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Your Doula Business

How To Create A More LGBTQ+ Inclusive Doula Business

By Sarah Taylor

The world of LGBTQ+ inclusion and equality can feel like a minefield full of acronyms, labels and changing legislation and rights for LGBTQ+ people. It can often be difficult to keep up, let alone learn about it all!

One thing I do want to say right from the get-go is that when it comes to allyship and running an inclusive business it’s ok to not always know what to do or how to do it. And I can promise, that we, LGBTQ+ people, would much rather you try, and make mistakes sometimes, than take no action at all. The reality is that we all have a lifetime of societal conditioning to unlearn and dismantle which will mean that sometimes we mess up.

[Read more…] about How To Create A More LGBTQ+ Inclusive Doula Business

Marketing your Doula Business during the festive period

Slimline your christmas marketing

Oooh… there’s a whiff of excitement in the air and it smells like cinnamon and mulled wine! People are officially using the C word… which can mean only one thing. How the jeepers did Christmas creep round so quickly?

Christmas this year – like the rest of 2020 – is not going to be “normal” but no matter your plans for the festivities, the business of birth continues, and doulas keep on working. And to do that we need to keep on promoting our services. How do we do that at this busy time of year?

Well don’t worry! The Nurturing Birth team is on the case and we’re here to share four secrets to keeping your marketing efforts on point so you can slay that festive guilt, and focus on more pressing things, like your next cocktail choice, thinking up creative ideas for Elf on the Shelf or which present to open first!

The secret to staying visible, active and sustaining your marketing efforts throughout the Christmas holidays is to take a more relaxed, slimline approach.  This way you’ll still look like you’re blogging, posting on social media, and chatting with your subscribers, but, secretly, you could be lying (totally laptop-less) on the sofa letting your lunch go down and catching up on TV.

Your doula business doesn’t have to take a back seat, just because you are. So with that in mind, here are…

Christmas Marketing for Doulas

Republish your Blogs

You don’t always have to create brand new doula blogs. If you’ve been blogging for a while, you’ve probably got more than enough content to republish some of your favourite older articles instead. Your newer followers may not have noticed a particular blog first-time around (or second or third in fact) so don’t worry! And if you’re sharing great content then that content is still great and is still really valuable to parents. That’s what it’s all about!

Schedule Your Social Media

There are stacks of social media scheduling apps around and some are worth their weight in brandy doused Christmas pud! Scheduling your social media in advance gives you that Superdoula feeling of having everything organised for the entire week by 7am on Monday! Scaling back on the number of posts you write and publish is another way to dilute the Christmas biz pressure too.

Maintaining your visibility is important and if the bare minimum is one post a day, then schedule one post a day on each of your social media platforms. Manage your follower expectations by posting that you’re taking a wee break over the festive season. Many of your followers will likely be doing the same so they will totally understand. This way you’re keeping your doula services visible, supporting people and at the same time drinking wine. Everyone’s a winner.

Create & Schedule Your Newsletter(s)

If you’re a weekly newsletter sender, then ease that festive burden and adopt a monthly approach during December and January. A bumper Christmas edition or two (which also directs your subscribers to your republished blogs) is perfectly acceptable – and sometimes more likely to be read. Save more time by creating and scheduling your newsletters in advance and you’ll know your subscribers won’t assume you’ve abandoned them. Ah… the beauty of automation. We love it!

Decide on a Simple Christmas Content Subject and Stick to it

Another great way to avoid trying to post on Facebook while you’re tucking into your trifle is to think about (and plan) the type of content you want to focus on over the next six to ten weeks.  Keep it easy by sifting through your calendar and finding any upcoming National or International days which fit with your interest as a doula. Take a handful of your blogs and weave the same subject thread through your social media pages and newsletters too.

In need of inspiration? Check out:

So go and enjoy your Christmas, make family memories (kids grow up so quickly!) and slay that Festive business guilt.

Come January you’ll feel refreshed, rejuvenated and ready to conquer the world, again!

Updated November 2020 by Emma

How to have sales conversations that feel like Magic! – Part 2

By Charlotte Bailey, Nurturing Birth Mentor

This is the second of a two-part series – click here for part one.

