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Doula Programs: Risk Management Strategies

To wrap up our discussion of risk management strategies for doula programs, the following steps are key to limiting liability:

Design and implement a program evaluation process. Program administrators will need to gather feedback from both the doulas and their clients and closely monitor that feedback. If a pattern emerges with a “problem” doula, it should be promptly reviewed with the doula and resolved. Doulas with repeated negative feedback, demonstrated poor judgment, or reliability
issues will need to be barred from participating with the program.

Identify high-risk incidents as they occur. A clear-cut support system for the doulas must be established, and response to potentially high-risk incidents must be made a priority. Doula program administrators should put a mechanism in place enabling doulas to notify them, as soon as possible, in the following instances:

  • Any time there is a poor birth outcome
  • Any incident in the home involving personal injury, when the doula is present
  • Any incident involving emergency hospitalization of the mother or baby, before or after delivery, if the doula is present or in any way involved
  • Any incident involving anger or rage on the part of the client
  • Any incident in which the doula is witness to illegal behavior
  • Any incident in which the doula feels that her personal safety is at risk
  • Any incident in which the client’s response seems unreasonable or out of proportion to the stimulus
  • Any incident in which the hospital’s patient advocate is called to intervene
  • Anytime the doula feels scared or lost in trying to manage a client scenario

The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.

Posted by Patty Brennan on July 28, 2011 • Filed under Doula Programs
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Doula Programs: Risk Management Strategies

Release forms are an additional tool that doula program administrators can use to limit liability.

  • Use a Client Confidentiality Release Form. Notify clients that doulas will be collecting information and data about services rendered, as well as birth and postpartum outcomes for mother and baby. All programs need to collect such data in order to demonstrate their outcomes to funders and to make a case for continued funding. The information should be kept confidential, but permission of the client needs to be given.
  • Use a Photographic Release Form. Have doulas and clients sign a release for their images to be used on the website, in program literature, in program reports, and so on. Photographs will help “sell” the doula program to providers, clients, and funders. A good photo will engage the viewer emotionally in the work of the doula. It tells our story in a more compelling way than any bulleted list of benefits can accomplish. Take photos of doula trainings, doulas in action, clients, and their babies. Encourage doulas and clients to share their photos. However, if you don’t have the signed release, then you don’t have permission to publish their image. The following language should suffice:

“I give [insert organization’s name] right and permission to copyright and/or publish, or use photographs of me, or in which I may be included in whole or in part, for art, education, advertising, media production, or any other lawful purpose whatsoever. I waive any right to inspect and/or approve the finished product in whatever way it may be used, including digital alterations.” (Include signature line, printed name, date, and witness.)

The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.

Posted by Patty Brennan on July 21, 2011 • Filed under Doula Programs
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Doula Programs: Risk Management Strategies

Doula program administrators are advised to develop a client contract that specifies the following:

  • services provided,
  • limits to services,
  • timeframe of services,
  • expectations of the client, and
  • experience level of the doulas.

Require clients to sign the contract as a condition of receiving services. In the case of language barriers or low literacy, the doula can review the contract with the client to ensure understanding. Some clients, in particular recent immigrants of questionable legal status, may be reluctant to sign forms of any kind. In such cases, program administrators may choose to waive this requirement and simply make an effort to ensure that the client understands the terms of the relationship.

The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.

Posted by Patty Brennan on July 14, 2011 • Filed under Doula Programs
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Doula Programs: Risk Management Strategies

To reduce liability risk associated with running a doula program, program administrators may want to implement the following strategies (continued):

  • Build in support for the doulas. If the program coordinator is not an MSW, an experienced social worker should be hired as a consultant on an as-needed basis. Her job is to help resolve any high-risk situations that the doulas might find themselves in and identify community resources for special client needs. The program coordinator assists the doulas in setting and maintaining good professional boundaries, consults with the social worker as appropriate, and identifies emerging training needs.
  • Host a doula support group. A monthly doula support group can be offered as a venue for doulas to come and share tips and resources, problem solve client scenarios, and learn from each other’s mistakes. Look for ways to build a sense of community among the doulas and the program. In our program, we worked to ensure that the doulas understood that, while they had a great deal of autonomy in their one-on-one relationship with the client, they nevertheless were part of a program and were accountable to the program.

The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.

Posted by Patty Brennan on July 7, 2011 • Filed under Doula Programs
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Birth & Parenting News: Preterm Birth and ADHD Risk

A study published online in the journal Pediatrics analyzes the effect of moderate and extreme preterm birth on the risk for Attention-Deficit/Hyperactivity Disorder (ADHD) in school-age children. Researchers analyzed data from a Swedish national cohort of over one million children born between 1987 and 2000, followed up for ADHD medication in 2006 at the age of 6 to 19 years. Previous research has shown that low birth weight and micro prematurity are risk factors for ADHD. This new study revealed that even babies born at 37 to 38 weeks of pregnancy might face a 20 percent increased ADHD risk. The authors note that the findings suggest that mothers considering scheduling cesarean births a few weeks early should reconsider and deliver as close to term as possible.

See also Perinatal Pitocin as an Early ADHD Biomarker: Neurodevelopmental Risk? Journal of Attention Disorders April 2011.

Each Wednesday, our Birth & Parenting News blog highlights the latest news items, research results, consumer alerts, and legislative action alerts of interest to expectant and new parents and the professionals who work them

Posted by Patty Brennan on July 6, 2011 • Filed under Birth & Parenting News
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