How Do Doulas Advocate For Clients?

• Transcript

  Kaely Harrod 00:04

  Welcome to doula Tips and Tits. This podcast is a place where we answer one question about doula work, both to support you and to help you support your clients. I'm Kaely Harrod. I've been supporting families in this perinatal space since my oldest was born 12 nearly 13 years ago. I am a birth and postpartum doula childbirth educator, lovely cheerleader and a doula coach. I love guiding and supporting doulas as they work out their doula business. It is a tremendous joy to be trusted in this way. Thank you for joining us on this journey. Hello, and welcome back. This is the second episode in this like very small mini series about advocacy. Today, we are talking about ways to advocate so kind of like actual steps scripts that you can use things you could do with clients prenatally and also during the birth. If you did not listen to Wednesday's episode, I do recommend that you go back and listen to that because that goes firmly hand in hand with today's episode. That's kind of episode number one. This is episode number two. Okay. So last episode, the question we were answering is, are doulas advocates? Do we advocate for our birth clients, specifically in birth for this conversation? But I do think it's applicable to postpartum as well. Today's question is how how do doulas advocate? Because we do. And if you haven't listened to Wednesday's episode yet, go back and listen to it? Because that's, that's my answer to that question. But of course, there's a lot more nuance there in that episode. So I want to talk through a few different things that I do with clients prenatally, and in the midst of the birth to help kind of provide some advocacy that maybe seems a little bit more subtle. I think my goal, always in a birth scenario, specifically is for a team to feel cohesive for the patients benefit, right. So for the benefit of my client, I want it to feel like I am working well with their team, not to the point that I'm on the side of the team. That's not what I'm saying. But that means advocacy as much as it can. I like it to look like centering the patient, rather than being at all like combative with the team. Right? Now, there are a variety of scenarios, right? So you don't always have the privilege of being subtle. And I will talk a bit about that. I'm going to share some examples today of what I've witnessed. To should give you a sense of like, when I think it's absolutely vital that a doula is willing and able to advocate, okay. So one of the things I always talk with clients about is that we need to write a birth plan prenatally, in part because as you arrive at a hospital, or a birth center, or you know anywhere else, that's not your house, if you're planning a birth out of out of your home, then you're wanting to communicate whatever you want the team to know about you in those moments, but you're like contracting, ideally, right? Usually contracting. So maybe you only have like two and a half minutes to communicate something, that's not a great amount of time. Plus, when you're in labor, we want you to really focus on labor, right? So the birth plan should be a to communicate your desires and things that you want the team to know about you, when you really can't communicate much because you're you're laboring to, because I just say and then to be, you know, I don't, my fingers are going up, if you could see me, this is finger number one, finger number two point B, or number two is that if it's written down, it's easier for me to go back to that with the team. And also the partner, right? So if there's a partner present with this person, whether it's a family member, a romantic partner, the parent of the child, whatever that is, that person also can go back to that written document. So I'm gonna explain a little bit about what I mean. But one thing that I think we hear sometimes we talk about making sure that doulas aren't like advocating in a way that they're like taking away the voice of the client is making sure that doulas are not making decisions for the client. So I want to kind of break that down a little because I think while it is incredibly important to not make decisions for your client, it is part of your role in my mind to remind them of things that mattered to them prenatally that you kind of talked through beforehand, right? And just would have give them space to change their mind, by all means, but to kind of be able to go back to like when you were not in labor. This is what you thought about that thing. Is that still what you think about it? And it's okay, if that's not right. So what that sometimes looks like is like, let's say, Sorry, my kiddos gave me a cold, I just have the slightest bit of hoarseness. Let's say a provider is saying like, Okay, we really want to have continuous monitoring, for instance, and your clients like, I don't remember what I wanted. One thing you can say is, oh, hey, I know that on your birth plan, you wanted intermittent monitoring? Do you remember the difference between those two? Do you want your provider to explain the difference or why they're wanting to expand continuous versus intermittent? Because that adds some nuance, right? Like, it's entirely possible that the provider is saying, We want you on continuous monitoring, because we're really concerned about your baby's heart rate, well, then that's a very legitimate and super important reason to be on continuous monitoring. It's also possible if the provider is just like, annoyed with intermittent monitoring and wants the person on continuous, I'm not saying these are scenarios where the provider is saying something that is always wrong, that's not necessarily the case, sometimes it's that they lack explanation, or they lack client or patient consent. And so some of your advocacy is kind of layering in the ability for your patient, your client to feel like as the patient, they are the decision maker, because that's really what we see tied to trauma, right? Like we see trauma, very tied to you being told what and how to do like what to do and how to do it in the process of birth, rather than being the person who is driving the conversation and making decisions all along the way. Okay, so. So that's one thing to think about is like a scenario where you can be like, Oh, hey, like, Lynn, I know that it really mattered to you that you had intermittent monitoring. And that was on your that's what you had on your birth plan? Do you still feel that way? Or have you know, do you have you changed your mind you have questions about it? Because you're not saying your doctor's wrong? You don't need continuous monitoring? You're saying, hey, how do you feel about this? Like, how are you feeling about this recommendation? Do you understand what the recommendation is? Do you understand how it's different from what you asked for? And are you okay, with moving forward of that? Again, not at all, because you necessarily disagree with the recommendation, it can be a very legitimate, incredibly important recommendation, and also your client as the patient needs to understand why it's being recommended. Okay. So that's one thing that I talked about prenatally is the birth plan kind of allows some advocacy to happen.

