I see it all the time. While reading through doula boards and group chats I see people throwing around awful, damaging advice under the guise of doula support. I can’t count the number of times I see a doula seek support for a client processing their medical providers’ recommendation that conflicts with their initial hopes and plans for birth. In summarizing the issue, the doula will say things like:

• “The supposedly supportive vbac OB is now saying…”
• “My client wants no interventions, but their provider says they have to…”
• “My client’s doctor said he supported a vaginal birth, but now he’s throwing around ‘big baby’ to scare her into a c-section.”
• “What should I tell my client? Her provider has flipped on supporting vaginal birth.”

And every time, the overwhelming response that I see is “find a new provider”. “Time to change providers”, “run as fast as you can”, “fire your doctor”, “just don’t show up”. The role of a doula shouldn’t be to jump to these conclusions. In addition, those pieces of advice (under most circumstances), won’t help anyone.

The correct role of a doula

Overall, these answers reek of privilege. These statements are contrary to the core role of a doula which is to provide unbiased support for their client. Responses like these are a total cop-out. They’re not helpful, useful, or realistic in any sense of the word. They are however dismissive, culturally incompetent, and a ginormous red flag that perhaps shows that the doula needs to be replaced, not the doctor.

Also keep in mind that the clients on the receiving end of this advice are typically toward the end of their pregnancy. They have built a relationship of trust and interdependence with their provider. Moreover, they are often “locked in” to the relationship with their delivering OB or midwife for any number of reasons. To suggest that any person can simply switch to a new provider with a snap of their fingers is severely out of touch. That kind of advice provides zero support or service to their clients.

Rather than offer untenable advice, it’s essential that we look at the challenges and barriers that families face in accessing birth services in our country. Insurance often limits who a client can see. OB’s and midwives may already be booked and/or may be resistant to take on a new client who’s fleeing their provider. This may be especially true if their “doula told them to do it.” It raises the issue of depreciating trust between medical practitioners and doulas, which we have worked so hard to establish. There are a multitude of barriers around access for care and I expect a doula to know and honor that.

Listen to ALL your care providers

We must also consider the very real possibility that the medically trained provider actually does know what they’re talking about. Yes, it is up to the client to weigh the risks and the advice along with their own feelings and values and intuition. However, it’s of paramount importance that we honor the red flags that providers may see. Consider their position on the values of appropriate interventions – they are professionals after all. To fully dismiss the recommendations from a medical provider is not only unethical, it is dangerous. It can harm to your client and places some liability squarely on your shoulders.

We can’t flippantly dismiss our clients’ concerns about how to navigate this unexpected change. Instead, we must sit with them, hear their concerns and worries, process their disappointment, and weigh the options moving forward. Nine times out of ten, what a person needs is understanding, space, and a compassionate ear. We should provide a safe and neutral place for our clients to mull over new information. They must be the ones to decide for themselves the best way to proceed.

Always put the client first

The phrase, “just get a new provider,” is blind to the real circumstances of women and birthing families in this country. I implore doulas to pause and consider the real position of their clients. Help them navigate their birth in their current culture and climate. Stay open and flexible. Listen and really hear your client. Then, and only then, ask them what they need. Use the B.R.A.I.N. acronym to work through decision-making and allow your client to determine what they’d like to do for themselves.

Of course, if your client asks how to change providers, provide some questions to ask and outline the process and procedure to do so. Be honest and upfront with the benefits and challenges to switching providers. Listening to your client’s needs is the one of the most important things to remember as your role as a doula. We must provide true support to improve birth outcomes, not vilify providers and encourage clients to drop their doctor.

Additionally, if you are beginning the journey of having a child, contact me today for expert doula services.

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