Hedgenotes — The System
To Educate, Support, and Advocate
If you've spent much time in the doula world you'll have come across this idea that the role of a doula is to educate, support, and advocate for their client. Of course its far more nuanced than it first appears. Educate about what specifically? Is there a line between which things can be shared with clients and which things can't? What sort of support? A doula by definition is not medical but is it just 'non-judgmental hand-holding' kind of support or does it mean something deeper and broader? And then there is advocacy. Its probably the benefit I hear people talk about most in online groups "Hire a doula so she can make sure your dr/midwife follows your birth plan. Your doula will speak up for you."
We Are Disconnected From Our Own Power
The single biggest issue which I believe gave rise to doula care as a profession was birthing persons wanting to feel truly safe and loved - the in-your-bones, deep and complete, mind-body-soul kind of safe and loved - but actually feeling pretty powerless.
Women DON'T feel safe in birth anymore - partly because of how systems and institutional policies are prioritized over the needs of individual people, which is manifested through caregiver actions, and partly because they no longer have real life everyday access to aunts, moms, grandmas, older sisters, or community wise women who are intimately familiar with the nature of birth and able to provide knowledge and comfort and love and a sense of security throughout pregnancy, birth, and beyond. We have multiple generations of women now who have been disconnected from their power as a result of their own birth experiences and, splintered connections causing distance (both literal and metaphorical) between families.
Women worry that their birth - which is once in a lifetime and life changing for them - will be just one more on the assembly line where they are forced along at a standard pace, pierced and cut and pressured to fit the mold with no regard for their individual needs, let alone their desires or even their rights. The system is satisfied as long as mother and baby are physically healthy at the end but we know in our hearts that merely surviving birth is far too low a standard. Even the WHO has released new guidelines in 2018 which reflect this deeper understanding of the importance of the birth experience.
Advocacy Does Not Mean Speaking FOR The Birthing Person
So doulas emerged. To educate. To support. And to advocate. But can I tell you something? Contrary to common use, advocacy does not mean speaking FOR the birthing person. I cannot be your voice. In my estimation, a doula who speaks for her client is little better than a caregiver who does. Even when it seems like a doula is so intuitive she can read her clients mind, advocacy is still something we each have to do for ourselves ultimately as we are the only ones who know innately what we need in the moment.
YOU are the boss of your body. It is YOUR baby. They are YOUR choices. A doula can reflect your power back to you. She can hold space. She can ask questions. She can remind you of conversations and plans and options. She can hold you up and she can have your back. But she is not your voice. YOUR voice is the one that needs to be heard. Your presence is the one that needs to be felt.
Going With the Flow Rarely Gets You Where You Want To Go
Far too many women have been led to believe that they can - even should - just 'go with the flow'... they hope despite the fear in their gut, that the standards of care will be enough, and so they don't tap into their own truth. They don't find their voice. They don't advocate for themselves. When you don't make clear the direction you want to travel, you will inevitably find yourself swept along with the system instead and most of the time that leaves you at least a little (but sometimes a lot!) battered and bruised, and it takes you to places you never intended to go.
A doula can help in many ways but is no substitute for the amazing power you already possess within yourself and which is waiting to emerge.
Tamara George of Healing Light Birth Support says it like this: “If you don't advocate for yourself…” (if you are not clear on your needs and desires and make them known) “...someone else will advocate for their wallet at your expense.” (they will take you along for the ride that serves *them* best, not you.)
Find Your Voice. Speak Your Truth. You Know You Best.
Finding *your voice* and speaking *your truth* is so very important in all of life, but especially so in the childbearing years. And while we're being honest about birth - advocating for yourself, hiring a doula, choosing a birth team who supports you fully - none of those things can guarantee outcomes. When you begin to advocate for yourself in pregnancy and birth though, it equips you to then advocate for yourself and your child(ren) for a lifetime and puts you in touch with a power only you possess. Nobody knows what you need to be whole better than you do.
Does every woman deserve a doula? That's a far more complex question than it first appears to be.
Years ago when I took my first doula training course I was taught that “every woman deserves a doula”. Practically speaking what that translated to, was that I as a doula needed to be willing to provide my services to anyone who wanted them and it would be wrong of me to deprive someone of my services “just because” they couldn’t afford it.
I was taught that it was okay to charge a fee if I had to, but I also had to be willing to waive it because otherwise I was being elitist and discriminatory. The ideal though was to provide doula care as a gift to anyone who wanted it.
Somewhere along the way, my thinking shifted a bit. I still believed that “every woman (who wants one) deserves a doula… **but that didn’t mean I had to be a doula for every person who asked**. I started to look at things practically, and recognized that there’s no such thing as free. If the client wasn’t paying for my parking fees and meals and gas and mileage and childcare and supplies and continuing education etc… then I was. Saying it is a “free” birth is deceptive because it makes it seem as though it doesn’t cost anyone anything but that’s just not true.
