What an exciting time to be a doula! The Swedish hospital system is going to be commencing a hospital based doula program that will be hiring doulas as independent contractors.
This is a big deal for a couple of reasons. Being accepted into what is seen as a legitimate medical setting in this way, normalizes doulas as a labor resource. One of the major potential bonuses for doulas out of this is that it will validate what we charge, as well as standardizing it. Being attached to a hospital also increases the chance that insurance will start to cover doula services as a medical expense more consistently. It has already been studied, and in my opinion proved that doulas reduce the cost of low risk pregnancy. This study in Wisconsin backs me up.
The idea of working consistently as a part of a hospital staff also holds some appeal to me in the relationship that can be created with the staff. If you are on a positive first name basis with the nurses and OB/GYN that will be assisting at the birth. That makes for a more relaxed atmosphere in the birth room, making it that much more pleasant for the family. The other ideal outcome for the program is to greatly expand the access to doulas for everyone who are and might be interested. Having a larger system presenting the option of having a doula at your birth will expand those who even know about doulas as a possibility.
Now on to the semi-cons side of working for a larger hospital. I have heard brought up the question of a conflict of interests. By working for the hospital, albeit as an independent contractor. If you find your client is describing a birth that would be better suited to a birth center or a home birth, it will be against your interest as an employee of Swedish to recommend a change in venue.
The position as I understand it is this; it is the doulas job to give their client all the information and resources that will help them to have the best birth possible. If that means recommending a birth center or midwife at home, then so be it. Our primary responsibility is to our client, not to a hospital.
Another qualm I have heard voiced in the doula community is the loss of clients for those who have worked at Swedish in the past, but are now going to be “supplanted” by the Swedish doulas. The concern is that if half of your clients used to be at a Swedish hospital, those clients will now be offered Swedish doulas instead of being left to find their own.
Here is my thought on that: If 30 people are hired as doulas in the program. On an optimistic side they each take 48 clients in a year, (4 a month). 1440 births through the program. I’ll even round up to 1500 even for a rounder number. Eventually additional cohorts are added and the number climbs to 60 doulas out of the 155 doulas on doulamatch.net. We have reached a really optimistic 3000 births now covered by Swedish doulas alone. Last year the swedish hospital system had 13,000 births. The program has an eventual goal of half of those being covered by a doula, but that’s a lot of doulas to cover 6500 births in a year. If the program is providing every one of those 13,000 families with the information and access to doulas, then there will likely always be more births than there are doulas available, and that is not a bad thing. I would say after those numbers work out that it’s a very good thing, and may actually increase the number of births covered by a doula, not just a swedish doula.