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"I feel like there's a third wheel in the
doctor-client relationship ... and I'm the one with the medical degree."
You may find that there are lots of extra
wheels being tacked onto your relationship with clients -- such as when they
come in with the latest article they downloaded from the internet! There's
no question that women seeking information from different sources makes your
job more complicated. Doulas are not there to offer medical advice or to
steer a client, but to support her informed choices. What can you do?
Set your boundaries and make them clear
to your client. If you see your role is in determining the
correct medical choice for your clients, based on your professional expertise, say so
outright. Many women will seek exactly that sort of clear direction from
their caregiver. If you feel a doula intrudes on that role, or that the
complications outweigh the
benefits to you
when your clients hire a doula, then clearly state to your clients that you
are not comfortable working with a doula. On the other hand, you may find it acceptable to take more of
the role of an expert advisor, and feel comfortable when your client makes
her own choices, even if they are not always the ones you would recommend.
In both of these instances, you and your client agree on your basic approach
to the doctor-client relationship. If there's a mismatch, however - if you
want to take a directive role and she wants an advisor - she may be happier finding another caregiver, and you may feel relieved too!
"She takes over the personal support, which is a lot of what
I enjoy about my job."
Nurses and midwives especially can feel that the close personal connection
that can be built with a woman in labor is lost to them when a doula -
especially one the couple knows well - is present. It doesn't have to be
nurse OR doula.
Greet the doula and show you are open to working
together as a team. (She should do the same!) Chat briefly with the
doula outside the room when you can - take the initiative to create a
positive working relationship (even when you don't feel like it). It pays
off! She is in your territory and may feel very nervous about approaching
the nursing staff herself. Very few people will be cranky or dismissive toward someone who has been
nothing but warm and friendly toward them.
Listen to the woman and read her birth plan. Speak
up about your ideas to help the woman achieve her goals. Even if she
ends up changing her mind, or things don't go to plan, she will be
enormously grateful that you have shown respect for her efforts. Especially
when unforeseen complications arise, your clinical expertise combined with
your personal support will be much valued by the woman and the doula.
"She has no medical degree, but some of the
things she's saying border on medical advice." ... "She's interfering
with medical care." ... "She doesn't know what she's talking about."
If you find that a doula working with one of your clients is
overstepping her role (see our Code of Practice), the first step is to speak
to her directly. (Also discuss your concerns with your client.) Sometimes
there has been a miscommunication. Listen to the doula's perspective on the
matter, and give yours. Listen to your client's perspective. See if you can
collaborate on a solution that you are all comfortable with. If you cannot
reach an agreement, you may choose not to work with that doula. Another
option is to lodge a complaint with the doula's certifying organization. See
the Childbirth International Code of Practice,
for example, for details on their grievance policy.
"She's giving information about things my policy (or hospital policy)
doesn't permit."
Some women will wish to make choices that
are unusual for you in your practice or against formal or informal policy. A
doula may offer information on a woman's options, but the choice is the woman's
alone. The doula's role is not to "encourage" women toward any particular
choice. It is your right to maintain a "comfort zone" in the way you
practice, but the key for avoiding a problem is in being open and clear with your client about
where your boundaries lie. Is the policy one you feel very strongly about
upholding in all cases? Then make it clear to your client where you
insist on a certain course of action. Are there some policies you might
compromise on, in certain circumstances? Discuss the circumstances
and come to a mutual understanding. Are you interested in re-evaluating
a particular policy or allowing exceptions? Take the opportunity if you wish.
Are you comfortable with the doula taking the role of explaining to the
mother all her options, including the option to refuse treatment? A doula is
obliged, if the client is asking for information on her options, to explain
that the mother has the right to informed refusal of treatment or care. Open
and effective communication with the mother and the doula from the outset is
usually enough to avoid problems in this area.
"She's physically in the way during the birth; it's too crowded in
the room."
A doula who is looking over your shoulder may be interested in learning
more about what you do and about the process of birth. But that shouldn't interfere with your job, or make
you feel unduly crowded. Discuss this before the birth: what procedures
might you do where you would expect the doula to stay well up near the
mother's head? Are there circumstances where you would ask the doula to
leave the room? Be clear, and reach a mutual understanding with your client
and the doula well before the mother's labor!
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