Last month Charlotte introduced us to some of her doula sales techniques. This month we share the second part of her article on how to really connect with the right clients.

Skill No. 3 – Sharing the opportunity. During your meeting with your prospective client remember to make them the main focus. They will want to know about you – especially if the meeting has been set up as an ‘interview’ (by the way, I much prefer the terms ‘meeting’ or ‘consultation’ as I believe it evokes a better sense of equality, but you’ll use the terminology you feel most comfortable with). Be mindful about how much you are speaking and how much you are listening. If you ask the right questions, the client will tell you everything you need to know in terms of what they are looking for and why, and thus you can tailor your explanation of what you can offer to their needs. It shows you’re aligned and also that you’ve really heard them. Keeping your language positive, based in facts, and focused on the transformation that your client is likely to experience if they work with you will help. A former business coach of mine, Bill McFarlan, wrote a great book (see below) about how the language we use to describe what we do is SO important and that we often can unconsciously talk ourselves out of a sale by accidentally conveying the wrong thing or simply by talking too much. Getting that balance takes a little practice and reflection but with awareness comes opportunity[E1] !

Skill No. 4 – Following-Up In sales, it is often said that ‘the fortune is in the follow-up’. I think this is SO true. Following-up is doing what you said you would do. If you say you are going to send some info or confirm a meet-up, then do it. My experience as a Doula so far has been that demonstrating reliability and commitment is MASSIVELY important to pregnant women and people. They need to know they can depend on you so show them – right from the get-go – what it’s like to work with you.

It takes the average person 4-6 meetings (or exposures) before they can say yes to an invitation to work together. Therefore, treat each exposure as an opportunity to set up the next expose until you feel you have established a trusting relationship with your prospective client, keeping relationship-building and understanding as the goal of each of those exposures. If you’ve signposted or referred your potential client to some info, you might ask to check back with them to find out how it helped them. Then, instead of asking ‘What did you think?’, you could ask questions that facilitate the development of your relationship whilst demonstrating what it’s like to work with you ie “Tell me what was most relevant for you, which parts weren’t? How do you think you might use this in your labour preparations? What do you feel you need now?”

I can’t remember where I heard it, but I’ve learnt its true; the universe loves speed! So condensing the exposures into the shortest amount of time possible can work in your favour. It prevents your prospective client from being distracted by life or from encountering obstacles that may ultimately prevent them from engaging your services (an unexpected expense or and impulse purchase that eats up their spare funds). Speed also helps you to keep their interest up. There is also the obvious fact that pregnancies are 42/43 weeks in length at the very most; A potential client might approach you in the latter stages of their third trimester in which case, you have to move quickly.

A pattern of exposures condensed into 2 weeks might look something like this:

1 – The first encounter (meeting through mutual friends/ chance encounter etc). Invite them to a PBM group.

2 – Text right away to say how nice it was to meet them. Give them a link to a relevant website/ book/ resource and confirm you’ll see them at the next PBM meeting

3 – 48 hours before the PBM Meeting, call them to confirm the meeting details

4 – Meet at the PBM. Arrange a one-to-one coffee date in 2-3 days’ time

5 – Send a voice message 24 hours ahead of time to confirm the coffee date

6 – Meet for coffee. Ask them about the benefits and usefulness of the resource you sent plus the PBM group. Invite them and their partner to learn more about possibly working with you. Set a time for the consultation. Ask to add them to your Doula Facebook Page.

7 – Call ahead to confirm the consultation and send them some relevant information

8 – At the consultation arrange a time to follow-up. Send them a thank you text after the meeting with any links to references you’ve made and confirm the date/ time of the follow-up.

9 – Follow-up when you agreed to. Ask if they have had enough information/ time to make a decision. If not, ask them what they need in order to do that and/or if there is any way you can further support them in making a decision (do they want to meet you again? Do they need to meet some other Doulas? Can you assist in connecting them to other local Doulas?). Arrange a time to check back with them and repeat until they have either arrived at a ‘no’ or a ‘yes’.

