Of Monitrices and Doulas

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Debates, recent local blog activity, and conversations have fueled this blog post.

First some clarification of terms:

A doula is, by the word itself, a female servant.

Recently, the term has been modified to specifically refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period (Doulas of North America, or DONA, 2011). A doula works within a very limited scope of practice.

A Monitrice is, by the word itself, one who monitors (french).

It is a birth attendant with specific training in maternal and fetal assessment and clinical skills who serves the family as a doula as well as monitor. Her skills include observing vital signs on mother, fetal heart tones on baby, vaginal exams for progress of labor, newborn assessment and care (postpartum doula skills), breastfeeding help, and prenatal education. These skills are performed during prenatal and postpartum visits; and while the woman is laboring at home. The monitrice does not perform these tasks at the hospital, birthing center, or when the nurse, doctor, or midwife is in attendance, unless directed by the primary caregiver. 

I love the clarity that Keen Doula gives over the difference between a doula and a monitrice.

Not only is it  not in the scope of a doula to check cervical dilation, fetal heart tones, positioning, blood pressure, etc., but it’s a huge liability to do these things with the proper training and credentials... The more that doulas practice as mini-midwives, the more moms will be hurt by birth.  The more doulas who practice outside of what they’re professionally trained for, the more that doulas, like me, will find it harder and harder to find clients, because let’s face it, who wouldn’t want an all-in-one doula? - Between the Kids

Lisa's post caused a bit of a stir. Those who were doulas felt vindicated while monitrices felt attacked... I  might be wrong, but I don't think that Lisa was saying that professionals trained and experienced as monitrices should not practice as them; I believe she was saying that you have to be cautious when hiring a doula who says she can do all of the additional skills of a monitrice.

Now, there are some doulas out there, even in our area, who have no training and minimal skills and simply want to practice as a monitrice. And that worries me, just as it does Lisa.

Let me be clear about one thing, if you choose a monitrice, make sure she is trained.

I am a doula. I also offer monitrice services. I bring my resume of skills and training to all consultations.

I believe that I am well practiced and trained in assessing and monitoring through both the scope of practice outlined for a doula and as a monitrice.  I do not replace a primary care provider and do not practice as a 'mini-midwife'... but my skills do come in handy in special circumstances, whether they be physical, emotional, and situational circumstances. 

I mostly practice the same way that Kathleen mentions,

I put the monitor to mamas belly when asked and often say, “does that sound good to you?”... Parents know what their baby should sound like on a doppler.  If something is up with the heartbeat, we know to go straight to the care provider and get more monitoring.

I also palpate at prenatals and suggest exercises to help baby get into the optimal position for delivery.  I use my hands, a rebozo and whatever furniture happens to be around to do these things.

I know accupressure points I use for a variety of reasons.

I carry a blood pressure cuff, thermometer and emergency delivery kit.  I rarely get any of this out of my bag.  But, we are with women who are birthing folks, BIRTHING!  Wouldn’t you rather me be prepared than stand aside and let nature take it’s course.- Labor Enabler

I can check cervical dilation and this can, at times, be a helpful assessment tool, but like most in the doula and midwife community will tell you, dilation alone tell you nada except how far open your cervix is. This can be helpful, though, if you are one of those mamas who have been told by your provider to come in ready to push, or if you truly want to stay home as.long.as.possible.

Monitrices are not the better option when compared to a doula. They simply have a few more tricks in their bag to help along the way. Doulas are such a wonderful asset that I don't want people to get hung up on the 'better option',  because every woman's desires and needs are different in labor and birth. Some women want the ability to have these other options accessible to them, others have no need for them.

I am not a midwife or doctor and don't plan to replace them. I am not a mini-midwife. I have additional skills, training, and experience that many women find comforting to have during labor and birth. I love having the skills and training to be able to offer these services to the women that I serve, but these skills are only a small facet of what we, as doulas and as monitrices, can, and do, bring to a birth.

Additional reading of interest:
 Schism
Our Own Worst Enemy