How many times have you seen (or maybe even posted) pleading questions in online doula groups that sound something like, “My client’s provider is showing all kinds of red flags! What do I do?” Maybe a client comes back from a prenatal appointment and reports that their provider won’t “allow” them to eat during labor. Or you’re in the birthing space and see the OB reaching for the scissors even though your client clearly communicated in their birthing plan that they do not want nor consent to an episiotomy.
Depending on your training, personal history, biases, and communication skills, it’s likely that you feel conflicted, afraid, unprepared, or uncomfortable taking any type of action when faced with these situations. Helping our clients recognize and address coercion and abuse in their care is part of being an advocate doula. And getting feedback when you feel stuck is necessary sometimes. But this is not simply a lack of experience at play here.
What if I told you that the medical system is not the only oppressive system at play in these moments? What if I told you that some difficult questions haven’t been asked when it comes to certification and the doula profession? We’re going to dig into a few key questions that MUST be asked if you are doing this work. Buckle-up because this road is rough but promises a patch of light at the end.
Why do you feel so conflicted and afraid?Why did you become a doula? Likely, you experienced or witnessed some form of birth trauma before you decided to start this work. You believe that birthing people deserve to maintain their autonomy and dignity during birth. You’re also beginning to see the flip side to this: that autonomy and dignity need to be protected, especially in an oppressive healthcare system. The more you work as a doula, the more you see that your clients are at risk of losing these things while birthing in our current systems. And that doula work is much more than just showing up to births.
And if you have some experience in birth, you also know that asking the laboring person to protect themselves while deep in the throes of labor is unfair and unrealistic. You know that a laboring person must turn inward to focus on the work of birthing their baby. That they cannot reasonably be expected to be vigilant and watch for potential abuses while working through transition.
This is not to say that you believe you know better than them or that you are their savior. It is just a reasonable understanding of physiology and knowledge of the way many birthing systems operate.
If you align with these beliefs, why do you feel so afraid and conflicted when you witness coercion and abuse of your clients. Why do you feel powerless to do anything in those moments? Why do you feel worried that if you speak up you are stepping “out of bounds” as a doula?
After talking to countless doulas, a common thread binds many doulas together - training and certification. You went to the workshops and learned about the stages of labor, how to do a hip squeeze, what to pack in your doula bag, and how to do a consult. And then you spend time learning about your scope as a doula (as defined by your certifying organization). But you likely received zero training on facilitating productive conversations between your client and their care provider.
You’re told that you are an advocate (and believe in advocacy as part of your role). And then a scope is placed on your advocacy That you advocate strictly through educating your clients. That you do not “speak for” your client. Or worse, that you don’t speak with medical staff at all.
You walk away with a name tag and a badge to put on your website showing you’re certified. You pay your recertification fees and build your business on the idea that your certification is the key to being qualified. Your permission slip to serve birthing people.
And then you witness abuse in real-time and walk away knowing you should have done more. But for some reason, you froze. Your fear and conflict about advocacy led to inaction, even though you believe what was happening was wrong.
I’m just going to say it right now - you feel conflicted because there is a battle between what we feel to be true and what you've been told is true. This is gaslighting. You’re being told that you’re an advocate and then handed a list of rules defining all of the ways you cannot advocate for your clients. It is crazymaking to be assigned a role and then be told you can’t actually fulfill that role in any practical way.
Pause here and think about the questions that follow. Sit with them and notice how you feel in your body. Take time to really think about your answers
There is nothing wrong with getting certified. It can be a great way to set up a solid foundation of knowledge and skills, begin building a community with other birth workers, and gain access to continuing education. But doulas are not regulated (yet), so your decision to get certified (and the organization you choose) must be carefully examined.
Who decides what your role is in the birthing space?Another line of thinking I hear from so many doulas is: “I am afraid of overstepping my bounds in the birthing space.” Or “I have to stay in my lane.” Thoughts and statements like this are in part a predictable result of working within oppressive systems and confusion about who decides what your role is in the birthing space.
When I work with doulas in my workshops, we spend time discussing and really thinking about who it is we work for as a doula. You may think, “of course I know whom I work for - my clients!” But don’t be so quick to answer this question. This is the correct answer, but the real question is whether or not you believe this fully.
Let’s break it down a bit more.
Your client hires you as an independent member of their birthing team. This means the decision about the scope and function of your role is between you and your client. Not your certifying organization. Not the hospital staff. Not the birth center staff. Not the homebirth midwife.
Your client determines and communicates what it is they need from you as their doula. The responsibility is on you to determine whether or not you can (and want to) fulfill the unique needs of your client.
If we go back to some of the statements and questions from earlier, the answers seem much clearer now:
“My client’s provider is showing all kinds of red flags! What do I do?”
