Ethical Standards of Practice Statement

Ethical Standards of Practice for toLabor Professional Birth Doulas

With the broader goal of improving care for mothers and babies, members of toLabor agree to the following ethical guidelines in the practice of assisting mothers and families through pregnancy, birth, and the postpartum period

I.     Regarding Clients

1. We are, as doulas, committed to providing competent labor support to our clients, with compassion and respect for our clients’ dignity and human rights. Our primary responsibility is to our clients. We will never knowingly make suggestions or take any action which may harm the client or her baby.

2. Privacy and Confidentiality: At all times, client privacy should be protected and all personal information pertaining to the client and her family must be kept in confidence, unless written permission has been granted by the client stating otherwise.

3. Client Autonomy and Decision-Making: We respect the right of our clients to make their own decisions regarding personal and medical care choices. As doulas, we will not impose our own preferences, but will respect the informed choices our clients make, and support them in a compassionate and non-judgmental manner. If the situation arises in which a doula cannot support the choice(s) of a client, she will discuss this with the client as far in advance as possible, and help make arrangements for alternate doula support if a resolution cannot be otherwise reached.

4. Access to Reliable Information: Doulas will provide any and all information requested by, or relevant to the needs of, their clients. In promoting evidence-based maternity care, we are committed to providing the most current and accurate information available, so that clients and their families have the necessary resources to make informed decisions, and are able to give properly informed consent during pregnancy, birth and the postpartum period. It is our goal to help clients be active participants in their maternity care, and we are committed to providing the information necessary to support this objective.

5. Continuity of Care: Once a client and doula have agreed to work together, a doula is committed to providing accurate information and appropriate resources, as needed, to her client. During labor and delivery, the doula is committed to attending the process in its entirety, providing continuous physical and emotional care to the client and her partner. Please note the following obligations of the doula to her client, with respect to potential obstacles to continuity of care:

  •  As noted above, if the occasion should arise in which a doula and her client can no longer work together, an appropriate replacement should be identified collaboratively by the original doula and her client.
  •  Occasionally, a doula will, unforeseeably, be unable to attend the needs of a client in labor. For this reason, doulas will make arrangements for back-up labor support, should the need arise. All efforts should be made for the back-up doula and client to meet ahead of time. Back-up doulas should be apprised of relevant client history, so as to provide appropriate care should the need arise. Back-up doulas treat client history and other personal information with the same respect for confidentiality as they would for their own clients.
  • If a client requires services beyond the scope of practice for doulas, doulas will make timely and appropriate referrals, reminding clients to discuss referrals or other treatment options with their primary care providers first, as needed.

6. Fair Dealing: Doulas will discuss their services with clients, making sure that they are clearly described to, and agreed upon by, the client. Fees should be clearly stated, and terms of refund discussed in advance. toLabor Professional Doulas are encouraged to write a contract for their clients to sign, so that a service agreement is clearly stated and understood. We are committed to fair and honest representation of our individual skills and abilities, and will not perform any action beyond what we are trained or authorized to do.

II.     Regarding Colleagues and the Profession

1. Uphold Standards of Practice: At all times, we will uphold the toLabor Professional Doulas Standards of Practice.• The choice to perform assessments such as palpation, checking fetal heart tones, or vaginal exams may be included if they are already a midwife, physician, or labor and delivery nurse or have received specific training qualifying them to perform these assessments. These professionals shall not call themselves Doula when including these assessments in their practice. They must identify themselves with one of the above titles to their clients, and other health-care providers, i.e., nurses, doctors, midwives, doulas, etc. This must be done in order to maintain the integrity of the profession and of the toLabor organization.

• If we are aware of a doula not appropriately upholding the Standards of Practice, we will discuss our concerns with her and/or refer to the toLabor administrators for further guidance and follow-up.

2. Uphold Professional Integrity: At all times, we will uphold the integrity of the doula profession and avoid actions that undermine or damage this integrity. If we are aware of a doula not appropriately upholding the integrity of the profession, we will discuss our concerns with her and/or refer to the toLabor administrators for further guidance and follow-up.

III.     Regarding Medical Care Providers

1. Foster a Professional Relationship: As support providers, doulas have the same ultimate goal as medical professionals and are therefore committed to maintaining a positive professional relationship with members of the medical staff. We are committed to treating all medical professionals with respect, courtesy and fairness, understanding that we are guests in their workplace.

2. Recognition of Clinical Responsibility: We recognize that responsibility for clinical management rests with the client’s primary care provider (nurse, midwife, and physician) and the client. We will not interfere with clinical management beyond making suggestions to, or respectfully asking questions of, the care providers and client, based on our understanding of our client’s preferences.

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