Saturday, January 10, 2009

What is a doula, anyway?

After six years I find I'm rediscovering it. It's not (for me now) what I thought (it was), and I'm not moving in the direction I feel is right anymore. I used to identify myself as the 'knowledgeable' doula and now I find that I want to learn more about mentoring, working alongside my client in a very different way. I think this is what attracted me to Birthing From Within (even though the love got lost along the way, I retained that value), the idea of mentoring and growing and learning alongside clients rather than being the keeper of the knowledge.

I don't like, nor agree with the perceived authority that comes with being the knowledgeable one. When a client looks to her doula and asks, "What are the risks of this decision?", the doula becomes the authority figure and the energy shifts from the client being in charge, the provider being responsible to distribute information, benefits and risks. Suddenly the doula is pitted between the client and provider as the 'trusted' person. No wonder providers don't like doulas! When did our role shift from being loving heart and hands to being the extra encyclopedia that clients could bring to their births?

What if we put the onus on the client to hire a provider she trusts, choose a space in which she feels safe, instead of hiring a doula to act as her encyclopedia, lie detector, advocate and defender? How many potential clients have I turned away when their inquiry was around me telling their provider NO if necessary? No wonder providers look at doulas as potential witnesses in lawsuits. If clients are trusting their doulas over their providers, who is legally responsible for a bad outcome? No wonder these waters are so muddy, and the bridges almost impossible to cross.

I'm learning to ask more questions than answering them. Even my teaching involves asking questions and helping them find access to answers (with a foundation of basic knowledge). I think the whole point of my classes is not so much to teach them about the benefits and risks of every possible thing they might encounter, but rather give them the tools with which they can get the information they need in the moment to discover that information for themselves. I really believe that that is where the power and strength lies in this work, because these are tools that the parents can take with them as they go forward and parent their child.

I have several goals this year - I want to be profitable at the end of the year (and that can be $1 into the black, that's fine!), I want to teach four class series (at least), and I want to have clients every month that we're accepting clients. So far we have clients in March and April; I am holding the door open for clients to fill slots for the rest of the year. I just ordered a business license so I'm looking forward to taking that next step to organizing my business as a business and not just an expensive hobby.

I feel concerned at growth of this profession in numbers without the growth in integrity and clarity. I raised the issue of peer review and I am really shocked how no one seems to have any feelings around the idea, supportive or challenging. The assumption is that their needs are met by talkign with a trusted partner or their own doula collective - but where are the lines of confidentiality drawn THEN? Doula orgs have standards but doulas can be certified for years and unless a client were to complain the certifying body would never know if the doula was breaching confidentiality or not.

One doula organization says that the concept of peer review challenges their ethics and they would not support it because confidentiality for the client couldn't be guaranteed (as if midwives or doctors can guarantee it?). Another org supports the idea as a positive one and is looking at ways to create a space for their doulas to participate in this in some way online.

For me, this feels like a 'taking it to the next level' thing. This feels like it could develop into a way for doulas to be taken much more seriously than we are, and for us to take ourselves more seriously than we do. I can't even fathom the types of things we might learn about our profession, our motives, our methods of delivering our agendas (which do exist), our diplomacy within the birth space, etc.

What hesitation do we have to go to the next level, to deliver better services, and to take more responsibility?


Stephanie said...

The difference between you and those who don't have strong feelings on your ideas is that you will be successful at reaching your goals and they won't. They are happy with doing things the way they have always done. Those who are successful are the ones who reevaluate where they are and where they want to be often. You are on the right path!
And I think a peer review for doulas would be awesome, personally. :] You have great ideas.
You really should check out Birthworks' ideas about what they believe doulas should do/be. They focus on a human values approach to birth with doulas encompassing the human values of Truth, Right Action, Peace, Love, and Non Violence. They believe a doula's job is to be the Hands and the Heart and definitely embody that vision you have of a doula... that of learning and loving, not being the keeper of knowledge.

pinky said...

You raise some very good points. When a woman comes into the hospital all the hcp have a certain job. Each should stick to their job but feel free to discuss all aspects of the plan. For example: I am a nurse. My job is to monitor, document and intervene as needed with a Doctor's supervision. As we progress as Nurses less supervision is required. More trust is established. If we had Doulas on staff which I think would be a good thing, then the Doula would have a better chance to work with the health care team. My understanding is that the Doula is their to comfort the Mother. The Doula is not their to make medical decisions. I am not there to make medical decisions. I can give pros and cons of each intervention but the ultimate captain of the ship is the Doctor or Midwife who has been chosen by the laboring family.

There is one Doula who comes to my hospital regularly. She is fabulous. She works with us. We know her and know she won't fight against us. I try to remember that sometimes the Doctor or the Aneshesiologist has informatin that they may not be sharing with us but they are intervening for a good reason. Yes, the Doctor should ask the patient but there is not always time in an emergency.

I have had Doulas in certain births that I wish I could kick under the table. One Doula was bossing the Midwife around. I almost thought she was going to suggest how-to sew up the repair. This was completely disrespectful. She didn't take into consideraton that this Midwife had 20 years of experience under her belt and knew exactly what she was doing. I think it often comes down to respect. I respect laboring families and the Doula they choose. Up until they disrespect me and then I just get quiet.

I think peer review would give more credence to Doulas in general. I think you have a lot of good ideas in this area. Good luck with that.