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#1 of 35 Old 04-17-2008, 06:13 AM - Thread Starter
 
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Let me preface by saying this is not to debate whether doulas should or should not attend UCs.

I've attended a UC as a doula (to a good friend) in the past and now have a potential client wanting a doula for her UC. Since it's not a friend, I'm trying to get my ducks in a row.

When you doula for a UC what are your requirements of the parents?
What kinds (if any) forms do you have them sign?
How do you educate them if they ask for it?
How do you perceive your role?
How do you decide if it's too risky of a situation?
What do you do if your role is more as a monitrice?

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#2 of 35 Old 04-17-2008, 08:55 AM
 
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Stupid question here...but what's a "monitrice"?

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#3 of 35 Old 04-17-2008, 09:55 AM
 
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IME & O I think there is no such thing as being a doula at a UC for someone other than a friend.

Technically speaking a doula's role does not include anything clinical. It is hard to for me to see that happening at a UC. I personally would feel a sense of being responsible.

Ask them and yourself why it is they feel the need of a doula as support in UC? I have had the experience of someone wanting me to 'be there' as a doula to 'take care of afterwards'. By that they meant, basically the whole 3rd stage and postpartum. This couple wanted a doula because they did not want to pay a midwife, I was not comfortable with that. They were also not as educated in birth as I feel they needed to be.

Along those lines, if you do support them in a UC, yes they do need to have sufficient knowledge of UC and birth to care for themselves. I would require a certain knowledge level of them. I would require they sign a waiver. Is homebirth legal in your state? Are they going outside the lines of the law in this? Is there any way you would be seen as 'practicing medicine without a license'? by doing this?

So let me end this by saying, yes at this point in my life, I probably would provide support at a UC. Yes I would require a certain level of knowledge, and yes I would require them to sign a waiver. I would also charge more at a UC birth. I would probably write up a different contract with this couple because I think providing support for a UC is out of the scope of the 'doula role'. I would ask them what they want me to do and what they see my role as to help create this. I would want to be really sure that I wasn't going to be placed in a situation I could not handle and I also want to be really careful not to step into the role of being a midwife for a couple that is hiring me simply because they don't want to pay a midwife to attend their birth. I feel that is too risky and totally undermines midwives.

I know you don't want to start a debate & I hope that I didn't !!!!

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#4 of 35 Old 04-17-2008, 10:26 AM
 
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Realized your location after the fact. Not sure about UC in Asia.

Good luck!

Megan Davidson, Labor & Postpartum Doula, Breastfeeding Counselor, Anthropologist, Mom to August (9) and Clay (4), Partner to Shawn.

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#5 of 35 Old 04-17-2008, 10:43 AM
 
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I would only go to a UC as an unpaid friend. Otherwise I would be considered a "lay midwife" if i was hired by you, that is illegal in most states.

If you interview and hire a doula for her professional services, the problem is not the legalities with you, but the states interpretation of her role. Especially when you have not hired a midwife or doctor to attend the birth but hired a "Doula".

Research what happens to lay midwives in your state and that is what the doula has to understand is her risk not that you will sue her.

You the birthing women does not assume any legal risk, and you cannot sign away the states right to arrest the "doula" for practicing medicine without a licence.


I just noticed you are in Asia.
Good luck.
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#6 of 35 Old 04-17-2008, 10:48 AM
 
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I don't understand why being a doula for a UC would be any different than being a doula for a homebirth with a midwife. You are there to provide support for the mom and partner (make sure she's drinking, rubbing shoulders and pressure on low back, light housekeeping, making sure the younger kiddos are doing okay, making sure Dad/partner is doing okay...); whether or not there is a midwife in attendance should not matter, in my opinion anyway.

I am a future UCer, and I've considered a doula. It would be nice to have someone who knows about birth help support me (in the ways listed above), and help with breastfeeding immediately afterwards. I ultimately decided against it because birth, to me, is a bit too sacred and intimate for someone I barely know to be in attendance, but there are lots of UCers who could benefit from the services of a good doula.

As long as the contract is clear that you will not be providing any medical services, I just don't see what the problem is.

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#7 of 35 Old 04-17-2008, 11:02 AM
 
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Stupid question here...but what's a "monitrice"?
They do clinical assessments.
(more likely to also be a nurse or midwifes assistant then a "doula" )
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#8 of 35 Old 04-17-2008, 11:10 AM
 
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Just want to say that once you become a monitrice, IMO, you have crossed a line that seems pretty certain to lead to legalistic difficulties. By which I mean that even if it doesn't come down to actual legal problems, but that the parents' expectations of you are quite a bit more than being simply a doula...too likely to get sticky I think.

