Doulas provide support before, during, and after pregnancy. While doulas are not primary caregivers, many pregnant women rely on doulas throughout the pregnancy period. Unfortunately, doulas can make mistakes that put the mother and baby at risk, leading to possible injury or even death.
What is a Doula?
A doula provides support to a pregnant woman before, during, and after pregnancy. A doula is a nonmedical individual, sometimes called a “birth companion,” who offers physical and emotional support to the pregnant woman and family.
According to the Doulas of North America (DONA), a doula is, “a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.”
Doulas have become more popular in the United States since about the 1980s. Pregnant women brought female friends or childbirth instructors for support during labor and to advocate to help them avoid cesarean births, which were on the rise. Since that time, the role of a doula has broadened to provide support throughout pregnancy.
Many pregnant women engage a doula to provide support that they do not receive from their doctors and nurses. Doctors and nurses may be busy taking care of a number of other patients, updating charts, and monitoring patients. This leaves many pregnant patients without someone to provide emotional, spiritual, or physical support.
Doulas understand pregnancy and childbirth to be a normal part of life and not a pathological condition that requires treatment like a disease. Doulas often focus on supporting the natural birth process and advocating for the mother in a hospital environment.
It is important to understand that a doula is not the same as a midwife. A certified nurse midwife (CNM) requires formal education, nursing licensure, and training. CNMs may require a bachelor's degree in nursing or a Master of Science in nursing. CNMs undergo training in working with pregnant women, assisting in births, and providing post-pregnancy care to women and infants. Midwife programs must be accredited by the Accreditation Commission for Midwifery Education (ACME). In order to practice as a midwife, individuals must pass the American Midwifery Certification Board (AMCB) exam.
Doula Malpractice in Maryland
Doulas are not primary caregivers. Doulas are not medical professionals and do not perform medical tasks. However, when a doula goes beyond their scope of practice or does something that injures the mother or baby, they may be liable for injuries. The injured mother may be able to file a lawsuit for damages sustained as a result of the doula's negligence.
In general, in order for a doula to be liable for damages, the plaintiff must show that the doula owed the mother or baby a duty of care and he or she breached that standard of care which caused the injury. A doula may be negligent by acting or failing to take action that a reasonably careful person would do in the same situation.
When determining whether a doula was liable for the damage, in some cases, the jury may consider the customs or practices of a doula. This may involve deciding what a reasonable doula would do in similar circumstances. Other doulas may offer expert testimony to help the jury decide whether the doula's actions were reasonable.
If a doula is found liable for injuries to the mother or baby, the victims may be able to claim lost wages, pain and suffering, medical bills, and any other damages associated with the injury.
Doula Training and Certification
Doulas are not regulated by state or federal law. There is no licensing agency for doulas and no formal requirements to carry the title of a doula. An individual with no formal training, education, or experience could become a doula.
There are groups that offer training and certification for doulas, including training as a Certified Labor Doula (CLD). Organizations include DONA International and Childbirth and Postpartum Professional Association (CAPPA). CAPPA provides training and certification for labor doulas, postpartum doulas, childbirth educators, lactation educators, and specialty training.
Certification generally requires a multi-day workshop, assigned reading, attendance and assistance at a number of births, a personal statement, and recommendations. Training includes learning about the birth process, possible medical issues, ways to offer support to mothers during labor, and advocating for the mother in the hospital.
DONA provides birth doula certification and postpartum doula certification. A birth doula certification requires:
- Attendance at a DONA-approved birth doula workshop
- Current membership in DONA International
- A DONA International Birth Doula Certification Packet
- Signing the Standards of Practice and Code of Ethics
- Additional reading/coursework on breastfeeding and other topics
- Birth experience and evaluation including 3 support experiences
- Home study of doula business
- Creation of a local resource guide
- Written essay on the value and purpose of labor support
- Written references from a perinatal health professional and client
- Approximately $700 to $1,100 in costs and fees
DONA also has approved postpartum doula workshops. These are generally offered through a 3-day workshop where participants learn about the role of a doula during the postpartum period and understanding the emotions of life with a newborn. DONA certified doulas are also required to recertify every 3 years, including continuing education requirements.
According to DONA, there are seven primary roles of a doula:
- To recognize birth as a key life experience that the mother will remember all of her life;
- To understand the physiology of birth and the emotional needs of a woman in labor;
- To assist the woman and her partner in preparing for and carrying out their plan for the birth;
- To stay by the side of the laboring woman throughout the entire labor;
- To provide emotional support, physical comfort measures, an objective viewpoint, and assistance to the woman in getting the information she needs to make good decisions;
- To facilitate communication between the laboring woman, her partner, and clinical care providers; and
- To perceive the doula's role as one who nurtures and protects the woman's memory of her birth experience.
