By Sharon Muza, BS, CD/BDT(DONA), LCCE, FACCE, CLE
Today is the sixth post in the occasional series, “Doula Me This!” Each post in the series provides a common scenario that a birth or postpartum (or both) doula may face. The “correct” answer (if there is one) requires some synthesis of the situation and at times consideration of DONA International’s Standards of Practice and Code of Ethics.
Today’s dilemma is based on a birth or postpartum doula needing backup for their clients. After reading the situation below, let us know in the blog comments section how you would handle this in your own practice? Have you faced this situation? How did you handle it?
Doula Me This!
You have recently moved to a new area and are now in the process of booking clients and rebuilding your business in your new town. You have not yet established or found a backup doula to cover your clients in case you are at another birth, ill or have a family emergency.
You are an experienced and successful birth and/or postpartum doula who has just relocated to a new city. You are starting to build up your business in this new spot. Interviews for birth and postpartum work are flowing in and happily, you are booking clients. You have begun to make inroads in connecting with the doula community in your new location but have not yet found birth or postpartum backup to cover you if you are not able to attend a client.
You know that it is your responsibility as a doula to provide backup to your clients if you are unable to attend their birth or support them during a scheduled postpartum shift. DONA International’s Code of Ethics for birth doulas and postpartum doulas reads:
“Reliability. When the doula agrees to work with a particular client, his/her obligation is to do so reliably, without fail, for the term of the agreement.”
Simply put, you cannot assure your clients that they will have a backup doula if needed. You are making every effort to rectify this situation but there is no backup birth or postpartum doulas in place at this time and may not be for the foreseeable future. You know it is important to be honest and upfront with your clients prior to hire and during the time you serve your clients. You are also very clear that you don’t want to misrepresent the circumstances in which you are operating your business currently.
What would you do?
Being a doula is how you support yourself financially, so not working while you establish a backup system is not feasible. Some potential (and booked) clients are inquiring about this issue and others have not brought it up. You are not sure how you should be sharing this information, in interviews and once hired? Being new to the area, you are not familiar with other birth professionals and worry about finding the right fit and a reliable fit. Should you offer a backup contract to the doulas you are hoping to utilize, especially starting off? How will that be received? You are always mindful of being professional, ethical and abiding by your DONA International’s Standards of Practice and Code of Ethics. While you have not needed your backup very frequently in the past, there have been situations that required a backup. Doulas, what do you do? Let us know what you think in the comments section below.
For birth clients: I would hustle way harder on establishing backup pronto, at least as hard as client seeking. In the meantime, I would have to amend my agreement in terms of backup and would have to hold more money in reserve in case of births I could not attend. (Though really, I wouldn’t take births unless I felt comfortable I could get backup). For postpartum: I would word the agreement to clarify that if I were unable to make it to a shift, rescheduling would be the option, and remove wording about having an option for a backup to come. Realistically, times I have not been able to make postpartum shifts, I have only had one instance a client wanted me to send a backup instead of just rescheduling, so that is less of a big deal for me.
When I was new, I joined my local doula organization and could post requests for back-up. Sometimes the back up was paid even if they didn’t attend the birth, other times we negotiated a trade. Once I found a group of women, trading back-up was pretty easy.
Perhaps interviewing other Doulas in your area accessed by the DONA “find a doula” page, would give you potentially adequate doulas for backup. Although the other Doulas are held to the same SOP, the match may not be perfect, but allow you time to get to your client before they deliver. Of course, all potential replacement doulas should be introduced to the mother before labor. Being generous in your allowances for backup help is appreciated.
I am so glad this came up. I live in a rural area and the closest doulas are an hour a away…and it can be hard to find someone to do back up for me. I am honest with my clients that I don’t have one….and thankfully I haven’t had to miss a birth yet…..
You absolutely have no alternative. From the time your client signs the contract the obligation is on the doula for backup to be available from then onwards. What if the client experiences premature labour or has important questions about the results of screening procedures? Although you cannot be instantly available 24/7 for upwards of 6 months, the client needs to know whom to turn to if you are not accessible. If the doula has priorized seeking clients before finding backup, that was an error.
Backup doulas can be sought out from local trainers, your provincial doula association , doula Facebook pages.
Personally , I feel backup contracts and a small retainer fee are useful except in the case of partnering with a doula whom you respect and feel comfortable with having a mutual backup agreement, as I have done for several years with no problems.
I always provide the name and full contacts information of the backup doula by the 2nd prenatal visit at the latest. My backup is happy to speak by phone with my clients if they wish, and me with them. In the case they wish to meet her in person, we arrange that and add a payment for travel.
I also have doulas I can call on should my regular doula be unavailable. I negotiate terms with these doulas on an individual basis.
I would not take on any clients prior to establishing back up. Therefore I would spend my energy connecting with doulas before connecting with clients.
I do birth doula trainings in areas where having no doula backup is the norm. Some strategies: Have the clients identify a friend or family member who they could rely on for support and we schedule an additional two hour visit. I suggest the doula go over coping rituals, comfort measures, BRAND, positioning basics, and the importance of the birthing person being involved in all decisions. In case they are totally unavailable, some doulas have a “backup by phone” arrangement with an experienced doula out of the area, so someone can consult via FaceTime or Skype. Still others have contacted homebirth midwives or labor and delivery nurses to do backup, especially if they are gone for a vacation that’s not around the due date.
Moving into a new area where there are established doulas is tricky. You’re their business competition, yet you need to work cooperatively to provide backup and to promote the doula profession. The newer to the area doula has to strike that balance between needing client backup now and cultivating relationships and letting them develop naturally over time. It’s more difficult if there are enough doulas for cliques to form – you don’t even know who’s with whom. By making the “wrong” initial choice of backup, the new doula can be seen as “taking a side” they never knew existed. (I’ve heard that story more than once.)
The doula has a clear responsibility to provide backup or its equivalent with the full knowledge of the client about those circumstances. The other comments covered that really well. But the doula also has to move at the right time in cultivating relationships in their new doula community. That leads to the future health of their business and the doula community in that area as a whole. Hopefully the doula is able to do both simultaneously by being strategic in building their relationships with all birth professionals in the new area.