The only situation in which I will provide 'monitrice' activity is for someone planning a hosp. birth who only wants to avoid going in too soon.
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#9 of 35 Old 04-17-2008, 11:23 AM
 
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I don't understand why being a doula for a UC would be any different than being a doula for a homebirth with a midwife. You are there to provide support for the mom and partner (make sure she's drinking, rubbing shoulders and pressure on low back, light housekeeping, making sure the younger kiddos are doing okay, making sure Dad/partner is doing okay...); whether or not there is a midwife in attendance should not matter, in my opinion anyway.

I am a future UCer, and I've considered a doula. It would be nice to have someone who knows about birth help support me (in the ways listed above), and help with breastfeeding immediately afterwards. I ultimately decided against it because birth, to me, is a bit too sacred and intimate for someone I barely know to be in attendance, but there are lots of UCers who could benefit from the services of a good doula.

As long as the contract is clear that you will not be providing any medical services, I just don't see what the problem is.
I'm very supportive of UC. I also believe that having an unassisted birth is about being alone, being unassisted by professional and being with your partner.

As you can see from the posters questions It gets all fuzzy when you start hiring people to be with you "uc". Is it a UC then?

We can not create states laws.
It is not like a homebirth with a midwife who has the legal right to attend births. If You have hired a professionally trained "doula" if something happens can she be charged that she is functioning as a "Lay midwife" since there is no other person hired to attend the birth .

I think the birthing women has no legal responsibly, but the hired doula should find out if she can be arrested because they might interpert her role as practicing midwifery or medicine without a licence.

Just my 2 cents
And I'm on the left of believing in signing contracts or waivers. I do none of these things with cliets and i own a doula service since 1991.

I do not usually care about laws and lawyers, and being sued etc.

But, for some reason this whole thing seems counter intuitive to me, and is raising red flags as a "hired trained doula".
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#10 of 35 Old 04-17-2008, 11:32 AM
 
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I've thought about this a lot recently. If I were to UC, I'd want a doula. I live far from any family and have no really close friends here yet. Not that close... I can't imagine not having a woman around during and immediately following birth. To sit there with that elated birth high alone or with DH would feel very lonely to me. With all of my children, I've appreciated having woman there to talk with after and process what just happened. As excited as my DH always is after a birth, he doesn't understand my feelings and emotions right then the way another mother would. He's also go a house and other kids to tend right about then. Personally, I'd also appreciate having another mother there to remind me of things I can't think of during birth. Nothing clinical just things that I know but may not be able to zoom in on when it counts.

Not that any of that is necessary for a UC at all but I think it would make the experience better for me.
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#11 of 35 Old 04-17-2008, 11:35 AM
 
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But the job description of a doula is to provide non-medical support to the birthing woman. As long as she does NOT provide medical support to the birthing woman, she is not stepping outside of her job description, and should not be seen as "practicing medicine without a license".

It doesn't matter if she's paid or not. To me, there's no difference between having a paid doula at your birth or having a paid cable guy fixing your cable while you're giving birth. As long as neither of them are providing medical services to the birthing woman, they are not breaking any laws.

Maybe I'm missing something here...

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#12 of 35 Old 04-17-2008, 11:45 AM
 
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I don't think you are. It's just that unfortunately, in our society so full of frivolous litigation people are fearful and feel like they have to protect themselves. I certainly understand that.
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#13 of 35 Old 04-17-2008, 12:06 PM
 
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I don't think you are. It's just that unfortunately, in our society so full of frivolous litigation people are fearful and feel like they have to protect themselves. I certainly understand that.

I also think this is the case. We live in a crazy culture And that is why i wrote what i did.

Fem earth, She is not the cable guy!
It's a UC, if you want another women there get a midwife, have family or a friend come over, but don't 'hire" someone.

I guess I'm a purest when it comes to Unassisted childbirth.
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#14 of 35 Old 04-17-2008, 12:09 PM
 
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But the job description of a doula is to provide non-medical support to the birthing woman. As long as she does NOT provide medical support to the birthing woman, she is not stepping outside of her job description, and should not be seen as "practicing medicine without a license".

It doesn't matter if she's paid or not. To me, there's no difference between having a paid doula at your birth or having a paid cable guy fixing your cable while you're giving birth. As long as neither of them are providing medical services to the birthing woman, they are not breaking any laws.