10 – Top tip: If you get a ‘no’, follow-up one last time anyway. Sometimes things don’t work out and having established a rapport with you, they may come back if you reach out. Sometimes feelings of awkwardness or a worry that they may have hurt your feelings prevents potential clients from coming back. Let them know that whatever their decision the door will always remain open. You never know, they might end up needing a back-up so find a creative way to keep in touch.

Now, you may feel resistance in consciously seeking to develop skills to turn conversations with potential clients into actual bookings. This could be because of the stories you hold about [E2] sales transactions or because of a lack of belief in either your ability to support that client or in Doulaing, in general. Spend some time with this. Ask yourself what stories you hold around sales, where they come from, if they serve you and what needs to happen for you to release them. Thereafter, the potential is that you are free to acquire any sales skills that will help to drive your business forward. All skills can be learnt and, with practice, mastered. However, skills – just like relationships – take time to build so be patient with yourself and allow time and space so that you and your dream clients need to build enough rapport that the magic happens. And it will happen!

Further reading (in no particular order)

  • Drop the Pink Elephant: 15 ways to say what you mean…and mean what you say – Bill McFarlan
  • Booked – Josh Turner
  • Awaken the Giant Within: How to take immediate control of your mental, physical, emotional and financial destiny – Anthony Robins
  • Playing Big: Find your voice, your mission and make things happen – Tara Mohr
  • Purple Cow – Seth Godin
  • The 7 Habits of Highly Effective People – Stephen R. Covey

Fresh out of University, Charlotte founded a social enterprise in 2005 and was a workshop facilitator for 10 years, running projects in the UK and internationally to foster the empowerment of marginalized communities. She later studied Midwifery with the intention of becoming an Independent Midwife before her final pivot in 2016 when she became a Doula. Charlotte understands that fostering women’s empowerment includes enabling financial independence and has, throughout 15 years of self-employment, taken a keen interest in educating herself and mentoring others on how to achieve this.  Charlotte offers Birth and Postnatal Doula services in Hampshire and has recently joined the team of Doula Mentors for Nurturing Birth. 

How to have sales conversations that feel like Magic! – Part 1

By Charlotte Bailey, Nurturing Birth Mentor

This is part one of two blogs – more coming in October 2020!

Let’s be honest here; for most of us there is a jarring incongruence between the idea of being a Doula and of being a Sales person.  The two roles, in my mind, certainly took some time to reconcile but once they did, in a way that felt natural and appropriate, magic happened! I stopped feeling like I was selling and started feeling like I was serving.

Recently, in one of our Virtual Cuppas, a Doula shared her frustration that despite having lots of positive conversations with potential clients/supporters, these conversations weren’t translating into client referrals or bookings. This particular Doula was upset and suspected something was blocking her results. I would like to offer this blog to anyone who relates to this, as a way of providing some possible insight into what those blocks might be and which practical steps can be taken to push through them.

In order to be the best Doula we can, we all have skills to hone…active listening, holding space, appropriate signposting etc. But building a successful Doula business (whatever size of business that means to you) means developing beyond these skills and acquiring new abilities to grow and manage a start-up enterprise. This is where the application of sales skills can be of enormous assistance in learning how to find potential clients, how to talk to them about what you do and how they might benefit, and how to nurture authentic relationships with potential clients until they feel ready to make a decision to work with you (or not!).

In a series of two blogs I will talk you through some of the key skills that will help you to find and connect with your perfect client – and build your doula business!

Skill No. 1- Finding possible clients

In 2018, around 735,000 babies were born in the UK. That’s a lot of babies! And when you consider how few Doulas there are in the UK in comparison to the number of babies that are born, that’s a lot of potential clients.

We know the benefits of working with a Doula, but most people don’t. And so our first job  is to help people to understand. This means sharing the facts with enough people and you’ll naturally start to find your clients. So, where can you share these facts?

