By Sharon Muza, BS, CD(DONA), BDT(DONA), LCCE, FACCE, CLE
Research indicates that between one-quarter to one-third of birthing people describe their labor and birth experience as traumatic. Lived experiences or a traumatic previous birth experience may all contribute to how a person feels during and after their birth. How a person is treated and whether they are respected and their voice heard before, during and after the process in addition to the clinical circumstances of the birth can all contribute to positive or negative feelings.
I very recently read a first-hand story shared on the Facebook social media platform from attorney Hermine Hayes-Klein, who is a consultant and advocate in cases concerning the treatment and rights of women during and around pregnancy and childbirth. Hermine supported a client in her local community who was hospitalized during a preterm birth concern. Hermine was present in the self-described role of “lawyer-doula” to serve her client. Hermine defined this term as a person who is present in the dual role of both attorney and doula, there to help their client prevent their human rights from being violated during childbirth and support the labor and birth process. You can read the entire account of Hermine’s experience here.
This term “lawyer-doula” is unfamiliar and new to me. I am not naive in recognizing that many birthing people are on the receiving end of disrespectful, hurtful care, where their voices and wishes are not heard or respected. I also know that these experiences have life-long negative effects and impact parenting, future births, and their lives in a significant, detrimental way. I have personally witnessed this type of treatment while attending births with my doula clients. I just know, after working as a birth doula for 15 years, that the role of the doula does not overlap with the role and responsibilities of an attorney. This joint role concerns me as a certified doula who believes strongly in following the scope of practice and code of ethics of my certifying organization. I immediately thought of the many ways that a doula can help their clients to not be in the position of needing both an attorney and a doula to support them during their childbirth experience. Below you will find steps you as a doula can take prenatally, during labor and after birth to support your client and help reduce the potential of an experience involving obstetrical violence, disrespect or trauma.
- Create a positive relationship of trust with your client, where they feel safe and comfortable sharing their fears and prior experiences.
- Support your client in developing plans for many contingencies, and identifying what type of support might be most helpful under those circumstances.
- Encourage your client to choose a facility and providers who are known for giving respectful care and shared decision making. Assist your clients in making changes if desired. I recognize the ability to change providers and facilities is often a sign of privilege and may not be an option for everyone.
- Help your client to create a short and simple info sheet with important background information that can be shared with everyone involved in your client’s care. This can serve as a reference when necessary.
- Consider role-playing situations to offer your client a chance to practice responding and making their voice heard.
- Share that your client has the right to respectful care and that they have a voice in every step of the process.
- Encourage your client to meet with the hospital or clinic’s patient ombudsman or patient representative in advance to voice their concerns about potential treatment and share their needs. In my area, one of the hospitals has a special nurse who meets with patients in advance and creates a “purple sheet” for L&D patients who have special needs and concerns. This purple sheet goes into the patient’s chart and everyone is aware of it when the patient arrives for care.
During labor and birth
- Remind your client that you are prepared and ready to help them find and amplify their voice if necessary.
- Encourage them to connect and share their own “simple info sheet” and also point staff to their chart for specific instructions, like a “purple sheet” (see above) with everyone who will be caring for them.
- Unless it is an emergency, ask your client if they would like a few minutes to discuss anything or regroup in private before things proceed.
- Describe what you are seeing happen out loud to your client and the room.
- Model good doula behavior (stop talking during contractions, keep your voice calm and soothing, use your client’s name, and repeat your client’s requests for clarification, are just some examples.)
- Encourage your client to state what they want at the moment and if they are able to articulate it, why they want that specific request.
- Support your client in obtaining information about all their options and choices.
- When your client’s wishes or preferences are not being honored, repeat your client’s request politely but firmly to the room so that everyone is aware of what your client has said. “I hear *client name* asking that the vaginal exam and cervical check be stopped right now.”
- If your client is uncomfortable with a specific nurse, midwife or doctor, help them to request a different one.
- Again, (because it is important enough to say twice!) help your client to voice their need for a “break” in care while they regroup or collect themselves and prepare to self-advocate for what they want.
- Listen to your client share their birth story with you, in their own words. Do not insert or substitute your observations or experiences with their own.
- If they express dissatisfaction with any aspect of the experience, ask them what might help them, what they might like to do or what they need.
- Let them know that they have the option to inform the facility of their concerns and dissatisfaction and help them to establish communication (written or verbal) with the appropriate people.
- Make appropriate referrals to therapists, mental health counselors, clinicians and support groups that can support them during the processing and healing from their experiences.
- Help them to receive logistical support (lactation, meals, family and friend support etc.,) that allows them to recover from birth and the transition of parenting a newborn.
- Let them know that their experience matters and they had the right to receive respectful and appropriate care and that they have recourse if they feel that this was not met.
It would be foolish of me to believe that everyone who births does so under circumstances where their voice is heard and they are fully respected. I know that is not the case. I am working for respectful and evidence-based care on a local and national level through my advocacy work. But I worry about what happens when the lawyer-doula shows up and attempts to work effectively in both roles at the same time. We can be an activist for change outside the birth room, but during a birth, we are of no use if we find ourselves removed from the birth room due to behavior that is outside doula scope.
How do you help your clients to receive respectful and appropriate care? How are you working inside the birth room to help your clients while still staying inside the doula scope of practice? What would you add to the list I have created above?