do not give medical care. They do not perform clinical tasks such as taking blood pressure, checking a cervix for dilation and effacement, or making diagnoses and forming an opinion based on clinical findings. Doulas are not responsible for diagnosing a situation and giving an expert opinion to help a patient make a decision.
A doula’s responsibility is, however, to meet the needs of the birthing person with information, education, physical support, and emotional and advocacy support. These topics of support can be confused if someone does not understand the role of a doula.
All doulas are unique, in training, philosophy, proficiency and personality. When/if a doula is giving options or reminding a birthing person of a conversation they had prior to birth, sometimes medical people get confused on what this relationship means. If these medical people think that a doula’s role is only emotional and physical support then this conversation could be perceived as “stepping out of scope.” However, supplying a client with information to read over to help their decision, educating a client on their options, and facilitating conversations around the birthing person have been seen as a doula giving medical advice. Giving medical advice and helping someone navigate information after educating them on the topic are two separate things.
To be clear, the doula role is more than physical and emotional support! Doulas can offer options to help with a decision the client needs to make and facilitate conversations given the information they know about the client and have been given permission to help. Yet, the bottom line is: Doulas do not have “scope.” The identity of a doula is to meet the needs of a client. This will look differently per doula and doula organization.
I would like to propose that we begin rewording the “scope of practice” of doula organizations to “Organizational Guidelines and Standards.” These guidelines would only apply to the doulas that are a part of that specific organization and meet the standards that organization has set for its members.
Are you a doula who has been told to “stay in your scope?” Are you looking for a community of other doulas and birth workers who are reducing trauma in the birth space by having conversations with the birth team and educating clients to prepare for birth? The Doula Instincts Mentoring Membership may be the place for you. We are a community that holds space for birth workers to find their identity in advocacy in the birth space. Click here for more information.
