Today is the fifth 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 the DONA International’s Standards of Practice and Code of Ethics. Today’s dilemma is based on an often confusing topic that may not be common but could feel quite sticky for a birth doula faced with this situation. How would you handle this in your own practice? Read through the scenario and let me know what you would do.

Doula Me This!

You have been hired by a family who was planning a home birth with a local midwife. Six weeks prior to their due date, they announce to you that they have decided to have an unassisted home birth, without having a health care provider present. They are still planning to have your birth doula support at the birth.

The Details

You were rehired by Natalie and Jonah to be the birth doula for the birth of their second child. You were their doula at the birth of their first child, who was born at home three years earlier with a local midwife. That birth was uneventful and without complications. At your first prenatal at 34 weeks for this second pregnancy, they inform you that after much consideration, they have decided to birth their second child unassisted in their home. They will continue to see their midwife for prenatal and postpartum care, but will not have the midwife attend their birth. They calmly explain their reasoning behind this change in plans and discuss how they are preparing for this unattended birth. They state that they are planning for you to support them again, in the birth doula role, as you did for their first birth and how they recognize how much help you were to both of them during the labor and birth.

The Dilemma

You are surprised by this unexpected change of plans. As you sit listening to them explain this shift in their thinking, you are wondering what really has caused this shift, and what your responsibility is both now and in the future. You have not been in this situation before, nor do you have any colleagues who have, to the best of your knowledge. You feel confused about how you should respond and a bit floored by this information. Your clients are looking at you excitedly, after sharing their plans, awaiting a response.

What would you do?

Do you attend this birth? Are you comfortable attending an unassisted birth? Are there any ethical ramifications? Do you have any legal exposure? Are you fully aware of any potential repercussions if there is no midwife present during the labor and birth? Should you study up on emergency childbirth procedures just in case? Do you decline to attend, despite having a signed contract and paid retainer? What are your obligations if you do not attend? What would you say at the moment when you first hear this news? So many things to consider, as you absorb what you are hearing and your thoughts after the prenatal is over and you alone. Please share what you would do in the comments below. Let me know your thought process and what you are basing your decisions and plan of action on.