Hospital Based Doula Programs - A Guide For The Professional
One of the most exciting and fast growing aspects of health care in the new millennium is the integration of doulas into the hospital setting. Hospital based doula programs that are either volunteer or paid, and are either on-call or personalized are beginning to make a difference in pregnancy outcomes all over the United States and Canada.
If you are employed by a hospital or are a doula ~ read on!
Making a Proposal About Doula Care
Meeting with upper management at the hospital to explain about doulas in a hospital setting takes homework. The presentation must be professional and should include the following: mission statement, goals, objectives, job descriptions, budget, short-term plans for implementation, long-term plans for sustaining the program (including grant funding), demographic study of the area, in-service education plans, record keeping forms, topics for policies/procedures and practice guidelines, evaluations, marketing plans and plans for training and certification of doulas. Launching the program with certified doulas is preferable but not a requirement.
Learning from the Past
Based on what happen as childbirth education in the 1980s moved from the home into the hospital, there is concern that doula care will suffer from co-optation as doula programs move into hospital settings. Used in this context, co-optation is the institutionalization of a service so that it becomes more of a mouth-piece of the institution rather than a consumer-oriented service. Many who are familiar with the co-optation of childbirth education are careful in the creation of doula programs. Careful wording of mission statements, goals, objectives and job descriptions can help maintain the consumer focus of doula care and avoid possible conflicts with hospital staff.
Establishing Clear Roles
The Medical Leadership Council is a research based subsidiary of the Health Care Advisory Board located in Washington DC. According to the 1996 report on the impact of doula care on maternity outcomes, one area of concern is the perception of doula care by hospital staff. Unfortunately in some areas, the doula may well be seen as an "intruder", a non-medical assistive person (also a nursing assistant or even nursing student) who invades the already established territory. Worse yet, doulas get to do the work that nurses truly entered nursing to do - the psychosocial, touchy-feely, loving and hand-holding care that has regretfully been replaced by technology and charting.
Presenting a clear and concise view of the doula's role, the positive effects of her presence on the birth outcome, and the importance of her role as a valuable member of the health care team are crucial to the success of the doula program. This brings out the unity in the medical community. Preliminary investigative teams examining the viability of doula care in a facility must be interdisciplinary. Also incorporated within this plan are the policies, procedures and practice guidelines that enable the mother, doula, nurse and physician/midwife to work as a team. In-service education programs that stress team roles, and support by upper management are a must.
Choosing the Right Program
There are three basic types of doula programs available at hospitals and birthing facilities - each has advantages and disadvantages.
On-call Programs. This type of program allows for flexibility on the part of the doula. The coordinator creates a rotating call schedule that allows for anyone to be called if they are on a master list of doulas. A doula is assigned a day when she is on-call either at the hospital or at home, and responds when a client comes into the hospital in labor and indicates the need for doula care. Payment for both on-call time and for the time the doula spends with laboring clients is a concern for the program coordinators.
Out-sourced Programs. For some hospitals, the most logical type of doula service is to out-source with an established doula group in the community. This provides the client with a choice of doulas and requires less budget and time from the hospital for administration of the program. It also reduces the liability for the hospital because the client hires the doula directly. The choice of the doula and overall cost are jointly determined by the client and the doula. For the doula, however, this type of program may limit the time spend with hospital staff and physicians to the birth experience only. The true interdisciplinary feel of the team is somewhat lost. The doulas are seen as "free-lancing" and are not as tightly bound by or knowledgeable of the policies, procedures, and practice guidelines of the department.
The continuum-based program actually functions more like an independent doula business. Clients contact one phone number, are assigned a doula and backup and begin to build a trusting relationship during the prenatal period. The doula then stays with the client during labor and birth and does a postpartum follow-up visit. A flat fee, which includes the on-call time, time spent in labor, and postpartum follow-up is charged by the hospital. Continuum-based doulas have their place in the maternity continuum of care and are represented in the meetings and planning of the maternity department. They often provide in-service education for staff on a variety of topics including non-pharmacological comfort measures, massage, using the Birth Ball or hydrotherapy. The doula program is included in the strategic plan and continuing education plans of the maternity department and benefits from departmental marketing strategies.
Dealing With Conflict
One of the common obstacles of hospital based doula programs is dealing with conflict. There might be conflict from instituting change in policy from nursing staff or physician, or even when doulas have come before and acted inappropriately. It is important to realize that for many, change is neither easy nor pleasant. Change must be presented in a way that incorporates the team philosophy, the focus that the mother and child benefit from the change, and that the patient satisfaction will increase. Addressing this issue can be enhanced by a presentation with question and answer period. We have the experience of coordinating a hospitals based doula program and can present to your targeted audience.
Follow Our 10 Steps to Success!
We have included the 10 Steps to a Successful Doula Program, online! For our record keeping needs as talked about in the 10 Steps, we'd like to suggest our Hospital Doula Program Package ~ includes all that you will need for establishing a program.
A Proven 3000 Year Old Concept
Doula care is not new - proof is seen in cave paintings and ancient sculptures dating back thousands of years. Throughout history, women have been supporting women during pregnancy, childbirth and the postpartum period. Women are wise and strong, and in trusting their bodies and instincts, they can assist other women with birth. Research documents what many of us have known all along - a positive birth experience shapes humanity. Doulas truly help shape our future by caring for families today.