Advocacy in the doula world is an ever-evolving conversation. Do you believe that advocacy is part of your role as a doula? What does that look like when you’re faced with busy care providers that are rushing through options and not really hearing what your client wants or needs? Or when your client comes back from a prenatal appointment not feeling heard or understood. Maybe you know that advocacy is important as a doula, but you just don’t know where to start or how to apply this idea in real life.
What if I told you the key to becoming a more impactful doula is understanding the difference between attitudes and beliefs? Learning how to recognize where you are on this journey and how to incorporate advocacy into your belief system will ensure you can confidently advocate for and empower your clients to step into and keep their power.
The difference between beliefs and attitudesThe definitions of belief and attitude are nuanced and overlapping, but a close look at the language highlights important differences worth examining as a birth worker.
According to Merriam-Webster attitude is defined as:
“a position assumed for a specific purpose; a feeling or emotion toward a fact or state”
And belief is defined as:
“a state or habit of mind in which trust or confidence is placed in some person or thing; conviction of the truth of some statement or the reality of some being or phenomenon especially when based on examination of evidence”
I like to think of attitude as a sweater -- something you put on and take off depending on the environment. The attitude you choose is in response to your surroundings, how you feel, your own preferences, and the situation you are in at the time.
You might be attached to a specific sweater, but it doesn’t actually help define and build who you are as a person. It can be changed without much drama and isn’t guiding your choices on a deep level. It might help influence certain choices like what shoes you wear to match (how you behave or what you talk about when certain people are around) but it doesn’t create lasting change when you don’t feel like you need it.
Beliefs, on the other hand, are more like your skin. Yes, there are things you can do to change aspects and the appearance of your skin (tanning, moisturizing, covering with clothing, shaving, waxing…), but it is a much more involved process and can even be painful. Characteristics of your skin are inherited and help shape your experiences. Integrated into your identity.
Attitudes are often dictated by feelings and emotions. Beliefs run deeper and are not so easily abandoned or changed. Beliefs are habitual where attitudes are situational.
Do you have an attitude of or a belief in advocacy (and why does it matter?)Let’s be honest - advocacy is NOT easy. Maybe your local birth community has strong feelings about how doulas are “allowed” to advocate. Maybe you were raised to think that being good is the same as always being “nice.” Quiet and never upsetting or inconveniencing anyone around you.
This stuff runs right up against what advocacy might ask of you. And guess what? Putting on your advocacy attitude sweater isn’t going to be enough to overcome these barriers. Looking the part isn’t going to be enough when your client is in the middle of a contraction and being emotionally coerced into something they made clear to you and the providers that they don’t want to do.
Identifying where you fall on the attitude-belief spectrum is the first step in fully integrating advocacy into your belief system and truly empowering your clients.
How can you make advocacy part of your belief system? Here are some steps you can take to start integrating advocacy into your belief system:
The last step is to commit to developing advocacy skill. This essential in overcoming those limiting beliefs and serving your clients with power. Role-play, get a mentor, take a course - do the work.
We invest in things we believe in. We have to step up and take advocacy seriously. Whether it should be this way or not - birthing people’s lives are at stake when we as doulas are not fully in our power. When we don’t have the skills and beliefs in place to have difficult conversations. To truly hold space and protect safe environments for our birthing families.
I am passionate about this and have developed different tools., to meet you where you’re at so you can start examining your biases and beliefs and develop the tools you need to be an effective advocate for your clients.
What would you do if you found out that your own biases and beliefs about birth were disempowering the clients you are serving? Chances are you started your important work as a doula after your own birthing experiences. And maybe that experience was a powerful, amazing birth that you believe all pregnant people deserve. More likely though, it was a birth that didn’t go as planned and you might even feel you need to protect your clients from their providers and the birthing system as a whole.
What if I told you that - positive or negative - your birth and beliefs about birth are deeply impacting your clients. Especially if those beliefs and experiences have not been examined. By understanding what biases are and how to take inventory of the ones you hold onto, you can truly empower yourself and your clients rather than creating an unintended dependency on you for their birthing experience and decisions.
