BADT Defines Our Doula Scope of Practice
In many medical and medically-adjacent fields, there is a scope of practice document which defines the roles of different care providers. Birth Advocacy Doula Training (BADT) stands apart from other doula training orgs in that we are committed to full-spectrum work from an anti-oppressive lens. As such, this document is expansive in nature and can be applied to many types of doula work– from abortion support to birth support to queer and trans advocacy.
This blog is going to serve as a working document for BADT teachers, trainers, staff, and students to reflect upon. This may also be a tool to share with clients as you discuss and build a doula-client relationship together.
The impact of doula work is felt by clients, families, and medical care providers. It feels minimizing to say that there is evidence that supports this positive impact, AND the reality is this kind of client or patient-centered care is not the norm under the medical industrial complex. Evidence Based Birth has published evidence about doulas, and while it is focused on the perinatal period, we believe this data can be applied to the full-spectrum of doula care.
The Role/Position
A full-spectrum doula is a care worker who witnesses and supports clients and community members through life and reproductive transitions. They may offer physical, emotional, informational, and/or advocacy support. A doula-client relationship tends to be relationally-focused, with both parties working towards trust, rapport, and open communication. A doula-client relationship may last a handful of days or a handful of months or even years.
While doulas often serve in or alongside the medical environment and hold a great deal of knowledge around medical and physiological processes, they are not medical professionals and do not perform any medical assessments, treatment, or advice.
At BADT, we also believe that doulas are an essential part of the Reproductive Justice movement. While doulas may work primarily 1:1 with clients, they are upholding and contributing to the values of bodily autonomy and choice.
Physical Support:
Physical support includes a range of physical comfort measures. Doulas may help clients prepare their physical space, learn and utilize different positions or movements, make plans for self-care routines, offer comforting touch or massage, and other hands-on acts of care like.
Emotional Support:
Emotional support includes processing before and after a life or reproductive transition, building rapport between doula and client, words of affirmation and validation, and holding space for the range of feelings that can be present through the client’s experience. Doulas may practice active listening, reflecting back what they are hearing/observing, and offer gentle suggestions for coping. The foundation of emotional support is the doula’s presence.
Doulas may also offer emotional support to a client’s family member(s)/friend(s) who are accompanying the client, or support to the client in navigating the emotional aspects of their social and/or familial relationships through their experience.
Informational Support:
Informational support includes providing information about a variety of topics including evidence-based practices, resources for support and education, comfort measures and coping skills, and referrals to other care providers, as needed. Doulas should offer information in a manner that’s as unbiased as possible and refer clients to reliable sources so that they can make their own decisions. It is the doulas job to seek resources that align with the clients’ identities, needs, and preferences. Doulas may also offer information to the client’s family member(s)/friend(s) who are accompanying the client.
Advocacy Support:
Advocacy support includes assistance in navigating the complex healthcare system. The companion works directly with clients to ensure they have a voice in their care and information to promote informed and empowered decision-making. While the doula will not be speaking for their client, they may need to uplift the client’s voice at times. If harm occurs in the medical space, the doula should report this harm to the proper personnel.
Additional Doula Responsibilities:
The doula protects the privacy of their clients.
The doula respects the role of each member of the client’s care team by fostering open communication and maintaining their scope of practice.
The doula will communicate honestly about their needs and boundaries.
The doula will offer continuity of care, securing backup doulas as needed, and giving advance notice if the nature of the relationship needs to change.
Client Responsibilities:
The client is responsible for their clinical and medical well being, this includes seeking and maintaining the ongoing care of medical providers.
The client is responsible for securing other layers of their support system and team.
The client will maintain open and ongoing communication with the doula.
The client will communicate honestly about their needs and boundaries.
The client is responsible for educating themselves through self-study and completing surgeon-required preparation in order to make informed decisions.
Limitations:
A doula is not a substitute for medical care or mental health support. Nothing that doulas say can or should be taken as direct medical advice. Any and all resources provided are for the benefit of the patient’s autonomous decision-making and as an added support to their network of care. Doulas do not perform clinical or medical tasks. Additionally, doulas are not therapists or trauma specialists, unless otherwise trained and licensed. Finally, doulas may or may not be certified, as there is no licensing body, but training is highly recommended.
Join Us in Community
We’d love for you to join us in the BADT community! Sign up for our email list if you’re a birth worker or aspiring birth worker, so you’ll be first to hear about new courses, open enrollment periods, and scholarship opportunities. Our full-spectrum doula course will be open for enrollment soon! Finally, there are various ways to become a doula; check out our team’s journeys into this work here.