Dear Doula Organizations...Let's Do Better
There is a battle going on. One that is between Doulas and Healthcare providers.
Providers commonly view Doulas as troublemakers. People who come into their workspace and step on toes and make life harder for the doctors, nurses, and other staff. They refuse to play by the rules, keep out of the way, be quiet, and stay within their scope.
Doulas, on the other side of this, commonly see upsetting things happening at births (especially hospital births) and start to view all hospitals and their staff as the bad guys. People who are out to do things to the clients that are only going to benefit the providers and put the clients in harm's way.
This all pushes these groups together into a contentious place where everyone is angry and distrusting of one another on sight. Care providers seeing Doulas as rogue, anti-doctor, woo-woo supports and Doulas seeing care providers as evil, selfish, stubborn members of an equally evil and corrupt system.
So what is going on? Are Doulas really getting in the way? Why do we have to prove ourselves so much when we walk into the hospital? Why is it such a problem across the board, regardless of where the Doula is working?
We all know that the general health of the maternity care system isn't the best. This isn't limited to the USA, though they have a genuine maternal health crisis on their hands that more than leans towards poor outcomes for BIPOC. This is the setting for a Doula's workspace. The workplace environment, if you will. In a normal, 9-5 job, you'd get a tour of your new workplace and a feel for the space you are entering. For a Doula, this is their training.
But what are Doulas learning about this workplace they are about to join? What are they learning about the politics and how to navigate the social structure of this job? What should they do if they see a "coworker", especially someone with more seniority or from a whole different department doing something unprofessional or unacceptable towards a common client?
In my training, we had a section/game called 'good Doula, bad Doula'. One of the examples offered had you stepping in when you saw something happening between your client and their care provider or nurse. You were supposed to declare the Doula doing this as a "Bad Doula". It was the only reference to what to do if something goes wrong or you see something you know is wrong. The message (then and throughout the training) was that doing anything at all to step in and help your client was "bad". The old shut-your-mouth-and-mind-your-business.
It was not an effective lesson and anyone who has never worked in counselling, crisis intervention, mental health, addictions, or with low-income people and marginalized groups...would be thrown into a cold reality just really unprepared.
Imagine having all of these lovely dreams of going to beautiful births and holding your client's hands as they push their baby out. Tears of joy are shed and you imagine how amazing it is all going to be. You finish your training with nothing to worry about, except remembering how to squeeze hips and don't be one of THOSE Doulas.
Then you get out there and your first client experiences obstetrical rape, or is pushed into interventions that they didn't want (and you have this feeling that maybe they weren't really needed), or is threatened with child protective services or the police if they don't comply with things like cervical checks, an IV, or pushing on their back. You may even be pretty sure that your client is facing racism.
At first maybe you think it is you. You are brand new, so maybe you are too sensitive. Maybe you think it's in your head, but then you see it again. And again. And again. You are angry and you don't want to stand by and let it happen, but you were told not to say or do anything. You'll be a "bad Doula" if you do, right? You don't want to fail as a Doula, but you don't want to fail your client.
But one day, you just can't watch it anymore. Your client is in tears and you know that what is happening is wrong. Your fear of failing or being a bad Doula goes right out the window. So you say something. You say it loudly. You put yourself between your client and what you believe is a threatening event. Now you are one of "those" Doulas. Now the hospital staff have more proof that Doulas are just trouble, in the way, and definitely not wanted in their workplace.
We really don't want this to be happening, truly, but the goal shouldn't be that Doulas shouldn't be saying anything. It's not that saying anything or doing anything is the issue. The issue is that the mantra behind Doula training for so long has been to keep quiet and not interfere with doctors and nurses, regardless of what is actively happening. Doulas are being sent out into hostile workplaces with no training on how to navigate a crisis of assault, racism, transphobia, discrimination, or abuse...except to be silent. So when they inevitably respond to a situation that they have seen repeatedly and they just can't stand by anymore, their response is huge. It's loud, aggressive, unprofessional, and unfocused...because they have no frame of reference to react appropriately and effectively from!
The solution is to teach new Doulas about what they might see outside of what their client is doing with positions or pushing. It's to teach them that they will attend births where everything is beautiful, but we are working with an imperfect system and here is how to handle things when you see something you shouldn't be standing by and saying absolutely nothing about. It's amazing how many ways you can respond to something terrible without turning to unprofessional tactics and still be able to defuse or stop things. "Let me just make a note about this. Could you repeat the request?" or "I see that your doctor/nurse is about to ________. Did you want to let them know your choice on that/did you need 5 minutes to decide?" are both easy and quick places to start. The basics of Stuff-Is-Going-Down 101.
But there are so many other ways to navigate what you see and hear in the birthing space and Doulas need to know them.
Certification groups need to step up their game in terms of training Doulas in crisis responding. Doulas are being failed by the people training them to work in this workplace of ours that is saturated in the maternal health crisis, systemic racism, and misunderstanding between healthcare professionals and Doulas. We can't make healthcare providers change their minds about hating us by staying quiet at the sacrifice of our client's wellbeing. We can't change their minds by hiding in a corner and hoping they don't notice that we are there. That's not going to fix a problem that is on-going and directly related to obstetrical violence and systemic issues around race, sexuality, gender, and diversity.
We can't change the maternal health crisis in the birth space, but we can teach our new Doulas how to swim in waters that we know are not always going to be calm...and by doing that, we will change how healthcare providers view Doulas and work with us.