Maybe I'm missing something here...
You're not missing anything. But the legal system is not run by people familiar with natural birthing. They assume any and all birthing mothers require medical assistance, and any person who presents herself as a professional in the birthing sphere - whether that's an OB, midwife or doula - is responsible for that medical assistance. They see a doula as a midwife, basically. They really cannot grasp the idea of the birthing woman as being responsible for her birth and "directing" it, and a doula just cooking soup and getting a fresh towel. Someone's gotta provide medical assistance, right?!?!

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#15 of 35 Old 04-17-2008, 12:13 PM
 
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Feminine Earth:

I hear you but here's where the line is IMO...what happens if in the event that mom has a PPH or baby needs resuscitation either both at the same time or independently and partner cannot or will not handle the situation? If UC doula knows how to deal with such things, it steps outside her scope to provide assistance, yet what is she to do, sit there and watch while the await the ambulance? And what if partner/mom do not want to call 911 in that event?

Do I expect a cable guy to know about handling PPH or resuscitation of a neonate? No but a doula may very well know these things and be trained in them. I do expect a cable guy to be able to call 911 and perhaps know CPR in the event a homeowner has a heart attack...but not necessarily. The difference is is that a doula most of the time knows about birth and complications and to put her in the position of having to have her hands tied at a UC (which is completely different than having hands tied in the hospital) is not fair to her or the midwifery community in general. It is a very fine line a doula has to walk when attending a UC, even if she is supportive of it.
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#16 of 35 Old 04-17-2008, 12:23 PM - Thread Starter
 
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And all of the above is why I can't decide if a contract is a good thing or not. To have a contract would imply I'm "hired" for "something" whereas if there's no contract, there's no proof that I'm there other than as a friend.

The UC I attended for a friend was a no-brainer. I was her friend and I just also happened to be a doula. She also was my friend who attended my twin UC who just happened to have some doula training.

So obviously outside of the "friend" role, it's a little more sticky. Where I live, the only options for birth are high-intervention hospitals or UC. No inbetweens. I have been very clear on the differences are between a midwife and doula. I will not be hired as a doula to fill that midwife role if that's what she really wants.

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#17 of 35 Old 04-17-2008, 01:36 PM
 
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I also think this is the case. We live in a crazy culture And that is why i wrote what i did.

Fem earth, She is not the cable guy!
It's a UC, if you want another women there get a midwife, have family or a friend come over, but don't 'hire" someone.

I guess I'm a purest when it comes to Unassisted childbirth.
I definitely don't want to get into the "What is the true definition of Unassisted Childbirth" discussion...that's not what this topic is about.

However, I really don't think it's fair to say that if a UCer wants another woman at her birth, that she must have a midwife or family and friends. I do not want a midwife at my birth (as of now, anyway) because I do not want to be medically monitored. I do not need anyone directing me how to give birth, just as I don't need anyone directing me how to have sex. I don't have any friends that I'd feel comfortable coming to my birth. Luckily for me, my mom is very supportive and she is going to be at my birth. But if I did not have my mom, I would probably look for a kind-hearted doula to support both me and my husband while I (not a midwife) deliver my child. And I would most definitely pay her for these very special services.

If, God forbid, an emergency happened at the birth, I would not expect a doula to do anything more than the cable guy or my husband or my mom. Truly. Honestly. If I hire someone knowing that she is only there to be supportive, then that's what I expect of her.

I definitely see where you guys are coming from. If something bad did happen, and the doula stepped in to help to her best ability, and someone (who though?) wanted to charge the doula with practicing medicine without a license, and the birthing mother +/- partner wanted to press charges, then the doula could be in serious trouble. But that's a lot of "ifs" and "ands", ya know?

So really, I guess it all depends on how well you know the birthing mama, how well you trust her and/or her partner, and what you'd be willing to risk if all of the above happened. It's a very unlikely situation, though, in my opinion, as long as you assert your intentions from the start.

Good luck with whatever you decide!

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#18 of 35 Old 04-17-2008, 02:37 PM
 
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And all of the above is why I can't decide if a contract is a good thing or not. To have a contract would imply I'm "hired" for "something" whereas if there's no contract, there's no proof that I'm there other than as a friend.

The UC I attended for a friend was a no-brainer. I was her friend and I just also happened to be a doula. She also was my friend who attended my twin UC who just happened to have some doula training.

So obviously outside of the "friend" role, it's a little more sticky. Where I live, the only options for birth are high-intervention hospitals or UC. No inbetweens. I have been very clear on the differences are between a midwife and doula. I will not be hired as a doula to fill that midwife role if that's what she really wants.

