Updates to Our Postpartum Doula Scope of Practice

Laura Nance – CPD, CLD, CLE®, CCCE, CPFE, Faculty, Senior Program Advisor

CAPPA recently made changes to the Postpartum Doula Scope of Practice.  These changes reflect the needs of postpartum doulas and the work they do with families.

First, let’s talk about why a Scope of Practice is even necessary.  It comes down to two very important reasons: safety and professionalism.

CAPPA Puts Safety First

We want our members and the families they serve to create boundaries in order to have a mutually beneficial working relationship and avoid liability.  These boundaries are meant to create understanding and safety for both our clients and ourselves.  When CAPPA Leadership develops the Scope of Practice, we look at the boundaries that create safety and avoid liability.  We talk with liability insurance companies to see what the options are for coverage.

CAPPA Professionals Are Set Apart

The other important reason for a Scope of Practice is professionalism.  Keeping a level of professionalism means doulas are different from family and friends.  This is part of why people hire doulas.  CAPPA is a professional organization.  A doula’s professionalism sets them apart from others.  Our Scope of Practice helps to define that line between working with a trained/certified postpartum doula and a friend or family member offering assistance.  Staying within the Scope of Practice is a vital part of that.

The Updated Scope

Now that we know why there is a Scope of Practice, let’s look at some of the changes in the Postpartum Doula Scope of Practice.  While there were some other minor tweaks in language, there are 4 main changes.

“CAPPA Postpartum Doulas do not take over complete care of the infant” was removed from the scope and replaced with 2 new distinguishing statements.

  • “CAPPA Postpartum Doulas do model infant care.”
  • “CAPPA Postpartum Doulas do not make parenting or infant care choices or decisions.”

This change reflects and clarifies what CAPPA Postpartum Doulas really do/do not do. Supporting the new parents and allowing them to rest and recover, sometimes requires a doula to take over the care of the infant for a short amount of time.

Our role as a CAPPA Postpartum Doula is to offer education and support.  When we take over care, we must keep that in mind.  We also want to model and teach infant care so that parents know how to care for their infant when the doula is not around.  At the same time, the doula should never make a decision about WHAT is done or HOW something is done.  This is always for the parents to decide.  Any change from the usual routine or plan always needs to be discussed with a parent, even if that means waking them or calling them.

“CAPPA Postpartum Doulas do not ‘sleep train’ babies” was replaced with “CAPPA Postpartum Doulas do educate families how to maximize age appropriate infant sleep.”

This change reflects a CAPPA Postpartum Doula’s abilities and expands the services they can provide for families.  Some previously understood the idea of not sleep training babies to mean that postpartum doulas cannot help with sleep education and support.  This is far from the truth.

Doulas are equipped to educate and support all normal developmental phases of the baby, including helping the family understand what normal infant sleep looks like and how to help everyone get more sleep.

“CAPPA Postpartum Doulas do not teach a cry it out approach” was added to more accurately reflect the original intent of not sleep training babies.

As CAPPA professionals we follow the CAPPA Mission, Vision, and Approach, all of which support evidence-based, compassionate, and confident parenting.  CAPPA professionals teach a responsive, intuitive attitude toward babies combined with evidence on normal infant sleep and play development.  Leaving young infants to cry does not reflect those standards.  This does not mean that babies won’t struggle and fuss in the doula’s care, but we do not encourage or teach leaving to cry in sleep or play.

“CAPPA Postpartum Doulas do not stay alone with babies or other children” has been expanded to say “CAPPA Postpartum Doulas do not stay alone with babies or other children routinely and for extended periods of time.”

What does this mean?  CAPPA Postpartum Doulas are now able to stay alone with babies or other children, but with some stipulations: doulas cannot do this “routinely AND for extended periods of time”.

Some examples of this are detailed below:

Situation 1:  A parent who needs to go pick up an older child from school.  Even though the run to the school may be routine (i.e. it happens at every shift the doula is working), it is not an extended period of time.

Situation 2: A parent must attend an appointment.  The appointment may be for a longer duration, but it is not a routine occurrence.

In general, if the parent(s) is gone for 2-3 hours, it is within the guidelines.  However, their absence cannot be the only reason the doula is called for.  If the parent is gone for the majority of the shift at every shift, this is not within the guidelines.  This has become childcare work/babysitting and is out of the Scope of Practice.

CAPPA Postpartum Doulas being allowed to stay alone with babies or other children is the biggest change to the Scope of Practice and some doulas may not be comfortable with this level of care.  (While other doulas are celebrating as they read this!)  It is ok to not feel comfortable with change.  And of course, just because it is allowed by the CAPPA Scope of Practice, doesn’t mean that every doula will opt to stay alone with infants and children.  One of the big benefits of being in business as a self-employed doula is the ability to make choices on the services provided.

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