The only time as a doula I've put my hand IN the vagina is when I had a friend and client who VBAC'd, had days of prodromal labor, and was exhausted by the time she was in transition decide to get an epidural, and then the epidural was WAY too strong and she couldn't feel to push. The doc tried putting pressure on the perineal floor, which really DID help her to find the "spot" to push into. He had another woman in labor in a room nearby and had to go catch, and we're familliar with each other and work well together. The nurse on this woman's case wasn't very eager to help ANYBODY do ANYTHING, so the OB asked me to step over and do the pressure. I was happy to for her, and it helped her make significant progress.
I prolly wouldn't do perineal massage during labor for somebody because it's my understanding that it can cause swollen tissues and thus increase the risk of tears.
However, I am MORE than happy to hold a warm compress on a woman's perineum if she has requested it, is comfortable with my doing it (or has asked me to), and other people in the room are doing other things.
I'm sorry but "scope of practice" to me is providing physical support. If this form of physical support means that the woman's tissues are softer and more supple and less likely to tear, how is that out of my scope of practice as a doula? I am not trying to catch a baby, and for goodness' sake, there are VERY few times that a woman is in any kind of advanced stage of pushing that hospital staff or midwives are not in the room. That kind of thing just reminds me how glad I am that I trained through the group I trained through.
I have had a couple of times where I was holding compresses while staff were getting things ready where the head popped down to the perineum very quickly...once last summer the nurse walked out to grab something, the doc was across the hall talking to some residents, and the mother had been pushing for quite some time (but then the doc had just given her a sacral adjustment and ran out to talk to the residents...apparently the adjustment WORKED. WELL.). I realized all of a sudden that the mother was making progress and called for the nurse. When she ran in, there was a finger's width of head. Next push palm's worth. Next push, same ctx, crown. She couldnt' find the call button, yelled out the door, then hit the emergency button on the wall... but she wasn't gloved and neither was the doc. By the time the doc had one glove on the head was out and was restituting.
I caught the top half of the baby, but handed the baby over to the doc to hand up...there just wasn't time to do anything else. And I didn't do anything but catch because the only other option was the baby hitting the floor.
Mom would have been pushing whether she'd asked me to hold compresses on her bottom or not...so had I been at her head, we may have had a baby before ANYBODY could get down there to catch! Is that out of my scope as a doula? Perhaps...but it's not like I said, "Hey--shhhhhh, let's just say I'm putting compresses on your perineum and then push till the babycomes out--I can catch, that's no big deal!" Uh, no. Acting as a doula, I do not WANT that level of responsibility! But to be penalized because it's out of scope?
Meh. Birth with a good birth team is a fluid thing. People do things to help one another out. If the nurses are getting stuff together for immediate post partum am I just supposed to say, "sorry, Chica, it's outside of my scope and the nurses are busy. Guess you're gonna have to suffer" Um, I'm not that kind of doula. I'm there to help the Mama and I'll do that if I have the capability.
Sorry. Off soapbox.