How many times have you heard -- or even said yourself --  “just switch providers,” after someone has a difficult prenatal appointment?

This response makes a lot of sense on the surface when your client is clearly mismatched with their provider, their goals and choices are not being supported, or they are not being treated respectfully. You know that if a pregnant person is meeting resistance around their preferences in their prenatal appointments, it is likely going to continue into the birthing space. You want to protect them and do everything possible to help your clients have empowering, beautiful, and safe birthing experiences. 

So why not just switch providers if they aren’t on board with your client’s preferences and birthing goals?

The short answer is that this doesn’t address the core issues here. And it absolutely doesn’t guarantee a better outcome or experience in the birthing space. 

We need to dig a little deeper. Let’s look into common reasons for provider-patient mismatches and the impacts of privilege and barriers to care, first. Then we can review practical skills and tools to support your clients in advocating for themselves at ALL times -- especially when switching providers just isn’t a realistic (or even the best) option. 

Common reasons for provider-patient mismatch
How do you know there is a serious mismatch between your client and their provider in the first place?

When our clients come back from a prenatal appointment feeling dis-empowered, unheard, or disrespected, it is easy to jump into protective mode. But this is precisely where we need to slow down and uncover the core issue before we can offer impactful support. 

Understanding common themes and barriers to communication will help you support your client in finding ways to meet their goals without immediately suggesting they jump ship. 

Communication barriers and breakdowns are almost always the culprit. And this can take many different forms: 

• Is the client informed enough about their options and goals to ask the right questions? 
• Is there a fear of authority preventing them from speaking up? 
• Are they feeling confident and supported when they walk into their appointments? 
• Do they have team-building skills or is there someone with them who does?
• Is there a power differential at play between them and the provider?
• Are there biases -- both with the provider or the client -- that may be blocking effective conversations?

Attending at least one prenatal appointment with your client can give you the opportunity to create better communication and work to build a sense of trust for the client and the provider. Having everyone rallied together around a common (and clearly communicated) goal can make a major difference in how your client feels about their care. 
Privilege and barriers to care
Are you taking into consideration privilege and barriers to care before suggesting your client find a different provider? This can make a huge difference between your client stepping into (and keeping) their power and feeling unheard, unseen, and disempowered. 

The reality for many birthing people in the United States is that they have very few choices or options when it comes to who actually provides care to them during pregnancy and birth. And if you fail to address these realities you cannot get to the core of the disconnect or fully support your client in having a positive birthing experience.

They may live in a state with legal and logistical barriers to midwifery care or community care options… 

Or in a rural area with only a handful of providers… 

Or they may be heavily restricted by their insurance coverage… 

Even if a client switches providers, what happens if that provider is part of a large group and they aren’t on call when your client goes into labor? What happens when your client plans on an out-of-hospital birth but they end up needing to be transferred?

What about the crisis level racial disparities that black birthing people face every day in our country? Will switching providers guarantee that every nurse/doctor/midwife they encounter will not have implicit or explicit biases against them, simply because they are birthing while black?

You must address privilege and biases in yourself first, and then acknowledge this reality for your clients if you are committed to changing birth for individuals and for society as a whole. 

Your job is to help identify where these barriers exist and help your client change the way they think about their care, their role in the relationship with their provider, and help them develop skills to advocate for themselves no matter what happens during their pregnancy and birth. 

What to do instead of suggesting someone switch providers
So what do you do when your client comes to you feeling defeated, overwhelmed, and dis-empowered after an interaction with their provider -- instead of suggesting they pack up and move onto greener pastures?

You go back to the basics of doula care. You hold space for them. And you provide them with a new way of thinking about their power in all experiences, not just in birth. 

Your suggestions and opinions might be helpful, but do they help your clients step into and keep their power? Or are you creating a dynamic where they turn to you for strength and guidance rather than turning inwards to tap into their power and wisdom?

Here are a few concrete steps you can take instead of telling your client to fire their provider:

• First, validate how they are feeling and what they experienced.
• Then, ask questions that help them get to the core of the disconnect. Is there a bias that needs to be dealt with or a breakdown in communication you can help them identify?
• Next, educate them on their options without trying to influence their decision. Help them get crystal clear on their goals, role play effective communication, and come up with a plan that recenters them as the expert on their bodies and their care. 
• Finally, offer to go with them and be a supportive presence at their next appointment.

Outside of these suggestions, it is so important to do the internal work on yourself required to be an effective advocate. Deal with your biases. Get additional training around communication and advocacy. Keep learning and growing as a person and a professional. 

If you don’t understand your own power you cannot help your clients see their strength either. 

The grass is rarely as green on the other side as we hope it will be… especially if the core problem isn’t dealt with from the beginning. 

The ultimate goal is to help clients discover their power and develop trust in themselves. Rather than creating dependency or ignoring your client’s power -- by quoting stats of different providers or simply handing them a list of providers that you prefer -- help them discover true empowerment by getting down to the bottom of their belief systems and the core of what they want to do. 
Recognizing what is causing the disconnect and understanding what barriers your client might be facing in access to their care will help you develop a solid foundation for your client to connect with and keep their power in all of their interactions -- before, during and after birth. 

Your work is incredibly important. You have the unique opportunity and are in a position to change not only your client’s pregnancy and birthing experience, but to change the way they move through the world. And to help them believe in and trust themselves. To transition into parenthood with confidence and power. 

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Good communication with your care team during pregnancy is an important start to building the foundation for your birthing goals, but you may be blindsided by a comment you don’t know how to handle. Maybe it’s not an extremely negative comment, but it still hurts none the less. Language matters. Words are strong. If your provider says any of these, it may be a red flag:

So I heard a story recently that has my brain reeling. 

During a birth, comments from a care provider about the baby "blowing out" mom's vagina to then give her the option of forceps or cesarean  after only 30 mins of pushing and baby doing well. 

As a doula, one of the very first questions I ask my clients is what is their belief system around birth? What are their birth experiences? What do they know about their own birth? I want to understand their perception of birth in their birth culture.

What the majority of families describe is a hands-off, family-centered, low intervention, natural feeling of care. They talk about wanting to be seen as a normal person who’s having a baby and not a medical condition. ​

by Traci Weafer

Back when I first begin doula work, I heard a lot of buzz about empowering women in labor. I read books, articles, and blogs. I went to conferences about birth, training's about how doulas work, and bought other doula things that hopefully shed some like on how to empower women in labor.

by Traci Weafer

​In the world of Douladom, there are many schools of thought surrounding birth. Birth philosophy is formed through one’s experiences, past birthing knowledge, obtaining certification, and diving into doula work in one’s community and birth culture.  Birth: What does it look like to you?