confidentiality with doulas/midwives- vent/question - Page 3

[April422]

Originally Posted by KellyandKatie

I am surprised how much room for interpretation there is about what confidentiality - or security means- 'as long as the family does not see it and it is just my personal friends and family and network' kind of idea is not confidentiality at all in my mind- it is not even being sensitive even if the code of confidentiality is not being broken
do different certifications have different standards of professionalism? Like DONA or CAPPA - is it written differently?

Is it in that code that all doulas are in that ring or circle of confidentiality- so all clients can just expect that every doula is going to share whatever with their birth network? I know with my birth professionals they told me who their back ups were- they told me who all might be involved as additional support or in the event that they could not make it- I assumed that these were the only other birth professionals that would be hearing about me and my pregnancy and birth

to say that 'going to a birth' is the same as 'going to work' just does not seem accurate. The professionals that I know put in an amazing amount of hours - for every one hour of actually helping at a birth compared to how many hours of support, education, resource, training etc etc hours - it seems to me that the birth is obviously the coolest part of what they do with any one client, but they do seem to put in so many hours upon hours during that time with each client prior to the actual main event

The three points above I wanted to address.

Point 1:
I wouldn't have a problem posting what limited info I post on my personal FB to my Business FB, "Off to a birth." , "A new baby has arrived earth-side" etc.

Point 2:
When a client hires me, or one of the doulas in the practice they sign a confidentiality release form. This form allows the doula to have full disclosure with her her backup, and allows us to discuss births at our staff meetings without any identifying information. We model our discussion about births around the "Obstetrical Grand Rounds" that our local hospital holds for the OBs and Midwives to discuss births for learning opportunities. We hold to the same confidentiality standards they do when discussing births. That's an accepted and commonly used set of standards, all across the US.

Point 3:
I spend on average 9 hours with my clients prenatally face to face in prenatals. I spend an average of 12 hours per birth with clients. Some being shorter others longer. There are days when I post "Full day of prenatal visits tomorrow, can't wait!" or something to that effect, but it's not often.

I've spent a great amount of time in the past day thinking about this whole topic. I still can't convince myself that saying "Off to a birth, baby born, etc" is a violation of conf. or trust.

However, the deeper question I've been mulling over is, why do I feel inclined to share that I'm going to a birth, specifically instead of "going to work" as a generality.

What I've settled on is "off to work" doesn't convey the power, sanctity, miraculous-ness of what it is I do and bear witness to while I'm at work. This isn't a "job" for me. It's so much more than that. To call it "work" devalues it for me.

I don't "go to work" every day. My "work" isn't something I dread doing."

"Off to a birth" or "A sweet baby just arrived earthside" conveys just a tiny tip of the iceburg of the amazing events that I'm about to participate in the unfolding of. The power, the softness, the flow, the trust, the vulnerability, the empowerment and the victory and miracle that is birth.

I've been a doula for over a decade, and I still have passion, wonder, amazement, stand in awe as life is given wings with which to go forth and fly with. How many people truly feel that kind of passion and awe at their "jobs"? OBs, Midwives, labor nurses, most start out that way, but how many maintain that feeling about their "work"?

So, for me, to say "off to work" isn't to honor the event I'm about to participate in, or have participated in. It's not about "coolness" it's about acknowledging the sacred, the miracle, the power of what it is I am allowed to participate in when I go to a birth. It's so much MORE than a "job" or "work". When it becomes a "job" or I feel like it's just another day at "work" it's long past the time for me to find another path.

[shruley]

I am friends with several doctors on Facebook, including my old OB/GYN who has now moved but we still keep in touch. She posts medical updates all the time...that's how I know she had 2 twin NSVDs in the last 2 days! She also posts when she's waiting for a VBAC and other things, such as just did a (insert some kind of gyn. surgery) on someone with BMI of 34 (or whatever a really high # is.) Lots of my Intensivist friends routinely comment when they're having a bad night, a slow night, or any particularly exciting updates -"just had 2 codes in the last hour" kind of thing. I'm not saying this is or isn't ok, but I think it's unfair to single out midwives as the only professionals that do this!!

[Carita]

Its not just FB, but I think this applies to everywhere and more than birth professionals. I had a childbirth class w/another couple and the doula and the doula asked me if she could tell them about the birth. And she would always follow HIPPA - if she told me something medical, it was w/out names. my MW did the same since she taught my yoga class & asked if she could pass it along.

in my own profession I am bound be the same sort of confidentiality w/my students. i do FB and talk about my teaching or what a student said, but don't use identifying info when i do so...

[sondancer]

I understand where you are coming from but...

