Advocacy and empowerment in birth
Melanie Butcher • 11 May 2021
The role of the Doula
There seems to be a little bit of controversy in the birth world around the role of Doula's when it comes to empowering and advocacy in the birth room. I want to try and unpick this little and give you my stance on this.
It is a view by some, that Doula's should not profess to 'empower' birthers, as they already have the power. They have it within themselves and therefore do not need to be given the means to achieve.
I wholeheartedly agree that birthing women and people, totally have the power to birth without needing to be given the power or tools to achieve their goals. However, as a society and within our maternity services, I think that we have eroded that knowledge, free choice and belief in ourselves. This is partly through the depiction of medicated birth that we so often see in films and on TV and partly through how our maternity services are run. They have a blanket 'one size fits all' approach, and one that does not easily and openly allow choice and autonomy. We are often told things like, "you have to be induced"
or "you're failing to progress"
or "we can't let you in the pool".
Surely with so much being taken away from us, a counter balance is needed? I feel that Doula's can fill that gap. We let you know that you always have choice even when you're told 'you're not allowed'. We give balanced information based on fact that takes into account the pros and cons, not just hospital policy. Plus we see the whole person, not just the machines, charts and clock. So in addressing the imbalance of our system, I think we are giving empowerment BACK.
Regarding advocacy, I think here the problem lies in our understanding of the definition. The verb of advocate means to recommend something. In the birth world this could therefore mean recommending one type of pain relief over another, or advising a particular place of birth. This definition goes against what the majority of Doula's offer and stand for. Where as the the British definition of the noun, advocate, means "a person who upholds or defends a cause; a supporter; a person who intercedes on behalf of another." This definition is much more in line with what I offer and feel is needed sometimes during birth.
When you work with a Doula, they spend hours with you ahead of a birth, understanding all your wants, fears, wishes and worries. We make birth plans with you for all eventualities. We get to the bottom of what your non-negotiable are and what you are willing to discuss depending on the situation. We have conversations with you about what you want to do in the event of any difficult circumstances. We know how you want us to work with you during labour as you've told us and we've listened. During birth, there may come a time when you want to stay in 'your zone', undisturbed. You may become overwhelmed and emotional. You may have been speaking to your birth team about what you want or need, but you might not be being heard. It is at these points that we can 'defend your cause', and advocate on your behalf. No, we aren't making decisions for you. We are however the ones that have understood your need and are able to articulate it clearly in that moment, when perhaps you are unable, unwilling or aren't being heard. When I have advocated on someone's behalf, I will do the talking but will always then refer back to the person I'm advocating for and check. "That's right isn't it?" or "have I summarised that for you correctly "
or "that's what you told me earlier, is that still the case?"
So empowerment and advocacy aren't something to fear or shy away from in the birth world, they are how we can give power back, voices back, address any previous imbalances, and make sure pregnant people are getting the births that they need and deserve, whatever that looks like for them.
Colins English Dictionary definitions:
"Empowerment - the empowerment of a person or group of people is the process of giving them power and status in a particular situation. To empower someone means to give them the means to achieve something, for example to become stronger or more successful."
"An advocate - a person who upholds or defends a cause; supporter
a person who intercedes on behalf of another..."
definitions taken from: https://www.collinsdictionary.com
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