Lots of people tell me they want to hire a doula to be their advocate in labor. I totally get it that people wanting to have an unmedicated birth in the hospital might feel that they need someone to help keep things on track. But in reality, I am most effective as your advocate BEFORE labor begins.
Just imagine for a minute that you work as a nurse in a hospital. There is a woman in labor (let's call her Carla Client) who has a doula in the room with her. She is laboring heavily, and as part of your intake you ask the laboring woman if she would like to get an epidural to help manage the contractions. Carla happens to have a big contraction right as you ask this question, and you can see in her eyes that she is feeling a little overwhelmed.
I can see at least two different scenarios coming from this.
In the first, the doula steps forward and says "Carla wants to have a natural birth! She doesn't want to have an epidural. That's why I'm here. Don't offer her an epidural again, she'll tell you if she wants one." As the nurse, you might feel a little miffed, right?
In another scenario, the doula presses on Carla's sacrum, relieving some of the pressure from the contraction, while breathing slowly, deeply, and calmly. Carla's partner holds her hand, looks into her eyes, and says "You're doing great, honey. We're right here with you. Let's breathe nice and deep together through this one." As the contraction fades, Carla and her partner nod at each other. Then Carla turns to her nurse and says, "We want to labor without an epidural for now. My partner, doula, and I have prepared for an unmedicated labor. If I change my mind I will let you know! Is it possible to make a note that I'd prefer not to be asked about the epidural for now?"
Which scenario do you think would result in the nurse feeling supportive of Carla's preference? In most cases, hearing directly from the laboring mom about her preferences will be received a lot better! Mom is empowered to speak with her own voice, sharing her preferences and communicating her needs. It is clear that the doula is here in a support role, not to initiate a power struggle!
But of course, when we are talking about advocacy in childbirth, we are not just talking about communicating preferences. There are many little (and big!) moments during labor and birth where you might want an advocate. If your doula has had the chance to work with you during your pregnancy, you can be a well prepared team in the face of many different scenarios.
The most effective ways a doula can be an advocate for your birth experience are to:
1) Help you understand and investigate your options, prenatally and during labor (which might include helping you examine whether your needs and preferences would be best met with the provider or birth location you are planning on!);
2) Encourage you to communicate your needs, preferences, and concerns with your care providers throughout pregnancy, labor and birth;
3) Provide guidance and space to practice during prenatal visits different self-advocacy techniques (some of those self-advocacy techniques include the BRAIN questions, asking for more time to decide, and sharing what is most important to you with each nurse, doctor or midwife with which you work);
4) Cue you non-verbally during labor when they see that it might be a good time for you to ask questions or get more information;
5) Ask you open-ended questions in front of the care providers when appropriate to encourage communication;
6) and finally, when nothing else is working, your doula might directly speak up on your behalf to the care provider. (I personally would only do this in more extreme circumstances, in order to balance not taking away your voice, keeping your environment conflict free, and maintaining good professional relationships with hospital staff so I can be the most effective support person for you and every other client working with this provider!)
There's nothing wrong with looking for an advocate for your birth experience. In fact, I think it's a fantastic idea! I simply encourage you to shift your expectations of what it might mean for you to have an advocate on your team. My priority as your doula and advocate is to help you have your own strong voice. I want to help you find the care providers and birth location best suited to your desires and needs so that when you are in labor and giving birth, you don't have to worry about someone playing bouncer! You can trust your doctor or midwife and be supported and cared for by your whole birth team.