This one’s going to be a wee bit more serious than I usually like to get, but I think it’s important so bare with me!
Over the last several years I have noticed that there is a huge, growing misconception – not only among parents but with some doulas as well – that it’s our job to advocate vocally on your behalf or to ‘save’ clients from the medical team.
I have been interviewed by potential clients who tell me that they are looking for someone to ‘speak up for them’, or to ‘be their voice’ if they can’t get the words out during birth or if their partner forgets to say something. Other clients have asked me point blank about my personal views and opinions about their choices or have asked me what I think they should do in a certain situation.
This is not something that a I as your doula, or the vast majority of seasoned doulas, will do. Some say that it’s because we are concerned with preserving the journey and respecting your autonomy. Although these are absolutely priorities for any of the doulas I’ve met there are other reasons that should be considered before asking your doula if she will take control of your birth.
1) We have absolutely no legal right to make medical decisions on your behalf. We are not your next of kin. We are not you. We do not hold power of attorney. Saying something as simple as “NO! An episiotomy is not on her birth plan!” would be making a medical decision on your behalf.
2) We are. Not. Doctors. Or nurses. Or midwives. Well, ok some of us are, but the majority of us are not. While an unexpected intervention can be stressful or scary, they also aren’t always automatically unnecessary or important. There may be a ton of stuff going on in the background between your medical history, your baby’s response to whatever is going on, and billions of other variables to consider when deciding what the best course of action to suggest is. We can help you uncover those and help guide that conversation with your medical team, but it would be wildly inappropriate to assume that as a doula I know FOR SURE what is best for you medically.
Imagine what the repercussions to you and your child might be if we declined an intervention on your behalf, or pressured you into going down one path over another because ‘we’ felt it was best. Do we know a lot? Heck yes. Have we seen a lot? HEEEECK yes. Are we medical providers? Does the responsibility of the physical well being of you and your baby rest on the doula? NOPE. If you feel like your medical provider is someone you need ‘saving’ from you might do well to consider changing providers. If that’s not possible, your doula should be able to make suggestions about how to work with your provider more cohesively, as well as suggest ways to work within the provider’s requirements while adhering as closely as possible to your preferences.
3) We are no good to you in the hallway or banned from the hospital. Physically interfering with a procedure, or directly pressuring you to ignore or go against your doctor’s advice is a quick way to land us there.
4) Sometimes things change. Regardless of how strongly held your views on things were before labour you may have a change of heart or birth may present things that require a change of plans. You wouldn’t likely appreciate guilt from me hounding you to “stick to the plan no matter what” any more than you would appreciate me insulting your choice of care providers, induction method, choice to wait beyond 42 weeks, to decline antibiotics for GBS, or any other early parenting decision (yes your pregnancy choices are the start of your early parenting experience!)
5) Perhaps most importantly, it’s YOUR body and YOUR baby. Your voice and the voice of your partner is your POWER. I can’t tell you what you should do if you call me at 37 weeks after learning that you are GBS positive, or tell you to that it’s in your best interest to decline that administrative/policy induction at 41 weeks without also robbing you of your power. Becoming a parent means making choices that affect another person and that starts now. Only you can know what’s best for you and your family and that will not change.
So what does advocating ACTUALLY look like? It’s a little bit different for every doula, but to me it means:
1) Making sure you have as much information as possible before labour begins.
2) During birth it means making sure you have all of the information you need as your birth unfolds.
3) It means making sure that you and your partner have been given as much time as possible to process the information you’re given, and that you are able to ask questions ( yes I will remind you of questions to ask if you can’t think of any).
4) It means that I will remind you that you DO have the right to both informed consent and informed refusal (key word there is informed, not reactionary) .
5) When all of that happens it means I will support whatever decision you feel is best for your body and your baby. I will back you up, remind you of wording that you can use to to get your point across, and I will help your partner find his or her voice as well.
Doulas can not BE your voice, but we can sure help you and your partner find your own.