  1. Pregnancy and Postnatal Support Groups  – What a fab way to meet local expectant parents and local birth workers. These are ‘promotion-free’ groups so you won’t be asked to talk about your business but you’ll have a mutual space where you can cultivate relationships with pregnant women and people. Naturally at some point they will ask you what you do for a living and you’re welcome at that point to tell them you are a Doula. They may have more questions, in which case, swap details and offer to meet outside of the group set-up.
  2. MVP Committees – As above, you won’t be invited back if you arrive at an MVP meeting with the agenda of finding clients, but by making valid and stand-out contributions to the meeting, you may find that you naturally attract the attention of expectant and new parents who feel a resonance to you.
  3. Doula Databases – There are international doula directories such as the Nurturing Birth Directory, Positive Birth Movement Directory, Doula UK Directory. There are also national or regional ones, eg Hampshire Doulas. How you write about your services and how you tell your story is really critical here. You might want to work with a Sales Consultant or professional Copywriter to put together an all-singing-all-dancing piece of text that you can adapt for use across your website and directory entries to ensure anyone reading your bio and/or business info really understands what you’re all about and knows how to contact you. Any online presence that links back to your website will help boost your Search Engine Optimisation. The greater your online presence with consistent text which clearly describes what you offer, and links that all point in the same direction (don’t forget to check them frequently in case a site you’re linking to has changed) will mean people searching for someone like you are more like to find a hit with your site.
  4. Online – Facebook groups, Linked In, Instagram, Twitter. Either run your own group or join existing groups that have a cross-over in their target audiences with your ideal client. Make time each week to comment and contribute in those groups – not about yourself or your business, but in relation to what group members are asking for. Offer genuine support without the intention of getting anything back from the interaction. If you show-up in those groups consistently enough, people will get to know you and start to investigate further so make sure your FB business page and your personal page are linked. Adding ‘doula’ to your online name means that people know straight away who you are if they are looking for a Doula.
  5. Networking Meetings – A great environment for sharing your business and opportunity. Everyone in the room is there to hear, share, learn, support and refer. Over time, you’ll cultivate trusting relationships. By investing time to learn about and support others and making appropriate referrals, others will do the same for you. Turning up once and vanishing will not bring results. Go along to a few different groups to test out which feel like the best fit for you and then commit to going regularly and booking 1-to-1 meetings with each member to get to know them better. Gather people’s contact details and find creative ways to stay in touch. This could be by hosting coffee mornings for business owners with target audiences that mirror yours, by inviting them into your FB business page and posting regularly, or by adding them (with their permission) to a newsletter database. Asking for referrals is a key part of networking, or starting a conversation with the question ‘Who do you know who…is pregnant/ had a bad birth experience/ is expecting a grandchild and wants to give a valuable gift…?’ offers a gentle and encouraging way to provoke peoples’ thinking beyond their own needs. If someone tells you they know someone who might be interested, ask them to set up a coffee date so they can introduce you. Ask to set a provisional time there and then in order to secure their commitment and move things forwards (see section on Following Up for more tips here)

Skill No. 2 – Inviting possible clients to learn more

Do you know who your ideal client is? We know that there is a potential for every expectant and new parent to benefit from hiring a Doula, but, egos aside now, not every potential client will feel you are the right fit for them. So, who is it that you are looking for, specifically? Spending time really getting to understand who your ideal client is will enable you to spot them when you see them. And more than that, they will resonate with you, too, and your ‘sales’ conversation will feel so natural and easy. Once you have identified your ideal client and cultivated a relationship with them, the next step is inviting them to have a focused meeting with you to discuss how they might benefit from working with you.

My hunch is that many Doulas will think that they must start off with a great reputation and impressive amount of experience and thus have a lot of influence in order for potential clients to want to have a consultation with them. This is not true. If your invitation to meet is so that you can learn more about them and to share more about what benefits a Doula could bring to them, then you’re more likely to secure a meeting, even if you’ve not attended a birth yet! You’re not hunting for a sale here, you’re looking to deepen your rapport, to build a friendship, and to support that person in deciding if they want work with a doula or not. You might not even invite that person to a one-to-one meeting with you, but rather an event where they get to learn a bit more about you first in a non-threatening way whilst gaining benefits from attending the meeting. I like to invite pregnant women and people to a local support group – usually the Positive Birth Movement Meet-Ups or our local MVP committee meeting. It gives us both a chance to meet again and continue to build our relationship. The more a person knows, likes and trusts you, the more likely they are to say ‘yes’ to working with you.

