OC Doula Development: Mission Hospital Starts Volunteer Doula Program

*Disclaimer: The author has significant bias in favor of the OBGYN + Midwife group supporting this initiative and has attended numerous volunteer births at local pregnancy shelters. This article is not written in an attempt to convince, persuade, or otherwise influence doulas in how they practice.*

For some families expecting a baby, childbirth may look much different than they anticipated during pregnancy. Most birthing people are surprised by at least one aspect of labor, birth, or the immediate postpartum period. Many are looking to soften around or prevent these surprises, unexpected outcomes, and/or potential traumas by hiring a doula to help guide and support the birther and any partner(s) that will be in attendance. However, some families can't find it in their budget to hire a private doula for support; others aren't even aware doulas exist before labor begins.

These families are the target populations for Mission Hospital's Volunteer Doula Program, which is set to start as early as January 2019. According to the director of the doula program and Executive Director of the Women and Infants Institute at Mission Hospital, Sue Jacobson, the primary goal of the doula program is to promote greater access to doulas for those who would otherwise not have doula support. She cites studies available which point to doula support being an integral part of an evidence-based approach to maternal and fetal care and says that the shifting culture at Mission Hospital is one that aims to include doulas for as many births as possible. A multitude of projects, trainings, and initiatives are in the works to improve the hospital birth experience at Mission Hospital.

To the professionals who attended the first information session about this new volunteer doula program, it seems obvious that the administration team involved in the creation of the volunteer program have absolutely lovely intentions. At the end of the day, bettering birth outcomes and experiences took focus in the conversation. The team, which also included Laguna Beach OBGYN's Kenneth James and Allison Molinski, was open to questions, critical feedback, and real dialogue about what would make a volunteer doula program in Orange County work well.

Lovely as they are, though, these stated intentions may not be enough to quell the concerns of some doulas in the community (and some within the profession at large) who argue against both volunteer doula work and the creation of hospital-based programs that either hire doulas, refer to specific doulas who have been trained for work at the hospital, and/or have volunteer doula programs. The arguments merit consideration and include (but are in no way limited to) the following thoughts:

-Doulas are skilled care providers who are already in an undervalued, service-based industry. Doulas often struggle to find gainful employment after training or certification is complete, so choosing not to pay professionals who need the income and provide specialized services feels like a slap in the face. Furthermore, offering free doula support anywhere can be viewed as undermining to those in the community who own doula businesses and support their families via income as birth doulas.

-Hospital-based doulas programs muddy the waters of the doula profession by transforming an independent, third-party participant into a staff member of the hospital. Doulas are generally people who work for the benefit of their clients, even if that means offering suggestions and options not considered or particularly well-received by care providers or hospitals. Doulas are often viewed as a sort of communication bridge by birthing families who desire quality relationships and respectful care within the hospital system. If a doula becomes a staff member of a hospital, by default there will be requirements that shift the perspective and priorities of the doula. A major question surrounding hospital-based doula programs is whether the doula employed by a hospital can be as effective as doulas who remain independent and untethered to the hospital's needs.

The team from Mission was eager to understand the perception of volunteer programs in the community and the needs of the birth doula profession and took these concerns seriously when addressing the group. It was communicated clearly that the intention of the program is not to undermine anyone, but to specifically bring awareness to the profession in total while helping patients of the hospital. Each representative stated that Mission Hospital staff are excited to work with, but not limit, the role of the doulas who volunteer and reiterated their commitment to remaining receptive to feedback from participants for troubleshooting as the program launches. The general tone of the meeting was inclusive, dialogue heavy, and patient-centered at every stage. All of this gives rise to hope that this volunteer program will be built and managed with thoughtfulness as it seems the coordinators involved genuinely desire to improve the birth culture in Orange County.

In addition to these broader concerns, there are specific logistical challenges that come with the launching of hospital-based doula programs. Trying to get people whose professions depend on being on-call for private clients to also find time to be on-call in a volunteer capacity is a tall order. The original FAQ page provided by Mission Hospital indicated that one requirement to volunteer would be either 2 years as an experienced doula or a certification from a doula training organization. In the conversation surrounding this requirement, the doulas attending the info session expressed concern about the limited pool of applicants this requirement would result in given the small number of professional doulas in total who also are able to work for free. Moreover, professional and experienced doulas are generally busy folks and would have limited time to offer for volunteering compared to brand new doulas just out of a workshop.