What are biases?
So what is bias and why does it matter?
A bias is an inclination and preference toward one type of person, choice, or thing over another. Biases are not inherently negative but are always a powerful force behind our behavior. To reserve your conscious thoughts for more complex problem solving, your brain creates shortcuts for categorizing and making sense of the constant input of information coming in through the five senses. These shortcuts can then develop into biases.
Knowing that biases are an evolutionary development that can help take some of the shame and drama away when we start to identify and address the biases we hold. This process is happening mostly in the background, outside of our conscious awareness. Biases have a very real impact on our lives and those around us, but getting lost in a shame spiral about it isn’t necessary or productive to positive change.
Two Types of Bias
Your mission is to support birthing people in whatever choices they make around their birth. Why is it then that when your client says they are considering an elective induction you can feel a rush of adrenaline and an overwhelming sense of dread. You leap into action and start listing off all of the potential risks and the cascade of interventions you feel are sure to follow an induction? Is this not in direct conflict with your mission to support your clients in what THEY want?
So what’s happening here?
This is likely a case of implicit bias creeping to the surface. According to the National Center for Cultural Competence, an implicit bias “operates outside of the person’s awareness and can be in direct contradiction to a person’s espoused beliefs and values;” whereas, a person with an explicit bias “is very clear about his or her feelings and attitudes, and related behaviors are conducted with intent.”
Common explicit biases in the birth world are providers in the medical model being staunchly opposed to home birth or VBACs. Although explicit biases are damaging, they are at least often out in the open and therefore easier for birthing people to avoid and navigate.
Implicit biases are more dangerous because of their hidden nature. This would look like an OB that says they are VBAC friendly, but then they start pressuring the birthing person to have a repeat cesarean because that is what they are comfortable with
Birth work is intersectional. It is the meeting places of so many important experiences, social issues, and identifiers. Essentially becoming a perfect situation for biases to be formed and show up for everyone involved. This is why it is critical to do the internal work necessary to identify and address your biases as a doula. There are too many opportunities for shortcuts to evolve and derail the goals and needs of your client.
Imagine you and your client work together to prep for their next prenatal visit with their OB by building a birth plan, role-playing, and getting educated on each of the client’s birth preferences. You are confident that your client is fully equipped to communicate their goals and stand their ground if there is any push back from their provider. Only to find out that the OB suggested something completely different than the original plan, and your client is feeling conflicted.
Now consider these two possible responses:
Option one is based on fear and likely an implicit bias about some specific procedure, birth setting, provider, etc. And it DOES NOT empower the client. It centers you and your belief that they must be saved from this particular choice. It creates a dependency on you to make the right decision for your client.
Option two comes from someone who has done the work to address their own biases. It holds space for the birthing person to honestly express their thoughts and feelings, without the added pressure of a doula determined to save them from themselves. This response doesn’t deny your own beliefs, knowledge, or experiences - it just doesn’t make them the star of the show.
So how do you get to a point where option two is your natural response? You must start confronting your implicit biases. This is not an easy process and will not happen overnight. It is a journey that requires honesty, commitment, and accountability. But it is essential if you are planning on serving birthing people in a positive and impactful way.
Birth work is not about you. Or me. It is about birthing people. It is about constantly recentering them as the authority on their bodies, their babies, and their experiences. Understanding what biases are, why they are so important, and how you can start the work of confronting your own you are on the path to being the best doula you can be.
This stuff is hard work and requires you to take a deep and honest inventory of yourself. This is part of the reason I created The Advanced Doula Workshop. So many of my fellow doulas received plenty of training on comfort measures, the stages of labor, and what to pack in their doula bag, but there is little space for this kind of intense self-exploration.
Join my newsletter to stay up to date on the next Advanced Doula Workshop and learn more about how to tackle your biases to make a positive impact on your clients and the birthing world as a whole.
Is your birth plan helping you connect to your power and confidently advocate for yourself and your goals?
Birth plans can be a strangely divisive topic in the birth world. Some people believe they are rigid lists of what you do or don’t want done during your birth. But a birth plan done right can help you obtain the education you need from your provider to be able to say yes or no to a procedure that is most likely a routine practice or policy.
