Is a doula an advocate? There is perhaps no question that inspires such passionate answers from doulas all over the world. The idea of a doula as an advocate or activist for many brings to mind a picture of a torch-wielding person barging into a sacred birth space and forcefully pushing a certain agenda on the birthing person and the staff. Advocates (especially women advocates) in our culture are generally seen as troublemakers, and the myth of the “rogue doula” perfectly aligns with this stereotype.
Why does DTI then argue that doulas are and should be advocates? If we take the autonomy of the birthing person as central to our philosophy of support, then we see that a doula is not advocating for a preconceived agenda, but for the birthing person her/himself. Doulas are advocates for birthing rights, for choice, for respect of all birthing people, and for our clients as the ultimate decision makers for themselves and their babies.
Historically the professional organizations have told doulas that they must never speak to the medical staff on behalf of their clients, that this is both “not their place” and disempowering to the client’s’ self-advocacy. Self-described “radical doula” Elisa Albert notes a turn in conversation at her doula training: We segue into a discussion about the word advocate, which one woman says makes her uncomfortable because it sounds too much like adversary.
We do not need to be afraid of this word and this role.
We were taught that providers would shun doulas if they spoke out against abuse and human rights violations they were witnessing, that our role was to hold space and bear witness for our clients, but not to interfere in any way or give voice to the abuse or to a lack of consent. Occupations that are traditionally female have frequently gone through similar beginnings and evolutions—these roles are meant to take orders and direction from higher-ups, not to make waves, question the status quo, or stand up for the people in the room most in need of a voice.
Certainly this can lead to doula burnout and a feeling of being part of the problem rather than part of the solution. Self-care and boundaries can go a long way towards protecting a birth worker from taking stress and anxiety into their bodies, but if they are repeatedly exposed to situations where they feel as though they do not have effective means to protect their client and change the situation, they can’t help but feel that abuse inside themselves. Modern doulas need more tools in their mental birth kits to navigate intense and tricky situations, and need to reclaim this role as one that is energizing, invigorating, and fierce.
Doulas have a unique opportunity to be change makers in the birthing space, while still being respected professionals and a valued member of the birth team. The question isn’t “are you an advocate?” but “how can we be the most effective advocates?” Doulas may witness non-consensual episiotomies, even over the frantic protests of the birthing person, or demeaning language, shaming, rough vaginal exams, or a client being forcibly held down. A doula who is banned from the hospital is not being effective, when the goal is to support the family and make an abusive situation stop. A doula who is able to reach the birth team in a humanized, compassionate way and change a disturbing turn of events into a moment where the birth team is once again working together to best support the birthing person is an effective advocate.
DTI doulas in Atlanta. Credit: Heather Goodbread Photography
How does a doula learn how to be this kind of change maker? Doulas who practice the Slow Doula Method™ (SDMⓇ) from Doula Trainings International are given the tools to help change a tense or abusive situation to one where the birthing person is given the space to advocate for themselves with the doula’s support, or one where the doula is able to effectively and professionally advocate on behalf of the client if the client is not in a position to do it for themselves. Doulas using SDMⓇ do not see the providers and medical staff as the enemy; they see themselves as skilled at being able to humanize each birth and build bridges with the medical staff to work collaboratively. They are also able to prioritize their own self-care in the birthing space so that they have a greater capacity to give and to be fully present. It is in our clients’ best interest that we know how to center ourselves, diffuse hostile situations, and shift the focus back to their birth preferences and autonomy.
At the end of the day, we work for our clients, not the hospital/provider. When we put our clients at the center of our professional lives, we see why we need to oppose hospital regulation of doulas. We are hired by our clients to provide non-judgemental support, to help them with their goals, and to protect their space and themselves. We can use SDMⓇ to advocate for our client’s wishes and bodily autonomy without having to feel we are complicit in abuse or overstepping our bounds, nor that we are speaking over them. It is an empowering tool for doulas because it helps us out of situations where we feel time speeding up and a situation spiraling out of control. We no longer need to be passive and quiet; we can be fierce and professional and grounded in our role as doula/advocate.
We’d love to hear from you. Connect with us on our Facebook groups, OneDoula and I Am Doula: Collaborative Entrepreneurship for the Modern Doula. OneDoula is an egalitarian space for doulas to explore their questions, create community, think creatively, learn from one another and honor the autonomy of doulas and the families we support. Topics at I Am Doula may include training, fees, gaining clients, finding your niche, autonomy for the doula as business owner, autonomy for the birthing person as decision-maker, birth support and advocacy, postpartum care, and business sustainability through radical self-care.