Our Own Worst Enemy

Lesley over at MotherWit wrote a post last year on Doulas Behaving Badly. This post returns to mind often, as I am seeing an increasing number of doctors and practices in my area refusing to ‘allow’ patients to have a doula attend them during their birthing time.

I love her post, it resounds so true, and is a great jumping off point for my own thoughts on the subject.

“... my purpose and my goal is to ensure women get the best possible care within the system they choose. This is not by control, but by support.” Lesley Everest

When I speak with women during labor and birth, it is never with bias or coercion, This is an important one – all doulas start their businesses with passion; a passion for things to happen the ‘right way’ or the ‘best way’… but, through experience and personal growth, we should all come to the realization that, as our name implies, our job is not to give every woman the ‘right’ or ‘best’ way to birth in our own eyes..

Our job is, as doulas, to give every woman ‘her right and best way to birth’ to the best of our abilities.

Much of this is accomplished prenatally.

We have all have encountered the women who want a doula to ‘save’ them from the experience of a hospital birth, and yet, they are choosing a hospital birth. My role, every doula’s role, is not to save a woman from the situation that she places herself in, instead it is to educate her prenatally on how to be an empowered and educated consumer within the system that they choose.

If a woman chooses a doctor whom I think it paternalistic and controlling, I will be sure to point out the inconsistencies in what she says she wants and the type of care giver she is choosing. If she persists with that caregiver, though, she has chosen that caregiver.

My job is to support her choices.

I cringe so hard when I read reports and hear stories like the ones in Doula Makes Four. In this article, a doula ends up walking out on a family who, prenatally, wanted a natural birth but, because of her particular labor situation, chose to have an epidural. In another example, a LC encourages a mom to take her preemies off of formula and only IV nourishment until mom was able to nurse.

I know doulas who have:

• Grabbed doctor’s hands to stop them
• Walked out on families who deviate from their birth plans
• Coarsely and rudely ‘call doctor’s out’ in front of their patients
• Turned off pitocin
• Yelled at nurses or spoken down to them

Again, my job is to support the woman’s choices, not make them for her.

Don’t get me wrong, I work my butt off to keep her on track with her prenatal choices and desires, but I, like any wise woman in the childbirth field, will tell you: labor and birth is organic, unscriptable, unknown.

It is best supported knowing what you want, doing all you can prenatally to ensure that the goal is feasibly accessible, and then working hard to achieve it.

That means, while in the birthing room, my job is to make communication between her caregiver and herself fluid and open. It is not my job to grapple with the medical staff, inhibit their care of our mutual client, or make choices for the couple I am working with.

If the mother has given me expressed desires, though, I will be sure to remind her of those throughout the birth journey so that she can make her own choices while traversing her own organic experience.

I do not give medical advice; I supply women with many options and recommend that she talk with her provider about which would be appropriate, through analysis of the risks and benefits, for her particular case.

I do not unhook a woman from IVs, encourage her to check herself out of the hospital AMA, or take women off of EFM. Though, I will remind a woman of how long she has been on them, ask the nurse if mom can get off the monitors, and be truthful with a mother about the ability to refuse any treatment at any time.

Doulas who create an atmosphere of tension, a power struggle, with the care providers whom the woman has chosen are stepping outside their role as a doula.

Doulas who tamper with medical equipment without notifying the medical staff or otherwise inhibit their care of the client are stepping outside their role as a doula.

Doulas who openly argue with nurses and care providers, contradicting them or openly and hostilely confronting them are doing their clients a disservice, not supporting the client’s choices, and stepping outside their role as a doula.

And the long term consequences of these actions are becoming evident: doulas are getting banned from doctors clients, offices clients, and even whole hospitals.

Now, I won’t place all of the blame on doulas…

Sometimes women choose to have a close female friend attend them at their birthing time – acting as their doula. This is a great option if you have a wholly supportive and educated female friend.

If you are one of those women and your friend does attend you during your birth though, please don't refer to her as your doula, call her your friend. I have been privy to a few occasions where a friend calls herself a doula, acts outside the standard of practice of a doula, and, as a result, taints the name of doulas to that particular doctor or practice.

The result could mean doulas being banned from that particular practice or hospital.

Bottom line, all of you Doulas behaving badly: cut it out. We have worked hard, as professionals, to create a standard of practice. If you want, consider it working within enemy lines, but the truth of the matter is this: in most situations we are all on the same team. We all want what we see is best for the women we serve.

Just as a mother hires her provider to provide her a service of childbearing care, so is she hiring you to provide her a service of educating and empowering her… not robbing her of that empowering opportunity by taking that power into your own hands.

You work for her… as a woman’s servant.

“You may justify yourselves all you want by making snide remarks about brown nose diplomacy. I would rather wipe off the occasional stain than have my spotless snout shut out entirely and responsible for leaving vulnerable women unbuffered in that system”... “Instead of healing this birth culture through your angry, righteous approach, you are going to get doulas, the very ones who hold the power to heal it, barred from hospitals entirely.” - Lesley Everest