  Kaely Harrod 08:13

  Occasionally, advocacy shows up in a situation where someone is being asked to make a decision, and kind of being pressured to make a decision decision. So one thing that I'll sometimes have clients, right, if they're telling me like, I really have a hard time saying no to authority figures, and I think if the provider comes in and says, like, we need to do X, and then just stands there looking at me, I'm going to feel really pressured to agree with them. But I want to make sure I'm giving myself space to think stuff through. And so in that scenario, I often recommend that they write in the birth plan, we want five minutes to discuss and think about possible questions that we have before making any non emergent decisions, right? So that's a scenario where like, someone's coming in, and they're, you know, the provider saying, I think we should maybe talk about breaking your water. Baby's looking fine, you're looking fine. It's not because of an emergency. It's because things need to progress, then that's a perfect time. If you look at if you look at your client, your client looks like the deer in the headlights kind of look right there. Their you look like they're getting you you see them look like they're getting overwhelmed by this, then reminding them like, Hey, do you remember that in your birth plan? You really wanted five minutes to talk it over every time you're making a decision. Do you still want that? Because then you're providing an outlet for them. Right? Not that they have to say no to breaking their water, for instance, right? That's again, it has nothing to do with whether or not the recommendation of the provider is good, or whether or not you agree with the recommendation of the provider. It is more about continuing to center your client in the experience. Okay. So another way that I think I kind of classify as advocacy, which some people don't, but I would say is a form of advocacy is kind of either narrating the room, or like explaining something to your client that isn't being explained. And I'm gonna tell you what I mean when I say that. So one thing that I sometimes see is actually see this scenario A lot of times is a provider comes in, they're saying, I think it's time I think I'd like to check your cervix. How do you feel about that? You know, the client saying, Yeah, but I want to wait until this contraction, this next contraction is over, I think I'm gonna contract soon. I want to do after that contraction, okay, great. They start contracting, the client has their eyes closed, they're in whatever position they're in. The provider in the meantime, puts on sterile gloves, and has like gel on their fingers. Right? So they're like ready to do the exam. The client finishes contracting, kind of recce is breathing normally again, but those contractions are coming relatively quickly. And so they're not necessarily aware that the provider is there ready to do that exam? Right? Now, this is not a scenario where the provider does the exam anyway, that's not where we're going, thankfully. But in that situation, I'll sometimes say, Hey, is that contraction over your providers ready to do the exam if you want them to still do it? Because what I'm not doing is saying you need to let them do the exam now, right? That's not what I'm saying. I'm also not saying you need to say yes to an exam right now. Right? What I am saying is that if you were like, maybe you have forgotten now that this contraction is over the an exam is what you had wanted, if you don't want it, just we'll just not do it, you know, no big deal provider can leave. But if you do want it, they're literally ready to do it, and can do it quickly before the next contraction happens, right. So sometimes that kind of information when the providers just maybe standing there with a glove and some gel, and not saying anything can be really helpful, because you're sort of informing the client of other stuff that's happening in the room. Sometimes that also looks like narrating other things, if there's, if there are things changing. So like, sometimes when I have a client who I know is really sensitive to who is in the room, and like especially, they don't want people that they haven't met in the room, or whatever that looks like for them, then if I if there's like movement, I'll explain to them what's happening, like, hey, a nurse just came in real quick to drop off some towels, or like, I just want you to know you're hearing that sound, that's them getting the table ready for delivery, right? Because then there's no space for the client to be like, What the heck is happening while I'm sitting here with my eyes closed? in labor? Am I safe? If I open my eyes? Am I gonna see people I've never seen, right. And especially when I know that's an anxiety point for clients, I make sure to kind of narrate that to them, okay. Now, there are scenarios where a client is just straight up being ignored, or not being consented? Well, okay. And I am going to go into that I'm not going to share a bunch of triggering scenarios. But I am going to talk about two phrases that I like to say. One is, I'll sometimes say to the client, you still have all the freedom to say no. So I'm gonna give you a little bit of a scenario, but it's not going into great depth about the situation. So there was a situation with one client where the provider was doing something that she had consented to. So doing a procedure ish thing that she had consented to, initially, my client kept looking at me saying, that really hurts me. And she was looking at me, it wasn't what I was doing that was hurting. It was what the provider was doing. And so I looked at my client and said, you can tell her know if you'd like to hurt a stop, but she's doing and the provider was like, Do you want me to stop? And my client was like, yes. But before I said that, she had said, This really hurts maybe two or three times to me, and the provider had never asked, Do you want me to stop right now, she had initially consented to what the provider was doing, but it wasn't something that she had to continue doing. If the client was in pain, for instance, right. And the client was clearly physically in pain and also verbally saying, This really hurts. But because she was looking at me and saying it to me, the provider was not acknowledging what she was saying, even though I think it was pretty obvious to everyone in the room that she was talking about what the provider was doing, right um, So that was a situation where I think that provider was a little bit pissed off at me, which I don't honestly care. Because I was like, in this situation, someone has to give more of a voice to this person, right? This client is lying here in pain, potentially walking away from this experience with some trauma. And at the very least, I can give her permission and remind her that she has space to speak up for herself. Now, in that moment, I didn't say provider, stop doing what you're doing, right? Because sometimes someone will say something like, yes, okay, I want a vaginal exam, vaginal exams happening, they're like, this is the worst. But I don't want you to stop doing it. Because I want to know what my cervix is doing. Right. So it's not a scenario where you're necessarily in that situation, not necessarily you stepping in and saying, provider, you need to stop doing what you're doing right. But giving your client a reminder, a solid reminder that they are in control of their body, and they are in control of their consent. And that is huge. Another situation is when you are situationally aware of what is happening. And it is not what your client asked for. So this is a very particular situation that I witnessed at a birth, where there was a midwife present, very much wanted to break my clients water. My client did not want her water broken. Every time we had the conversation. The client said, No, I don't want you to break my water. I don't want you to break my water don't want to break my water. And so then the midwife came in, asked if she could do a vaginal exam, my client said, Yes. I would like to know what my cervix is doing. The midwife said, are you okay with me breaking your water? client said, No, I don't want my water broken. But I am okay with you doing a vaginal exam. That midwife the way that she had been pushing, I was already a little suspicious of like, I think she's going to maybe try to break the water anyway, right. So one tool that a provider can use for something like breaking the water is a small hook that can, it's almost like a tip of a glove that can go over the end of their finger with sterile gloves. So she put the sterile gloves on, my client was like, I'm gonna contract again. And then you can check my cervix, she was laboring with her eyes closed, she wasn't looking at the provider while she was talking. So she laid on her back. And I saw the midwife put the thing on her finger. And I was in that moment, like, you're about to break my client's water when she has told you bunches of times that she doesn't want to broken. And so I turned to my client, I said, Hey,