I know nothing about Asia and the laws where you live, I am in the States and I know that your "contract" means absolutely nothing to a District attorney determined on prosecuting "lay midwives". We still have witch hunts in the USA against lay midwives.
The doula will likely be seen as a lay midwife because she was *hired* and there is no other birth professional attending and the doula does have a background and training in the process of normal birth.
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#19 of 35 Old 04-17-2008, 06:44 PM
 
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I definitely see where you guys are coming from. If something bad did happen, and the doula stepped in to help to her best ability, and someone (who though?) wanted to charge the doula with practicing medicine without a license, and the birthing mother +/- partner wanted to press charges, then the doula could be in serious trouble. But that's a lot of "ifs" and "ands", ya know?
Bolding mine.

I believe the major concern here is that the parents don't have to WANT to press charges. Most often, in the case of a prosecutor charging somebody with practicing medicine without a license, the parents BEG the prosecutor NOT to charge the person who attended said birth. However as a PP mentioned, witchhunts are the norm lately, especially in the midwest, and no bad feelings from the parents are needed by the state to press charges. They just take it upon themselves to "save" the ignorant masses from the evil clutches of the voo-doo practitioners who are the natural birthing world (that last part said with a great deal of sarcasm, by the way).

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#20 of 35 Old 04-17-2008, 06:55 PM
 
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Bolding mine.

I believe the major concern here is that the parents don't have to WANT to press charges. Most often, in the case of a prosecutor charging somebody with practicing medicine without a license, the parents BEG the prosecutor NOT to charge the person who attended said birth. However as a PP mentioned, witchhunts are the norm lately, especially in the midwest, and no bad feelings from the parents are needed by the state to press charges. They just take it upon themselves to "save" the ignorant masses from the evil clutches of the voo-doo practitioners who are the natural birthing world (that last part said with a great deal of sarcasm, by the way).
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#21 of 35 Old 04-17-2008, 07:14 PM
 
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I wonder then if doulas in Oregon would be less likely to have the same trepidations since lay midwifery here is legal.

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#22 of 35 Old 04-17-2008, 07:19 PM
 
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maybe, maybe not. They could still be charged with practicing medicine without a license, especially if it is found that they are not trained in midwifery in any manner. Generally, lay midwives have apprenticed and etc. to feel comfortable attending births on their own. A doula may or may not have any kind of extensive training. And a prosecutor with a bug up their butt won't charge them with practicing midwifery, they would charge them with practicing medicine. Because doesn't one NEED medical intervention to give birth?!

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#23 of 35 Old 04-17-2008, 07:23 PM
 
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Good luck, Fem-Earth. I'm not sure what I would do in my doula pants, honestly.

My UC-birthing mama pants don't understand why a doula would be wanted at a planned UC. (Yes, I'm reading what this mama is telling you, and what you think she wants, and what you might want in some future where you might UC)

If it were anyone other then a stranger contacting me for doula "services" (ie one of my sisters, cousins, neighbors or former CBE students, friends) I would keep their offer in mind, clear my calendar and be open to them calling when in labor. No contracts, no lessons.

My hesitation to help a stranger or have a business relationship is this: WHY have a doula in any place?

Typically, and I mean 99% of the time (and I am a trained and practicing doula), In my experience; I find it's because women distrust their caregiver, partner or self or the normal birth process and want to have a buffer or keep them safe.

I find it more personally rewarding as a friend or birth-teacher to show them (partner included) how find the courage to ask for what they want (from themselves, partner, caregiver or body) and not rely on anyone else to see them through.

Give a man bread vs. teach a man to make his own bread

be sure to let us know how it turns out!

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#24 of 35 Old 04-17-2008, 10:07 PM
 
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Thanks, Rockies, but I'm not the OP.

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#25 of 35 Old 04-17-2008, 10:32 PM - Thread Starter
 
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She is researching UC on her own and I'll be interested to see where this leads her. I directed her to the UC forum here and a few other places.


The legal situation here is this: no foreigners can practice without a license, to get a license is almost impossible, doulas/midwives are seen as the same thing. And BTW, there are NO nationals here who attend homebirths either unless you go way up into the tribal/mountainous areas.


Which makes me think: If I'm not worried about prosecution, and doulas and midwives are viewed as the same thing, then why not be a monitrice if that's what may be what is really wanted?

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#26 of 35 Old 04-17-2008, 11:14 PM
 
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Thanks, Rockies, but I'm not the OP.
oops.

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#27 of 35 Old 04-18-2008, 09:56 AM
 
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Bolding mine.

