Most traditionally trained doulas accept the confines of the old paradigm "scope" that spares no expense in driving home the importance of “non-advocacy.” Molded by this kind of staunch and unyielding perspective that makes no room for “what-ifs” or fine-tuning, many practicing birth support professionals are convinced that there will never under any circumstance present a scenario where it is “appropriate” for a doula to be an advocate. I accept that this may be the perspective of the vast majority of traditionally trained doulas. At the same time, I recognize that these persons are likely to be unreceptive and impervious to the logic offered herein.
I can appreciate the consistency offered by old paradigm doulas who fly the non-advocacy flag, but not their rigidity and unwillingness to imagine a new, more intuition-based approach. I posit that those who answer adversely to the prospect of expanding the doula’s scope to include “mother’s advocacy” if need be either 1) have never been called to this role by a mother whose own voice is being disregarded, or 2) have been faced with this dilemma and have chosen to prioritize guidelines over a mother’s honor. If the later were the case, I would hardly wonder about the motivations for aversion to broadening the doula’s scope. One who has failed to answer a desperate mother’s cries for solidarity, when it would have made the difference between life and death, likely has his/her own demons to wrestle.
I can imagine how those bystanders who choose to harden themselves in the critical moments that demand flexibility could, in their own way, be broken by the birth experience. Those who deny the mother’s hand and clench instead to a lifeless and rigid handbook full of hard and fast “rules of conduct” choose the hardened state. Residual trauma, as experienced by birth support workers who witness abuse and violation endured by the mother, is a very real phenomenon. Long after the last contractions have ceased, feelings of desperation that once flooded the psyche of the birthing mother can come to rest with the doula who never eased her death grip on that handbook. Tattered and torn by trials of transition, all witnesses to the violation of the divine feminine resemble that ragged rulebook. A mother who has endured these grotesque violations first hand has little choice but to peer into the abyss revealed by her abandonment. Yet the doula and other support workers still have a choice in the matter. Most will scramble to find justification for their failure to respond intuitively, because the opposite course of action requires vulnerability to that abyss and a kind of fierce authenticity that they are either unwilling or unable to proffer. This is the definition of adding insult to injury.
There is currently no recognized, non-medical, professional advocacy role available to women who specifically desire someone willing to stand in solidarity and advocate for them if need be. This reveals a major shortfall within birthwork at present. Outright refusal of many doulas to even entertain the thought of stepping up to the plate and accommodating a desperate mother’s cries for solidarity further exposes this profound deficit in care. This has real life (and death) impact and effects more women than any of us would like to imagine.
During my own labor and delivery, the issue was not in my ability to "find" or "use my own voice." I spoke clearly and passionately about my desires for an "emergency cesarean," but these repeated requests were disregarded and my son was allowed to expire inside of me slowly over the course of several hours, with worsening and obvious fetal heart rate abnormalities.
There was an excess of evidentiary justification for surgical intervention, from prolonged rupture of membranes and full-blown chorioamnionitis, to meconium and worsening, recurrent late fetal heart rate decelerations. I feel I did everything I could to advocate for what my son and I needed, to no avail. I had contracted with what I was sure was the “obstetric dream team,” including (but not limited to) three CNM's, a LMHC, a doula and an OB on-call. It became obvious to all that my wishes and needs were not being honored, yet not one of these individuals spoke up for me and my Sun when doing so would have likely been the difference between swaddling my baby in comfy cotton blends and enrobing him in burial cloth. I screamed and pleaded for someone to answer my call for solidarity, but not one of my sisters responded.
What I needed in those twelve hours between hospital transfer and the eventual death of my son, was just one person willing to move from a place of intuition and empathy. This should have been the modus operandi of everyone in my midst, but it could have been the doula. Instead, she withheld her voice. I can only speculate that she felt bound by the dubious tradition of "non-advocacy" or simply felt subordinate to the deafening hum of business as usual. This tragic experience directed the brightest of spotlights on what I feel is adequately described as a gaping deficit in both support and sisterhood that exists for women like me, who find themselves the rare, but very real "unintended statistic."
The moral dilemma that presented itself to my doula may never happen to 99.9% of practicing support providers in 99.9% of cases. But what about that 0.01% of the time when a woman is able to and does advocate for herself, but is ignored? My answer is both simple and assured, but I have been quite disheartened to learn of what seems to be the "knee-jerk" reaction from most traditionally trained doulas.
The fact that this majority appears to make absolutely no room for what I refer to as the “unanticipated gray area,” wherein advocacy is both appropriate and ethically demanded, makes it glaringly apparent to me that a distinct paradigm shift ushering in a new response-ability of non-medical birth support workers is not only justified, but urgently required.