The original thought process around this requirement made sense: new doulas being thrown into the deep end without specific guidance, mentorship, experience in hospital environments, etc. might not be as effective for laboring people who would be meeting the doula for the first time in the throws of active labor. Again, the intentions behind the stated requirements are patient-centered as the staff would not want a lack of familiarity and knowledge to negatively impact a birthing person's experience.

Another item of concern from doulas in attendance was the originally stated requirement for doulas to be at the hospital within 30 minutes of being called during their predetermined on-call window. Because most doulas in private practice are in contact with their clients for many hours (or days) leading up to the point when families need in-person support, contracts between the parties often allow for 1-2 hours prep and travel time before the client expects to see the doula. This would not be the case in the hospital doula program, as the plan is for nurses to offer doula support to clients upon admission. Since folks walk into the hospital anywhere from 0-10cm dilated, there's sometimes going to be a need for quick response time on the part of the doula. However, this may be simply impossible in a place like Orange County, where those who live even a few miles away might encounter traffic that results in lengthy commutes. A new proposed time frame of 1 hour is being considered to address the needs of potential volunteers while still accounting for the nature of being called to a last-minute birth.

It is obvious that this program is in its infancy and will progress and shift over time. It was modeled off of UCSD's volunteer doula program with Orange County birth culture and doula professionals taken into account. Please do not cite this article as a definitive source of information regarding the Mission Hospital Doula Program. Many of the basic requirements mirror UCSD's thresholds and are in alignment with other volunteer opportunities that exist in hospitals. The following are some of the requirements that seem set in stone:

-A doula training at minimum, possibly a specific number of births required prior to volunteering with Mission Hospital.

-Mission Hospital on-boarding process that includes a 6-hour unpaid hospital orientation, a 2-hour unpaid birth center orientation, a physical examination, a background check, a drug and alcohol screening, and verification of vaccinations or immunity to a list of diseases. The specific vaccines required will be released at a later date, but definitely include TB clearance and the flu shot (there was mention of potentially wearing a mask for those who do not get the flu shot). The cost of the screenings is apparently covered by Mission Hospital).

-A commitment to prioritize hospital clients over private clients when on-call for the volunteer role. This was discussed at length, and the staff at Mission Hospital expect the doula on-call to utilize a paid backup for private clients in the event that a private client and a hospital volunteer client were in labor simultaneously. The additional option discussed was that the volunteer doula could potentially call in a sub volunteer doula, if one was available. -A commitment to volunteer for at least 6 months.

-A commitment to volunteer for at least 24 hours total in a one-month period, either in one chunk or split into two 12-hour shifts.

-A uniform set by Mission Hospital of a provided t-shirt and black pants as well as close-toed shoes.

-Attendance of at least 2 of 4 doula meetings per year at Mission Hospital as a debriefing and feedback process.

For those that can fulfill these requirements and are interested, the proposed benefits of joining the volunteer doula program at Mission Hospital include:

-Access to midwives, doctors, and nurses to learn from and work with collaboratively.

-The opportunity to give back to the community and serve folks who might not otherwise have had access to or understanding of doula support.

-If new doulas are invited, this would be an opportunity to gain experience at hospital births without investing money or resources into advertising to find clients.

-Parking pass for the campus is provided.

-One meal per volunteer shift is provided.

-A welcome bag with doula tools/resource items such as rebozos, heat pads, and more.

-Promotion on the Mission Hospital website as a "preferred doula partner."

-An on-call room and locker for use while volunteering were discussed as potential perks.

Another information session is being planned for January 2019, but volunteers are welcome to enroll before that. If interested, reach out to Sue Jacobson ( sue.jacobson@stjoe.org ) to start the process or inquire with further questions.

Amanda Cagle is a professional doula, educator, and student midwife located in Orange County, CA who offers comprehensive services to growing families and birth professionals alike. Amanda can be reached via email at yourbirthteam@gmail.com or through www.yourbirthteam.com.