Doula/Advocate

Dictionary: Advocate (noun)

To speak, plead, or argue in favor of.

1. One that argues for a cause; a supporter or defender: an advocate of civil rights.
2. One that pleads in another's behalf; an intercessor: advocates for abused children and spouses.
3. A lawyer.

Thesaurus: Advocate

verb

To aid the cause of by approving or favoring: back, champion, endorse, get behind, plump for, recommend, side with, stand behind, stand by, support, uphold. Idioms: align oneself with, go to bat for, take the part of. See support/oppose.

In South Africa, a doula is a fairly new concept. Certainly with an actual “job title” and specifically within the private sector hospitals. The majority of women who birth at home, or in the rural areas, would have a support person who would be their “doula” – not having a specific qualification to do so but having the most important aspect, which would be experience and the understanding that what this woman is doing is a completely natural thing.

So, I suppose when being a doula became a career – where a qualification would thrust you into this amazing (most midwife births) and devastating world (most gynae births). It was now a job where you get paid for (albeit not much) and you could run your household on this income. There are guidelines to being a doula, and these are the guidelines that a mother and father would specifically hire a doula to assist with during the prenatal, birth and postpartum period. These are what she can “sell” her services on – which means she needs to deliver.

One of the most important services of being a doula, is to be an advocate for the family, specifically the mother in the birthing room. When she is at her most vulnerable, it is very easy for her to be bullied by her medical caregivers into “choosing” certain interventions that she previously did not want and were not part of the birth plan and would essentially change her recollection of what her birth could have been. This causes major issues with bonding with the baby and many other things that I will need to spend another time writing on.

So what do we need to do to ensure that the mother gets what she wants? We need to buy time from the doctors, we need to educate the parents on what the pros and cons are on each intervention. Then who tells the doctor that the mother would not actually like an epidural, but will moan through her pain – which would make a noise in the hospital and “unsettle the other mothers” according to the doctors? Who will tell the obstetrician that she wants to birth upright (hopefully this would be discussion beforehand though)? Who will tell the very pushy nurses that the mother is exclusively breastfeeding and she doesn’t want to top up? The definition of advocate is specifically defined as one who “argues for a cause; a supporter or defender; pleads in another's behalf; an intercessor”. To me that means that we need to be the one in-between the mother and the caregiver? The buffer, the middle-man? Do we live up to this? Do you as a doula live up to this?

When I did my doula programme, we were specifically told not to “kick up a stink” or “get yourself kicked out the hospital”. We were told that we were not allowed to frankly speak to the staff and that we would need to speak to the mother and father, help them make their decision, and then it was their responsibility to then tell the staff what they choose. In a way, I completely understand why a doula would be required to do this, specifically in the situation that doulas stand in this country and specifically within the private healthcare hospitals. If we get kicked out the hospital or upset the staff, we mess it up for every other doula who would have potentially worked in that hospital. So do we work for the “greater good” and our colleagues or do we work for our mothers and ensure that EVERY single one has the birth experience that she wanted? Who do we protect? Ourselves – our pride – and our colleagues?

I know how difficult it is to speak to a doctor/nurse/midwife in a birth situation – seeing as they are the medical professionals. But a mother and a father are not medical professionals either – they are expected to know best how to raise their children, so would the mother now know best how to birth her child? A should doula be the person that encourages her to believe in her inherent ability to give birth to a child perfectly. The mother is not medical, the doula is not medical, but the caregiver is – and ofcourse they are the be all, end all and all knowing!? I don’t buy it, but in a corporate world we are to trust them as we should god, otherwise risk losing your career, losing integrity on behalf of your colleagues, tarnishing all doulas whom have worked so hard to even be able to enter a private hospital. If we did not have our predecessors who prepared the path for us to even practice in that environment, we would not even have that client. But that client is a mother, a labouring beautiful mother who deserves the best birth because it may be one of only a couple for her, but one of maybe hundreds in the career of a doula. We may as well become obstetricians if we are not going to be advocates for our mothers.