In either case there are some fundamentals about the emotion of inviting;

  1. You must emotionally detach yourself from the outcome. Remember, our initial goal is to help parents to be to  better understand what benefits a Doula would bring to them. It’s not to book a new client. In other words, if you shift your focus away from your own needs onto theirs, away from signing a client and instead to supporting them with their needs, things get a whole lot more enjoyable and lot simpler. Whilst this sounds easy, it may feel difficult to do, especially if you have a strong desire to secure that first client or a real financial need. But being aware of your own ‘stuff’ and choosing not to allow it to cloud your intentions will hopefully keep you in good stead.
  2. Be yourself. Be your best self, but keep it authentic. You have nothing to prove. You are already enough. The more ‘real’ you can be, the more attractive you will be to your dream client and the more comfortable and trusting they will feel in your presence.
  3. Bring the passion, the enthusiasm, the FUN! Positivity is infectious and it’s ok to get a little fired-up so long as the focus remains on the woman or person that you are talking with. If you are feeling nervous before a Networking Event or a one-to-one, why not take a few moments before entering the room to buzz yourself up. Maybe listen to some motivational music to help change your state, something that makes you come alive, or take some grounding deep breaths and envision yourself shining. Remember, you’ve got this!
  4. Check your posture. The way you position yourself physically and emotionally will speak volumes to whomever you are interacting with. Are you someone who is often apologising for things that are beyond your control? Are you (unintentionally or otherwise) dumbing down the value of what you have to offer? Why? Do you believe what you have to offer is of value? Do you believe you can deliver? Have you already mentally decided that this potential client will reject you before you’ve even invited them to meet with you? Is your body language communicating feelings of self-doubt/ insecurity or of assuring confidence? Working on your mindset and your emotional posture here is key. I’ve listed some books below that may help you build your self-belief and confidence.

Once you’ve invited your potential client to meet with you again, confirm the time and their commitment there and then, rather than leaving things open and in their hands. The chances are if you do the latter, the energy of your initial meet-up will be lost. If they’ve told you that they’d like to see you again, confirm the date and the time and add it to your diary immediately, so that they see you are serious and committed. Ask for their permission to contact them the day before and confirm they are still able to meet. Take their number in order that you can do this. If someone has said they will pass your details on to someone they know, ask them when they are next seeing that person. If they say Wednesday, for example, ask if it would be ok to contact them on Wednesday afternoon to find out how the third party responded and what the next steps might be. Again, make a note of the date and deliver on your commitments.

I hope that these tips help you to feel more confident about approaching your sales and marketing. Look out for the second half of this blog in October!

Further reading (in no particular order)

  • Drop the Pink Elephant: 15 ways to say what you mean…and mean what you say – Bill McFarlan
  • Booked – Josh Turner
  • Awaken the Giant Within: How to take immediate control of your mental, physical, emotional and financial destiny – Anthony Robins
  • Playing Big: Find your voice, your mission and make things happen – Tara Mohr
  • Purple Cow – Seth Godin
  • The 7 Habits of Highly Effective People – Stephen R. Covey

Fresh out of University, Charlotte founded a social enterprise in 2005 and was a workshop facilitator for 10 years, running projects in the UK and internationally to foster the empowerment of marginalized communities. She later studied Midwifery with the intention of becoming an Independent Midwife before her final pivot in 2016 when she became a Doula. Charlotte understands that fostering women’s empowerment includes enabling financial independence and has, throughout 15 years of self-employment, taken a keen interest in educating herself and mentoring others on how to achieve this.  Charlotte offers Birth and Postnatal Doula services in Hampshire and has recently joined the team of Doula Mentors for Nurturing Birth. 

Duped as a Digital Doula

Nikki Barrow describes her experience with a ‘client’ who made up a traumatic birth and baby loss. Some subjects within this post may be triggering – related to mental health and baby loss.

