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


Lisa said...

Yes, Yes, Yes, Amen, Amen, Amen!!

motherwitdoula said...

My hands are pressed together at my heart, and I am bowing to you, my sister.


Carol said...

I started getting certified for being a doula and then realized that at this time in my life being a labor doula is not for me. But every now and again I have friends who want me to be there for their births as their doula.. I make sure to stress to them I am only their friend, who happens to be pro natural birth and knows techniques to help with X,Y,Z. I dont like to be called a doula even though I am filling that role. Why? Because the one time my friend said that I was her doula the nurses demeanor changed.. They didnt like the fact that I was there. I have spoken to L/D nurses that say that Doulas always advocate for the patient when they shouldn't...

pinky said...

Thank you.

Birthing Service said...

As a doula, I feel that it is my job to help educate and empower families to make the best decision for them.
I however do not think that doulas as a whole will ever be banned, and if by some chance they are, then I would just change my name I would be a birth support professional, or a close family friend or something. I think that the birth community as a whole worries far to much about what everyone else is doing and not enough about what they themselves are doing. After all if I can establish a good relationship with a care provider it may means that while that care provider may be leery of other doulas, I will always be welcomed at a birth with them.

Rebecca said...

Not sure if I'm playing devil's advocate here, but here are a few thoughts that came up for me as I read this. I agree that doulas CAN be our own worst enemies, by stepping outside our scope of practice or making women's births about our own desires vs. their wishes and needs...but ARE we?

But I still see my biggest obstacles as the medical staff who are hostile to doulas not for what we do that is outside of our scope of practice, but what we do that is INSIDE our scope of practice. Those medical staff do not want me to ask the nurse if she can get off the monitors, advise the woman of her options, or remind her she didn't want medication. I have heard many stories of nurses saying to doulas "Oh, you're great, I haven't liked doulas before because they were so hostile/gave my patients advice/did something inappropriate etc."

Is this because they worked with a Bad Doula before, and now they are working with a Good Doula? Or is it just because this birth happens to be going smoothly and presents few opportunities for conflict? My experience is that the medical staff like me if they think I am helping them achieve what they want for the mom, and if I play any role in empowering her to deviate from their plan, I'm now the Bad Doula, and they can probably even twist my appropriate actions/advice into something that sounds like it's not appropriate/outside my scope of practice. Then they can pass that story around and it just creates more hostility towards doulas and a greater suspicion of anything a doula does.

ACTUAL Bad Doulas out there make things worse - and I do know they exist!! - but I take all Bad Doula stories with a grain of salt. It is too easy to be labeled one; just because someone doesn't like what we do doesn't mean it's not appropriate.

Nicole D said...

Hi Rebecca - I don't think you are playing devil's advocate, and I understand what you are saying. There was a time and a place where I might agree with you...

I can deal with a few doctors not liking us for what we do WITHIN our scope of practice, we will always find those.. but it is the doula behaving inappropriately that can ruin it for a whole community of doulas/moms - which is what I am seeing happen more and more in recent years.

Women can always go find another doctor who is simply a hard #%$ for working with doulas, but the 'bad doula' rap is something that CAN ruin a whole community and we HAVE the power to control with how we behave, reducing the risk of a woman having even less options. That is the body of this post. :)

Nicole D said...

Hi Birthing Service! I understand and agree with what you are saying - by all means, we should regularly take a critical look at our own practices and make sure that we are providing service above reproach. Additionally, there are those docs who trust me and not others so much. I have worked with OBs and midwives who routinely recommend me and shy away from others. That is GOOD. It is a sign that you are doing well!

BUT, I want women to continue to have full options that range from nurses who don't have a chip on their shoulders, to OBs who haven't had someone cause a hostile environment for their clients.

Just as I am an advocate for my client, I am an advocate for my community.. so, if I see a doula behaving badly, I consider it only right to call them out on it and tell them to stop.

As a birth community, we should be looking out for one another. Just as I might call out a doctor who is lying to women, or call out a childbirth educator who has bad business practices, we have a moral obligation to work as advocates for our community (for a definition of community, http://www.merriam-webster.com/dictionary/community)

We have a common interest, the interests for the women we work with, and I want to ensure that their options remain open.

By all means, and you are right, we should keep a keen eye on ourselves as well. And, if I EVER try pulling a sliver out of one doulas eye and ignore the plank in my own, PLEASE be sure to point it out to me.

I know GOOD DOCTORS who used to LOVE doulas.. but then they had a run in with two different doulas who behaved ill. Now, those GOOD DOCTORS are remiss to allow ANY doulas in to the birthing room. That is sad. If a woman wants this GOOD DOC and a GOOD DOULA, she can't have both. If I can prevent that by admonishing those doulas who are practicing ill, I will.

We live in a society were 'live and let live'. I don't live that way, though. I feel a responsibility to advocate for my childbirth community (common and professional interests) and my maternal community (interacting population).

Juliea said...

I pride myself on being a doula who works within this realm of respect for the individual and the choices that they have made. I will be the first to admit that I have strong beliefs about what is best for mother and child before, during and after the birth of their babies - but I have always respected and honored that the choices that people make are theirs alone. The most I can hope for is that I can help to educate and promote fully informed decision making. I am not responsible for anything beyond that except for pure love and support...which I'm really good at. ;)


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