Preventing a Doula Backlash

This is great ... it was written by Penny Simpkin, PT, CD(DONA) and is AWESOME! I know of a few doulas who should read this thing in its entirety (at http://dolphin.upenn.edu/~doulas/documents/Inservice-backlash+communication.pdf). All underlined items are mine and done that way for emphasis...

Preventing a “Doula Backlash”

Penny Simpkin, PT, CD(DONA)

The “advocacy” role.

Doulas often contribute to problems in relationships with medical staff, which can also cuase problems for their clients. The most common mistake doulas make is in how they interpret the “advocacy” role. They believe they should be able to influence the doctor, nurse, or midwife to manage the woman’s labor in a particular way (usually in accordance with the woman’s stated preferences). This is an inappropriate role for the doula, especially since she is not trained clinically and is not able to assess the mother’s or baby’s well-being. In fact, the doula should not try to control clinical management. If she does, it may lead to anger or dismissal by the care provider and refusal to allow doulas at any births. This is what we mean by “backlash.”

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What can the doula control?

The doula can control only her interactions with her clients, by adhering to the limits of her scope of practice, which includes continuous presence, emotional support, physical comfort, nonclinical advice, and facilitating communication between her clients and the clinical staff. Advocacy, as the term applies to the doula, means standing by while the woman asks questions and makes decisions. Sometimes, when a procedure is suggested, the woman asks the doula, “Should I do this?” The doula should not respond with a “yes” or “no.” It is better to reply, “It sounds as if you have some questions about it,” or “Why don’t you ask more about this? I’ll support you in whatever you decide.” The doula cannot control the management or the decisions the woman makes.

How should the doula interact with medical staff?

The doula should speak when spoken to or acknowledged. If the doula has a question relating to non-clinical activities, she should suggest that the woman ask the nurse, “Is it okay for us to try the bath now…, take a walk…, drink some juice…, etc.” (In settings where the doula is familiar to and respected by the staff, she would be able to ask such questions without jeopardizing a backlash. If she is new to the hospital, is inexperienced as a doula, or is in a hospital that is unfriendly to doulas, she should leave the talking to the woman or her partner.)