Advocate (n.) /ˈadvəkət/
1. A person who publicly supports or recommends a particular cause or policy.
Every human being has the potential to be a changemaker, no matter what one’s role. Advocacy is often thought to be synonymous with fighting, and in our field there is a pervasive belief that being an advocate means “crossing the line” by speaking up on behalf of your client or confronting a provider in an inappropriate way.
Doula Trainings International (DTI) is committed to re-imagining the role of the doula and re-contextualizing our role in today’s current birth climate – a climate which is increasingly medicalized and too often disempowering to the birthing person. DTI feels strongly that doulas, by virtue of their unique position as advocates and allies, can be agents of social change. And that the change we seek would place a birthing person’s needs front and center of their own birth experience.
Social change never comes out of a place of comfort and ease. It takes courage to create an environment in which every human being is respected, and where a model of compassionate care can exist for the mother, the midwife, the doctor, the nurse, the resident and, yes, the doula. Together we have an opportunity for all of us to be in conversation and shared exploration about how to improve the birthing experience and birth outcomes for our families.
Abuse in childbirth is an act that dismisses the agency and autonomy women have over their own body and their babies. Abuse consists of any poor treatment, any treatment that is considered cruel, violent, or damaging. And in birth, it is the mother who defines what is and isn’t abusive. We believe that what this kind of abuse in the birth room does is dehumanize the mother, and so the 
question that comes to mind is: What does humanizing birth look like?
As doulas, we must reconsider the climate that women are birthing in today. Not only are women increasingly stepping forward and speaking up to report their abuses in birth, but we know that doulas are also suffering from witnessing obstetric violence. Doulas are experiencing residual trauma as witnesses to abuse.
When we at DTI speak about advocacy, we are speaking about the choice each doula has in how we support our clients and in how we respond when we witness the gross and subtle violations of our clients’ bodies and wills. In those moments of witnessing, we have agency – the ability to act. We have a choice as to how we will interact with care providers. Which is not to say, “fight” or “confront.” But we do have a choice – to create an environment where deeper compassion and empathy is employed, effectively and strategically, to address the mistreatment our client may be experiencing. We can advocate for our clients so that they have the opportunity to speak for themselves and address the situation in question. In doing so, we are actively shifting the culture of birth by modeling a form of care that 
is rooted in humanity. But to claim a role as advocate, and to facilitate culture change, is to be willing to re-imagine the role of the doula, it is to transform our self-definition from passive to active supporter.
This is not an agenda to vilify medical care providers. In fact, we can point to example after example of relationships with medical care providers that have been transformed – and birth outcomes positively impacted for all – through confident and compassionate advocacyby our doulas. We must be honest about the environment of systemic violence within which people are birthing and doulas are working. Until all people are treated with dignified, respectful care, our work is not done. For DTI and our doulas, this is all about the birthing individual. We are hired to support that person and we have an integral role in shifting how they receive the humane support and care they require and deserve. Non-judgemental unconditional support? Yes. But let’s be clear about what we are in support of as doulas. Are we in support of perpetuating abuse? Of remaining silent while our client is being mistreated? No. Mainstream traditional doula organizations train 
doulas to not speak up on their clients behalf. But to not speak up is to be complicit in the very abuse that we are working so hard to eliminate. In this re-imagined role of the doula, the doula plays a VITAL role as advocate, not accomplice. None of that takes away from us acknowledging that the birthing person, the center of the birth experience, is the decider. In fact, it puts the birthing person directly in a position to be truly supported by the doula. Humanizing birth starts with them and extends to everyone else in the room, including the doula.
When we lift the veil to examine the current paradigm of managed care, we begin to become aware of the constructs of birth work. We also see an opportunity to define the doula’s role in a new way. Building alliances is about finding that place where our reserves of deep empathy and compassion live within each of us, and then using those reserves to meet “the other” in a way that unites us in our shared humanity. It is hard work. It can be scary. It requires courage and trust. We think it’s a good place to start if we’re truly going to make change.
So yes: doulas are advocates.
Announcement!!
We’re taking a stand and making a deeper commitment to expanding the conversation on the doula’s role as an advocate.
DTI and Kathi Valeii of Birth Anarchy are excited to roll out new offerings for the beginning of 2016. Stay tuned!
In solidarity,
Aimee, Tara and Gina
DTI Co-Owners