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Advocate: the act of pleading for, supporting, or recommending;

Typically, women giving birth have not been adequately prepared for the choices they will be faced with.  They often have not discussed the pros and cons with their providers, nor are they even made aware of their right to make health care choices for themselves.  Instead of being asked if they want certain procedures, they are told they will have them or are unaware of what is happening.  This is not to demonize the medical institutions or the people who work in them.  Having been a part of these institutions as a nurse, I worked with very well meaning and compassionate people.  But it is our culture of birth that is problematic.  Our current culture currently sees the doctor and nurses as the decision makers in a woman’s care, not necessarily the woman herself.  This is such a part of our culture, that many people do not even recognize it, but just assume that that is how it is supposed to be.  Because of this, New Beginnings believes that many women are in need of support in standing up for their own voice, particularly in an environment where choice is minimized and women are placed in very vulnerable positions.

The question remains, then, how do doulas best act to plead for, support, or recommend(endorse) a woman’s autonomy during childbirth without overstepping their scope as supportive care.  There are some doulas that feel like they need to fight or be passive aggressive in their advocacy role.  While this may help a woman in some respects, these are ineffective communication styles in the long run, and may lead to a breakdown in the type of care a woman may receive.

Learning to communicate effectively is one of the number one things a doula can do.  If you are interested in working within a collaborative care system while still advocating for your client’s autonomy, below are some communication strategies you can use.

  1. Motivational interviewing: A way to increase the ability of the doula to advocate their client’s autonomy by assisting her in navigating her own decisions and desires to change.  Motivational interviewing has been used in counseling and other health related professions before.  Currently, New Beginnings has a course available for new and experienced doulas in this method. (Webinar now available in shop)
  2. Conflict management strategies:  Conflict is a normal part of daily living and happens when two people or groups have different needs that are not met.  If handled poorly, it can be harmful.  Poorly handled conflict during a birth can impact not only how a woman views a birth, but create physiologic problems during birth.  Thus, a doula should work to create a more positive way of dealing with conflict.  Some healthy ways to respond include looking at the issue through the other person’s eyes, staying calm and non-defensive, seeking compromise, and a willingness to seek for a common solution.
  3. Anger management strategies:
    While anger is a normal emotion, it is not necessarily healthy if used in an unproductive way.  It can harm relationships with your clients and birth team, and cause rifts that are hard to repair.  Some healthy ways of working through anger include relaxation, restructuring your thoughts to be more rational, and stepping away from the environment for a moment.
  4. Active listening skills

Collaboration and advocacy need not be exclusive to one another.  It is my hope that we can work to help both women and their birth teams in order to better serve everyone.


Abushaikha, Lubna and Sheil, Eileen P. (2006). Labor Stress and Nursing Support: How do They Relate?. Journal of International Women’s Studies, 7(4), 198-208.
Segal, J., Smith, M. (2016). Conflict Resolution Skills. Retrieved online. Feb. 8, 2017. https://www.helpguide.org/articles/relationships/conflict-resolution-skills.htm

American Psycological Association. (2017). Controlling Anger Before it Controls You. Retrieved online Feb. 8, 2017. http://www.apa.org/topics/anger/control.aspx







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.

2 Responses

  1. Darlene Hernandez
    | Reply

    I’m new to your course and looking forward to learning from everyone. Thank you for taking time from your busy life to help others.

  2. Samantha Kitchel
    | Reply

    Welcome to New Beginnings, Darlene!

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