Is Attending an Unassisted Birth within DONA International’s Scope of Practice?

By Sharon Muza, BS, CD(DONA), BDT(DONA), LCCE, FACCE, CLE

Last week’s Doula Me This! post asked birth doulas to consider what they would do if a contracted client shared that they were now planning an unassisted birth. Many doulas responded on social media and/or the blog post itself, sharing their thoughts, how they would handle it and if they felt it was appropriate to attend a planned unassisted birth as a DONA International doula.

There were a lot of comments and questions that mentioned DONA International’s Scope of Practice and Code of Ethics as supporting evidence for their views. People based their answers both for and against attending an unassisted birth on their interpretation of both of these documents.

DONA International (and the SoP and CoE) does not prohibit doulas from attending unassisted births. This may come as a surprise to some people. In fact, DONA International has a white paper that speaks to this very topic.

DONA International’s Statement On Unassisted Birth Attended by a Doula, last reviewed and updated in 2016, is clear that each individual doula must make a decision on whether they are open to attending a planned unassisted birth. This thorough white paper defines what a planned unassisted birth is. (Note: it is not when a baby comes precipitously before a qualified health care provider can be in attendance.) 

DONA International’s Standards of Practice is clear that providing medical assistance or performing clinical skills is outside the scope of a doula. It is entirely possible to support an unassisted birth and NOT step out of scope. The doula provides the emotional, informational and physical support that the birthing person needs, whether a health care provider is present or not. This does not change. According to DONA International:

DONA International certified and member doulas are strongly encouraged to consider the multifaceted considerations of attending a planned UC… A DONA International doula’s personal answers to the following questions should help determine decisions on this important topic:

• What are the legalities surrounding caregivers in a homebirth or UC environment where I and/or my clients reside?
• What are the potential implications to me under the circumstances? Might someone other than the parents, such as a prosecutor or medical care provider, file a lawsuit against me?
• Am I prepared to deal with any potential consequences of such a claim, whether or not warranted?
• Will I be expected to perform any tasks that are outside of DONA International’s scope of practice?

I also urge any doula to consider and read carefully their professional liability insurance policy (if they have one) to see if it specifically prohibits attendance at a planned unassisted birth. Doing so when the carrier calls this out may void the coverage. If in doubt, check with the company you have purchased your professional liability policy from.

What I do think doulas have an obligation to do is to spell out on their website, in their contract and in personal discussions with their clients what their personal policy is in regard to attending planned unassisted births. That way, those families who are planning to birth without a health care provider are clear on where the doula stands. Also clearly state what the doula’s responsibilities and actions will be if families make this decision to birth unassisted after the doula has been hired. If your policy is to not attend unassisted births, you should state that should this be a decision made after hire, you will no longer be able to serve this family but will be happy to refer to a doula who can. Also, state what the refund policy will be.

Every doula is responsible for examining all the issues surrounding doula support at an unassisted birth before making a decision if providing this service feels right to them. If supporting families who plan to birth without a health care provider present is something that you will be doing, clearly communicating in writing and verbally with your clients what services they can expect from you and what is out of scope for you as a birth doula is of critical importance.

Our responsibility as a doula is to provide nonjudgmental support to the families we work with. If attending an unassisted birth is not something we do, we clearly state that up front and without judgment on the parents’ choice and professionally offer referrals to another doula who can serve in that capacity.

As you consider how you would like to run your own doula business, I encourage you to thoroughly familiarize yourself with DONA International’s Scope of Practice, Code of Ethics and Statement On Unassisted Birth Attended by a Doula. These documents will help you clarify what is the right decision for you.

Have you made the decision to attend or not attend unassisted births?  How do you communicate this to clients? Have you had any concerns when you were supporting a family at their unassisted birth?  Please let us know in the comments section below.