WORKING WITH CLIENTS ONLINE, ARE YOU REALLY READY? AND ARE YOU SAFE?

Due to the Covid19 pandemic it’s now become a necessity to offer Birth Work support ‘virtually’. What a learning curve it has been for those of us that have never worked in this way! What actually is ‘Zoom’? This change has been thrust upon us and as a result, setting it up may have been done in rather a hurry? For those of you who aren’t yet offering this way of working you most likely will want to soon! Our potential clients/students will now expect us to work in this way even after ‘lockdown’ has come to an end. So how do you navigate all this as a lone worker in the online world?

My experience

My first ‘digital’ experience was with a ‘hoaxer’ – a woman who faked her pregnancy and birth with me, over the phone and then ongoing into hours of video/text/phone support.

I was contacted initially by text, by a woman who was 34 weeks pregnant and looking for antenatal and emotional support via text and phone, up until the birth of her baby. She told me she was looking for text/phone support in order to answer basic questions she might have during the final weeks of her pregnancy. She was a first-time single mum-to-be, with hardly any friends, and her boyfriend/one night stand was still over in New Zealand where she had met him.

On day 2 we had some more contact via text and phone – she sent me some of her photography work to look at. It looked great…and I was thinking that we could definitely work towards a skill swap for my support. I continued to type up a contract for support. Day 3, I got a call from her to say that her waters had gone, and she was going into labour early. She immediately asked if she could scrap our original plan and would I be available to support her that evening during her labour – using the Digital/Virtual Doula Package I had listed on my website. At that time, my fees were completely different – and way too low…anyhow, verbal agreement was given.

I felt under pressure to agree there and then, she sounded anxious and distressed – vulnerable…..I agreed to be there for her on the phone. She said: “Tell me you won’t leave me! tell me you’ll be there for me tonight – i need you, I am totally unprepared”. So obviously, there was little time to put together a contract of any sort as she needed help from that very moment. After I agreed, I told her she should probably get her bag organised and get to the hospital….So at around 7pm, before I knew it, I was with her on the phone, involved in her labour, in this ‘virtual’ capacity.

The support I gave: Regardless of the fact that this woman faked her pregnancy and birth, I helped support her with breathing techniques over the phone, helped suggest different positions to labour in, helped with ideas on what to eat and reminded her to stay hydrated. I assisted with emotional decisions – such as when to ask her parents to leave her, and to go home, also talking through what clothes she felt most comfortable while birthing. I felt as though I may as well have been in the birth room with her.

In the morning I texted her to see how she was. She said that at 2am she had given birth to a boy – she was gushing about the support I had given her….She then told me that the baby wasn’t very well though. She said that he had been taken moments after birth to Great Ormond Street as he had a bad bleed on the brain and his lungs weren’t working properly. She didn’t seem at all worried, but was off to see him soon. I told her I would check in in a few days to see how she and baby were doing….I was left feeling worried.

That afternoon she then texted me to ask if I would be up for supporting her postnatally as she felt she would need help. Money was tight ….but given the fact her baby was so ill, and, after going through her birth with her….I told her to just message or call me if she needed to.…I then went on to support her everyday for hours per day, usually in the evenings when I was trying to get dinner for my children, with her plugged into my headphones so I still had my hands free to do things in the kitchen…over the course of hours it felt like I was entwined in this woman’s life.

Her baby was very ill, it was unlikely he was going to make it. He was supported to come home with regular care visits in place. There were lots of dramatic event that occured over the following weeks – her Dad died of a heart attack, she had a big bleed, and fainted…I was intimately involved in messaging with her concerned mother as well (text) and also her brother (again via text).

Her video calls with me were always in the evening, after her baby had fed. He didn’t move much as his condition ‘maple syrup syndrome’, plus other conditions with his heart and lungs, meant that he was sedated.

After supporting her for around 8 weeks, there were 2 nights she felt it might be her baby’s last night….I braced myself for this event as I knew it would be hard to go through….on the 3rd night, her baby passed away. We lit a candle for him. I cried.

