Traci Doula Traci Weafer

ADVOCACY AND THE DOULA

by Traci Weafer

I’ve been active in doula work for 20 years and presently doing more mentoring. I find it very important to pass down the knowledge to keep this work alive.  Two very interesting topics have continuously come up in talking with Doulas.

  1. Speaking on behalf of clients
  2. A doula cannot/should not speak to medical staff

 I hear on almost a weekly basis how confused a doula might be because it’s a rocky line when supporting a mom’s wishes or communicating goals. Let’s look at some of the top Doula certifying agencies on what their codes of conduct/ethics look like.

CBI:
“[R]ecognizes that it is always the client who makes decisions, and that it is not the Birth Professionals responsibility to advocate with caregivers on behalf of the client; the Birth Professional may discuss options, or remind a client of her previously stated wishes, but it is the client’s responsibility to state her preferences and intentions, and to determine whether to accept medical interventions.”

DONA:
“Advocacy. The doula advocates for the client’s wishes as expressed in her birth plan, in prenatal conversations, and intrapartum discussion, by encouraging her client to ask questions of her care provider and to express her preferences and concerns. The doula helps the mother incorporate changes in plans if, and when, the need arises and enhances the communication between client and care provider. Clients and doulas must recognize that the advocacy role does not include the doula speaking instead of the client or making decisions for the client. The advocacy role is best described as support, information and mediation or negotiation.“

Birth Arts International:
“Birth Arts International Doulas act as advocates; they do not act as decision makers for clients. All health care choices are made by the client and not the doula. All communication referring to health care decisions are made by the client to their primary health care provider. Advocates do not speak for the client but offer education and support.”

Let’s look at the definition of “speaking on the behalf of someone.”  As I was researching this idea or group of words, I came across two different mindsets. I think they are both very important.
1. Speak for:  act for or on behalf of, appear for, hold a brief for, hold a mandate for, represent  

2. Speak on behalf of:  “Some people make a distinction between the meaning of the word behalf when paired with “in” versus “on.” “In behalf,” they argue, is used when the meaning is in the interest of someone else, but “on behalf” is used when speaking for someone. For example, a medical decision would be made in behalf of the patient, and you would speak on behalf of your family. The reality is that on behalf is typically used for both meanings.” 

As doulas, we are committed to our clients. We educate, support, and journey with our families to help them obtain the goals that are important to them. This has nothing to do with our personal opinions or biases when working in our doula roles. Looking at the words in behalf vs. on behalf makes perfect sense as to why this can be very confusing to doulas.  
We work for the interest of our clients. We build relationships with them and get to know them intimately. In order to do our jobs well, we need to know them.  
But we do not make medical decisions for them. As noted above, “on behalf” is about making a decision that is our own opinion for our client. This would be the same as being given the Power of Attorney to make a medical decision instead of our loved one who couldn’t do so.  
Clearly “on behalf” is NOT what a doula does, but “in behalf” IS our job. “In behalf” is the essence of why we are hired as doulas. We hold space. We help the couple labor without a worry because we hold their interest in the forefront of our priority.

Clearly, we do not set out to make decisions for our clients.

This flows into the next phrase I hear from time to time: “Doulas do not talk to hospital staff.”

If I have said it once, I think I have said it a thousand times that doulas are a crucial part of a birth team. One of our main jobs is to bring the team together to make sure all team members and systems work together to achieve the birthing family’s goals.  If there is no communication, then there is no team. If there is no team, there will be no scoring in the game.

My son played soccer for 17 years. In the early years, the kids were figuring out their positions and skills and there were seasons where scoring was low. Once they found their place and learned the roles of the other positions, it helped them develop the skills needed to work as a team and score winning seasons. 
Communication and understanding each position is what brought the team together. This is the same with doulas and a birthing team.

Here is a quote from an L&D nurse about her thoughts on the assertion: “Doulas should not talk to hospital staff.”

“This would create a major divide between nurses and patients. You [doula] have a relationship with moms, they just met us coming in. You [doula] establish trust. If there’s no communication, a patient isn’t going to trust us.

“I could be working in another room and it be cold and hard to build rapport with the family, but I come into a room you’re [Traci, doula] there and it’s so much easier, because you’re like, Hey I’m so glad you’re here. How can I help you?” “This makes the patient feel at ease and at least know I’m [nurse] not going to hurt her and I care about her.”
– Brentley Greene, L&D nurse at Baptist Medical Center East, Montgomery AL

In the recently updated Evidence Based Birth article on the evidence on doulas, Rebecca Dekker, PhD, RN, APRN, LCCE, founder and author of Evidence Based Birth®, lists various ways that a doula can advocate for the birthing person. One line stands out most to me on this subject: “Facilitating communication between the parents and care providers”  
Facilitating communication as advocacy is especially important as we look for ways to combat the epidemic of high maternal death rates for Black birthing people in the United States. Rebecca Dekker highlights five themes found in responses from women of color when asked about why doula support is so important in disrupting racism in childbirth.  
The first theme says:
“they found that doulas play an important role in Agency. Agency is defined as the capacity of individuals to act or to make their own choices. Doulas helped their clients to understand their options and they facilitated communications with care providers, so that clients felt a sense of empowerment or ownership over their care.”
Most doulas agree that the ultimate outcome of our work is for our clients to feel empowered to reach their goals and have safe, positive birthing experiences. We are working to create a space that prevents trauma and protects the dignity of the birthing person and their family. 
“My role is a process that produces a non-traumatized person that was autonomous, that was respected, that was supported whatever the outcome. The process is going to matter. Nobody else is doing my role. That role is to ensure to really keep my eyes at all time on my clients wellness, physiological wellness, dignity, and non-discrimination…… respect. That’s why being a Doula Is being an activist and being a Doula is being an advocate because your role is respected dignity in the maternal health system that does not always deliver that by itself….most of the time does not.”

  • Hermine Haynes Klein, Expert Legal and Counseling Services in Family Law, Maternal Health and Childbirth Law, and Advocacy for Midwives and Doulas 

I think we can all agree that there are some gray areas and confusion in the doula work world. But two things are true:

  1. Doulas do NOT speak for or in their own opinions make decisions for clients. But they DO hold their clients best interest as a priority remembering their relationship and the birthing person’s preferences and desires.
  2. Doulas are a crucial team member who with great benefit facilitates communication between families and staff.

Doula Advocacy is built on the the foundation of the beliefs and needs of the client. Advocacy is an action not an idea.

If you are interested in listening about Doula Advocacy I encourage you to listen to This podcast with Birth Allowed Radio an interview with Cristen Pascucci as I talk about how I advocate for my birthing clients.
HOW TO ADVOCATE WITHOUT GETTING KICKED OUT OF THE ROOM | DOULA TRACI WEAFER 

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Traci Weafer

Childbirth Educator, Mentor, Advocate, Parent

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