In attempting to broach this topic and share my personal experiences as a means of justifying the worthiness of such dialogue, I have been blocked, banned, censored and silenced. The old paradigm will stop at nothing to defend the security of its institutions. Judging by the harsh reception my attempts to broach this topic have prompted thus far, I’d posit that the task of filling this gap isn’t likely to be undertaken by traditionally-trained doulas obedient to the code of non-advocacy. So be it. After all, it would be quite a tall order to expect those who don’t even perceive or acknowledge a gap in care to be the ones to go about structuring ways to bridge that gap. Without strain, I can easily imagine whole communities of birthworkers stepping forth to dismiss this suggestion on its face.
Nevertheless, to persons like me, who have borne the blow of betrayal and felt anything but empowered during the birth experience when our attempts to “self-advocate” fell on deaf ears, the offering of advocacy support if need be will be a welcomed addition to what ought to have always been a full spectrum of choice. The existence of this gap in support and the reluctance (and often times outright refusal) by current birth professionals to fill it necessitates a demand for the creation of a brand new vocation in the field of perinatal support.
Birth is the essence of creation-- And so, from my very traumatic and eye opening birth experience, I can now see with clarity that a demand exists for which a new vocation within the field of birth support will emerge. Enhancements in the way of “birth advocacy” may seem redundant to some and completely unnecessary to others.
There tend to be two main objections presented when I have attempted to raise the topic of doula scope as it pertains to advocacy. The first objection stems from the proposition that empowerment is achieved when a woman finds and/or uses her own voice during the birth experience (see Figure 3). Next to a healthy outcome, empowerment of the birthing mother is certainly an objective, or ought to be. On this assertion I cannot agree more. Yet, there is an issue of question concerning the methodology by which this value is realized. As I experienced first hand, a woman's ability to advocate for herself by making and vocalizing her "informed choices" does not ensure that her choices will be honored or guaranteed empowerment. Two critical components are missing from the "empowerment argument"-- In addition to "making informed decisions" the mother's voice must also be heard and honored.
Let's assume that 999 times out of 1000, a birthing woman who advocates for herself, is heard and honored and she feels empowered because of this. But what about that 1 in 1000 instance when a woman communicates her desires plainly, is heard by support workers and IS NOT honored? Many doulas may never encounter such brazen violation of the feminine during their careers, and again, that would be the ideal. But, what about the woman who finds herself the unforeseen statistic? I am that woman.
The trauma and loss I endured as a result of doing my utmost to advocate for myself and not having my choices honored is a misery I would not wish upon my worst enemy. When the niceties of informed consent were refused to me, my Sun and I could have absolutely utilized and appreciated someone on our side to yell directly into the diaphragm of the physician’s stethoscope and do their damnedest to amplify my pleas. No such person availed themselves to me and my Sun lost his life because my "informed choices" were not honored. Because of what I was forced to endure and the way I was grossly violated by my birth team, I now have very specific requirements of any birth support worker I might contract with in the future. The willingness to be an advocate if need be is at the very top of my list.
So we see, if “empowerment” is indeed one of our primary objectives for the mother during the birth experience, then by necessity we must acknowledge the weeping woman in the gray area for whom “empowerment” means the ability to have a comrade by her side, willing to do and say anything and everything to uphold her safety and honor.
I offer another critique of the “empowerment” argument made as grounds for objection of “mother’s advocacy.” Even within women’s empowerment initiatives we see a tendency to gravitate towards umbrella language that, whether intentionally or not, attributes specific characteristics, features and belief systems to “women,” as in “all women.” If one looks, there is no shortage of examples across the birthwork community, which we can point toward to help elucidate this tendency of ours to pigeonhole our sisters and assume that we know exactly what ingredients are called for in the recipe for “women’s” empowerment. We see a kind of low-key oppression running rampant on most “natural” birth forums, wherein a woman’s ability to birth a child vaginally is proposed as both obvious and implied, owing to her body being “built for the act” and knowing “just what to do” (See Figure 4).
Another example of this kind of haphazard stereotyping rarely called out within the sisterhood presents in the very statement purporting GPS coordinates to "women’s empowerment." For instance, “If a woman does (fill in the blank), she will feel empowered.” Similarly, we assert, “If a woman does not (fill in the blank), she will not feel empowered.”
This is problematic on its face because, news flash, “all women” as a category doesn’t have much import past census calculations. What is an “empowering” act to one person with a vagina may be, at best, a mundane and barely rousing act to another person with a similar, but not identical, vagina. To bring this home—In my labor and birth experience, the act of clearly and repeatedly voicing my desires (“aka advocating for myself”) and having these desires ignored and disregarded was far from empowering. To the contrary, as my eyes searched the hospital room with disbelief for someone, anyone, willing to join their voice with mine to assist me in having my desires met, I felt anything but empowered. Instead, I felt marginalized and cast out from the very experience of parturition.