I then gradually tried to pull away slowly. She had a ‘crisis team’ involved, social workers etc….all of which were poised for her committing suicide. I needed to let go as I was exhausted by this point.

Anyway….to cut the story there…she was ‘discovered’ after making lots of other enquiries in my area …She had been dealing with two other doulas at the same time as me. All different tragic scenarios, all involving baby loss.

There are, as you can imagine, lots of emotions that you go through after finding out that this was all a lie…..

The enquiries received by other doulas from this particular hoaxer date back as far as the past four to five years, usually under different names.

My own experience with her is so complex. I spent hours on video chat with her. I cried with her when she was crying. I lifted her up when she was down. I texted with her most days for weeks, and spoke on the phone for sometimes 3-4 hours a day. I was totally engulfed in her story. Unfortunately with such clever concealment of her identity, numerous personas (my dealings with her brother and mother were all in fact HER), Social Media accounts, numbers, and email addresses, it’s almost impossible to locate her, and get her the real help and support she needs.

This woman had a huge impact on my life, and my family life… I have learned the hard way, and I will not support any client in this way in the future, without confirming ID, and a contract being signed. I hope that by raising awareness we will all be more vigilant in the future.

Keeping yourself safe

I cover more of this in my training sessions (see below), but some important factors are:

  • · limit your initial contact
  • · move to video chat asap! collect some ID
  • · make sure they look pregnant
  • · if supporting postnatally – make sure you see a baby, and that the baby is awake

Things to think about when creating your own online offering

  • 1. Consider how you might offer your client reassurance in who they are dealing with – what would build confidence in your interactions with them?
  • 2. How will you feel confident in who you are speaking with? will you ask them for ID?
  • 3. How will you progress further? Ask for a video chat? or for an agreement / contract to be signed and fee received before going ahead?
  • 4. How will you deal with someone who is in emotional distress from the start of your contact with them?
  • 5. Do you have relevant helpline numbers and other signposting support to offer to them?
  • 6. Do you have your T’s and C’s clearly stated on your website/accounts etc?
  • 7. What level of support are you comfortable to offer?

Of course, there is never going to be a completely foolproof way of confirming identity, however, hopefully by having clear boundaries and measures in place, you will only attract genuine clients. I know it’s inconceivable to think you could be duped – however unfortunately there is a high probablility that you might receive some fake enquiries now that there is so much online support being offered. These individuals are unfortunately craving the attention of anyone that will listen.

As a final point, please PLEASE check out who you become friends with on Social Media…it’s recently been discovered that my hoaxer was friends with over 200 Birthworkers….they had all become friends with her because she had been clever enough in building a great profile a while ago, befriending Birthworkers, and then those Birthworkers over the years allowing her as a friend, purely because they saw that she had ‘ 53 mutual friends’ for example….when you actually visit that profile now, it’s very sparse looking, with little info and a stock photo. So, please, don’t just accept people as a friend or follower, until you have visited their profiles and checked out their company websites etc.

I am now offering training sessions (online based) which cover key practical steps on how you can stay safe when working online as a birth worker. I have also set up a support group on Facebook to help support those dealing with difficult enquiries.

Thank you for reading and stay safe online

Doula Love xx

Consent in birth and the Montgomery ruling: why doulas need to understand it

By Emma Ashworth

Photo of Emma Ashworth, white woman with shoulder length brown hair wearing a floral dress.

What is the Montgomery ruling?

‘Montgomery’ refers to a legal case, formally known as ‘Montgomery V Lanarkshire’, where Montgomery is Mrs Nadine Montgomery, and Lanarkshire is the Lanarkshire Health Board in Scotland. The case was brought after Mrs Montgomery’s son was severely injured during his birth. During pregnancy, Mrs Montgomery was very concerned about her forthcoming birth because she felt that her baby was too big for her to birth vaginally. She had diabetes, was very small herself, and the baby appeared to be large. However, her obstetrician did not offer her a caesarean birth as an option to consider.

During the birth, Mrs Montgomery’s son experienced a very severe shoulder dystocia. After a variety of interventions he was born by caesarean, and now lives with cerebral palsy and a damaged shoulder.

