Doulas’ Dilemma #2: The Doula Scope of Practice
This is the second blog in a series of three that I began writing in November. I am very passionate about the doula profession. That’s why I feel called to write this series before it is too late. And by “too late” I mean that I think our profession is in danger. Being a doula trainer and at the same time an approved continuing education provider for obstetric nurses, allows me to be connected and empathetic to both sides of the conflict – doula and medical caregivers. On top of listening to nurses’ pain points in their relationships with doulas, I recently have been invited to speak at a few OBGYN and midwives’ practices and heard that they are on the verge of banning doulas
Additionally, recent events confirm what I have been fearing – the current practice of doulas’ who share evidence-based information that supports better obstetric practice (while not being medically trained and bearing no liability for their clients’ health) is going to hurt us.
- It puts our relationships with medical caregivers at risk.
- It will lead more cities to follow New York in attempts to license doulas.
- It will lead our best friends – hospital-based midwives – to ban doulas or have blacklists of unwanted doulas that they don’t trust.
- It might also make it harder for us to find paying clients because they hear more and more stories about doulas who break the trust and rapport that couples have established with their medical providers.
I wanted to quit, but I discovered coaching and got excited again about being a doula.
After a decade of practicing as a doula and childbirth educator, I was about to quit. I was burnt-out. The rising rate of medical interventions led me to doubt my ability to fulfill my role and facilitate healthy and positive birth experiences. Additionally, the growing gap between doulas’ approach to childbirth and the approach held by the medical caregivers that our clients trust for their journey, triggered a lot of tension in me. These circumstances, in addition to the given hardship of the doula practice, made me reconsider my career path.
Ten years have passed since I felt under-resourced and I still enjoy practicing as a doula and training doulas. How did this happen? I discovered coaching!
In the last couple of years, I have come to learn that I am not the only one to have gone through this professional struggle. In spite of ACOG’s recognition of doulas’ benefits and some big headlines reporting the many celebrities who hire doulas for their birth, doulas experience a few major dilemmas that cause great hardship.
This uneasiness reflects in social media and doulas’ blog posts, and I can sense the confusion, frustration, and disputes that percolate within the doula community. Being passionate about doulas and our valuable stewardship position, I’d like to share my personal path that helped me resolve the three major dilemmas doulas face:
Doulas often feel that they are accountable for their client’s positive and healthy birth experience. While this is somehow true, it certainly does not dismiss the couple’s efforts to achieve their desired birth experience. The presence of a doula at the birth should not by itself be perceived as a guarantee to a healthy and active childbirth. When couples choose not to engage in other types of labor support and preparation activities such as pregnancy physical activity, prenatal yoga, or childbirth education classes, there is a high chance that the doula will be the only one accountable for their positive birth experience. In this case, both parties risk a complicated relationship which might involve disappointment and lead to a non-satisfying birth experience.
The advocacy dilemma in the field of childbirth support is a tough one to crack. The dilemma lies in the tension between certain components of birth support practice, such as serving and supporting, and other components such as being a change agent in our society and a birth activist. By relying on coaching principles and strategies, I suggest that you can be sure to practice within your scope of practice and to refrain from projecting or engaging any ‘activists agenda’ in your relationships with your birth clients. Coaching is the pathway to client-centered relationships and care.
Is your birth client as accountable as you are for her birth process?
A couple of days ago I had a beautiful mentoring session with two local doulas; we will call them Iris and Lily. We were going over some challenging cases they experienced recently and exploring how the Birth Coach Method’s strategies and tools help. Pretty early in our discussion, I learned that their ‘typical birth clients’ represent some degree of polarity: Iris works only with clients who are strongly committed to an unmedicated birth. She feels that potential clients who are “willing to try [birthing] with no epidural but leave themselves open to the option of taking it” are not a good match for her. Lily said that her clients are hiring her in order to “Check the box” of doula services; meaning that they read the statistics showing doulas reduce cesarean rates and they are hiring her to avoid a cesarean.
Recently I watched the movie ‘Trial of Labor’, and listened to the stories of three women who wished for a VBAC (Vaginal Birth After Cesarean). It made doubt the approach we, birth activists, take in our efforts to improve maternal care. Especially our continuous attempts to educate and empower expectant individuals by pointing out the flaws of the medical system and its representatives.
What did birth activism look like in the 90s?
I gave birth to my oldest child in 1995. I often say that she was my muse since my first pregnancy and birth experience led me to pursue a career in the field of birth support. I was lucky to go through this journey in the 1990s, as it seems that these years offered women a wealth of information about natural childbirth: Barbara Harper first published Gentle Birth Choices in 1994, the same exact year that Michel Odent published his book – Birth Reborn. Janet Balaskas published Active Birth in 1992, and Marshal H. Klaus published Mothering the Mother in 1993. Henci Goer closed the 1990s by publishing The Thinking Woman’s Guide to a Better Birth in 1999. All of these authors were, and still, are my teachers and mentors, not to mention idols.