Today's guest post is written by Jessica Atkins, a certified professional midwife, doula, childbirth educator, doula trainer and co-founder of Tiny Love Doula Training & Certification.
I have been asked this question countless times over the years of teaching and mentoring doulas:
Is there a risk of catching an STD from my client with ?
Sexually Transmitted Diseases, or as it is now usually referred to, Sexually Transmitted Infections (STI), may have the potential for some impact for the birth doula. Translation, you probably don't need to worry about catching anything from your clients, but doulas should be aware of universal precautions, and use them every time. Several things come to mind as practical habits used to help protect yourself and prevent the spread of disease.
Because STIs are defined as sexually transmitted, doulas should avoid contact with their client's genital fluids. This means wearing gloves when there is a potential for contact with body fluids of any kind, and whether or not the client has a known infection. Most often contact happens while helping a mother to the bathroom or to change positions when she is leaking fluids, or during second stage. Some doulas will help their clients by changing the bed pads if they are getting soiled, in this instance gloves should always be worn. One of the first things a smart doula does is become familiar with the birth place, find out where she can find gloves (or bring her own) and a hand washing sink, as well as other things to assist her clients.
Doulas might consider wearing eye protection, such as glasses, even the prescription-free glasses with clear lenses are smart to wear during second stage while a woman is pushing, because of the potential for spraying amniotic fluid. Never touch your eyes unless your hands are thoroughly cleaned.
When the doula is touching the baby to assist with breastfeeding, gloves should be worn. The baby is covered in a wonderful protective substance called vernix. It is antiviral, antifungal and antibacterial, and it also helps the skin to adjust to living outside of water. This should be left on the baby as long as possible for maximum benefit. However, the baby also has vaginal fluids and blood and possibly bacteria or even mom's poop on its skin. Wearing gloves will protect the doula and the baby.
Doulas should have a designated set of clothing, or a "uniform" so to speak, to wear to births; it should be comfortable and allow movement. Scrubs are not appropriate since that can be interpreted as clinical and this can actually work against a doula in a hospital setting. I recommend cleaning everything immediately after a birth, including shoes that can be sprayed down with bleach-water (or other germ-killer), tops and bottoms, and allowed to air dry. Some doulas wear washable shoes that can go in the laundry with all of the clothes, it's a personal choice. Ordinary laundering and running through the dryer is enough to sanitize clothing. After the clothes and shoes are clean and sanitized, pack them up in a plastic bag and put them in the car, or your doula bag. This way they are ready to change into when the client calls and you have a clean set of clothes and shoes to put back on. Change out of your birth clothes and especially shoes before getting in the car to prevent spreading anything from your shoes into the car to be picked up the next time.
Sexually Transmitted Infections, such as Hepatitis and HIV are transmitted through blood and can be present in other body fluids. Hepatitis can live for a long time outside of the body. Other STI's such as HPV, Herpes, Chlamydia, Gonorrhea, Syphilis and others are far more difficult to acquire in casual contact. Hospitals are dirty places harboring communicable infections such as Hospital-Acquired Infection (HAI) an infection that is contracted from the environment or staff of a healthcare facility and may be spread by nurses, allied health care workers, and doulas; and MRSA, or Methicillin (Medication)-Resistant Staphylococcus Aureus, a bacterium responsible for several difficult-to-treat infections in humans. Numerous times I have seen blood from other patients still on the floor, beds, toilets and walls in the hospital as well as birth centers.
A smart doula knows where the gloves are (or brings her own) and does what she can to limit exposure to infection. The simplest way to do this is by washing your hands well and frequently using soap, water and a lot of friction. Avoid touching the floor and don't allow your clients to touch the floor either. Do not touch your mouth or nose unless your hands are clean. Cover any open cuts or sores. Also, after saying all that, don't be too concerned, people work there every day and follow simple protocols for cleanliness and are just fine. Birth at home is different since it is not likely to carry much disease or infection, however, doulas should still use the suggestions above for avoiding contact risk with blood and other bodily fluids.
When the work is done and you are ready to leave the birth place to go home, enjoy your moment of satisfaction, then wash hands, and change into your clean clothes and shoes before getting in your car to go home. Take a shower when you get home. Wash any tools or gear you used during your birth, then re-pack for the next call. The antiseptic wipes do a pretty good job in a pinch otherwise scrub with soap and hot water or launder anything you plan to use again.
Finally, the risk of encountering something infectious is small so don't let this impede the quality of your care and your physical contact, which is vital in your role as a doula. With this new knowledge and by following these tips at every birth you will be a safer, smarter doula.
About Jessica Atkins
Being a doula, a midwife, a childbirth educator and a doula trainer for more than 2 decades has taught me that birth is normal, sacred, and something that will affect mothers, children and fathers for the rest of their lives. It sets the foundation for everything that follows. It also teaches us that when we open up our body and heart, accept support from others, and connect on a deeper level, it brings out the mother in each of us. I have mentored countless doulas, trained hundreds of birth doulas, and been fortunate enough to have shared birth with so many families from various cultural backgrounds, all while raising my own two amazing and beautiful babies. Through many years of doula training around the country, I have actively worked towards my goal as a doula and a mentor – to bring out the mother, strengthen the family bond, and provide a valuable service. I try to convey that through the Tiny Love Doula Certification Program.
Edited March 27, 2017 – Jessica passed away on March 9, 2017, at the age of 45 after a heartbreaking battle with cancer. In order to continue her support of women in birth and birth workers, Jessica had a memorial fund created to 1) Provide scholarships to those who want to become doulas and midwives, and 2) Give financial support to doulas and midwives faced with illness. To donate or inquire about financial support, visit Jessica's Memorial Fund website here.