Doula Advocacy: How to Advocate Without Speaking for the Client

We get into the business of birthwork because there’s too much intervention in the mainstream birth experience. There’s too many doctors speaking on behalf of pregnant people, too much policing of pregnant bodies. There’s not enough individual agency, not enough trusting of the pregnant individual to know what’s best for them. Too much coercion and fear-mongering about the potential effects on the baby.

This excerpt from Yes! Magazine article, “During Childbirth, Enduring the Patriarchy Was The Hardest Part,” paints a painful picture of the current state of birthing in the US:

“Everyone from medical professionals to strangers tell pregnant people what they should and shouldn’t be doing with their bodies. Throughout my two pregnancies, OB-GYNs, nurses, family, and friends often used phrases like “you can’t,” “you’re not allowed to,” and “we’ll let you” when discussing my body.”

Unfortunately, this is standard practice in U.S. medicine, which supports a disease-based, doctor-centered, patriarchal model of care (as opposed to patient-based care, which emphasizes collaboration, understanding, and choices.)”

As certified doulas or doulas-in-training, we’re eager to shift the status quo and tip the scale of control back into the hands of the birthing individual. We prioritize collaboration, understanding, and choices. We read books and we watch films and we gather knowledge and experiences. We form a community and exchange stories and tips. We get certified, a process that reassures us, “Yes, I am qualified to do this.”

An advocate, according to Merriam-Webster, is “a person who supports or promotes the interests of a cause or group.”Our “group” is pretty large (DTI currently has about 800 doulas worldwide) and our interest is universal: To improve the birth and postpartum experience. Doulas are human rights advocates. We’re birth and postpartum experts. We’re professional entrepreneurs.

We’re supporters, not saviors.

It’s this distinction in our Compass of Care identities that we must always respect as we learn and grow in our practice.

We must always honor the purpose behind why we got into this work in the first place: To grant autonomy. To hold space. To give an informed opinion. To convey “I got you,” not “I know what’s best for you.”

For example, sometimes we hear from a potential client, “I don’t want a cesarean birth”.  As doulas, it  is important to hold space for that desire, while also building education and confidence in the client and working to eliminate the fear around a cesarean birth. Where is that desire and/or fear coming from? Ultimately, having a doula does not guarantee a vaginal birth. But perhaps the continual support from a doula, even through a cesarean birth, can ease that fear. Again, we are supporters, not saviors.

It’s a tricky, delicate line in the sandpit of good intentions and striving for a better world and systematic change. But when you commit to being an advocate, whether you’re working for birth justice or in any other realm of justice work, it’s a line you have a responsibility to draw.

A doula’s role, whether working in birth, postpartum, or both, is to present the full range of options to meet the needs of the birthing individual. What that looks like specifically is different for every client, but the themes are the same: Gaining trust, providing comfort, and offering a hand to hold, a shoulder to lean on, and a sacred presence to confide in.

No amount of expertise in the world can ever take the place of humility and listening, in the birth business and beyond.

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