Traci Doula Traci Weafer

IMPLICIT BIAS AND WHY SHOULD YOU CARE AS A DOULA

What would you do if you found out that your own biases and beliefs about birth were disempowering the clients you are serving? Chances are you started your important work as a doula after your own birthing experiences. And maybe that experience was a powerful, amazing birth that you believe all pregnant people deserve. More likely though, it was a birth that didn’t go as planned and you might even feel you need to protect your clients from their providers and the birthing system as a whole. 

What if I told you that – positive or negative – your birth and beliefs about birth are deeply impacting your clients. Especially if those beliefs and experiences have not been examined. By understanding what biases are and how to take inventory of the ones you hold onto, you can truly empower yourself and your clients rather than creating an unintended dependency on you for their birthing experience and decisions. 

What are biases?

So what is bias and why does it matter?

A bias is an inclination and preference toward one type of person, choice, or thing over another. Biases are not inherently negative but are always a powerful force behind our behavior. To reserve your conscious thoughts for more complex problem solving, your brain creates shortcuts for categorizing and making sense of the constant input of information coming in through the five senses. These shortcuts can then develop into biases. 

Knowing that biases are an evolutionary development that can help take some of the shame and drama away when we start to identify and address the biases we hold. This process is happening mostly in the background, outside of our conscious awareness. Biases have a very real impact on our lives and those around us, but getting lost in a shame spiral about it isn’t necessary or productive to positive change. 

Two Types of Bias

Your mission is to support birthing people in whatever choices they make around their birth. Why is it then that when your client says they are considering an elective induction you can feel a rush of adrenaline and an overwhelming sense of dread. You leap into action and start listing off all of the potential risks and the cascade of interventions you feel are sure to follow an induction? Is this not in direct conflict with your mission to support your clients in what THEY want?

So what’s happening here?

This is likely a case of implicit bias creeping to the surface. According to the National Center for Cultural Competence, an implicit bias “operates outside of the person’s awareness and can be in direct contradiction to a person’s espoused beliefs and values;” whereas, a person with an explicit bias “is very clear about his or her feelings and attitudes, and related behaviors are conducted with intent.”

Common explicit biases in the birth world are providers in the medical model being staunchly opposed to home birth or VBACs. Although explicit biases are damaging, they are at least often out in the open and therefore easier for birthing people to avoid and navigate. 

Implicit biases are more dangerous because of their hidden nature. This would look like an OB that says they are VBAC friendly, but then they start pressuring the birthing person to have a repeat cesarean because that is what they are comfortable with

Birth work is intersectional. It is the meeting places of so many important experiences, social issues, and identifiers. Essentially becoming a perfect situation for biases to be formed and show up for everyone involved. This is why it is critical to do the internal work necessary to identify and address your biases as a doula. There are too many opportunities for shortcuts to evolve and derail the goals and needs of your client. 
Addressing Biases
Imagine you and your client work together to prep for their next prenatal visit with their OB by building a birth plan, role-playing, and getting educated on each of the client’s birth preferences. You are confident that your client is fully equipped to communicate their goals and stand their ground if there is any push back from their provider. Only to find out that the OB suggested something completely different than the original plan, and your client is feeling conflicted. 

Now consider these two possible responses:

  1. You gather all of the evidence based articles you can find, put together a list of patient rights, and remind your client they can always change providers. You even have a list of alternative options for them to review just in case the provider didn’t explain them. Then you send them the B.R.A.I.N. exercise to make sure they fully understand the option they are considering. 
  2. You know that you adequately prepared your client for this meeting and you fully trust in and support their autonomy. Because they do seem a bit conflicted, you take time to genuinely ask them how THEY FEEL about the proposed procedure or change to their birth plan. You listen to their answer, help them address any underlying fears or concerns, offer additional resources if they are interested, and then you truly support whatever choice they make.

How does each of these responses make you feel?

Option one is based on fear and likely an implicit bias about some specific procedure, birth setting, provider, etc. And it DOES NOT empower the client. It centers you and your belief that they must be saved from this particular choice. It creates a dependency on you to make the right decision for your client. 

Option two comes from someone who has done the work to address their own biases. It holds space for the birthing person to honestly express their thoughts and feelings, without the added pressure of a doula determined to save them from themselves. This response doesn’t deny your own beliefs, knowledge, or experiences – it just doesn’t make them the star of the show. 

So how do you get to a point where option two is your natural response? You must start confronting your implicit biases. This is not an easy process and will not happen overnight. It is a journey that requires honesty, commitment, and accountability. But it is essential if you are planning on serving birthing people in a positive and impactful way.

  • A great place to start is by taking Harvard University’s Implicit Association Test (IAT). This will help you identify important biases you hold subconsciously
  • Next is fostering awareness around those biases in your daily life. This might look like:
    -Recognizing when you had a stereotyping thought about someone, something, or a group of people
    -Questioning that thought – is it even true? What are some examples of times it isn’t true
    -Reframing the thought into something positive rather than negative
    -Empathizing with the person/group you’ve stereotyped – how would it feel if automatic assumptions were made about you?
    -Actively seeking out opportunities to engage with the people, places, and things you have biases against. Find ways to learn more and put yourself in contact with things that you have discomfort with to break down your biases and negative assumptions.
  • Alongside awareness is the need for reflection and accountability.
  • Repeat. This work is never done. Make sure you have a plan to stay engaged with this process. It is easy to get distracted, especially if you are in a place of privilege (race, economic status, gender, education, etc.). Get an accountability partner. Schedule time to reflect. Do whatever you need to do to keep pushing forward. 

Birth work is not about you. Or me. It is about birthing people. It is about constantly recentering them as the authority on their bodies, their babies, and their experiences. Understanding what biases are, why they are so important, and how you can start the work of confronting your own you are on the path to being the best doula you can be. 

This stuff is hard work and requires you to take a deep and honest inventory of yourself. This is part of the reason I created The Advanced Doula Workshop. So many of my fellow doulas received plenty of training on comfort measures, the stages of labor, and what to pack in their doula bag, but there is little space for this kind of intense self-exploration. 

Join my newsletter to stay up to date on the next Advanced Doula Workshop and learn more about how to tackle your biases to make a positive impact on your clients and the birthing world as a whole. 

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Traci Weafer

Childbirth Educator, Mentor, Advocate, Parent

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