19. Your Responsibility in Birth (Part Two)
In my previous post, I wrote about the problems with responsibility in labor and birth and what happens when each of the three groups (providers, birthers, doulas/support people) takes too much, too little, or the wrong kind of responsibility. I hadn’t meant to go as in-depth as I did, but it turns out there was a lot I wanted to say on the topic!
It’s easy to critique what others are doing and hard to make big changes in the way you show up in the world, so I want to explore what those changes could look like. All three groups could put in the work (and a lot of people already are!) to create lasting change in the birth world.
Of course these are just my thoughts, limited by my own knowledge and experiences. I don’t have answers, but I do have ideas on where to start.
I’ll begin with myself and my own ever evolving journey into the kind of support I want to provide clients.
Radical Responsibilities of the Doula
examine why you’re here: It’s incredibly important for doulas to explore their own path to becoming a doula. We’re in this field because we’re passionate about birth. Maybe we even hope to change birth culture as a whole. These big philosophical goals are amazing, and they also shouldn’t get in the way of truly serving the people we’ve chosen to work with. (This is a whole other blog post that I’ll be writing shortly!)
own your birth stories: We’ve likely had our own experiences with birth, and those may be joyful, but they also may be heavy. It’s our responsibility to process our own stories and recognize the way they may creep into our care of clients without us realizing it. Was your birth amazing? How does that affect how you support clients? Was your birth traumatic? How does that affect how you support clients? The more you see how your own stories have shaped you and your practice, the more aware you can be of their influence and whether that’s serving you and your clients well in each particular moment.
recognize where you end and your client begins: In the beginning, I cared so much about my clients that I think I would sometimes hold what they wanted in birth tighter than they did. It was important for me to learn that no matter what I wanted for them, the only thing that really mattered was them. Our clients are in charge of their own actions and decisions. They choose how they want to prepare for birth, they communicate what they want (and don’t) in labor, they make decisions, and we stand beside them and hold space for all of that.
remember it’s not about you: We’re not the experts. Our clients are. They may want information and context from us, and we can definitely share that with them, but at the end of the day, only they know what is truly right for them. Along with this, when we step into a birth space, we need to take a moment to observe and see what is already working. We’re there to add support where it is needed, not run the show. Sometimes the most essential work of doula-ing is just being beside someone.
give everyone the benefit of the doubt: Everyone has bad days. People grow and change. We also have no idea what’s going on in other people’s lives. We’re members of the birth team, and we want to treat everyone else with respect and set the tone for a positive, collaborative, and birther-centered environment.
recognize you’ll never know everything: This is a good thing. There’s room to keep learning, and there’s room for surprise.
Radical Responsibilities of the Provider
process your trauma: If you’ve been practicing for a certain amount of time, you’re going to see scary things: complications, emergent situations, poor outcomes. Seeing these things is bound to affect your mental health and your practice. Establish a regular debriefing and processing practice so that you can move through these experiences in a supported way. Learn what you can, identify the things that were in and out of your control, and figure out what you can take with you and what you can set down.
recognize the full complexity and humanity of your patients: People come into birth carrying all their past experiences, beliefs, values, and stories. There is not enough time in pregnancy and labor for you to learn all of these things. Know that there may be so much more behind a decision, question, or value than you could ever see, and respect your patients as fellow humans, even if you disagree or don’t understand where they are coming from.
remember your patients are the final authority on their bodies: You can provide information and medical recommendations to your patients (as you should!), but they will make the final decisions. Sometimes you will feel good about their decisions. Sometimes you will not. This is okay. You do your best to inform your patients, and you understand that you cannot control their decisions, and that their decisions are truly theirs to make.
recognize your own humanity: You are a human being. It’s impossible to prevent all bad outcomes from happening. You do your best, and you also recognize that you are not a god. Sometimes you will make mistakes. Sometimes you will learn new things. Sometimes things will happen that are outside of your control.
learn as much as you can: Developing the skills to support breech birth, resolve shoulder dystocia in multiple positions, perform a breech extraction in twin vaginal birth, etc are so important. There may be reasons why you can’t offer these skills on purpose, but we all know unexpected things happen, and you can be ready. And the skills you can offer, like supporting births in positions other than lithotomy, are going to make a world of difference to patients.
communicate clearly: Even (especially!) in urgent situations, communicating clearly with the birther is essential. Talk to them instead of around them, meet them at eye level, explain the situation, what you recommend, any risks, and ask for their decision. Tell them how much time they have to decide. Please involve them in their care, especially when it’s important and time-sensitive. This small act would prevent so much trauma!
recognize you’ll never know everything: This is a good thing. There’s room to keep learning, and there’s room for surprise.
Radical Responsibilities of the Birther
put yourself in charge of your birth: You make all the final decisions about your body and your baby. Make them on purpose.
assemble your team carefully: Surround yourself with trusted resources. Find people who know pregnancy and birth well, and ask them lots of questions. Put together a team of people who know you well, and prepare them to support you throughout your journey. You want to feel seen, safe, and supported by everyone on your team. If this isn’t the case and you can’t change that, prepare the other people on your team to help you navigate any tough situations that may come up.
do a deep dive into yourself: What do you already know/believe about birth? What are you worried about? What are you excited for? How do you usually handle stress? Uncertainty? Pain? Decisions? What’s challenging for you? What skills do you want to learn before it’s time to meet your baby?
recognize what is within and outside of your control: You can pick your team and your birth location. You can practice the skills you’ll need to move through labor (see next point). You can choose how you respond to challenges. You can’t control exactly how you and your baby respond to labor. That’s okay. You’re not supposed to. You can do everything “right” and have a challenging birth. You can do everything “wrong” and have a smooth birth. Prepare yourself, and then get ready to go into the unknown.
practice coping strategies: I mean coping strategies for labor contractions, but I also mean coping strategies for all the unknowns, uncertainties, and unpredictability that comes with pregnancy, birth, and raising a human.
practice advocacy skills: You are responsible for communicating your decisions in labor and birth. If you’re worried about how you’ll do this, prepare with your support people in advance and practice different scenarios.
recognize you’ll never know everything: This is a good thing. There’s room to keep learning, and there’s room for surprise.