If you are a doula, or are in the process of becoming involved with the work of labor support, it is imperative to consider in advance any possibilities that may arise, and be prepared with a plan ahead of time. Just as you encourage your mamas to communicate their birth wishes ahead of time so that you can offer the best support possible, outlining your needs through your conversations and written agreements is like writing your own birth plan. In the same way that birth can be full of surprises, there are always unexpected moments that can arise in doula work, and it’s in our best interest to be prepared for them. Proper planning and good communication is essential in our verbal and written service agreements with clients. Rather than being in an unanticipated position and scrambling to figure out what might be best for you in the spur of the moment, giving this serious thought now can help you navigate the twists and turns with grace as they arise.
The more you think this through when defining your boundaries, the better you will be prepared to provide stellar service in any birth scenario. The importance of knowing your own physical, financial, mental and emotional limits cannot be overemphasized. Clients cannot be expected to honor boundaries that you do not know you have.
With that in mind, consider the following as suggested points to ponder for yourself.
Who will you accept as a client?
What are your feelings about having client relationships with people who are an ongoing part of your personal life?
Will you offer birth services to friends, family, or co-workers? What about members of your church, parenting support groups, or other parents at your children’s school?
Do you accept online friend requests from clients?
What is your comfort level with forming friendships with your clients during or after their pregnancy?
What personal biases (about birth choices, parenting choices, spiritual practices, etc) do you have that would make you turn down a client as “not a good fit”?
What if you have met a woman or a couple who isn’t a good fit for you? How will you handle declining a potential client?
At what point in pregnancy will you contract with a client? What if she’s three weeks along? What if she’s 41 weeks when she calls you for the first time?
How many clients will you take on within any given time period? Under what circumstances would you make an exception?
Do you require a face-to-face consult prior to being hired? Are you willing to accept a contract from someone you have not yet met in person? Do you require a consult prior to hire from someone you already know socially?
Do you have a requirement to meet a mama’s partner prior to the birth, or prior to being hired?
Establishing a Service Area:
How far are you willing to travel for a birth or postpartum care?
Under what circumstances, if any, would you consider traveling beyond your service area? How will you adjust your fee accordingly? Who pays your travel expenses, parking fees and tolls?
Are there areas where you would not prefer to travel, even if they are within your mileage range, due to heavy traffic routes, an unsafe commute, or a lack of parking?
Choosing Birth Practices and Facilities:
Are there OB or midwifery practices with whom you would not attend a birth?
Are there hospitals at which you would not be willing to provide service?
Will you attend births in hospitals, teaching hospitals, birth centers, or home births?
Will you attend unassisted births?
Interviews and Prenatal Meetings:
Where are you comfortable meeting for an initial interview – a client’s home, a public location, or their doctor’s office?
What would you choose to do if a client’s home seemed unsafe to you?
At what point will you meet with a mama with her other support people present?
How many prenatal meetings will you offer? At what point in pregnancy will they occur?
Do you require a minimum number of prenatal visits? Do you have a maximum number of visits you are willing to offer?
Do you require an in-home visit prior to the day of birth?
Will you offer meetings by Skype or phone?
Will you conduct meetings with a client’s other children present, or will you ask that childcare be arranged for your visits?
What do you think about arranging prenatal meetings as playdates with your children during their pregnancy or after their birth?
When do you choose to be available for consultations, prenatal visits, or postpartum care? Will you schedule meetings on weekends, during evenings, daytime only, evenings only? Do you permit your clients to choose any day and time for your meetings or do you set a specific schedule for when you are available?
What is your fee?
Have you calculated your own expenses for mileage, meals, childcare, trainings, uniforms, taxes, and your time?
Under what circumstances are you willing to negotiate for a lower fee? (Adoption placement, deployed spouse, etc) What is the lowest you will go? What will you do if someone cannot work with your minimum?
Will you accept a signed contact at the time of interview? Do you request that clients take a night to sleep on it before making a decision?
How long after an interview will you hold a spot on your calendar for someone who has not yet made a decision or has not yet given you a signed contract & deposit? What if someone has said she intends to hire you but hasn’t contracted with you within this set time period?
What are your financial agreements about receiving your deposit and balance due?
Are you willing to attend a birth for a client who has neglected to pay you? Will you be on-call for someone who has a balance due?
What is your refund policy? Is a portion of your fee non-refundable? What will you do if someone has a fast labor, or doesn’t call you, or there are circumstances beyond your control?
Do you have a specified bounced check fee, or late payment fees?
What will you do if someone chooses to break your contract?
Are there circumstances under which you are willing to release someone from your contract agreement?
If you have fulfilled your contract agreements, what steps are you willing to take to ensure that you are paid?
How will you handle communicating the code of conduct and scope of practice for your profession?
How will you make it clear what your professional boundaries will and will not allow?
What hours are you available by phone for non-emergency questions and check-ins?
Will you communicate via text and email? Phone only? A combination of the above?
What is your preferred mode for contact?
Under what circumstances MUST a client contact you voice-to-voice?
How often do you prefer to get updates from your clients during pregnancy? Do you have a minimum standard for frequency of checking in with updates? Once a week? Once a month? Once during the pregnancy?
Within what time frame can you be expected to return non-emergency calls or emails? Do you need ten minutes, an hour, a day?
Who is responsible for initiating and maintaining client contact? Do you have a schedule for calling clients, or are they responsible for remembering to call you?
What limits do you need with how frequently clients may call you? Do you have a limit on the length of phone calls? Can she call you every day for an hour, or do you allow ten minutes to talk before asking to make a phone appointment fora longer conversation?
Have you set aside times of day or days of the week when you are not available to answer your phone except for labor or emergencies? Are there times when you are intentionally not available by email, facebook, or text message? How do you let clients know this?
