There is a book making waves in the birth community right now, called
"Pushed" by Jennifer Block. I haven't read it yet, but I have seen it come up on a number of blogs and discussion boards. A portion of the book questions the role of doula's and whether we are helping or ultimately harming women, through our support. Most recently, a midwife named Pamela wrote about it
here.So now, my thoughts on it all (reposted from the comments section at SageFemme.)
As a doula (although I've only been one for a couple years, and I've only attended hospital births), I make it very clear to clients that I do NOT speak for them. I am not their protector. I am not a guarantee of anything. This is clear in my paperwork, and in all my initial conversations. Some people understand this. Others say "never mind then" and move on. I wish I could support these people too, because they are obviously searching for something.... but to enter into a relationship with false expectations is not healthy for them or for me and so I don't do it.
I don't generally quote (to potential clients) the doula stats about cesareans or epidurals etc, because my personal stats don't coincide. The statistical information is available on my website if people want it. I occasionally say "some studies have shown, that some women, when they have a trained doula whom they trust, may experience fewer interventions/better satisfaction with their experience...."
I believe that even though there are absolutely pros and cons for various policies and procedures (and I provide this info if they want it), in the end, the right decision for Mom is the decision she is most comfortable with. Fear has such an influence on a woman's ability to birth, that I do whatever I can to help ease the fears, and that includes supporting her decisions unconditionally, regardless of how I personally feel about them. I don't mean to say that I gloss over risks, side-effects, things that are hard, etc. But I encourage Mom's to explore, to ask, to build trust.
In prenatal meetings I ask a wide range of questions, and provide clients with info based on what they tell me/ask me. I am mostly trying to get a sense of 'who they are'... what makes them tick.... what do they love.... what do they fear.....? If I learn a client is really afraid of being alone, then I will stay within arms reach and directly in her eyeline, unless she asks/shows she wants otherwise during labour. If English is not her first language I will offer to learn key words of her language to use during the birth. If I learn a client is overwhelmed by touch and talk then I sit off to the side and wait quietly for her cues. I try to create an 'atmosphere' in the room, so that everyone who comes in knows the space is sacred. What this looks like varies from client to client (and I've yet to use any form of sign), but I know it's worked when the Mom and her partner are relaxed, and the medical staff pause and take a deep relaxing breath when they walk through the door. Sometimes a small smile will even creep across their face or they'll comment on it. But most of what I do at a birth isn't something I can plan in advance. I watch, I listen, I am available. I respond according to what I'm observing, and according to what my intuition is nudging.
The closest I come to advocacy, is if a client has made it really clear they do/don't want something to happen during labour/birth/pp, and they haven't mentioned it to their caregiver after getting to the hospital, then I will ask them about it privately first (J, we talked before about procedure X. Do you want to mention that to dr/nurse?) If they say yes, but get caught up in the buysness that always occurs when the dr/nurse comes in, then I will ask them in front of the dr/nurse (J, did you want to mention X to dr/nurse? or J, do you have anything you want to mention while dr/nurse is here?). That way the caregiver knows something is on the radar, but it's still up to Mom/Partner to say what they want to (or don't want to!)
For me to presume I can speak for a woman in labour is just, well, presumptuous. I understand that some doulas/midwives/nurses feel they know Mom well enough to do this, but I don't.
As for how I navigate the hospital policies and procedures..... I view every nurse and doctor as an ally (until they prove otherwise, and even then I still treat them with the utmost respect because the last thing I want is for my presence to make things worse). I view myself as a guest who is there to serve the Mom first, her partner(s) second, and the medical caregivers third. It is a constant dance between the Mother, partner(s), caregivers, and myself, and I do whatever I can to keep the dance flowing well so that Mom can birth well (her definition of 'well'). Does that make sense? My 'formula' if you will, is simply to follow Mom's lead and keep the birth climate as positive as possible.
I have heard that the book Pushed says doula's are basically a bandaid (my paraphrase); that we (doula's) are cushioning women when in reality we should be allowing the heartache to happen so that there is more motivation to change the system. *Sigh*.... I understand that logic. And YET, I cannot abandon women to the system. Not when the stakes are this high.
There ARE times when the right thing to do is fight for justice in our un-just world. There are also times when we are called to love and support unconditionally those persons touched by injustice and heartache.
I think the line between 'condoning birth abuses', and 'bearing witness to birth abuses', is a very fine one. I don't feel that I am condoning the abuses that occur, because I acknowledge them as abuses. When a Mom cries because the vaginal exam was rough and hurt so badly, I don't say "there there. it's normal. it's okay." (condoning) I say "I'm sorry you had to go through that. I know it hurt. I know you didn't want it to be this way. Right now your options are...... what do you need?" (acknowledging and supporting). It's not easy to do this. I often come home from a birth and cry out of anger and frustration and sadness. But it is what I'm called to so I'll keep at it.
But when the heartache is too much, or the fighting is too hard, then it's time to step aside for a while. It's not giving up. It is recognizing our limitations.