Doulas and Advocacy

There used to be many, and there are still some, doula trainers and training organizations explicitly teaching that “doulas are not advocates.”

This phrase carries a few different meanings, but the central meaning is that doulas are not supposed to speak to medical care staff on behalf of their clients. The reasons for this are related to consent and liability. If a doula communicates to medical care staff about a certain matter, and there are negative medical outcomes related to that matter, the doula could be open to the accusation of having made that communication without the client’s full understanding/consent, and could be held liable for the outcomes. In addition, “doulas are not advocates” gestures towards an idea of neutrality on the doula’s part: the doula does not argue for one thing or another, but instead offers the client a neutral supportive presence.

In short, the positive intention behind the “doulas are not advocates” is clear: to protect both doula and client from unnecessary relational, medical, and legal complications.

The problem with this concept, and the reason that many doula trainers and training organizations no longer emphasize it, is that it is, in many ways, a prerogative of privilege. Birthing people who belong to oppressed or marginalized groups -- most notably, Black birthing people, who are at much higher risk than their counterparts of other races -- often face a much more serious uphill battle in their interactions with care providers than people who have more privileged identities. This means that they are more likely to need increased amplification and support in communications with medical staff.

The “doulas are not advocates” concept also tends to assume that the birthing person has a partner who can communicate, and be listened to, on their behalf. If there is no partner, or if the partner belongs to an oppressed or marginalized group themselves, it is again more likely that the doula will need to provide increased amplification and support in communications with medical staff.

Too, if the doula has one or more oppressed or marginalized identities, their very presence in the birth room becomes an act of self-advocacy -- an argument for their right to occupy that space, and/or to be considered as a competent professional -- in a way that it would not be for a doula who carries various dimensions of privilege, such as being white, cisgender, thin, etc. Many doulas, like many birthing people, simply do not have the privilege of being the neutral presence implied by “doulas are not advocates,” no matter what they do or say.

Finally, it’s worth noting that doulas are not robots, and are not invited to births for the purpose of performing rote tasks in pre-determined ways. They are sentient human beings who are invited to births for their flexibility, discernment, compassion, technical expertise, and critical thinking skills. While it is important for doulas to understand why speaking directly to medical staff on the client’s behalf is not likely to be their standard go-to strategy at every moment of every birth, it is also important to allow for and respect doulas’ fundamental humanity, and to give space to their right, and even responsibility, to respond to things that are happening in the birth room in a range of ways, up to and including directly addressing medical care providers.

The Birthing from Within Code of Conduct for doulas includes the following:  

·Doulas amplify their clients’ voices, facilitate conversations between client and caregiver, and advocate for their clients if they are not being listened to.

·Doulas will advocate for the rights of marginalized people, and work to dismantle systemic oppression and racism in themselves and in their communities.

Taken together, these principles offer nuanced, flexible understandings that respect both a wide range of client needs as well as a doula’s ability to choose appropriate strategies to address those needs. Cultivating this kind of nuance and discernment will ultimately be more useful to both you and your clients than the oversimplified “doulas are not advocates” concept.