Advocacy: What it is, and what it is not.
A lot of women choose to hire a doula to advocate for them, and help them experience the birth they want. Maybe they are a first time mom and want someone they know that is more experienced in the room to support them. Maybe they had a previous birth that was traumatic, and want to avoid another outcome like last time. Or maybe they had an incredible experience with a doula in the past, and want to replicate that. Whatever the case may be, the majority of women who choose a doula do so with the hope that she will advocate for them.
This brings up the question, what is advocacy? How does a doula advocate? And maybe more importantly, how does she not?
To answer this question, we need some legal context. Doulas are not a regulated profession like midwives, nurses, or OBGYNs. There are no governing boards to define qualifications for a doula. They are not medical providers. A doula can offer support, resources, or occasionally opinions on specific medical interventions and situations. They cannot make medical decisions, perform medical interventions, take vitals, or give medical recommendations. If a doula were to perform medical procedures of any kind, she would be breaking the law.
With that legal standing in mind, what does advocacy look like? Let’s start with what advocacy is, and then we will look at what it is not. Advocacy looks like asking questions and facilitating communication between the parents and the medical providers. If I see a provider reaching for an IV without asking a mother’s consent, I may ask “Did she consent to having an IV placed?” Or I may speak to the mother and say “Your doctor would like to place an IV. Do you have any questions about the procedure before you make a decision?” And this applies to any procedure. If the medical provider wants to start an intervention, I can ask “Is there any danger to the mother or baby if we wait five minutes?” This helps the provider slow down and give time to the mother to make an informed decision.
Advocacy also looks like explaining procedures to the parents and giving them information about pros and cons, risks and benefits. My entire job is to help parents make informed decisions that they can feel confident in, and help mothers advocate for themselves. During active labor, it is very difficult for mothers to even speak, much less make conscious decisions. This is why having a doula is so important, because we are an extra person in the room working alongside you to protect you and encourage your providers to treat you with the respect you deserve. The most I can say though, is “She has not consented to this procedure, you need to have her informed consent.”
This brings us to what advocacy is NOT. Advocacy is not making decisions for you! I legally cannot tell your provider what you do or do not want. I have no authority to make medical decisions for you. Advocacy is not waving your birth plan in the provider's face, telling them they have to stop what they are doing, or denying interventions on your behalf. As we established earlier, doulas do not have the legal standing to make any medical decisions. We are there to support and empower you, not control your birth experience.
Ultimately, you have to advocate for yourself. As your doula, I will walk alongside you as you make your birth plan, choose a birth location that best fits your needs, and talk about potential decisions that you will have to make. Remember, birth is an act of surrender, not control. You can have an incredible birth experience even if nothing goes according to plan, as long as you feel safe to make decisions and know that those decisions will be respected.
I hope this helps you understand more about the role a doula plays during birth!
God Bless,
Heli