I did the math quite a number of years ago, and my basic costs at the time came to around $500 per birth. So if my client wasn’t paying for those costs, I was essentially giving them $500+ out of my own pocket. After being burned out by clients who took advantage of that, (another part of doula work you're not 'supposed to' talk about) I eventually stopped offering free or even discounted births. My fee was my fee. And instead I pumped up my website with all sorts of informational resources, and poured time into online groups - providing information free of charge instead (free… there’s that deceptive word again…) I assauged my guilt about not being a doula for everyone by making information available to everyone.
And then - - I stopped actively attending births as a doula. This niggling piece of me woke up and realized that "Every woman deserves a doula" - no matter how you spin it - isn’t actually TRUE. But for someone who had BEEN a doula for 14 years, I still think of myself as a doula, this felt almost like heresy and so I kept my thoughts to myself. I didn’t want it to look like I was throwing my doula friends under the bus.
Until this week. Ang Gallo of Heart & Hustle talked about this in an Instagram video for her new doula training. She opened her video saying essentially that she knew she wasn’t supposed to say it, but Eff It, she was gonna say it anyways. And she proceeded to talk about the “every woman deserves a doula” concept in terms of the harm that this belief does to aspiring doulas. And she’s right. This concept DOES hurt aspiring doulas. It keeps doulas small. It keeps us “in our place”. It makes us doubt our power. It makes us work from a place of scarcity instead of abdundence. But it does even more damage than that.
Women have been serving other women in birth forever. Doulas though, came to be a profession over the last 20 or so years due to the isolation and disrespect and abuse birthing women have experienced in our current system. Professional doulas emerged to fill a void, to stop a gap. But doulas aren't actually the solution. We're a bandaid on a broken system. An awesome bandaid with evidence to support the benefits. Lol. But a bandaid nonetheless.
I’ve been hearing story after story lately of women who hired a doula, and yet their births were still terrible, terrifying, traumatizing. All those statistics you hear about the benefits of hiring a doula - - how they reduce the risk of things like assisted deliveries and cesareans, or the need for pain medications…. It’s all smoke and mirrors. I - as a doula - cannot stop the freight train that is coming at you as a birthing person in our current system. My experiences can let you know the train is coming. I can help support you as it flies by. I can let you know about options other than the train for giving birth, but I can’t actually stop the train. Those statistical benefits doulas provide, its like saying “Here, buy an umbrella to hold while you stand under Niagara Falls. You’ll be 25% less wet.” Really? I mean REALLY? Doulas in our current system are a bandaid at best; an umbrella in a hurricane. Yes we DO make a difference. For those who are giving birth with a very limited or even NO support system a doula can be lifechanging. In a fractured society where we don’t have built-in support from knowledgeable aunts and older sisters and Grandma’s anymore a doula can fill this space. Sometimes having a doula truly changes the course of a person’s birth. I’m not saying we need to toss out the doula care model. I am a doula. I had a doula at my births.
What I am saying is that every birthing person deserves MORE THAN A BANDAID; more than an umbrella under Niagara Falls. Every birthing person deserves to be treated with respect, compassion and dignity. Every birthing person deserves to feel safe and supported in their pregnancy, birth, and postpartum experience. Every birthing person deserves to feel that their needs and desires matter and are a priority to those caring for them.
When we say 'every woman deserves a doula' I’m starting to get the feeling that we're all getting duped. Like, if we're all so focused on doula services and who deserves them and whether they’re paid for or free or independent or hospital-based or mainstream or “rogue”....then maybe we’ll forget about why women needed doulas in the first place and we’ll forget to be angry about a broken maternal-healthcare system and instead turn our anger on each other. If we’re all busy fighting amongst ourselves, the linear, scientific, patriarchal model of birth we have now can just keep barreling along unchecked. What we deserve isn’t a doula. What we deserve is to have our fundamental human rights respected and to be treated with compassion and dignity. That should be the default. And when that’s the default, phrases like “every woman deserves a doula” will become irrelevant, a piece of history.
Would you rather watch/listen than read? Here ya go!
An industry ‘insider’ was recently asked what should be done to bring about positive change to maternal-infant care practices. Their reply comes across at first as really positive and helpful until you let the implications sink in. In fact the suggestions are reflective of just how big the problem is and unfortunately they aren't unusual at all. I'm going to assume the person meant well by trying to keep things “positive”, but truth be told sometimes change is a messy dirty business. Here's what the "insider" had to say about how change can happen:
- ~ Small suggestions are best. Instead of complaining about the terrible care everyone got, identify an issue which can be stated without blame/accusation/anger/frustration and come up with one step to make change.
~ Blaming people and submitting complaints is not the solution.
~ Without also giving a proposed solution, a complaint is not productive.
~ Negativity is not productive.
~ Complaining and placing blame gets us nowhere other than creating anger and resentment and job burnout.
~ There is a lot of work to do in the area of maternal-infant care. It is no one’s fault.
~ Individual healthcare practitioners are not at fault.
~ It’s a systemic issue that needs systemic change and that will take time.
~ It will take a long time to get those in power to make changes.
~ When someone criticizes us we get defensive and feel hurt and become resistant to change.
Spread the word:
Sometimes change is a dirty mess business.