Your comfort level and what is legal and appropriate are VERY different things. First of all, saying "I'm going to another birth" is not illegal or inappropriate. It's basically like saying "I'm going to work" because that is what doulas and midwives do!
I agree that names shouldn't be mentioned but if you are on doula forums and midwive forums stalking them for the info they relate to other birth professionals, than I think that is a larger issue. I am a doula and I am on those forums. Doulas and Midwives NEVER share identifying information about clients but they share birth successes and sometimes processes difficult births with other doulas and midwives and there is NOTHING wrong with that. Social workers share information with other workers (nonidentifying info) about difficult cases to get feedback or new strategies and doctors do the same with colleagues, informally, and also at formal events like conferences and paper presentations.

If you are upset that people mention they are on their way to a birth, that is really your issue not the issue of the person who posted it. Also, I respect that you are pregnant and obviously a very private person. If you want your doula NOT to mention anything related to your birth, simply tell her ahead of time and be specific! Don't say, don't facebook about my birth because if she tweets or facebooks "I'm going to another birth" NO ONE is going to know she means you except you, so let her know you don't want her to even say that, otherwise you are setting yourself up for a reason to be angry with her and a tense situation.

[MsBlack]

Originally Posted by sondancer

Doulas and Midwives NEVER share identifying information about clients but they share birth successes and sometimes processes difficult births with other doulas and midwives and there is NOTHING wrong with that.

There is nothing wrong with that IF the providers don't do this on fb or other, more public forums. Really, nothing online is entirely private--but at least on a professional forum with restricted membership and confidentiality agreements, you have a better chance of affording clients privacy.

Except now I remember another privacy violation that occurred for me: it was on a prof. forum, and the issue was that a member in all innocence copy-pasted remarks made by some of us, to her personal blog. She did not ask permission to do so, nor did she remove identifiers from our posts. It was 'innocent' in that she meant no harm, hadn't thought about the privacy ramifications (it was political commentary--so not identifying clients, but posed a risk for the mws practicing under-the-radar). I woud not have minded if she had at least removed names and places in order to conceal identities. So, even the presumably 'restricted and confidential' forums are open to 'leaks'....it is SO easy to copy/paste!

And see, I've found that when you are discussing a difficult birth--and for meaningful feedback, that will have to include details of the birth (even if you never mentions names/places). JUST those birth details can 'identify' a client to others.

I do think it's a good thing for clients to avoid taking things too personally--worrying too much about general comments like 'off to a birth'. But I also think that practitioners need to be VERY wary of what they say, and where they say it, and how they say it, on public forums--even supposedly 'restricted/confidential professional' forums.

[Schae]

what an interesting thread. many pertinent points raised on both 'sides'.

I think in general people are 'okay' with generic comments such as 'off to a birth' or 'off to do my 20th major brain surgery' - it's a big deal in their lives and they want to share it. I don't see it as a violation of trust. But obviously there are people who are more private than the majority - and those people need to be catered for as well. Not sure who to bridge the gap there.

I have no problem with my MW posting on her fb that she's off to a birth. When I go to my prenatal appt with her and she looks exhausted and tells me that she had 4 births in 3 days - that isn't a violation of privacy, it's her sharing why she's tired.

Different strokes for different folks I guess.

[sweet.p]

Without clear consent from a client the doula should not post publicly about a clients labor and delivery.
It's not appropriate and it's an invasion of the clients privacy.
It reflects poorly on all doulas as unprofessional.

FB, blogs and tweeting without client permission has become a big issue for doulas!

There was a doula on one of my professional lists whose client was furious the doula did updates on FB about the birth. The family reported her to DONA when the client read the doulas FB page and recognized the dates and circumstances as her labor and saw the doula was putting updates about the client while the doula was at the birth taking breaks.

[sweet.p]

Originally Posted by MsBlack

This is something that really bugs me, too. I don't even 'do' facebook, for various reasons but in part because of just the issues mentioned here: potential HIPPA violations as well as privacy concerns that are far greater for some clients than for others--and we don't always know for sure as well as we may think we do about that.

As a birth professional, over the years I've had some struggles w/confidentiality in just the ways the OP mentioned--saying what seem to be very general or oblique things about a client, meaning to conceal identities, only to find that the person I'm speaking to knows who I mean. It is a very small world! Even if you don't live in a small town, it's a small world. Remember that homebirthers/mws and even doulas/clients are a small population, often somewhat isolated because of that--we tend to connect with each other from all over. I know that I have stepped on or over the line a few times, quite unintentionally--fortunately with no ill results that I know of--and it made me really really wary of confidentiality.
.

I completely agree with you.
Doulas need to think of FB, blogs and Twitter exactly like their clients neighborhood supermarket or kids soccer games .
It becomes gossip about your clients births when you talk or post about them!
Exactly as if you are telling your clients neighbors about the labor /delivery / breastfeeding.

Doulas Writing on their blog or FB that you attended a "difficult birth" is insulting to clients, since they likely viewed thier birth as a magical moment in there life, including it ending in an unnecessary cesarean after 24 hours of interventions!!!!
This is not your birth!