Standards of Practice for Birth Doulas
DONA International’s Standards of Practice define a doula’s role
As the premier association of doulas in the world, DONA International’s Standards of Practice help doulas worldwide to play a valuable and appropriate role during birth and the postpartum weeks.
A. Services Rendered
The doula accompanies the woman in labor, provides emotional and physical support, suggests comfort measures, and provides support and suggestions for the partner. Whenever possible, the doula provides pre- and post-partum emotional support, including explanation and discussion of practices and procedures, and assistance in acquiring the knowledge necessary to make informed decisions about her care. Additionally, as doulas do not “prescribe” treatment, any suggestions or information provided within the role of the doula must be done with the proviso that the doula advise her client to check with her primary care provider before using any application.
B. Limits to Practice
DONA International Standards and Certification apply to emotional and physical support only. The DONA International certified doula does not perform clinical or medical tasks such as taking blood pressure or temperature, fetal heart tone checks, vaginal examinations, or postpartum clinical care. If doulas who are also health care professionals choose to provide services for a client that are outside the doula’s scope of practice, they should not describe themselves as doulas to their client or to others. In such cases they should describe themselves by a name other than “doula” and provide services according to the scopes of practice and the standards of their health care profession. On the other hand, if a health care professional chooses to limit her services to those provided by doulas, it is acceptable according to DONA International’s standards for her to describe herself as a doula.
The doula advocates for the client’s wishes as expressed in her birth plan, in prenatal conversations, and intrapartum discussion, by encouraging her client to ask questions of her caregiver and to express her preferences and concerns. The doula helps the mother incorporate changes in plans if and when the need arises, and enhances the communication between client and caregiver. Clients and doulas must recognize that the advocacy role does not include the doula speaking instead of the client or making decisions for the client. The advocacy role is best described as support, information, and mediation or negotiation.
For client needs beyond the scope of the doula’s training, referrals are made to appropriate resources.
II. CONTINUITY OF CARE
The doula should make back-up arrangements with another doula to ensure services to the client if the doula is unable to attend the birth. Should any doula feel a need to discontinue service to an established client, it is the doula’s responsibility to notify the client in writing and arrange for a replacement, if the client so desires. This may be accomplished by:
- Introducing the client to the back-up doula.
- Suggesting that another member of DONA International or other doula may be more appropriate for the situation.
- Contacting a DONA International Regional Representative or local doula organization for names of other doulas in the area.
- Following up with client or back-up doula to make sure the client’s needs are being accommodated.
III. TRAINING AND EXPERIENCE
Doulas who are certified by DONA International will have completed all the requirements as set forth in the DONA International Requirements for Certification. This includes training in childbirth and attendance at a birth doula workshop which has been approved the DONA Education Committee; completion of a breastfeeding requirement; required reading from the DONA International Reading List; development of a resource list for her clients; completion of an essay that demonstrates understanding of the integral concepts of labor support and a Basic Knowledge Self Assessment Test. See the DONA International Requirements for Certification for more detail on Training and Experience.
Doulas certified by DONA International will have the experience as set forth in the DONA International Requirements for Certification. This includes provision of support to a minimum number of clients, positive evaluations from clients and health care providers and records of three births, including a summary, observation form and account of each birth.
B. Maintenance of Certification
DONA certified doulas will maintain certification as outlined in the DONA International recertification packet. Recertification must be completed after each three-year period of practice.