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).
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