“I am afraid of overstepping my bounds in the birthing space.”
“I have to stay in my lane.”
How do these questions and statements feel when you think about our client’s unique needs as the ultimate definition of your role as a doula?
You ask your client how they feel about their care provider’s comments/behavior and LISTEN to their answer before offering additional options or information.
Your client defines what the boundaries are in their birthing space. Your only concern is supporting your client and the boundaries they set.
Your lane is defined by your client and your own experience.
Your clients determine the standards for your job. When you align yourself with a care provider, certifying organization, hospital system, etc. before or over your client, you have given away your own power as a doula.
Your role as a doula is first helping clients identify their own unique beliefs, values, and goals when it comes to their care. You check your biases at the door and then do everything you can to keep your clients at the center of care during their pregnancy, birth, and postpartum journeys by listening to and honoring those beliefs, values, and goals.
Where do you go from here? I’ve said it before, but it deserves repeating: knowledge is not power - the implementation of knowledge is power. This is where the work really begins (and the tough love).
Lastly, reconnect with and remind yourself often why you started this work. For many of us, we are passionate about helping our clients connect to and preserve their power. We can only do this if we first understand our own biases and beliefs, constantly recenter care and authority to our clients, and invest in the skills necessary to prevent trauma (for our clients and ourselves).
I will be announcing an amazing new resource soon, so be sure to sign up for the newsletter so you can be first in line!
What happens when you show up to a prenatal appointment and your favorite care provider in the practice says something that leaves you feeling stunned, betrayed, or feeling helpless? You have built what felt like a respectful, trusting relationship with this provider, and they’ve been so nice up to this point. Maybe you misheard it? Maybe what you were saying wasn’t clear. But, no. You confirmed your birthing choices with them and they said something like “I wouldn’t recommend that if you were my daughter…” or “you want to have a healthy baby, right?”
Language matters and it can be difficult to navigate when you are depending on an expert to interpret their knowledge and experience into medical advice. You can’t prevent someone from using coercive language, but by understanding what your expectations are of your care provider first and then learning to recognize how you feel when someone else is using coercive language you can respond in ways that keep the power and ultimate authority where it belongs: within yourself.
What is your care provider’s role?Keeping your power begins with your beliefs. This is no less true when it comes to protecting yourself against language that is coercive during pregnancy and birth. Before you dive into what makes a statement or situation coercive, you need to take time asking yourself what you believe about the role of your provider.
In my experience, it comes down to two basic beliefs: you believe your care provider should offer emotional support alongside medical advice or you believe they are strictly medical advisors responsible for providing recommendations based on their knowledge and experience. Likely, you fall somewhere between these two beliefs. Being honest about where you fall on this spectrum is essential to having empowering, productive conversations with your provider.
If you believe your provider should be offering emotional support you might ask questions like “what would you do in this situation?” You might find yourself seeking the provider’s approval for your medical choices, asking them for reassurance, or feel concerned that you won’t have a good experience without them at your birth.
On the other hand, if you view your provider as strictly a medical advisor you’re likely to ask what evidence supports a suggestion made by a provider, be less concerned if one specific provider attends your birth, seek emotional support from friends, family, or doulas.
Having an emotionally supportive provider is like the icing on top of a cupcake. It can make things smoother, sweeter, and more pleasant, but it isn’t the foundation. Foundationally, you need a provider that can explain your options in pregnancy and birth without bias and supported by evidence.
What makes it coercive?With your beliefs clarified, you can dive into recognizing coercive language when it’s happening. Most of us can identify when someone is overtly threatening or trying to intimidate us. But what happens when your provider offers to pray with you and then tells you that attempting a VBAC is like wandering into the middle of a busy road? It’s easy to assume that coercion is overt, obvious, and intentionally malicious. And don’t get me wrong - it sometimes is all of those things, but you aren’t fully prepared or protected if we don’t talk about the other types of coercion.
What I see much more often is what I like to call soft coercion. This is sprinkled into pleasant conversation with some southern charm. “How’s your mom doing? Oh great! I know you mentioned wanting to avoid an epidural, but nobody gets a trophy for birth. Let me do the work so you can be comfortable.”
I’m not picking on providers here (or my fellow southerners). Interactions like this have much more to do with unrecognized biases and fears by the provider than intentional manipulation. But the thing is, intention doesn’t really matter. All that matters is the RESULT of the language being used. Is the language your provider uses resulting in you feeling informed and confident or trapped and afraid? If it’s the latter, you are likely on the receiving end of coercive language (even if it’s wrapped in concern for you or your baby).
It’s helpful to think of coercive language on a spectrum from soft to hard that can look like this:
What can you do when you encounter coercive language?You might be thinking yourself “Now what?” Having clarity on some of your beliefs and understanding more about the different types of coercive language isn’t worth much if you don’t know how to put it into practice. Don’t worry - I’m going to outline a few actionable steps to help you prepare and protect yourself against coercive language.
