Scope of practice and autonomy in birth work

What is a doula's or birth worker's scope of practice and what does it mean to work in our autonomy in a medicalised, patriarchal system?

We often talk about doula support in terms of providing information, physical and emotional support. But is this enough in the modern maternity system and does this truly encompass what for many feels like their true scope of practice when they choose to work in their autonomy. 

You can always tell when you meet a midwife who is secure in their power and knowledge, they are self assured, gentle and patient. They are totally expert at putting the birthing woman/ person at ease. And they don’t feel threatened by the presence of a doula/ birth worker/birth keeper. We work together supporting the incredible dance of birth.

But what about doulas/ birth workers/ birth keepers working in autonomy?

It’s all too easy for us to throw our hands up and say, “oh but I don’t do anything medical”, like because of this our presence is some how unnecessary, unimportant and has little impact on the birth process. This can also make us complicit in a paternalistic, medicalised system. Sit with that for a moment because it’s is bloody uncomfortable.

What is the point in your presence at that birth if not to help protect that birthing persons desire for the birth to unfold as they wish (which in the majority of cases is physiologically).

What is the point of your presence if you throw your hands up in the air afterwards and say ‘there’s nothing I could have done”, when we know that the cocktail of hormones needed to elicit labour is impacted massively by the people present in the birth space. I know I have done exactly this in years gone by - when I’ve felt impotent.

Now some births, a very small percentage truly require expert medical intervention to save the life of mother/ parent and child. And thank goodness for incredibly talented obstetricians and midwives.

But how often do we, as birth workers, see interventions that are completely unnecessary, enacted from a place of fear (risk aversion)? How often do you as a doula, yoga teacher, antenatal teacher, hypnobirthing teacher think “what the hell happened” after the months of prep work you enabled that mother/ parent to put into their birth preparation for it all to unravel at the 99th hour.

What is happening in during people's pregnancy journey's and in the birth space  that leads to an induction rate of nearly 50% in this country? Iatrogenic harm being caused to parents. PTSD experienced by up to 14% a parents (a rate higher that soldiers returning from combat). Are we certain that despite achieving the miracle of pregnancy and carrying that healthy baby to term nearly 50% of birthing women and people require medical intervention to get that baby out again?

If you are going to step into birth work and call yourself a doula/ birth worker/ birth keeper/ birth coach know this... the impact you have on that birthing woman/ person is profound. You never forget your birth and who was involved.

Your talent lies in building rapport and trust so as your client nears birth you can support the flow of oxytocin because you help that mother/ parent to feel safe, secure, loved.

You trust the process that their body is going through implicitly because you understand exactly how it works and why.

You stand in your autonomy and they can feel it. 

You work for them and no one else. 

You can’t prevent a medical emergency unfolding but you can help prevent unnecessary intervention through the work you do antenatally; discussing how the maternity system works, what kind of things they can expect to be offered (coerced into) and why so there are no surprises, explain the hierarchy of intervention, what it can be like birthing in a medicalised setting, how to advocate for what they want and how their body works with their baby, enabling their baby to be born when this is facilitated by patient, confident care providers.

You work with your client to build their trust in the incredible transformative but completely normal process their body will move through to birth their baby.

Do not under-estimate your power or do your clients a disservice by lacking the understanding and confidence to facilitate physiological birth.