"Passing the Buck" is not the answer.
I was stunned. But really, I shouldn’t be.
Shifting responsibility to the nefarious, untouchable, “system” so that individual practitioners are not accountable for the harms they cause (the system did not grab food out of a labouring person's hands and throw it in the garbage, or use the ultrasound wand so aggressively they caused bruises, or tell the woman she had to stop breastfeeding an infant based on incorrect information, or do a stretch & sweep without consent during a vaginal exam)...
Telling victims that they shouldn’t complain because it makes the recipient feel bad as well as angry and resentful and defensive and no longer able to do their job (which is actually a subtle warning that if you make waves you could be treated poorly in future and also taps into that deeply rooted cultural idea that it is the woman's job to keep everyone happy/be a people-pleaser. If you don't do that you are a selfish b***h and will deserve what you get)...
Telling women they shouldn't bother complaining because it's such a big problem and is gonna take so long to address (aka this is too tough to worry your pretty lil head about)...
Telling women that if they aren't ‘nice’ it's their own fault that they aren’t listened to because the person in power whom they’re addressing is too fragile to cope...
... Those things are not ok.
Spread the word:
Blaming "the system" does not absolve individuals of responsibility for their actions.
Asking victims to educate those who caused them harm is not the answer.
It is NOT the victim’s responsibility to put aside emotion, examine the big picture issues, then calmly and graciously educate the offender (being careful not to upset them in any way), about why what they did was wrong, and then to ALSO educate that person about what they need to do differently. (And for real - how seriously is the offender or their employer going to take even a perfectly presented suggestion about how they should do their job, from an outsider who isn't trained in how to do their job, doesn't understand working in the system etc etc). Nope. I don't buy it.
The victim’s ONLY responsibility is to heal their own heart as best they can; to make the best decisions they can for themselves, that will allow them to be whole and to live with integrity. And if that includes screaming from the rooftops (or writing over and over to the complaints department until they feel heard) that what happened was WRONG, the offender has NO right - NONE - to say: “But wait, you aren’t speaking nicely to me so I don’t have to listen to you. Come back when you’re calm and try again. Besides it's not my fault anyway and you're making me feel bad.” (note that I am NOT saying its okay to be emotionally or physical abusive when expressing hurt. That of course is unacceptable. Those ‘receiving’ the hurt words have to very cautious though that we don’t demonize legitimate emotion and label it as abusive as a means to shut it down simply because it makes us uncomfortable.)
When someone tells you they are hurt by your actions, or that your institutional policy caused harm, the correct response is to acknowledge the hurt and work with the victim to make it right.
It is not the victim’s responsibility to do all the emotional work and practical work so that it's easier for the professional to handle.
I do get that being complained about is hard. Being called out for something is always hard. It's harder still when you're ‘just doing your job’ because you have bills to pay and mouths to feed. It does make you feel angry, hurt, afraid, defensive... when you or your department receive another complaint. I hear that and your feelings are legitimate. That doesn't mean though that the person who expressed the complaint should remain silent. Your discomfort does not trump their trauma.
Spread the word:
Heal your heart and do what you need to be whole.
Changing "the system" requires both a change in policies AND in values.
So many medical professionals start out with a passion which has slowly been eroded by the crushing patriarchal mindset that dominates modern medicine and which DOES need to be addressed at a systemic level. The system is not it's own entity though. The system is made up of people. It is made up of people from the top of the food chain all the way down who are each responsible for the choices they make and the values they hold. The system is created by the people who work within it and the values they hold privately and collectively. If we want to change the system that means changing how people see the world of maternal-infant care and that means telling people what happened that is wrong so that the process of making it right can begin.
If you have been a victim of poor or harmful maternal-infant care, and have already been through the process of healing your negative or even traumatic experience, and you truly wish to make it easier for professionals working in the medical system to consider changing then by all means “Identify an issue which can be stated without blame/accusation/anger/frustration and come up with one step to make change. “ It would be an extraordinary gift to give. Choose to be gracious and calm and to figure out what you think the problem is and how you wish for them to address the problem if that is what you're passionate about. But remember that it's a gift you are giving, it is not something you owe them if you want to be heard. Remember too that they don't have to accept that gift of your insight. They may very well look at it and say “Thanks but no thanks. That doesn't work for me/us/our institution.” Or “That's a great idea but our supervisor/insurance would never approve" Or "Great idea but it would take too much time/too many people/too much money”
We have to ask BIG questions to find true solutions. Like the chicken and the egg (which comes first?) we have to address both small scale policies and large scale values.
In the midst of all of that, women’s voices deserve to be heard. Your story needs to be told (when & where & how you are ready to tell it). You do not have to swallow your trauma and play nice. You do not have to offer solutions as payment for the privilege of expressing your hurt. Your experience matters because you matter.
The answer to how positive change comes to maternal-infant care is not honey-coated gift-wrapped suggestions. At our core we all want to be seen and heard and respected. That's where the answer lies. In the messy business of victims making themselves heard and in professionals truly listening.
Spread the word:
Your story matters because you matter.