I'm reading a few things on this thread that have me quite alarmed...
|I did ALACE, because DONA doesn't want you doing VEs or palpation, and I already do them, as a homebirth doula, and even for hospital clients(but for them I don't do VEs.)|
There is no doula program out there that endorses a doula doing a vaginal exam. Doulas should not be doing vaginal exams.
If you are a midwife acting in the capacity of a doula, you should not do a vaginal exam. If you are an L&D nurse acting as a doula- you do not do the vaginal exam!
Doulas get kicked out of hospitals for behavior like this! There is a hospital in San Francisco that BANNED doulas because a nurse walked in on a doula performing a vaginal exam! I realize you're not doing them at the hospital but if you have a home birth client who needs to transfer before the midwife gets there and the hospital finds out you've done a vaginal exam....
Doulas DO NOT perform vaginal exams whether they are in the hospital or at home! I can not emphasize enough how DANGEROUS this is for our profession- if you are caught performing vaginal exams, there are huge
repercussions for the other doulas practicing in your area! Please, please- if you are a trained professional who can do this, make sure that you are NOT calling yourself a doula. A monitrice is a doula who is essentially trained in some clinical aspects like vaginal exams, heart tones, etc but can not do anything diagnostic - maybe that is more up your alley? If you are skilled at these things then market your skills! But please- do not call yourself a doula and do clinical things. I realize how strongly worded this is and it is not in any way intended to attack but I am alarmed after reading this!
I am a midwife assistant and I would never
do heart tones, vitals, etc for a doula client- NO WAY.
|Actually, ALACE is more medicalized than DONA. ALACE doulas are trained to do vaginal exams, etc... and DONA doulas are not.|
This is not exactly true. ALACE training involves doing a vaginal exam/having one done on you by the class participants if you wish.
This is for experience, and not training.
You are NOT trained to perform vaginal exams in an ALACE training- the purpose behind this is to expose women to what it is like to perform a vaginal exam, see what another woman's vagina is like, etc.- but does NOT prepare you in ANY way to diagnose dilation, effacement, station, etc. They do not endorse that their doulas run out and do vaginal exams on clients- rather it is explained very clearly to the participants that this is for experience only. ALACE began as a precursor to midwifery training- doulas who intend to be midwives usually perfer the ALACE training because they are exposed to some things that the other programs don't. However- the scope of practice does NOT include allowing doulas to perform clinical skills (for which they are not even trained properly)!
This is from the ALACE site, please note the wording (emphasis mine):
|You will also receive an introduction to the following skills:|
* Maternal vital signs during pregnancy and birth
* Palpation of fetal position and presentation
* Auscultation of fetal heart tones by fetoscope
* Sterile technique
* Understanding common tests and techniques
* Basic pelvic examination
Each organization has their own focus and you have to decide which is the one for you. One of the big things people liked about CAPPA was the wide range of skills you can learn from one organization. Others like DONA because it is the most well established, oldest and widely known organization out there. Everyone has their reasons for choosing one org over another, but not one of these doula organizations endorses doulas performing clinical skills. The very definition of a doula is that we are non-medical providers.
I highly suggest figuring out what YOUR values are about being a doula.
- What are your long term goals? Do you want to also do childbirth education? Lactation? Midwifery?
- Who has trainings nearby, and if the org you like doesn't, will they send a trainer if you host a training?
- Do they offer distance learning?
- What can you afford?
- Talk to people who have chosen each organization and listen to their experience. Does the organization return calls in a timely manner? Are they professional? Are there additional learning opportunities? Etc.
Also, you don't have to go with one of the 'big three', you can choose Birthworks
, Birthing From Within
, and there may be local doula organizations who can also provide trainings as well. Don't limit yourself to just CAPPA, DONA and ALACE.
For me personally, I was trained as a DONA doula but intend on attending an ALACE training just for the range of experience. Also, I am a midwife's assistant. I had professional issues with CAPPA but still believe they have a good program- I just had some other conflicts that left a bad taste in my mouth. I intend on certifying with Birthing From Within, because I believe in the philosophy and I find their certification process challenging.
I also encourage all doulas to network with other doulas in your community. We have created a website
to help unify the folks in our community who are providing services to pregnant and birthing women, and new families. We just needed to find someone who'd host for free and someone who could build it- and it's growing daily. We also meet monthly to get to know each other, offer support, share experiences and just build our community. Now when I am contacted by a client I can't take, I have a few names of people I trust will provide her excellent care to refer her to, versus having to just hand her a list with no clue how anyone practices. If you can network, you can find out who is choosing what path and why- and use that information to help make your decision.
Best of luck to everyone!