When a Doula Says No

Lately on many private doula pages I am on, there have been doulas discussing watching their clients being abused and what the role of a doula is when that happens. And it is a difficult situation. We can not give medical advice nor be disrespectful to a care provider, but when we see abuse and have to stand quietly out of the way it is very difficult. What many doulas have done, and I personally have chosen to do is to step away from taking clients who have abusive providers.

Recently I had to decline being the doula for a client whom I have been the doula for twice before. She continues to go to the same provider although she is not listened to and is even abused in my eyes. I wanted to be there for her but I can not enable her to continue on the path she chooses. And I am not going to get into why women allow this to happen to them… the vulnerability and issues behind it are outside of my understanding.

We watch women being lied to…outright lies. They are told things that are not evidenced based and are totally biased. We watch women have their cervix stripped after asking to not have it be done. We have women have rough vaginal exams in labor only to be told that is why they need to choose an epidural. We have women have their amniotic sac broken without consent and sometimes even after telling the doctor they did not want that to be done. We watch their perineum being sliced without consent. We watch women get bamboozled into inductions that are not warranted and into medication they did not desire. And for some of us we see worse. When we see women shut down- not listened to- not being heard when they speak- not having a say in their births, we want to yell STOP! But we can’t. We can stand by her side and remind her of what she desired and try to help her find her power. But some women give their power away. They know what they wanted but they are quick to give it away. It makes us go home and cry for that woman and that baby and that birth experience.

I have attended over 600 births and I realized after the first couple of hundred that I had to put my foot down and protect myself from burning out. I had to say, no I will not be party to watching that abuse, that birth rape occur in my presence again, feeling powerless and being damaged emotionally by watching it. So there are providers that if a mom chooses that provider, I have to decline being her doula. There are only a few- one at Gwinnett Medical and two at Northside.  I am reminded of something an OB told me years ago, “ObGyns are either one of two kinds of people. Those who hate women and want to control them, and those who love women and want to support them.” I have found this to be true.

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Recently our local hospital that does more births than any other facility in the country came out with a form that is required by the patient and doula to sign. It is attached for you to see it. It must have come after doulas stepped outside of their scope of practice. I only did one birth there in 2014, so I have not heard the scuttlebutt of what caused this to happen. But it is a shame. The scrutiny of the doula in the support team is sad. If I go as a friend or family member I am not held to signing this agreement. But it seems that although the parents want a doula to accompany them, a nurse can decide that that doula has to leave. How do you feel about a hospital that can control that aspect? And this form is not about overstepping medical advice- it is about support – things your family members do and most nurses prefer for us to help with- but someone decided to make doulas sign it- controlling your choice in having a doula.

I have only been asked to leave by a doctor once- when he wanted to control the mom and dictate who she could have in the room, inviting some who were not invited and then saying too many were in the room and I had to leave. The mother watched in horror but without her voice. Later as she clung to my neck and cried about the horror she had just experienced at his hands, she broke my heart. I had a midwife decide the room needed to be cleared once and ask everyone to leave. She thought that was best. But again, the mom was voiceless. It breaks my heart when care providers feel the need to control the birth room without regard with the mom’s desires. That is about as dis-empowering as it gets.

I think women need to have their voices heard in labor and birth- but I also feel doulas have to know when to say no. I have cried many tears for women who allow their births to be taken away from them. It is always about control. And watching women give their birth choices away to someone else to control breaks my heart.

Here is the form that is now required to be signed if a doula remains in your labor room at Northside Hospital. If you can not read it from this pic- let me share some of the verbiage:

The role of the doula is to provide labor support, which may include emotional support and coping strategies for your labor and birth. The role of the labor doula does not include performing clinical task such as assessing your medical needs for those of your baby, diagnosing medical conditions affecting you or your baby, offering medical advice, operating any monitoring or medical equipment, removing or applying monitors, assisting you out of bed to the bathroom, making decisions regarding your care and treatment or providing instructions or information that would be required by a licensed professional registered nurse or medical provider. 

If at any time your doctor midwife or nurse believe that the doula is not adhering to his or her role in providing you with labor support or if your care providers believe that you’re doing is intrusive in the care and treatment provided to you during your stay at the hospital, we reserve the right to instruct the doula to leave the hospital. You may dismiss your doula as well.

10978551_10153121460466789_4188755323257192461_nSo although a doula should not be giving or providing medical advice or treatment, the document seems to possibly restrict us helping our clients get informed consent. The words like “being obtrusive in the care” and we are told all of the time to unplug a mom to help get her up to the toilet… and when we ask about this we are told of course we can- but if we do- this is grounds to have us dismissed… could be treading on tricky waters. So be aware of the situation your doula may be being put in by supporting you at this facility.