So how do you create a powerful birth plan? When you stop the information overload and uncover the values, beliefs, and goals behind your birth preferences you can create a birth plan that helps you connect with your power and feel confident advocating for yourself no matter what happens during your birth.
I hate to do this to you, but knowing all of the things about pregnancy and birth is not enough to build a powerful birth plan.
Now, don’t get me wrong. It is extremely important to know your options as a birthing person. Education and preparation can make a massive difference in your birthing experience. Taking a childbirth education class, hiring a doula, researching evidence-based care… These are all important pieces of the puzzle, but information alone isn’t enough.
You can spend hours pouring over information, review all of the options with your doula, and agonize over building a detailed birth plan, but if you come back from your prenatal appointments feeling unheard, your birth plan isn’t working for you.
It is really easy to get caught up in the gathering information stage of preparation. But having information (either in your birth plan or in your head) isn’t especially helpful if you can’t effectively communicate why that information is important to you.
How to uncover core beliefs and values
Getting clear on your core beliefs, values, and goals is the key to creating a powerful birth plan. When your plan is built on this foundation the process itself can be transformative and help you feel confident and empowered when making decisions about your care during pregnancy and birth.
But what does this look like in real life?
Here are some practical tips to help you uncover your core beliefs and values around birth so that your plan and goals are all in alignment:
You can repeat this process as many times as needed until you feel confident that you have gotten to the very core of your beliefs and values around birth.
Now you have a compass to guide each decision on your birth plan (and as things inevitably change during your birth).
Creating a powerful birth plan
I say this from a place of love, but If your birth plan does connect to your deepest beliefs and goals it isn’t worth the paper it is printed on.
Information is extremely important, but information without a WHY will not help you when you meet resistance or when things don’t go as planned.
It isn’t realistic to think you will be able to learn everything about every single choice, outcome, or procedure that could happen during birth. Using your core beliefs, values, and goals to guide the creation of your birth plan will help you focus on what is truly important to you and feel confident when communicating these goals with any care provider.
This is how you can put your WHY into action when creating your birth plan:
When you identify your core beliefs and goals about birth FIRST you can stop information overload and build a birth plan that is deeply connected to your power and lays the foundation to confidently advocate for yourself and your baby no matter who your care provider is or what happens in your birth.
Working with your doula, involving your care providers, and digging deeper than a basic birth plan is the first step in shifting the way you think about pregnancy, birth, and parenting.
I talk about this in the Keeping Your Power ® for birthing persons course. Do not miss out on this valuable information that you won’t find anywhere else. This course will help you communicate with your providers and care staff effectively in pregnancy and labor to plan the birth you want and is best for you!
Learn more about the Keeping Your Power ® concept here
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:
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:
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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I recently read a fascinating article in Romper called, "My Husband said no to a Doula & I'm still pissed." Writer Kelly Green openly discusses her frustration about her partner's decision "quasi-unilaterally" that they did not need to hire a doula for the birth of their child, a choice that Green writes should have been hers to make. I know hiring a doula can be a tricky thing, but they are beneficial for dads too.
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.
I’ve been a Doula in Alabama for many years, working, serving my community, and watching the birth climate change. That’s what we refer to as an Anchor Doula. As an Anchor in my community, I receive messages and emails on a weekly basis asking the same question: "How can I become a Doula?"
The first thing you need to know is that Doulas are not nationally regulated in any state. A person wanting to serve or help birthing families does NOT have to obtain certification to do so. While it’s not mandatory, I highly encourage a formal education process that will give you a solid foundation of knowledge before deciding if the Doula profession is right for you.
Ask Yourself These Questions
Whenever I’m asked how to become a Doula, I tend to answer the question with a series of questions:
When planning a birth, it is important that the information you receive is evidence based. Reading the evidence can help you make unbiased decisions about your upcoming birth. So many women are pressured into procedures or other assertive birth techniques that either do nothing to help the baby or can actively cause harm. That's why I believe in evidence.