As International Doula Month draws to a close, Kim James, experienced doula and childbirth educator, examines both roles and discusses how the doula and the childbirth educator responsibilities differ when meeting the needs of the families they serve. When doulas make the decision to provide educational support as if they were a childbirth educator, they are not supporting their clients' self advocacy and are practicing outside their scope. Do you wear both of these hats? How do you maintain a separation between the roles? Doulas - how do you stay within scope and not provide educational support when you are hired to be the doula?- Sharon Muza, Community Manager, Science & Sensibility.

I am both a doula and childbirth educator. The roles beautifully complement each other and the training and certification I received for both helps me excel in each role. But, I'm exquisitely careful about maintaining my boundaries around providing informational support and education depending on what role I'm in. Let me explain:

As a Lamaze International certified educator, I provide education based on a curriculum that I design that must be:

• Consistent with the mission, vision and fundamentals of Lamaze International
• Promotes the Six Healthy Birth Practices
• Is evidence based
• Promotes shared decision-making

I am responsible for delivering content and teaching in ways where retention and actual use of that content during childbirth is high. I am directing parents.

As a DONA International certified birth doula, I provide informational support at my clients' direction that includes:

• Explanation and discussion of practices and procedures
• Assistance acquiring knowledge necessary to make informed decision
• Encouraging clients to ask questions of their care providers
• Encouraging clients to express their preferences and concerns to their care providers

I am responsible for helping my clients become their own experts. I support my clients' curiosity and desire for information, but I do not provide education. Rather, I am a conduit for their own self-education. I point clients towards the information they want, when they ask. Parents are directing me.

Do you see the difference?

Doulas, even if they are also childbirth educators, must remember to practice within their doula scope when they are wearing their doula hat. Trying to wear both the childbirth educator hat and doula hat at the same time is fraught with pitfalls. In the childbirth educator role, you become the source of the information you share. You are responsible for choosing the information and the conclusions and distinctions you present to families. In the doula role, you simply act as a conduit and guide so parents can find the information they need. This distinction matters because we want parents to be their own experts. We want parents to own their knowledge, choices and values. We also want them to own the reasoning behind their choices. We want our clients to come to their own conclusions, not parrot ours. It's more empowering for your clients to seek their own knowledge rather than be told what to do.

Ultimately, I bring far more doula skills to my educator role than I bring educator skills to my doula role. The doula's empathy training and ability to actively listen without judgement helps me understand my class members' culture, beliefs and values. Because I'm a doula, I can better connect with my class members' unique, individual needs.

While being a doula makes me a better educator, being an educator doesn't make me a better doula. I appreciate having a high understanding of medical tools and hospital routines and the ability to anticipate my clients' experiences because of my educator training. But I don't share that knowledge. That is my own knowledge and expertise. In the doula's role, my goal is to support parents' self-empowerment by helping parents find their own way, through gathering their own knowledge and expertise and encouraging deep, trusting connections with their medical care providers.

About Kim James

Kim James BA, BDT(DONA), CD(PALS), ICCE, LCCE, is an ICEA and Lamaze certified childbirth educator teaching at Parent Trust for Washington Children/Great Starts where she sits on the Education Committee. She owns and operates www.DoulaMatch.net and is a DONA International and PALS Doulas certified birth doula as well as a DONA-approved birth doula trainer working at the Simkin Center/Bastyr University. Kim also volunteers her time on the Lamaze International membership committee and serves as Washington State DONA SPAR. Her daughters are 11 and 18 years old. Kim and her family live in Seattle, Washington.

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