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Tuesday
Apr172012

Doulas & Advocacy

Patrice Nichole Byers of Birth Your Way wrote a great post entitled, “Doulas and Advocacy: Are they mutually exclusive?” In there she discusses the role of doulas and whether speaking out for the mother during birth is an appropriate thing to do or not.

“I hear time and time again. I'm sitting in an interview with potential clients and they tell me that one of the reasons they want to hire a doula is to have someone advocate for them in the birthing room. I'm constantly explaining to clients that while I do consider myself an advocate of choices in birth, natural birth, and natural postpartum choices; I do not advocate for you during birth, but rather help you to advocate for yourself.”

I’ve also heard women say they want someone to “advocate” for them in labor. What I’ve learned they really are saying is they want someone who will speak up for them so they don’t have to. When women are in the throes of labor, it’s understandable they don’t want to be the one to disagree with the nurse or doctor. How appealing to have someone else be the heavy, deflecting any of the negative energy that might be coming from the medical personnel, allowing the laboring woman more peace to work her birth.

But when a doula opens her mouth with “She doesn’t want that,” it all too often sounds like the doula is directing the labor, not the woman herself. Especially if the client is wrapped up in her labor and doesn’t affirm what the doula said, the doula really does begin digging a hole for herself, credibility falling precipitously into the chasm.

If the doula was only saying “She doesn’t want that,” it might not be so bad, but it’s far worse as Patrice continues:

“I'd hear over and over about stories of doulas who would get into heated conversations with doctors and nurses about hospital policy, clients wishes, evidence-based practices and more. I'd hear doulas brag about arguments they felt they won, shouting matching, standoffs, and more. The worst to me are the stories of doulas who unhooked IV's, stopped the pit machine, and spent time interpreting fetal monitor readouts.”

You’d think these rogue doulas are rare, but from talking to my nurse friends (who are extremely doula and natural birth friendly), they are not. Many doulas seem to see their role as adversarial instead of supportive. That attitude alone sets the client up for a negative experience. Not that it’s always bad, but cooperation works much better for women than hiring a body guard.

If a woman feels she needs a body guard, if she’s in a state with legal midwives and can find one with impeccable education and skills, she should look elsewhere to birth. (I know, that’s a lot of “ifs.”)

I don’t have a perfect answer for the women who do feel they need to hire someone to speak for them. Perhaps in their experience they aren’t very vocal in labor or they want to immerse themselves in Labor Land instead of remembering, as one woman recently said, to try to remember “intermittent monitoring, not continuous.” In these cases, I would say the burden falls onto the partner. I usually encourage the other parent to let go and be in labor, too, that they don’t need to stand guard over their wives, questioning every move the nurse makes, but perhaps there is a place for a Bradley course after all.

I’d love to hear what doulas and women have to say about this topic. Thoughts?