Integrating Doulas into Community Birth Transfer Drills

Practicing for community-to-hospital birth transfers for clinical emergencies is crucial for effective preparedness for all professionals involved in the birth process. Though these events are rare, there is a real chance that a birth doula will be present when a birthing person requires a transfer from a home or birth center.

As part of the care team, doulas improve care for patients through their presence, empowering and supporting patients physically, emotionally, and informationally. They help patients navigate complex health systems, access resources and information, and ensure more respectful maternity care. Beyond what they do for the patient and family, because doulas attend births in a diversity of settings, they are in a unique position to observe and reflect on processes across the system.

doula assisting a clinical simulation of a birth emergency

Doula Role in Transfers

Doulas are hired by families to help the birthing person feel calm, comfortable, and informed, and are often the one person who remains constant throughout the entire birth process.

During pregnancy, doulas can encourage families to make a plan for their birth preferences, discuss how to have shared decision making discussions, and participate in advanced planning for the possibility of complications that might necessitate a hospital transfer. This may include creation of a birth preferences plan for birth and postpartum at the hospital.

During labor, doulas provide physical, emotional, and informational support when complications arise. The doula can empower the patient to advocate for themselves and facilitate informed decision making conversations.

During transfers, the doula is a calm and reassuring presence, helping the birthing person and their partner and/or family members understand what is going on while clinical care providers and emergency responders are doing their jobs. In some instances, the doula may be the patient’s only support person, making them an essential source of psychosocial support for the birthing person.

Doulas can also assist care teams throughout the transfer process. Midwives and paramedics may be moving quickly to prepare for a transfer, administer medications, or physically transporting the patient. Doulas can assist in logistically preparing the patient for transport, for example by gathering clothing, bags, and insurance documents. Doulas can be an extra set of hands to hold open doors for emergency responders during an acute transfer situation.

In certain situations, the doula can ride in the ambulance with the patient to help keep the patient calm, informed, and supported. Alternatively, if a partner and/or midwife accompanies the patient to the hospital, the doula may stay with family members while the birthing person is transferred. At the hospital, doulas can continue to provide emotional and informational support and navigate informed decision making conversations.

Doula Role in Drills

Including doulas in birth transfer drills has several benefits, both for clinical teams and for doulas. Midwifery practices, emergency responders, and hospitals should build relationships with doulas and invite them to transfer drills. By practicing with realistic scenarios, everyone involved is learning, building confidence and muscle memory, enhancing communication, improving operational readiness, and building relationships and trust. During drills, care providers will learn the doula role and practice how they will interact with and engage doulas to reduce any transfer delays. Their participation can help care providers consider what might be said:

By the home birth midwife, when the patient looks to her doula for advice when you suggest a transfer to the hospital?
By an EMT, if the patient asks that her doula join her in the ambulance?
By the OB hospitalist, if the doula is helping advocate for her patient’s care in the hospital?

Participation in drills helps better educate doulas on clinical emergencies and better prepare them for their participation in transfers. It will allow them to prepare for the unexpected, learn to manage emotions, and to assist in minimizing any transfer delays.

Doulas are in a position to be a participant observer in the transfer process from start to finish. As such, they should be invited to participate in drill debrief sessions and hospital perinatal care quality improvement work group meetings. Because doulas are independent patient advocates, they can help drill teams reflect on whether and how well communication, shared decision making, and patient-centered care occurred during the transfer drill.

Doulas are present at births in many hospitals and community settings in your community, allowing them to provide valuable quality improvement feedback such as weaknesses or gaps in the process specific to the community being served. Involve doulas to allow their perspectives to be heard.

Doulas are an important part of the care team and can assist in improving transfer of care, which further contributes to the improvement of the quality of the perinatal care system.