Healthcare Providers and Social Media

The American Medical Association has issued a new policy on the use of social media (AMA Issues New Policy To Guide Physicians’ Use of Social Media on the Health Care Law Blog). The new policy "aims at helping physicians to maintain a positive online presence and preserve the integrity of the patient-physician relationship."

Do you think that the AMA guidelines would be helpful for other types of healthcare providers, such as midwives, doulas, chiropractors, and so on? Although these types of providers often have a much closer, personal relationship with their clients than do medical doctors, it is always a good idea to protect client's privacy (whether or not the provider is a HIPAA-covered entity) and to separate personal and professional online content.

Pregnant Inmates Need Doulas, Too

In honor of Nicole Richie's newly-announced pregnancy - and the fact that she may soon be spending time behind bars for a DUI conviction - I give you this wonderful article by Amie Newman, Pregnant Behind Bars: The Prison Doula Project. Amie interviews Christy Hall, the co-founder and Development Coordinator for The Birth Attendants, which started the project:

"A lot of the issues that are the general issues for pregnant women are magnified in prison. For instance, which provider will you choose for pregnancy and childbirth? In prison, you don't get to choose your provider - not being able to choose who attends your birth is a big deal. Up until recently, in the prison we work in, there was only a male doctor available for labor and delivery. But for many women in prison - a huge number of whom have experienced sexual and domestic violence - having a male provider between your legs is not exactly ideal. Another issue is lack of informed consent - the lack of information and resources around having a healthy pregnancy for these women is huge. They just aren't given any information on pregnancy, their health, their bodies. The lack of access to proper nutrition during pregnancy is a big problem - the pregnant women in the prison we work with get "extra canteen" which means they get like an extra pack of Fritos. Also, the lack of access to health care in prison means that, in general, a health issue is not dealt with until it turns into a huge problem. It's a high-risk population anyway because, for the most part, these women lacked proper health care before coming to prison and being pregnant in prison doesn't change that. Also, there is a much higher rate of cesarean sections for women in prison as compared to women on the outside - mostly for the convenience of medical and prison staff."

The article mentions another organization, The Rebecca Project, which aims to end the practice of shackling pregnant inmates, particularly during labor and delivery, through the enactment of federal legislation.

Also check out this 1997 article by Sheila Kitzinger on the state of pregnant women and mothers in Great Britain.

Doula Liability

Doulicia (like yours truly, a non-practicing lawyer) covers Doula Liability and Insurance.

Katrina Relief and Babies

*** Scroll down for updates ***

As you no doubt are aware if you watch the evening news, there are a number of women affected by hurricane Katrina who are pregnant or have recently given birth, some even in the midst of the evacuation. Below are listed several efforts by the childbirth community to reach out to these women and their babies. If you know of any others, please email me so I can update the list.

The Barefoot Doctors Academy, a Hawaii-based non-profit, is focusing its recovery efforts on "arranging for medical assistance and relocation for families containing pregnant women, infants and small children". They are looking for volunteers who are doctors, midwives, childbirth educators, doulas, lactation consultants, and La Leche League leaders. In particular, they are wanting midwives to travel with relocating pregnant women to provide support, childbirth education, and emergency childbirth services en route if necessary.

The American College of Nurse-Midwives is activating their annual Blankets for Babies Campaign:

Distribution centers have been set up by nurse-midwives in Dallas-Fort Worth and Galveston, Texas. Thousands of families are being offered shelter and support in Texas, and many midwives will be providing health care services to these families. They have graciously agreed to accept and work with local relief efforts to distribute your donations.

Their website lists addresses where you can send donations of blankets and baby clothes. The ACNM has also set up an eMidwife list for KatrinaSupport information.

The Midwives' Alliance of North American (MANA) is offering to post notices of relief projects on their website. They also note that "many Texas state licensing boards and programs are providing expedited processes to assist refugees displaced by Hurricane Katrina who are seeking employment in Texas" and list contact numbers for the Texas CNM and LM/DEM licensing authorities.

There was talk in certain circles that CAPPA's Operation Special Delivery, (which provides volunteer Doula services to birthing women whose partners are on military deployment), might expand their efforts to reach those affected by Katrina. However, as of today there is nothing about it on OSD's or CAPPA's websites. Nevertheless, if you know of someone who is pregnant and could use a Doula, I would suggest contacting CAPPA or DONA and see if they can't locate a Doula in your area who would volunteer. I know there are many doulas, midwives, childbirth educators, and lactation consultants who would be glad to help out evacuees free of charge.
**UPDATE 10/03/05** Operation Special Delivery has a new website with Katrina support information on the main page.


**UPDATE 9/15/05 **
The March of Dimes has announced several efforts to help babies and women affected by hurricane Katrina, including providing support parents of NICU babies and donating supplies, maternity and baby clothing.

**UPDATE 10/01/05 **
The African American Breastfeeding Alliance has teamed up with Mocha Moms and La Leche League to provide breastfeeding support and resources for families affected by Hurricane Katrina. "In addition to on-the-ground efforts in Texas, AABA is providing a support hotline where mothers can get breastfeeding information. The AABA Breastfeeding Support Hotline Number is 1-877-532-8535"
Press Release (PDF)

**UPDATE 11/27/05**
Project Breastfeeding Book Recovery - Pharmasoft Publishing and Crystal Stearns, IBCLC, have teamed up to help Lactation Consultants and La Leche League Leaders who may have lost breastfeeding reference materials in the hurricane. Donations accepted here. Additional lists of lactation-related relief efforts are posted by the La Leche Leage Alumni Association and the International Lactation Consultant Association.

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?