• Julia

Doulas and obstetricians - what's the deal?

This post has been on my mind for a while, in particular as the number of clients I am supporting in the private hospital sector is increasing. In the past you may have thought that only women who are planning a homebirth or are under midwifery care in a public hospital are choosing doula support but this is changing. Irrelevant of birth philosophy, being 'high risk' or 'low risk', first or fourth baby, women are recognising the benefit of continuous support during pregnancy and during the birth that a doula provides.

Often during my initial meetings with families I am asked how obstetricians and midwives feel about a doula. My answer to this question is based on my personal experience and other doulas may answer it differently but I have never had a situation where there has been open conflict or disapproval from a care provider towards my presence in the birthing room. Quite the opposite, my general experience is one of mutual respect, often working as a team towards the same goal in particular with midwives and a friendly tone between obstetricians and myself with an appreciation that their patient is fully supported. This has been my overall experience with some exceptions few and far in between which you would expect in any workplace environment. If someone is defensive towards me (almost always someone who hasn't met me before) I never take it personally but just continue with my focus which is always the woman - and smile.

What are the keys for doulas to manage relationships with care providers?

1. The first is one that applies to every aspect of the support we provide to our clients: It is not about us, our views, opinions, feelings...it is not our birth experience and we are not supporting our choices but those of our clients. Any doula who cannot detach herself from her own 'stuff' is in the wrong profession or needs to be very selective in the clients she chooses to support. For me personally, any woman who asks for my support is deserving of it, irrelevant of birth intentions and who she has chosen to care for her medically.

2. Our role is to ensure the woman and her partner are fully aware of their options, understand what is happening and knowing that they have a choice. We serve our clients by fully and wholeheartedly supporting their choices but we do not make decisions. I always focus on empowering through the provision of information and then encourage my clients to verbalise their choice towards the care provider - not me unless there is a reason they cannot communicate it for themselves.

3. We are professionals. Any other approach will get any doula quickly into difficult waters with a care provider and essentially prevent her from being able to do her job which is to support her client. How can we support a woman and her partner during labour if there is open 'confrontation' or affront between a doula and care provider? This does not include situations where a care provider ignores a woman's choice or doesn't seek consent before procedures where I would always speak up.

We can ask questions with a smile, display respect for the care providers role and understand our boundaries without losing sight of our role and purpose.

4. Understand and respect our client's approach to birth and choice of care provider. If a woman has chosen a private obstetrician with a low VBAC success rate for her own VBAC journey then we must provide our support within that framework, accepting that we are not an 'insurance policy' towards a positive birth experience. The responsibility lies with the woman and the choices she makes.

The things I've listed are a reflection of my personal experience and understanding of my role as a doula. In the birth suite I don't see myself as a 'warrior' who's there to fix the shortcomings of birth within the hospital system in Australia (of which there are many) but I'm there to ensure my client is respected, supported on every level and has choices. In my opinion, creating change as a doula in the birth environment doesn't happen through attacking care providers but empowering women through information and telling them that they themselves carry responsibility for their pregnancy and birth experience.

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