Labor doulas work with pregnant women and their families during pregnancy and during the labor and birth process. This includes offering support, information, encouragement, and non-clinical comfort. Doulas may encourage and promote communication between the pregnant woman and the healthcare team.
A doula does not diagnose medical conditions, perform clinical procedures, administer medication, interpret clinical results, prescribe medication, prescribe alternative therapies, or make medical decisions for the patient. In some cases, a doula may also have training as a nurse or other healthcare professional. In these cases, the doula should present their healthcare services as separate from their services as a doula.
Doula Responsibilities After Birth
Some doulas may provide care after pregnancy and birth. These services may be provided by a Certified Postpartum Doula (CPD). Postpartum doulas provide emotional, physical, and informational support to the family after the birth of a new baby.
According to CAPPA, postpartum doulas:
- Provide non-biased emotional, physical, and informational support during the postpartum period
- Encourage the family to seek care that reflects their values and needs
- Models and teaches effective communication
- Encourage informed decision-making
- Support the physical and emotional healing of the mother
- Provide information on care options and resources for the mother and newborn
- Support and assists with infant feeding
- Educate the family on newborn care and characteristics
- Provide support to the new mother's partner and/or family
- Assist with household organization
- Refer to healthcare professionals when support requires clinical assessment, a need for prescription, or medical diagnosis
Injuries Involving a Doula
Doulas can make mistakes just like anyone else. However, when a doula makes a mistake, the pregnant mother or infant baby may suffer a serious injury. Injuries involving doulas can include:
- Failing to call for medical care when there is a medical problem
- Making medical decisions for the patient that result in an injury
- Failing to refer to a healthcare professional when support requires a medical diagnosis
- Improperly applying a heat pack leading to a burn injury
- Offering potentially dangerous holistic medicines, herbs, or remedies
- Massaging a mother's feet with massage oil leading to a slip and fall injury
- Dropping an infant when handing the child to the mother
- Using a product that causes an allergic reaction in the patient
- Interfering with doctors and healthcare professionals providing necessary care
Doulas who go beyond the scope of their training and responsibilities may be putting the mother and baby in danger and could be breaking the law. Doulas are not qualified to make a medical diagnosis, interpret medical results, or prescribe medications. Doulas cannot act as a healthcare professional without proper training and certification.
Doulas should also make sure their clients understand what they can and cannot do. This includes making it clear that a doula is not a healthcare professional. Failure to explain the limits of a doula's care may lead to confusion on the part of the patient, possibly risking injury to the mother or the baby.
Doula Academic Studies and Reports
In 2015, the General Nursing Council of Spain (Consejo General de Enfermería) published a report on The Truth About Doulas. The executive summary reports:
- A doula is a figure that does not legally exist in Spain or the European Union.
- Doulas are unregulated, are not considered health professionals, and act outside the law.
- Anyone can become a doula after attending a workshop and paying money to get a doula title.
- Doula leaders are other doulas and “experts” in techniques like, “voice yoga”, “rebirth”, and “Goddess of the White Rose.”
- Doulas involve a lucrative and fraudulent business.
- Doulas practice rites contrary to public health.
- Doulas pose a risk to the mother and the baby, including undetected hemorrhages, hypoxia, sepsis, cerebrovascular accidents, and preeclampsia.
In an interview, Maximo Gonzales Durado, the president of the General Nursing Council said, “These birth attendants have no formal qualifications, they put mother and baby at risk and should be investigated.”
Other studies have found that birthing mothers have a generally positive experience when using a doula. “A randomized control trial of continuous support in labor by a lay doula,” was published in the Journal Obstetrics and Gynecologic Neonatal Nursing in 2006. The survey found that doula mothers had shorter lengths of labor, more cervical dilation, and higher Apgar scores at 1 and 5 minutes.
A 2013 survey, “Impact of Doulas on Healthy Birth Outcomes,” published in the Journal of Perinatal Medicine, reported a similar finding. According to the abstract, “expectant mothers matched with a doula had better birth outcomes. Doula-assisted mothers were four times less likely to have a low birth weight baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding. Communication with and encouragement from a doula throughout the pregnancy may have increased the mother's self-efficacy regarding her ability to impact her own pregnancy outcomes.”
Doula Malpractice Lawyers Gilman & Bedigian
If you or your child were injured because of an accident or mistake involving a doula, you may have a legal claim to seek compensation in court. When filing a claim against a doula, the injured patient can seek damages for lost wages, pain and suffering, medical bills, and other compensation. Family members may also be able to seek compensation. You should not have to suffer because of your doula's negligence.
At Gilman & Bedigian, we will use our experience, knowledge, and dedication to fight for you to receive the compensation you and your family deserve. Our aggressive trial lawyers have helped our clients recover millions of dollars in compensation related to pregnancy and birth injuries. Contact us online or call our law office at (800) 529-6162 for a free consultation.