By Sharon Muza, BS, CD(DONA), BDT(DONA), LCCE, FACCE, CLE
Today is the second post in the occasional series “Doula Me This!” Each post in the series provides a common scenario that a birth or postpartum (or both) doula may face. The “correct” answer (if there is one) requires some synthesis of the situation and at times consideration of the DONA International’s Standards of Practice and Code of Ethics.
I got the idea for today’s “Doula Me This!” post after reading a recent blog post “Doulas are Not Magic” by Alice Turner, Doula and Lamaze Certified Childbirth Educator. I thought her post was well-written, spot on and addresses a common conundrum for doulas who are often faced with clients who have unrealistic expectations of what a doula does. I wanted to share a scenario about meeting with potential clients who have a misconception about the role of a birth doula. Read through this scenario here and let me know how you would handle such a situation in the comments below. If you are struggling to find clarity on how you would respond, consider reading Alice’s post for additional support.
Doula Me This!
You are sitting down for an interview with a pregnant person and their partner. They are 32 weeks pregnant with their first baby and interested in hiring you to be their birth doula. They were referred by a co-worker who was a former client of yours, and they are excited to see if you are a good fit for them.
- Doula: Sophie
- Pregnant person: Jamie
- Partner: Sam
After getting introductions out of the way, Jamie and Sam begin to ask you most of the common questions you typically hear at interviews. After that, you ask the family what interests them about having a doula and how they believe a doula might support them. Jamie excitedly shares that they have heard wonderful things about having a doula and believes it will really help them have the non-medicated, low intervention birth they are planning for.
Jamie: My sister had a very long labor with an OP baby who never rotated, and she needed a cesarean after the baby would not drop and come out. She never dilated past 7cm and hard horrible, painful back labor.
Sam: We think that if we had you with us, you can help us correct the baby’s position if it was facing backward so that the same thing won’t happen to us.
Jamie: After all, you have all this training and birth experience helping other families. Also, we really wanted to birth at Seneca Hospital which has great outcomes and low cesarean rates, but our insurance only covers our care at Spring Street Hospital. We know there is a high epidural rate there and a lot of policies that don’t always follow the evidence we learned in childbirth classes. Also, they have a high cesarean rate, even for low-risk people. We feel that having you with us will help us to avoid those things. My doctor shared that she feels it is better to have an epidural on board just in case we need a cesarean, but I would prefer not to.
Sam: You can tell the staff and our doctor that we are hoping for no interventions and can help us to cope and progress our labor naturally.
Jamie: I hope you now understand a little more about why we are hoping to have a doula at our birth and we have heard so many good things about you from our co-worker, that we are confident that you can help us have the birth we want. We would like you to be our doula. Do you have any questions for us?
While Jamie is speaking, Sam is taking out his checkbook and inquiring who should they make the check out to?
It is clear that this couple is ready and wants to hire you right on the spot. You have felt a real connection with them and love working with clients referred from satisfied past clients. As you sit there with the potential to “seal the deal,” you ponder the appropriate next step.
What Would You Do
Your doula calendar is pretty open, and having these clients on the books will really reduce some financial pressure during a rather lean time. You like this couple and would like to work with them. After what you just heard about why they want to have a doula at their birth, do you have any concerns? Should you agree to work with them? Does something else need to happen first? Do you tell them you are not the doula for them and end the interview with some referrals to other doulas? What would you do?
I have no comment on this particular situation as I am a postpartum doula. However, I would love to process through a postpartum related situation. I hope that you have one in the bag for postpartum doulas.
hi Tonja – Indeed, a postpartum scenario is in the lineup next, so get ready. In the meantime, what if this scenario was all about a family who had unrealistic expectations about what a postpartum doula does? How would you respond?
I have a very simple thought that I communicate to clients from the first phone call: “The only predictable thing about birth is that it is unpredictable”. I acknowledge the supportive evidence that they’ve obviously gathered about doula care within that context – that it can be beneficial to have goals….and to gather the information and support that will give them the best chance of reaching those goals….but that there can be no guarantee – especially from the doula – that the best-laid plans will have to change. I will support their choices and assist as they wish in doing whatever is possible to reach their goals – but my presence guarantees NO outcome. Tough case!!
I have noticed two points in text where it is not in my Doula set of skills. First off, I have training to be a Doula and other trainings but still I am not trained in spinning babies yoga soo I would have to offer a referral for them since they want someone around who can move the babys position since my training only provides a very slight chance of this happening. I also am trained to help lay out a guideline of a plan for advocating for ones self and aiding in being a partner through my client speaking her points of view and being there with options and support with which ever way things go. All in all, I would put a hault in the process going to booking me until I have clearly gotten them to understand these lines that have been crossed about my presence as a Doula through Labour and Birth.
I would compliment them for doing their research on hospitals and for taking the time to figure out what they want. I would reiterate that I cannot speak on their behalf to the medical professionals and that birth is a delicate dance between power and surrender. I would remind them that having a doula isn’t a silver bullet.
I think I’d be wrestling with two things – I’d feel excited by the belief they have in me (and how that would create a platform for chemistry and trust), but also nervous about the responsibility they are placing on me for a good outcome. It’d be tough because I love working with women & their partners who know what they want but have situations that limit some of their options. I like being up against the odds with them.
But ultimately I couldn’t move forward until we established a mutual understanding of the scope of my role and influence. I’d want to protect them from unnecessary disappointment and protect my reputation in the case there were many medical interventions during the birth.
I agree with everything you said! I would definitely want to make sure they understand I can encourage them in their goals and help them advocate for THEMSELVES, but I cannot cross certain lines. I love their goals and desires and can support them to that end – but we still need to address other possibilities and outcomes to have backup plans in place. I am not a magician and don’t want to pretend to be one! I always walk through the fears and their worst case scenarios before birth to help me understand what is motivating them as well. Sometimes that helps get to the root of what they actually desire instead of what they initially parrot.
In this situation, I would detail my role in labor and delivery support. The couple needs to understand that while a plan must be made, things don’t always go as planned. We have no idea how the baby feels and any interference that may get in the way of the plan. The couple seems to want to use the doula as a liaison and while that is not uncommon, this is not the role of a doula. We are involved for support in preparing for, during and immediately after delivery.