One comment I often during interviews is that our potential clients are hiring a doula to be their advocates. They mention wanting us to stand up to their providers, speak for them, protect their birth plans and prevent unwanted interventions. In fact, I make sure to leave plenty of time to discuss this very topic with all the families inquiring about labor doula services. Why? Because we are not your advocates.
Clearly this brings up questions from many people …
But, wait, don’t doulas “stand up” for their clients in the face of their providers? NO.
Don’t doulas speak for their clients and make sure the birthing person’s wishes are being heard? No, probably not in the way you’re imagining.
Aren’t doulas supposed to advocate for the birthing person? Yes, but not in the way most people think.
Let’s look at this a little deeper to understand.
Much of the confusion comes from misconceptions about a doula’s role and birthing people’s expectations. And that’s understandable. Simply google “doula” and page after page describes doulas as advocates. In fact, advocacy is detailed as a major role that doulas should take for many doula training organizations, listed immediately and clearly on American Pregnancy’s page, and even as a part of the job description on a very prominent (and trustworthy) website, Evidence Based Birth.
If you read these links closely, you’ll see that the advocacy that well-trained, professional doulas undertake involves being present to provide support, helping our clients use THEIR voices to gather information and make THEIR OWN decisions about birth. Instead of “standing up” to providers, we encourage dialogue and team building long before you enter labor and delivery.
A wise, long time doula in my area does the very best job describing how the word “advocate” misses the mark. Denise Beaudoin taught class called Collaborative Practice (currently still being offered by other outstanding doulas from our area) that helps doulas be more effective at working collaboratively with providers. The class focuses on creating a more empathetic perspective around providers so that doulas can best serve their clients. See how this is already different from “save me from my provider?”.
In Denise’s training, participants conjure up an image of what “advocacy” means. Most people start thinking of people on picket lines, holding up signs calling for rights for other people, or something similar. Clients who think of doulas as advocates may expect us to act in a similar manner – asking us to “prevent” things from happening, “argue with the provider”, keep the doctors abay by stating our client’s wishes. This sort of behavior does not go over well in a labor and delivery room. In fact, actions like this is why many providers around the nation don’t want to work with doulas or ban them altogether.
Denise goes on to describe the doula’s role a bit differently. As a diplomat. Hmm, think about that. What image is conjured up? Does it ryle you? Do you picture signs and chanting for a cause? I picture someone who helps facilitate conversation, supports the thoughts and goals of the people involved, creates the dialogue that is needed for informed consent and increases mutual understanding. Sounds nicer, doesn’t it? This is what a doula does.
We ARE there to support your wishes. We are there to advocate “your birth”, but not “FOR you”. We can’t birth this baby for you, and we can’t make decisions for you. Instead, professional doulas guide you, help you navigate the trails of birth, and actively build relationships with providers, nurses – even your family members.
If you’re scared of your provider- we talk about that: what your fears may be, where it comes from, and how to navigate this situation. I’ve seen so many clients’ fears be completely extinguished by simply getting to the root of the fear, creating a list of questions the client wants clarification about, and the client having an in-depth conversation with their provider. Often fears are based on miscommunication and judgement.
If a provider offers an intervention during your birth, we watch and see how you respond. We may remind you that this is different from your original plan and ask you if you want to ask more questions. If you’re not aware something is happening , we do call attention to the situation and encourage your input. (This is rare in our area, by the way.) See how this approach facilitates a more collaborative relationship with your provider and you?
This approach also means that we aren’t “advocating” for a choice that you might not have made on your own. You get to change your mind during birth. You get to decide what is right for YOU. So, while we may have talked about your desire to not have an epidural or break your bag of waters during labor, you may come to a point where you change your mind. If we jump in when a provider offers these tools, we’re getting in the way of your voice and your decision making. Our goal is to be a positive intervention, not one that causes discord during your experience.
Many of our clients are referred to Birthing Stone’s doulas by their providers not only because of feedback from their patients, but also because they, personally, have seen our professionalism, our collaboration, and our ability to truly support our clients in self-advocacy.
We’ll help build you up before your birth and enable you to speak up if you feel vulnerable. As your doula, we’ll be there to help make sure that the strongest voice in your birth is YOURS. So come hire us for our support, encouragement, ability to help you advocate for yourself, but please don’t hire us to be your advocates.
Birthing Stone Doula is a birth and postpartum doula agency supporting families in the Portland, Or area.
Copy write 2016, Tiffany Decker, Jen Ames-Brown, Claire Hoffman