  Kaely Harrod 17:52

  are you okay with her breaking your water right now when she does this vaginal exam. And she opened her eyes, looked at me, looked at the midwife and said, Do not break my water. When you do the exam, the midwife looked at me really pissed, and pulled the thing off her finger, and then did a vaginal exam without breaking the water. And in that moment, I was like, if I hadn't said something, you would not have known that she put that on her finger. And she probably would have just said, Oh, your water broke when I did your exam or something? I don't know. Because it didn't happen, thankfully. But that's a form of advocacy that I think we have a responsibility to how, how can you as a doula, watch something like that happen and feel like you don't need to say something? And again, I didn't say to the midwife, don't you dare break her water. Right? I said to my client. Hey, just to clarify for everybody who's in the room right now. Are you okay with her breaking your water with this vaginal exam right now? Because I might, that's what she's about to do. But I didn't say that to my client. I said, are you okay with that? And then she opened her eyes, looked at the midwife looked at me and specifically said, You are not allowed to break my water, do not break my water. And then the midwife didn't do it. Right. But in that moment, and that, I mean, I would even argue, honestly, this is not even a huge example, like this is a huge example. But it's not, because it's not such a situation where someone could have died, right? It's a situation where someone was being potentially about to be assaulted, and something that they had specifically said not to do. And so it's vital, but also, that's not even a scenario where someone is in danger, right. So, I clearly have lots of thoughts and feelings around this. These things that I share just now as the scripts, kind of some of the things that I use. Those are in the show notes, so you're welcome to use those. You're welcome to practice them. You're welcome to try them out with different clients. Absolutely as doulas we're teaching our clients to advocate for themselves and what their rights are, what their autonomy is, etc, right? But in a moment where you're seeing injustice, you're seeing coercion, you're seeing danger, you're seeing someone being neglected. As a birth doula, you have to be ready and willing to speak up when the patient can't or when the patient doesn't know that they need to or when the patient is unaware of how to do it or whatever that looks like you have to be willing to do that to provide a safer space in birth. Okay. So that is the end of today's episode. I'm sure this is not the last time that we will discuss advocacy. I am incredibly passionate about this. This is a big part of what I talk about with birth, doulas with coaching folks with with birth professionals in general, because I think this is a vital part of people going into parenthood without the kind of trauma that we have them going into parenthood with right now. And even surviving to go into parenthood like this. The way that birth currently happens in the US is just straight up dangerous for too many people. And as doulas part of our work has to be making it safer it has to be what are we even good for if that's not part of our work? Okay, that's the end, I promise. So, coming up in July, all you have to look forward to is a number of guest episodes from different providers talking about what they want duelists to know about referring patients to them. So those should be just full of wonderful treasures for you. I'm really excited to have a bunch of different new people on the podcast for the summertime. And then of course as always, I always want to hear questions and comments that you have Instagram is the easiest place to connect with me at Herat doula so that we can have a more like thorough and and continued conversation around advocacy. All right, until next time, I wish you consent filled, wonderfully beautiful birth experiences.

