Doulas support birthers, babies, and family members during an intimate and emotionally charged experience that often involves many medical twists and turns along the way. For many doula clients, pregnancy and childbirth are among the most complicated experiences with our healthcare system they will have ever had to navigate. We know that birthers need to feel in control of what happens to their bodies and to be making informed choices about their care to create a positive experience and avoid trauma. 

Doulas can change a person’s healthcare experience for the better by supporting their bodily autonomy and informed decision-making. Additionally, we are well placed to notice systemic issues that impact our clients again and again, and to use our knowledge to encourage and support changes.

Learning to engage in this type of advocacy within the scope of the doula’s role, so that our efforts are helpful, is an important aspect of our learning and professional development. To support our students and alumni, Doula Canada has developed an advocacy framework that defines advocacy in the context of doula practice and describes approaches to individual advocacy that are aligned with respect for client autonomy. 

Our framework identifies three categories of advocacy that doulas engage in: systemic advocacy, self-advocacy promotion, and individual advocacy. 

Systemic advocacy is any effort to change, remove, or add a policy or process that affects the lives of birthers, families, babies, or doulas. Examples include lobbying your elected federal representative to change the birth evacuation policy or amplifying social media campaigns that raise awareness regarding perinatal mental illness.

While we don’t usually think of it as such, our work with clients to support them to know the evidence regarding their perinatal circumstances, and ask the right questions of their healthcare providers is a form of advocacy. We encourage them to use their voice and make their conversations more effective because they are armed with information.

Sometimes, especially in the birth room, it might be necessary to advocate for the client in more direct ways. It is important that this individual advocacy does not manifest as speaking for or over the client, or in a manner that could worsen their care or medical situation.

A 2020 paper by S.S. Yam based on interviews with doulas identified three types of tactics that doulas use to advocate for their clients during labour and delivery. She calls these “soft-advocacy” techniques because they differ from what we usually think of as advocacy. Staff and instructors at Doula Canada agreed they used these strategies and had lots of guidance to offer on exactly how to use them. Their guidance was used to develop the advocacy framework. 

The three tactics identified by Yam are 1) creating deliberative space, 2) cultural and knowledge brokering, and 3) physical touch and spatial maneuvers. 

Creating deliberative space refers to strategies that give the client more time to ask questions and make decisions. One example of how doulas do this is by noticing that care that deviates from their preferences is about to happen and bringing it to the client’s attention, prompting them to ask about the intervention that is about to happen.

Cultural and knowledge brokering refer to the tactics doulas use to make sure the client understands medical jargon or cultural norms. This could involve paying close attention to the information provided by the medical team, observing how well this is understood by the client, and repeating the information in language that the client uses and understands.

Physical touch and spatial maneuvering refers to the ways we use our bodies and physical contact with the client to advocate for their needs. Examples include using our bodies to conceal the client from view, modeling consent by asking permission each time we touch the client, and using our presence to back up the client during interactions. 

The complete framework is linked below. It offers more detail on the three types of advocacy and the soft-advocacy strategies. It illustrates these concepts using case studies based on staff and instructor experiences. 

In 2023, Doula Canada will continue its work to support advocacy among its members by developing an advocacy toolkit from the framework and launching an advocacy working group for students and alumni.

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