I believe the major concern here is that the parents don't have to WANT to press charges. Most often, in the case of a prosecutor charging somebody with practicing medicine without a license, the parents BEG the prosecutor NOT to charge the person who attended said birth. However as a PP mentioned, witchhunts are the norm lately, especially in the midwest, and no bad feelings from the parents are needed by the state to press charges. They just take it upon themselves to "save" the ignorant masses from the evil clutches of the voo-doo practitioners who are the natural birthing world (that last part said with a great deal of sarcasm, by the way).

Absolutely this is what happens.
Any one on professional e-mailing lists, (doula, CBE & midwifery groups) we frequently read pleas from friends and clients of a lay midwife arrested for going to a birth and "practicing medicine without a licence".

It is never initiated by clients (so contracts are not the issue).
Even if you had a contract, a client can not wavier the law.

Half the time I think these local arrests are motivated by the strong arm lobbying tactics of ACOG members.
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#28 of 35 Old 04-18-2008, 10:03 AM
 
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Originally Posted by Rockies5 View Post
Good luck, Fem-Earth. I'm not sure what I would do in my doula pants, honestly.

My UC-birthing mama pants don't understand why a doula would be wanted at a planned UC. (Yes, I'm reading what this mama is telling you, and what you think she wants, and what you might want in some future where you might UC)

If it were anyone other then a stranger contacting me for doula "services" (ie one of my sisters, cousins, neighbors or former CBE students, friends) I would keep their offer in mind, clear my calendar and be open to them calling when in labor. No contracts, no lessons.

My hesitation to help a stranger or have a business relationship is this: WHY have a doula in any place?

Typically, and I mean 99% of the time (and I am a trained and practicing doula), In my experience; I find it's because women distrust their caregiver, partner or self or the normal birth process and want to have a buffer or keep them safe.

I find it more personally rewarding as a friend or birth-teacher to show them (partner included) how find the courage to ask for what they want (from themselves, partner, caregiver or body) and not rely on anyone else to see them through.

Give a man bread vs. teach a man to make his own bread

be sure to let us know how it turns out!
Rockies,
Thank you for saying this so sweetly and kindly, it is exactly how i feel when a women wants a hired Labor doula at an "Unassisted birth".


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#29 of 35 Old 04-18-2008, 11:22 AM
 
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Originally Posted by courtenay_e View Post
maybe, maybe not. They could still be charged with practicing medicine without a license, especially if it is found that they are not trained in midwifery in any manner. Generally, lay midwives have apprenticed and etc. to feel comfortable attending births on their own. A doula may or may not have any kind of extensive training. And a prosecutor with a bug up their butt won't charge them with practicing midwifery, they would charge them with practicing medicine. Because doesn't one NEED medical intervention to give birth?!
I think the thing with Oregon is that lay midwifery is legal, and it's specified in law that they can choose to be licensed by the state or not as they wish. That's just what I've heard, too lazy to look it up now. I don't know that there is any kind of stipulation on what kind of training one has to have to hold oneself out as a midwife, licensed or no.
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#30 of 35 Old 04-18-2008, 01:43 PM
 
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It's a UC, if you want another women there get a midwife, have family or a friend come over, but don't 'hire" someone.
I believe the point is, in this case, that many women who want to have UC, would like to have a friend or family member there, in addition to their partner, just for practical things like getting towels and soup. they want someone to give emotional support to both parents and help take care of older children.
fair enough. get your mother or sister or best friend to come.
But in many cases (like this one), there is no friend or relative to ask.
These people are expats living in an asian country, with very limited family/ support, and NO homebirthing options of any sort, except for UC.
It's a different kettle of fish.

Like feminine earth said; I don't think fair to say that if a UCer wants another woman at her birth, that she must have a midwife or family and friends. I don't see a problem with hiring a doula for filling that role.

A lot hangs on what the parents expect of you, as a doula, and that you have a clear agreement from the outset. If you're hired as a doula to give emotional support, then you can't be expected to perform medical procedures during an emergency, other than basic CPR and calling 911 (and I know that where mamarabbit is, 911 doesn't exist)

Obviously, if there is an emergency, and you are there, you will do everything in your power to prevent/ save the situation.

If there is a bad outcome, you might want to have an agreement with the parents that you were never actually there, or something similar.

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Originally Posted by MamaRabbit View Post
If I'm not worried about prosecution, and doulas and midwives are viewed as the same thing, then why not be a monitrice if that's what may be what is really wanted?
I'm personally thinking this way too. (well, you know where I stand on it )
but I would make some kind of safety net, legally, that officially you aren't doing anything clinical. just emotional support.

and I really believe that in order to do this the parents need to be very well informed about UC and natural birth.
I do agree with the "give a man a fish..." philosophy of midwifery

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