Monday, December 20, 2010

The Red Hat of Midwifery

I remember when I want to the CAPPA conference in my town many years ago and saw Linda Smith, RN talk about breastfeeding. She had her conference talk and when she couldn't resist chiming in with her own personal opinion, she'd slap a red baseball cap on her head so you knew the difference. It was charming and clarifying and it's a concept I've used many times since then.

One area that I try hard to never wear a 'red hat of opinion' on is my doula work. It's hard sometimes; I see what the client wants, and I see what she's asking for, and being objective, I see the difference in those two things. I ask lots of questions and when clients ask me, "What would you do?" with that serious look on their faces, I know that they weigh my opinion heavily, and that my response will not just be casually catalogued with the opinion of the woman who does her nails. Like it or not, I'm seen as a woman wise to the ways of birth, wise to the ways of navigating providers, and myriad other facets of what we do when having our babies. I'm going to be heard as an authority. I have to take that really seriously because it IS serious.

When she asks me this question, "What would YOU do in my situation?" I remind her that what I would do is based on my own values, my own experience. It is not necessarily what anyone else would do. Also, what I do may not be appropriate for her situation. Last, I do not have to live with her choice- she does.

Sometimes she'll continue to press me, "I know, I know, but if I was your sister, what would you say?"

I care about my clients and being human, I of course also have this urge to share my opinion that is hard to deny- but it's SO important that I do exactly that.  If she presses I tell her pretty directly - "I'm not going to tell you what I'd do. I'm here to help you figure out what YOU need to do. What do you need to know right now in order to make this decision?" I have found that shifting it back toward her turns the conversation away from me, and toward something she can actually use.

Now I'm working closely with a lovely midwife - working hard to be a great assistant and soak up everything I can learn in the meantime. I'm navigating a new world and one where (the midwife's) opinion is expected and offered to clients, alongside support, encouragement, and trust in herself. I'm finding that I have to literally take the Red Hat of Midwifery off of my head when dealing with my doula clients. Because the worlds are so very different, it is a conscious choice I have to make to go back to questioning, rather than answering (not that I'm giving any information to midwifery clients, I'm not, but I don't have to be restrained in my own mind the way I do with my doula clients.) Basically, if I'm not in the right head space, the lines get blurred VERY quickly.

I was talking to my friend about this and I wondered if this was why some doulas struggle between their desire to be midwives and their power as doulas. It takes a lot of restraint, as I'm learning things, not to want to share what I'm learning! I would be *harming* my relationships with my clients if I wasn't clear.

I can see where, when doulas are offered the chance to feel a cervix, check heart tones, etc. that it is so difficult to say no. I've been offered, even implored, to check and I've had to say no. It was VERY difficult because I desperately want to learn these things! However, I knew that no matter what I said, they'd weigh my interpretation very heavily and it was so important that I not disrupt her own knowing with what would have largely been a really inept guess. Imagine if I'd thought she was barely dilated and it turned out she wasn't, and we left too late? Or the opposite- I thought she was further along than she was, we left and found out that she wasn't nearly dilated and we'd gone in too soon, thus exposing her to increased interventions or having to choose to leave? No thanks!

As I move into 2011 I'm finding both feet firmly in the midwifery world- I'm not asking for doula client this year like I did last year - I am accepting what comes, but I am most excited about sitting at the feet of the midwives who invite me along, and holding space for these mothers as they teach me too, in their own knowing, their unfussy-ness, their tentative steps into the unknown with bare feet and round bellies.

I will say that having been so conscious about my professional boundaries, and so serious about not crossing them, has liberated me to become a doula strong in communication, intuition, and heart - things that I know will serve me brilliantly as I inch my way toward midwifery.