  Kaely Harrod 22:36

  Thanks for joining us for this episode of the doula Tips and Tips podcast. If you learned something today or had an aha moment, we'd love for you to share that on Instagram and tag us at Herat doula, so we can celebrate alongside you. If you found this podcast helpful. We would so appreciate you taking a second to leave a rating and review on your favorite podcast app that helps other doulas find us as we do this work together. This podcast is intended as educational and entertainment it is not medical advice or business advice. Please consult your own medical or legal team for your own needs around

Doulas do advocate, we talked about that in the last episode which is linked below. But HOW? How do doulas advocate without making decisions for our clients? Or making a birth scenario about us? That’s today’s episode. How  do doulas advocate for their clients during a birth? What are some phrases and strategies doulas can use to advocate for their clients? 

“my goal, always in a birth scenario, specifically is for a team to feel cohesive for the patients benefit, right. So for the benefit of my client, I want it to feel like I am working well with their team, not to the point that I'm on the side of the team. That's not what I'm saying. But that means advocacy as much as it can. I like it to look like centering the patient, rather than being at all like combative with the team.”

One big prenatal step is writing a birth plan. This gives the client time to decide what their thoughts are on things and also gives you a reference to point back to. Either in the form of reminding the client of their plan and desire OR of reminding the team to read the plan/desire. Both can be incredibly helpful. 

“Let's say a provider is saying ‘Okay, we really want to have continuous monitoring’, for instance, and your client says, I don't remember what I wanted. One thing you can say is, ‘oh, hey, I know that on your birth plan, you wanted intermittent monitoring? Do you remember the difference between those two? Do you want your provider to explain the difference or why they're wanting to expand continuous versus intermittent?’ Because that adds some nuance, right? Like, it's entirely possible that the provider is saying, We want you on continuous monitoring, because we're really concerned about your baby's heart rate, well, then that's a very legitimate and super important reason to be on continuous monitoring. It's also possible that the provider is just like, annoyed with intermittent monitoring and wants the person on continuous, I'm not saying these are scenarios where the provider is saying something that is always wrong, that's not necessarily the case, sometimes it's that they lack explanation, or they lack client or patient consent.”

Doula Advocacy Scripts:

“(name of client) I know you mentioned in the prenatal visits that you were concerned about X do you have any questions about that now?”

“(name of client) wrote out on their birth plan their desires around (insert issue)” especially if someone is mid-contraction

“(name of client), you let us know when you’re ready for X” (when someone has said yes to an exam after this next contraction but isn’t opening eyes, etc.

“I heard (name of client) say no. Is that right (name of client)?” when a client is being ignored

“Name of client do you want your water broken?” if you see a provider preparing for a procedure that your client has not consented to

Listen to the previous episode here: 

https://www.harroddoulaservices.com/kaely-daily-podcast

CONNECT with Kaely on TikTok or  Instagram

https://www.tiktok.com/@doulacoach

https://www.instagram.com/Harroddoula/

If you like this episode, don't forget to share it to your Instagram stories and tag me @harroddoula

Kaely Daily is produced by Kaely Harrod of Harrod Doula Services

It is sponsored by The Birth Prep Blueprint Childbirth Class

Music by Madirfan: Hidden Place on Pixabay