What situations might require you set a boundary with a client about contacting you and how would you enforce it?
Within what time frame can you be expected to return calls in an emergency?
When does your on-call time officially begin? When are you available until?
What would you do if someone went into labor prior to your on-call time?
What are the necessary steps for notifying you of labor, and letting you know when it’s time to come?
What would you do if someone chose to notify you in a different way, such as through email, facebook, or text message?
How do you decide that it’s time for you to join the mama in labor?
How much time to you need between the “come now” call and your arrival time?
Are you willing to provide labor support at home, or do you only provide in-hospital support?
Under what circumstances would you NOT meet someone at home?
What is your guideline for deciding when to go to the hospital in labor?
Under what circumstances would you recommend meeting at the hospital?
What is your plan for times when a client is in labor or having an emergency and is for any reason unable to reach you?
What are your guidelines for attending an induced labor? Are you there from the beginning, or will you be called in once active labor has begun?
What if a mama says she needs you “right now”?
What will you do if you aren’t sure that a mama is in labor?
What is your protocol for when a mama’s water breaks before labor has begun?
What will you do if a mama decides that she is not comfortable with a particular staff member (doctor, nurse, or midwife) in her birth place?
How would you handle a mama changing her mind about having one of her chosen support people in the room?
What is your plan if a mama changes her mind about any of the birth wishes she has expressed to you?
Will your offered services be different in any way for a mama who has a planned cesarean birth?
How will you support a mama who has an unplanned cesarean birth?
What will you say to the mama who says that she doesn’t need childbirth classes if she has you?
What concern would you have about a mama who has “interviewed every doula in town”, and you’re “the only one she likes”?
What is your advice for a mama who says that she doesn’t trust the practitioner she has chosen?
What will you recommend to the mama who tells you that she is terrified of giving birth?
What would you suggest to the mama who is sure that her labor will be easy and quick?
What will you say to a mama who informs you that her doctor or midwife doesn’t want to work with doulas?
What are your thoughts if someone other than the mama calls to tell you that the mama is in labor, and that you should come now/not come yet?
What is your plan when a mama suddenly refuses to leave for the hospital?
What are you able to do if a request is made that would require you to breach your code of ethics?
What would you say to a mama who tells you that she is secretly hoping to “accidentally” have the baby at home?
What will you say to a mama who asks you what she should do?
What concerns would you have for a mama who is a survivor of abuse or assault?
Under which circumstances will you not attend a birth?
Home and Family Life:
What personal events are you not willing to miss for a birth (birthdays, holidays, weddings, funerals, school functions, etc)?
How and when do you notify clients of the times you are unavailable?
What personal events are ok for you to miss? How would you deal with any response from your family or friends in this situation?
How can you support your partner and your home life while you are away for births?
What concerns do your partner or children have about your doula work? How will you address these concerns, should they arise?
What childcare arrangements do you need to have in place? Do these arrangements change with the time of day, day of the week, or weekends and holidays?
What will you do if you or your own child is sick?
Do you have arrangements in place for back up?
What will you do if two clients are in labor at the same time?
How will you handle paying your back up? Does this arrangement change based on how many hours she is there, or what you have been paid for this birth?
Do you provide clients with the opportunity to meet, interview, or have phone contact with your backup?
What will you do if a client would prefer a different backup person than the one with whom you have made arrangements?
What would you do if a mama thinks your backup “didn’t do the job like you would have”?
How much time do you allow to be on call after a baby has been born?
How much postpartum contact are you willing to provide?
Do you have a limit for how many hours or weeks you are available by phone after birth?
How many home visits are you willing to allow before requiring a separate postpartum care contract?
How early or late in pregnancy are you willing to negotiate a postpartum care contract?
What would you say to the mama who is unhappy with her birth outcome?
Who will you call for a mama who needs more help than you can give?
Do you provide a resource list for postnatal support, such as support groups for postpartum depression, cesarean support, etc?
What will you recommend for a mama who has experienced birth trauma, from this birth or from prior births?
Do you have a plan for births that happen very close together? Would you make arrangements to provide yourself time to rest in between, or will you go from one birth directly to another?
What is your personal limit for how long you will be away from your home or family?
How long are you willing to go without sleep? What will you do to get home safely after a long stretch with no sleep?
After how many hours of labor support would you call on another person to provide you with the chance to take a break, nap, or eat? Will your client provide an alternate support person, or do you make this backup arrangement for yourself?
How will you manage a situation that arises when an extended family member, partner, or client becomes verbally abusive to you?
What will you do if a staff member at the birthing facility becomes verbally abusive to you?
Do you have a support system in place for your own needs?
What other doulas, birth professionals, or counselors can you can process birth experiences with without breaching confidentiality rules?
What can you do to provide yourself time and space to focus on non-birth priorities, such as family time and self care?
In considering your thoughts, feelings, and wishes now, and deciding in advance what you will do, you pave the way for smoother births and happy client relationships for years to come. This will help you build strong client relationships, foster trust in you as a birth professional, and prevent you from feeling frazzled and burned out when the inevitable bumps happen. Use the personal guidelines you have uncovered here to write clear service agreements to be shared with and signed by your clients. Revisit them in your prenatal visits, and whenever the need arises. Clear communication can resolve many potential conflicts, and having this “birth plan” in place will go a long way in keeping you and your clients happy. Just as a birth plan is a useful tool between birthing mama and her practitioner, clear guidelines about your personal and professional boundaries can help keep everyone on the same page, figuratively and literally. As you continue to learn and grow, you may gain more clarity along the way about what your own boundaries are. Commit now to using this learning to define your own boundaries for the benefit of your future clients by continuing to hone and define your own service agreements. Blessings on the journey, and happy doula-ing!
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