The “unintended gray area” as I have termed it often materializes when we least expect it, when our convictions are at their most assured. It manifests out of sheer necessity to wrench our grip free of old beliefs and comfort zones where growth can find no footing. Humans have the stubborn tendency to seek out solace where we have grown to expect solidity. Yet, as I said earlier, birth is the essence of creation. Try as we might to throw bridles on the act, her very nature is untamable. She desires to move always like water in its liquid form, unrestrained and able to navigate new realms without the hindrance of rigidity. In keeping with this sentiment, one who finds his/herself in the profession of birthwork ought to honor the vocation by treating it with the very same flexibility.
Allowing for flexibility in the face of unbridled wilderness is the nature of bearing witness and journeying alongside a birthing mother. Rigidity in birthwork is as useful as coffin nails, often with the very same effect. The pelvic girdle knows this truth well-- Seemingly concrete in composition, it is by nature designed to give and make way for burgeoning mystery.
For those of us who find ourselves resistant to change and clinging to the familiarity of old-paradigms, now is no longer a time for business as usual. Be not like hardened ice, moving only to grind up against unbending boulders. For these steely boulders need not, nor should they be perceived as obstacles-- They are our full-bellied sistren rising up out of necessity to uproot our icy obstinance. Unchartered territories harbor no reverence for our maps or telescopes. Such is the nature of creation. No matter how experienced a voyager we imagine ourself to be, or how many frontiers we think we’ve conquered, in the role of birth support worker we are but a guest. At best we are dignitaries. Our imported scriptures do not set the tone in the wilderness of birth. As support workers we would do best to stay humble and flexible here.
The boulder appearing before us is meant to remind us of the importance of fluidity. Its very presence mandates that we bow and bend.
The “unanticipated gray area” materialized in the wilderness of my birth as a demand to acknowledge that, for some boulder-bellied mothers, the most empowering happening that can transpire during their birth experience is to have someone by your side courageous enough to toss preordained parameters right out the window and let intuition and integrity reign.
This kind of unashamed advocacy may be completely “off the table” for many practicing birth professionals, but refusal to offer this kind support if need be does not discount the deservedness of the desirer to have it. At the very least, a refusal by one group to serve in this capacity if need be only gives more merit to the emerging skillset of "new paradigm doulas."
Another of the main objections to permitting “advocacy” on an as needed basis into the doula’s scope concerns itself with the professional consequence of advocacy. Many practicing doulas will offer the possibility of “getting thrown out” or black listed as the rationale for not permitting advocacy into their scope of practice. I'm not saying that it's not possible to be thrown out. Nor am I saying that such repressive reactions to advocacy should be ignored or not considered. I am simply saying that, if a mother desires a professional support person present at their birth who is willing to advocate for her if need be, then she deserves to have exactly that. Her very desire for this level of support is justification enough for the presence of such a professional.
Further explanation of this truth should not be necessary, but I will offer that I can attest to its certainty. I did not require the conventional support services of a doula, but I did happen to need the very thing that everyone surrounding me refused to provide-- a voice offered in solidarity and in unison with mine. This I would call unabashed advocacy. And this is what is acutely lacking for women like me. Our needs and desires may not be the standard, but we deserve a standard of care that is currently absent and, at present, patently refused to us.
Having this conversation also requires that we give attention to the old paradigm structures of who is "allowed" to be present and who has no standing in the hospital environment. All too often we accept as canon the parameters set before us as birth workers by institutions and authorities outside of ourselves. Yet, these established “scopes” and guidelines for professional conduct were designed brick by brick by human hands, and can be dismantled much the same way.
I'm not suggesting that the entire field of birth support must completely transform. Although I certainly wouldn’t object to such a proposal, sheer demolition of the status quo is not the subject I address here. A birthing revolution, however attractive a proposition, is unnecessary to usher in a new paradigm. Space simply needs to be made for those intuition-based practitioners that choose to be like liquid water, willing to offer advocacy within their scope of service for when need be. Space needs to be made for those courageous enough to unite their voices in unison with the mothers so as to sing the sacred song of solidarity. And, where no space is voluntarily made, icy attitudes, sure of their strength and righteousness, will be met by steely boulders and reminded of the importance of fluidity.
I thank you, the reader, for entertaining this topic. Likewise, I thank all who, with feet firmly planted in the old paradigm, refuse to oblige the merits of the argument for inclusion of “advocacy if need be” within the scope of practice. Without the naysayers, unwilling to offer fluidity of presence where icy attitudes were a death sentence, I never would have been administered the medicine endowed to me when my own Sun ceased breath. This fierce initiation, granted in betrayal and disempowerment was necessary to calibrate my vision to behold a new paradigm.
The sorrow introduced by my exploration of the feminine wound, will find its equivalency only in the joy that is realized when “scope” and “guidelines” take a much-needed backseat to intuition and integrity. This will be the silver lining to the cruel clouds that overhang my memory. Again, if we have eyes to allow for it, we can see that from great destruction, great creation can spring and bring life to visions yet unimagined.