Q In your last Ask A Doula column, you mentioned that a birth stool would need to be easy to clean. This reminded me about a question I’ve had for a long time: I want my doula practice to be high touch and high intimacy, and wearing gloves just feels like it totally goes against all that. On the other hand, I want to protect myself from bloodbourne pathogens. How can I balance these ways of thinking?
A This is a very common concern! There’s definitely a balance between the two aspects of doula care, but I don’t think they are in conflict at all. There’s a time and place for warm personal touch and a time and place for caution. It’s not just about protecting yourself, it’s also about protecting your clients! If not this client, future clients. It’s entirely possible to be taking precautions AND have warm personal touch. Each doula will have to think carefully about where their line is. Here is how I handle it as a birth doula:
I keep several pair of gloves in the cargo pocket of my pants. I put them on when needed at births, and take them off when needed. So I might be rubbing my client’s back without gloves while they sit and rock on the birth ball. If my client asks me to change out the chux pad on the ball that is full of amniotic fluid, I’ll put on a glove take care of it, and then remove it when I go back to rubbing their back. After every pair I use, I try to grab another so I always have a few pair in my pocket.
I try to use only one glove when I can so I have a gloved hand and a not gloved hand.
I wear gloves whenever I am dealing with bodily fluids, when supporting a leg during pushing, or rubbing feet when they don’t have a pad on. Basically I try to think about fluids potentially flying around and plan ahead.
It’s not just about gloves, either. I wash my hands or use hand sanitizer fairly often at births. If I go to grab something to eat, I wash. After I eat, I wash. If I blow my nose or use the restroom, I wash. When I leave the room, and when I return to the room, I wash. If needed, I’ll use a little of the unscented massage oil from my bag to prevent my hands from getting overly dry.
The clothes I wear to births are just for births, nothing else. Sometimes shoes, too. When I get home from a birth, the very first thing I do is put all my clothes in the washer for a hot water wash.
And finally, I make sure all my labor tools are either single use items I leave with my client (like lip balm, pony tail holders, etc.) or can be washed/sterilized (I choose to use racquetballs over tennis balls for this reason. I throw them in a bucket of bleach water in between clients. My foam knee pads have a washable vinyl outer layer as well.)
As a postpartum doula, there is much less need for gloves but they could still be useful when helping with breastfeeding if you are touching the baby’s mouth or the client’s breast. They also should be used if you’re washing laundry that has bloodstains on it, whether from a home birth or just lochia after the birth.
I also make sure that when I do touch my clients, they’re comfortable with it, and I do use warm skin to skin touch whenever possible.