First, check into your body at each appointment with your provider. Do you feel tense? Knots in your stomach? Did you suddenly feel flushed and sweaty after something your provider said? Maybe even nauseous? Your body is providing you with important information here. Coercion does not signal safety to your brain or your body. Your body might be priming for protection mode if your provider says things that feel coercive. Don’t ignore the physical signs.
Next, check into your belief system. If you don’t believe your provider’s main role is giving you emotional support, don’t ask questions that open that door. You need medical advice here.
And if your provider offers up suggestions based on what they would do, or what choice they would want a loved one to make, you have a few options:
Last, remind yourself (and your provider if necessary) that you are the ultimate authority on your body, pregnancy, and baby. You are the one who is able to weigh the risks and benefits of each choice against your specific beliefs, values, and goals.
Unfortunately, coercive language is commonplace in most birthing cultures. Perceived power differentials, paternalistic ideologies of care, the pathologizing of birth, and defensive practices (to reduce legal liability risks) prime many care providers to feel they need to convince you to make very specific choices when it comes to pregnancy and birth.
Understanding your own beliefs, values, and goals when it comes to birth is the first line of defense when it comes to Keeping Your Power® in these situations. Learning how to recognize coercive language when you hear it is the next step. And finally, having actionable tools in your toolbox will help you navigate difficult situations when it comes to getting the medical advice you need to meet your birthing goals.
You’ve seen the evidence and know you want doula support for your pregnancy and birth. So you hop online and do a quick search for doulas in your area - should be simple right? The short answer is no, depending on your local birth community. You might be facing a long list of doulas with stark differences in support style, beliefs, and skills.
How do you narrow down your search and find a doula that aligns with your birthing goals? The key starts with you. Taking the time to understand your beliefs about birth, explore what your ideal birth would look like, and ask the right questions during interviews will help you find your perfect doula match. And you can do it without wasting precious time and energy sifting through doulas that won’t be a good fit.
Beliefs about birth
Your heart is set on an unmedicated birth, but do you know why? Assessing medical risks and benefits is important -- don’t get me wrong. But benefits and risks don't paint the full picture. Understanding your core beliefs is essential to creating birthing goals that matter to you. Without clarity on your beliefs, you will be more susceptible to influence from those who don't share your vision. It is much more difficult to advocate for what you want and need if you don’t know why you are making those choices.
But what does this have to do with finding the right doula? I’m glad you asked!
Do you believe that birth is a sacred, spiritual experience? That the birthing space needs protection?
Do you believe that care providers know what’s best for you and view them as the authority on birth?
Did you have a traumatic experience during a prior birth?
Do you know you need help advocating for your goals and rights during birth to avoid further trauma?
These different beliefs demand different types of doulas. Here are some tips for figuring out your beliefs so you can find the right doula for YOU:
Debrief prior births: find a person or community that feels safe for you. Dig into your past birth experience if you’ve already given birth before. What went well? What would you change? What do you want to be different this time?
Make birth art: draw or sculpt a pregnant person. Paint what giving birth looks/feels like. Write a poem about what being a parent looks/feels like. How do you feel as you’re making the art? How do you feel when you look at your finished work? Do any fears come up?
Make a values statement: What are your core values? Break them down into categories like personal, social, political, economic, and religious values. How do these values relate to and intersect with birth?
Take the Keeping Your Power® course: learn how to not only identify your beliefs and values, but real skills to apply in all aspects of your life to always keep your power.
Your doula will also have core beliefs about birth and their role as a doula. If you know what you believe, you will be able to identify doulas that match your unique birthing needs.
Knowing what you believe about birth is a great start. Now it’s time to put this information into action. Your birth beliefs will be the compass as you work out what your ideal birth will look like. This is not a wish list or a rigid prescription. Your ideal birth helps you create a roadmap for your birthing experience.
There is no right or wrong answer here. The gold is in the exploration. What fears come up? What stands out for you? Write it all down.
Tune into your gut and listen to what your body is telling you as you share your ideal birth with potential doulas. Is this person on the same page as you? Do they fit into the visualization you have made for your birth?
Asking the right questions
With your birth belief compass and ideal birth roadmap in hand, it’s time to start mapping out your birth route. The way you do this is by asking the right questions of yourself and your potential doula.
Who you allow into your birthing space can change the course of your birth. Not all doulas will be right for you, and that is just fine. Using your compass, roadmap, and route for birth as a guide will ensure you find the perfect doula match for YOU.
If you are trying to find a doula that believes advocacy is integral, I have a project in the works for you! Sign up for the newsletter to stay updated.
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.