The injuries that occurred during his birth are rare, and, statistically speaking, were unlikely to occur even with the risk factors that Mrs Montgomery had. However, the legal case came about not because of the complications themselves, nor how they were handled, but because the obstetrician made the decision to not share the information about the possible outcomes of a vaginal birth and a caesarean with Mrs Montgomery, thus stopping her from being able to make an informed decision herself over what was right for her. Ultimately, the case came down to whether or not information was shared to support informed decision making – and, the case found, it was not.

What did it change about consent and birth?

Before the Montgomery case, what doctors shared with pregnant women depended, basically, on what other health care providers were sharing. They could decide to limit what information they shared with women as long as other doctors were doing the same. This was known as the ‘Bolam Test’, and it states, “If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent”. This applied to all areas of medicine, and led to many outdated principles still occurring (eg immediate cord clamping) because, from the practitioner’s point of view, if they did what most other doctors did, they had more protection against being sued.

With Montgomery, all this changed. Rather than just relying on what most other people did, practitioners are now obliged to share information on ‘all material risks’, meaning any risk (of an intervention or NOT intervening) that might be important to that pregnant woman or person, irrespective of what was normally done by their colleagues. If followed, this gives the pregnant person information they need to be able to make an informed decision about their own care.

Why do doulas need to know about it?

Sadly, no single legal ruling can resolve all of the problems that we have within the maternity system. Montgomery has given us a hugely valuable legal framework to support informed decision making.  It means that the pregnant woman or person must be offered information to ensure that they are able to make an informed decision about their care. If your client isn’t experiencing this, you can suggest that they raise this as an issue with their health care provider, and remind them that they alone can make decisions about their body.

Unfortunately, there are downsides to this ruling in practice, if not within the aims of the law. The ruling states that providers should ensure that they take “reasonable care” to ensure that “patients” are aware of “material risks”.

The text reads, ‘The test of materiality is whether, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it.’

What this should mean is that individualised care is offered, with doctors and midwives ensuring that women are given information that is relevant to them, personally, depending on their personal needs and wishes. What is happening in reality is that doctors and midwives misunderstand this to mean that they have to tell women of every possible horrific outcome that might happen if they decide to decline an intervention, or birth outside the hospital. They seem to be forgetting that their obligation is to offer a balanced picture of all of the material consequences of interventions and non-intervention (when was the last time that you heard all the potential risks of an induction, for example?), and they also seem to be forgetting that women are not obliged to listen to any of this!

Pregnant women are still autonomous beings, and they alone can decide what they want to hear. Our clients do not have to attend meetings with doctors or midwives who they don’t feel are supportive of their rights or decisions if they don’t want to. They don’t have to listen to a stream of possible horrific outcomes if they don’t want to. If they want the information, they can choose to ask for another midwife or doctor, and they can point out that being told only one part of the picture is coercion, not informed consent, and is going against the Montgomery ruling just as much as not being offered information is.

Further reading

The online content of Nurturing Birth’s Expansive Doula Course has a video on consent which includes information on Montgomery.  This presentation is also available to Nurturing Birth graduates who purchase the online modules after completing their Intensive Doula Course. 

AIMS has published a helpful article on the Montgomery ruling by a solicitor who looks at the ways it can be used in medical negligence cases within maternity: https://www.aims.org.uk/journal/item/montgomery

The MDU (Medical Defence Union) has a web page on Montgomery which clearly explains the legal situation: https://www.themdu.com/guidance-and-advice/guides/montgomery-and-informed-consent

Birthrights is continuing its work on consent, following the Montgomery ruling, by offering workshops to midwives and doctors on this topic, and they are part of a team launching an app for women to use in labour: https://www.birthrights.org.uk/campaigns-research/montgomery-and-consent/

Emma Ashworth is a Nurturing Birth doula, a trustee of AIMS and she is currently the AIMS Journal Editor. She has a special interest in consent and has written extensively on women’s rights in birth. Her book, “The AIMS Guide to Your Rights in Pregnancy and Birth” is available from AIMS. You can find Emma at her Nurturing Birth Directory listing here…