There’s a lot of controversy over volunteer doulas. We have a very important job to do that often takes a lot of our time and energy, shouldn’t we be paid for it? The answer, in my opinion, is a resounding yes. In some states, like Minnesota, insurance companies cover doulas. In those states doulas can work for low income families and still get paid by the insurance companies. Unfortunately this isn’t the case in all 50 states. Here in California, insurance companies don’t cover doulas. Therefore, the only way low income families can afford doulas is if our time is volunteered. There are some more experienced doulas who have decided they want to volunteer for one birth every so often (every couple months or so). There are some students, primarily nursing students, who have decided (because it is required?) to volunteer as a doula for a while during school. Others are new doulas trying to get a feel for what it's like to be a doula, or trying to get their births required for certification. In my opinion it is extremely unfortunate that those who need the most help and have the potential to have the most challenging births are those who get the most inexperienced doulas. Why do I call their births the most potentially challenging? Low income and homeless population have the greatest potential to have drug and alcohol abuse or domestic abuse issues which can greatly affect all those involved in the birthing process.
Personally I decided to get my required births for certification as I gained a greater understanding for the profession through volunteering. I am a volunteer birth doula at two different hospitals in the city: St Luke’s and San Francisco General Hospital (SFGH). Both have very different approaches to their volunteer programs. San Francisco General Hospital has an older, more formal program. I applied for their program in January 2017 and did not have my phone interview until the end of March. It then took just over two months to complete orientation, all of the requirements to get a badge and do a shadow shift. I started attending births at SFGH in June, 2017. St Luke's was a different story entirely. I learned about the program in March of 2017, quickly attended an orientation and was set up with my first client who gave birth at the beginning of May. Volunteers at St Luke's don't have badges nor is there a long waitlist for the program.
Beyond the initial entry process both programs are set up in very similar ways. They both have two approaches for birth doulas: on call doulas and shift doulas. On call doulas are set up with a family prenatally and able to serve them as we would a private client (two prenatal visits and the birth). At St Luke's these visits are up to the doula. Personally I often schedule them at the client's home, as I would with a private client, and include a postpartum visit soon after the birth. At SFGH doulas are required to do all prenatal visits in the hospital. Since there are also volunteer postpartum doulas, birth doulas do not visit clients postpartum. Shift doulas, on the other hand, are very different than private clients. Shift doulas schedule a 12 hour shift with the hospital. At SFGH shift doulas spend the 12 hours on the labor and delivery ward of the hospital. It is their job to understand the patient board to a certain extent and have conversations with the nurses about which patients they should attend to. Patients in this situation have already been admitted to the hospital and in some cases medical interventions have already started. Doulas do not have the added advantage of working with patients prenatally to develop relationships and discuss childbirth education and options. Nor are doulas involved in the discussion of whether and when the patient should go to the hospital. It is also up to the nurse whether they feel comfortable having a doula in the room. If they are not interested in using the shift doula there is no requirement for them to ask the patient whether they want a doula or not. Shift doulas are very similar at St Luke's with the one exception that they are not allowed on the ward unless a patient has already requested a doula. Instead of waiting on the ward, looking at the board and having conversations with the nurses, shift doulas must wait in coffee shops and other nearby locations and call in to get information about patients from the nurses. One disadvantage to this, in my opinion, is the old adage "out of sight, out of mind".
For some people being a shift doula is much easier. If a doula has a full time job or is a student, it is much easier to be able to schedule their time for being a doula. I have the privilege of a very flexible schedule and would prefer developing a relationship prenatally with the client and their family so I prefer being an on call doula. I have learned a lot by being a volunteer doula and take every opportunity I can to make the most of these situations. Currently SFGH has many more volunteer opportunities than St Luke's, so I have decided to become a volunteer postpartum doula and OB Simulation Actress in addition to a birth doula. At SFGH a postpartum doula is someone who comes by the rooms to check in on whatever they may need assistance / education with. Some postpartum doulas help with basic breastfeeding, teaching how to swaddle or diaper the baby, or listening to an individual's birth story. Others are trained as lactation consultants and can provide extensive breastfeeding assistance. All postpartum doulas check in with the nurses prior to going in to the rooms so they know what would help the patient the most and are on the same page with the medical staff. An OB Simulation Actress is a volunteer who goes to the hospital and pretends they are pregnant so that the medical staff can simulate what they would do in different situations. The actress is given instructions by the charge nurse as to the scenario they need to act out. I have not been an actress quite yet but I could imagine that this would be a great opportunity to observe the medical staff and learn a lot from them as one is pretending to be in labor.