Friday, July 15, 2005

Doula Liability

This legal question popped up on several of my newsgroups last week: Should doulas carry emergency childbirth kits when providing home labor support?

Factual background: A labor doula is a woman who supports a woman in childbirth. She provides emotional encouragement, coaching, education, and some physical support such as massage, hand-holding, etc. Doulas do not, however, perform any clinical or medical tasks, nor are they trained to deliver babies. They may, however, have had instruction in emergency childbirth and/or infant CPR.

An emergency childbirth kit can be purchased for about $25 on eBay and includes things like a bulb syringe, cord clamps, sterile gloves, disposable pads, etc.

Often, doulas may come to the mother'’s home to provide support during early labor before accompanying her to the hospital or, in the case of a homebirth, before the midwife arrives. It happens very rarely that when a doula arrives at the home, it is apparent that labor has progressed more quickly than expected, and baby is on his way, with no time to go anywhere. Should a doula carry an emergency childbirth kit in order to be prepared for such an event?

The legal issue: Could a doula, by carrying an emergency childbirth kit, be charged with "practicing midwifery without a license"; or, in states where direct-entry midwifery is not entirely legal/regulated, "practicing nurse-midwifery" or "practicing medicine without a license"? What steps could she take to protect herself from liability? Are "Good Samaritan" statutes applicable?

Here are some suggestions made by non-lawyer birth professionals:
  • Call 911 right away, and follow the instructions given to you over the phone while you wait for help to arrive. (Nevermind that EMTs typically have less than 5 hours instruction in emergency childbirth, while a certified Doula has 16 hours of classroom instruction and 15 or more hours observing actual births prior to certification. We'’re talking legal liability, not actual ability, here).

  • Suggest that the parents themselves keep an emergency childbirth kit just in case. In fact, a doula could sell such a kit to her clients, and then repurchase it after the birth if it was not needed.

  • Inform the parents that you are not acting in the role of a Labor Doula anymore, but as a concerned friend. Obtain their permission to assist the birth, or have them formally ask you for help.

  • Do not accept payment for the labor support.

  • Let Dad do the actual catching. This has the added benefit of keeping the Doula's name off the birth certificate.

  • Make sure that parents have a birth plan which would state they were planning to go to a hospital. Preferably this would already be on file with the doctor or hospital.

Non-legal discussion centered around whether or not the items in the birth kit were necessary; i.e. it is not usually necessary to clamp the cord or suction the baby.

Personally, I think that some, if not most, of the above suggestions for reducing liability would be ineffective. So, I was hoping for some additional lawyer brains. Were any significant issues missed? What do you think?


I am a Milliner's Dream, a woman of many "hats"... said...

Regardless of whether we should--it's nigh unto impossible to find right now. My current research shows no company offering the coverage for birth doulas and only one for "postpartum care providers."

The Mommy Blawger said...

You are refering to liability insurance coverage? I agree it should be available. But in this post I am referring specifically to criminal liability, and insurance is not going to help there. Though I know that doulas do get sued from time to time (usually in a hospital setting where everyone in the room is named as a defendant), I seriously doubt that a doula is going to incur any civil liability in the described situation.

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