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A few months ago, I wrote a post about what it means to be an advocate as a doula.  It focused on the idea that communication with the entire birth team (your client, medical providers, and other support people), is essential to being an effective advocate for women and their rights in childbirth.   In current trends among doulas and communication, there appears to be three camps on advocacy.

One way has used more aggressive forms of communication.  A doula uses aggressive communication to get what they want without regards to other’s rights to choose or make decisions.  This includes not allowing other members of the birth team to advocate for themselves or do the job they were hired to do.  When the doula uses this method of communication, they place their concerns before others, and may not acknowledge their own biases in their actions.  Typically, training organizations discourage this as a way to advocate and communicate with the birth team.

In response to this, some doulas and organizations have defined advocacy in ambiguous or contentious terms.  Thus, advocacy has become a term that doulas look down on.  Instead of using aggressive methods of communication, they have instead turned to passive aggressive forms of communicating.  While these address the problems that more aggressive behavior brings, it does not solve the communication barriers that members of the birth team have built between each other.  Instead, some doulas avoid direct confrontation, and often they deny problems in an effort to appear cooperative.  While this may solve the problems inherent with more aggressive style of communication, it does not address the power hierarchy that puts both doulas and their clients without a voice or choice in birth.

New Beginnings has described an assertive method of communication.  In this style of communication, members of the birth team uphold respect for one another, while still acknowledging differences of opinions.  Listening to others is key in this style as well as staying calm and working to uphold a connection between all members of the birth team.  In order to achieve this goal, we use a theory of autonomy called relational autonomy to describe how doulas can act as advocates and uphold the rights of all members of the birth team to express their opinions.

Relational autonomy says a woman’s autonomy operates in a social context.  While women can act without being influenced by this social context by voicing their own choices, many women have not been taught how to do this, nor do they know they can.  Because most women operate in a social context, there are a few things a doula can do in order to advocate in a respectful, assertive manner:

  1. They can present their clients with information about choices available to them within their chosen social context and help them decide if those choices are what they want.  In doing this, doulas only act as providers of information, not decision makers.
  2. Doulas can model respectful assertiveness by asking clarifying information to medical professionals to help the mother guide her decisions.  In doing this, she can first model, then guide their client as she asks question on her own as she learns to do so.
  3. Doulas can also work with medical professionals to address action steps to take when abuse is seen.
  4. Doulas can help strengthen healthy care-provider relationships in a collaborative effort to increase healthy outcomes.

Doulas can also help to promote the autonomy of women in these ways:

  1. Support their clients as the primary decision maker and the center of their care.
  2. Support their clients understanding by providing them with information and asking clarifying information
  3. Support their clients to recognize the biases within all their social systems which can help or hinder their care.


Follow Rachel Leavitt:

Rachel has worked as a register nurse (BSN from University of Utah) since 2004 with a work history in Labor and Delivery, NICU and Postpartum Care. She is also the founder of New Beginnings Doula Training which she organized in 2011. When she's not busy being a mother and grandmother, she can be found reading research papers related to some aspect of childbirth.

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