AIMS

By Emma Ashworth, Nurturing Birth doula

Why are you a doula (or want to be a doula)? At the heart and soul of it, we passionately want women and people to have incredible, empowering, beautiful births, right? And because we see when that’s not happening and we want it to stop! For many of us this leads us down the path of activism – which is what this blog is all about. Can you be a birth activist and a doula?

You might wonder why not… indeed, many amazing doulas are also extraordinary birth activists. Birth activism changes the birth world for the better – as do doulas – so in a way, every act of doulaing is an act of birth activism. However, there are some parts of being a birth activist which need to be kept quite separate from being a doula.

Being a doula means that we support the pregnant woman or person who is our client, and, if they want us to, their family (eg partner, children). We are there to help that woman or person to find their way through the maze of maternity care. We are not there to guide them through it. We are there to show them what doors are available, support them in their decision about which door is right for them, and then walk with them through those doors. We don’t tell them which door to take.

Sometimes we may see injustice and as doulas who care so deeply for our doula clients we want to fix it. Right now, we are seeing deep injustice, and in some cases real trauma, from Covid-related hospital rules which are limiting access to hospital for partners and other supporters (including doulas). As has been pointed out in a recent social media campaign, if we can go to the pub, why can’t we have the person we want with us at an antenatal scan? As birth campaigner Ruth Weston points out in her excellent blog, some pregnant women and people find out at a routine that their baby died. Not only is hearing this alone a horrific experience for the pregnant woman or person, the other parent has to hear it over the phone, or second hand in the car park.

Here’s the thing. Here’s where it is absolutely imperative that we are completely clear about separating out being a doula and being a birth activist.

Our client may be really upset at the idea that they may have to attend an appointment alone, or be alone through much of their labour if they birth outside the home, or be alone on the postnatal ward. They may be able to have one birth partner there, but not two, and this might mean that they have to choose between their doula (you) and their partner. This feels wrong. This is wrong. So what do you do?

It may feel obvious that the right answer is to get on the phone, or send emails to a senior midwife, telling them how anxious this situation is making your doula client. Perhaps you might go through the details of your doula client’s specific case. Maybe she had a miscarriage last year that she only found out about at her 12 week scan. Maybe they are wanting to talk to a doctor about having a caesarean and they are worried about it being denied. Isn’t it our job to fix it?

No!

This is tricky stuff, and of course your doula mentor would be an amazing person to talk to about the complexities of the boundaries of a doula, however here is a starting point to this hugely important area.

One of the most important roles of the doula is to work with our doula clients to help them to achieve the pregnancy, birth and parenthood experiences that they want. Here’s the key words:

“to help them to achieve”

There are two big risks of “fixing” things for doula clients

1. We can, inadvertently, take away from our doula clients’ own power.
2. We can, inadvertently, do things for our doula clients that they didn’t actually want to happen.

When we see things which are wrong in the maternity system, it is absolutely fine to work towards fixing them. If we see guidelines, protocols or limitations of care which are unfair, unreasonable or unkind then fight against them with all of your power, if you wish to. Just do it as you, as a birth activist, rather than trying to do it on behalf of your client. It’s fine to say, “I know local women who this policy is affecting very seriously”. This is powerful and desperately needed work. You can absolutely be a birth activist and a doula.

What we have to be extremely careful to avoid, though, is trying to fix things ourselves, for our individual doula clients, when we see injustice happening. Instead, we are better focusing on what we can do to support our clients to make the changes that they want to see for themselves, so that they remain in control of their decisions  and we don’t accidentally push for something that they’re not totally ready for. This means that our doula clients are the ones who are deciding which doors to walk through, and this is how they work with and build on their own power and strength.

There is huge benefit in large numbers of people campaigning on a specific issue, so many pregnant women and people feeding back to the trust and pressing for change is the most likely way that things will improve. But the only people who can do this are those who are wanting to do so. As with all options around pregnancy and birth, we, as doulas, can ensure that our doula clients know that this ‘door’ is there, but, like everything else, it we must show them this option with no pressure, no judgement and with no attempt to encourage them through it, but if they decide to open it themselves then we can step through it together with them, if they want us to.

Birth activism becomes a heart-need for many, and activism in the birth world is essential for change. We can campaign for change as we see the need, and yet ensure that we keep our doula work separate, carefully ensuring that we support our clients to achieve what they want, not what we want to see done better.

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Emma is a Nurturing Birth doula, and manages the Nurturing Birth blog. She is also a breastfeeding counsellor, birth researcher and writer and a birth activist with AIMS.