Doulas~Can this birth count towards certification?

[herbanmama]

Okay, here's the scoop. I'm working towards my DONA certification, and I have a client who will deliver any day now. She called me on Thursday after her visit to the doc, and she's 4 cm dialated and 80% effaced. I spoke with her again tonight, and she's still hanging in there. Problem? The DONA certification packet states that labor support must begin at the onset of active labor. DONA considers active labor to begin at 4 cm. Obviously, I am not going to move in with client because she's 4 cm, and has been for 4 days. She's just fine, carrying on with life as usual, and doesn't need me at all right now.

Additionally, the hospital will only allow 2 people in the birthing room : and she wants her SIL who is also her best friend, and DP in the room. However, DP is unreliable as a birth partner per her last birth, and may not even show on time. DONA states my support must be constant. What if she asks me to leave because she wants a private moment with DP, or we have to rotate to accomodate hospital policy (which will almost certainly happen unless I can convince them to bend the rules)? Does that disqualify the birth for cert purposes?

I'm almost thinking that I should just give up on using this for cert, and only for experience. What do you all think?

[redpajama]

I'm certifying with ALACE and I'm not entirely familiar with DONA, but it seems weird to me (maybe "contrived" is a better word) to say that you need to be with the client beginning at a certain point in dilation. Every labor is different, every woman is different. I would think that, at this point, you are *supporting* her by being available to answer questions, and being prepared to leave when she needs you. As far as being present at the birth, I suppose this could be a DONA thing, too, but if the way that you support that woman during her labor and delivery is to be there to relieve her husband and sister (or whomever), and you aren't in the room when the baby's born...if you did your job as a doula, it seems to me that it counts. Because the point in attending a certain number of births for certification is to give you experience as a doula, right--not necessarily to watch a given number of babies be born. And as a doula--a real, live, certified doula--you might sometimes be called upon to do just that, right? I mean, if you were certified in this situation, the hospital regulation would still be for only two people to be present, and this client would still want her sister and her partner present. So you might not be in the room when the birth actually took place. I don't see why it shouldn't count toward your certification, as long as you're there doing your job.

[GrrlyElizabeth]

I've taken DONA training, but I'm very undecided on whether I will certify with them because I'm irked by their process. IMO, the dilation thing is ridiculous. DONA is pretty clearly against doulas doing internal exams, so how would you even know where she is if you labor at home with a couple for any length of time before going to the hospital? That one just makes no sense to me.

As far as the rotating support, I don't know what their official answer on that would be, but I think that you'll just know if you did the support that your client need from you. You'll almost certainly be out of the room for a "moment" (or many more... ya gotta pee! ) during the birth, so don't worry about that. If you're taking turns supporting her, I'd just go with my gut on whether you can count it.

Good luck! I hope your client has a great birth.

[1stimestar]

"At the onset of active labor" is the key point. If your client is dilated to 4 cm a day before she goes into labor and you go when she calls you, labor for a while at home, then go to the hospital and she is 5 cm. then that would still probably count. Use your essay to explain the situation. The point that you would be tag teaming with dh and/or sister would be the problem. Yes, you may run into this situation as a non certifying/already certified doula, but the whole purpose of the certifying births is to give you the widest variety of experience in BIRTH, not in waiting in the hall. YOU need the experience of continuous support. Many doulas must do more then 3 births to get in all the qualifications necessary for certification. That's what makes the certification worth something. So when you do become certified you can wear your CD with pride.

Many hospitals have the two person rule and I have found that it is normally not enforced too strictly unless someone is being loud or disturbing the laboring woman. Good luck.

[Lizafava]

I assumed also, based on DONA's wording, that the client had to be 4cm. I was recently told by a state rep., that you can define "Active Labor" in other ways. So, we'll see. I made the mistake of not even bothering to fill out the forms at a birth because the mom didn't have checks at all.

I do think the wording implicitly implies to new doulas that DONA is supportive of frequent vaginal exams and not supportive of laboring with clients at home

At any rate, I know lots of doulas do many times over the required 3 births before they get their certification . . .

[1stimestar]

I am also a state representative.

Please carefully go over your certificaton packet. You can also find certification information on DONA's website. http://www.dona.org/develop/birth_cert.php

Labor support must begin before or at the onset of the active phase of labor. For certification purposes, active labor will be considered 4 centimeters.

I've already commented on this part but if you have any questions, PLEASE feel free to call or email your State Representative or [e-mail] for clarification. I'm concerned that people seem to be making assumptions when apparently not understanding what the requirements are or why they ARE requirements. While I am not on the certification committee, a doula should realize the importance of gaining the experience that the requirements cover.

Every vaginal exam must be documented on the Birth Record Sheet’s Labor Progression Chart.

If there are no VEs then obviously, there would be none to document. Asking for documentation of any VEs that ARE done, is not promoting VEs.

[1stimestar]

Originally Posted by Lizafava

I assumed also, based on DONA's wording, that the client had to be 4cm. I was recently told by a state rep., that you can define "Active Labor" in other ways. So, we'll see. I made the mistake of not even bothering to fill out the forms at a birth because the mom didn't have checks at all.

That is why you also have the essay, to give you a place to explain how the client was behaving. There are emotional signposts to determine active labor which you should be able to use. How was the client reacting to the contractions? How was she behaving during the contractions?

I do think the wording implicitly implies to new doulas that DONA is supportive of frequent vaginal exams and not supportive of laboring with clients at home

And this is where "for certification purposes" is an important part of the process. A new doula could easily miss the other signs that show the client needs to be in her birth location. How you work as a more experienced doula will be different then how you need to work as a new doula. As a more experienced doula you will probably be more comfortable with the moms laboring at home for longer periods of time. Not saying that the doula should encourage moms to go to the hospital early. You should go to the hospital when MOM feels the need to go. That is why one should not expect to get certified with only 3 births under her belt. If they don't meet the requirements for a certification birth, they are still an important tool and you still get to benefit from the experience.

[Lizafava]

Hmm. Tone is so hard to convey sometimes on message boards. I just meant that I think the wording is confusing, as me, and many other doulas I know have been confused by it, and, I guess, have gotten the wrong impression .

And yes, doulas should definitely expect to attend many more births than the required three.

Originally Posted by 1stimestar

That is why you also have the essay, to give you a place to explain how the client was behaving. There are emotional signposts to determine active labor which you should be able to use. How was the client reacting to the contractions? How was she behaving during the contractions?



And this is where "for certification purposes" is an important part of the process. A new doula could easily miss the other signs that show the client needs to be in her birth location. How you work as a more experienced doula will be different then how you need to work as a new doula. As a more experienced doula you will probably be more comfortable with the moms laboring at home for longer periods of time. Not saying that the doula should encourage moms to go to the hospital early. You should go to the hospital when MOM feels the need to go. That is why one should not expect to get certified with only 3 births under her belt. If they don't meet the requirements for a certification birth, they are still an important tool and you still get to benefit from the experience.

[1stimestar]

Originally Posted by Lizafava

Hmm. Tone is so hard to convey sometimes on message boards. I just meant that I think the wording is confusing, as me, and many other doulas I know have been confused by it, and, I guess, have gotten the wrong impression .

And yes, doulas should definitely expect to attend many more births than the required three.

Yes, I do know it is confusing. That is why I suggest people writing in to DONA or their state reps to ASK. When people post that they don't like DONA's requirements when they do not understand what those requirements are....it leaves a bad feeling. If someone didn't like DONA because of their philosophy or training or much of anything, that would be fine for me, different organizations for different people. But when they diss us because THEIR information is not correct, it is not benefiting to any doula anywhere or clients for that matter. Much like when people say they don't like ALACE because they "teach" their doulas to do vaginal exams (which we know is incorrect.)

[SublimeBirthGirl]

I had enough births to certify with DONA but decided not to, because it just seemed like too much of a hassle. Plus I wasn't sure I was totally in line with their philosophies. I say submit it, and see what happens.

[herbanmama]

Thanks for the replies, all. I typed up a big response earlier, and the computer ate it. : I shouldn't type any more because I am having some computer-related injury problems with my shoulder-elbow-wrist-neck, and am trying to stay away from the desk.

I'll report back after the birth with an update.

[sunshine's mama]

I hope you get this figured out and the labor is nice and smooth for you and mama...

If I was able to have a doula the first go round 3 years ago and active labor was defined at 4cm, my poor doula would've had to have been with me for almost an entire month offering support...

Good Luck mama!!!

I'm off to search for a doula now........some have gotten back to me but are $$$$ and some have yet to get back tome......

[sweetsadie77]

If she's not in labour, then it's not "active labour" no matter how dilated she is. Seems like a badly worded rule and that the birth should count.
Good luck in your journey.