An open letter to Midwives struggling to work with Doulas…………..

An open letter to a midwife…………

Dear Midwife………..

Today you were assigned to support a birthing mum whose birth support team consisted of her husband and her Doula.  I was their Doula.

As we proceeded to spend most of the day with one another I spent a lot of time listening to you and observing the way you worked.  You seemed happy in your work and my clients and I were reassured by your approach.  It is so important that the birth space and atmosphere is a positive space for the birthing family.   However, despite your friendly manner, as time went on the signs were unfortunately there.  I’m truly sorry that you felt threatened by my presence in the birth space.

I try to understand how hard it must be for you to forge relationships with a birthing family that you have just met and support them through one of the biggest, most vulnerable and powerful events of their life.  I try to understand what it must feel like to come into a space where there is a relationship with someone else that is giving emotional and practical support.  I understand how difficult it is to offer support, without bringing your own ego into the equation.  Its really hard.   You came on your shift that morning, and we had been under another persons care for the previous 8hrs. Your understanding from your notes and handover was that contractions were not effective.  You have to build a picture and make strong connections in a short space of time.   You have to do that in the knowledge that the birthing couple didnt choose you to attend their birth.  They are assigned a midwife based on who is available when they come in to the Birth Centre or Delivery unit.  That must be very hard when you know the other person providing emotional and practical support within the birth space was interviewed and selected by the birthing family based on the connection they felt when they interviewed a number of Doulas, probably many months before.

You didnt attend all of the antenatal meetings we’d had over the past 6 months.  You hadn’t talked at length with the birthing couple about their anxieties, their hopes and wishes, their fear of becoming parents, their family dynamics. You hadn’t been on call for the past 4 weeks, waiting to join the birthing couple as soon as they felt it would be helpful.  You hadn’t picked up the phone over the past week, at 4am when she thought she might be in labour – and then spent the days leading up to her labour reassuring her over the phone, that labour will happen.   You hadn’t seen the huge, overpowering sensations my client had been experiencing during the active birth that she’d hoped for, in the previous 24hrs.  You didn’t see that i’d been dancing and swaying with my client through each contraction, leaning over a birth pool for endless contractions rubbing her back, clearing up her vomit, holding her while she cried. Looking after her shell shocked and tired husband.  You also hadn’t witnessed the wonderfully respectful way in which your previous colleagues had worked with us.  Coordinating care, taking the time to understand my clients wishes.  Sitting back and observing, coming forward when needed, joining in with respectful and understanding discussions, offering her expert advice when asked.   Welcoming me as part of the team, never undermining my role, welcoming my thoughts within the discussion.  We had all danced together each bringing a different part of the puzzle to the table – and my clients felt so wonderfully supported.

As we conversed you talked about your journey to becoming a midwife, the qualifications you had undertaken, and the interview you’d had against 140 other candidates.  You were rightly very proud of the achievements you had accomplished.  I was genuinely interested in your stories.

I wonder why you felt it was necessary to ask me if it was right that Doula’s do not have to undertake any training to become a Doula?  Of course, I put you right – that if we wanted to be affiliated to – Doula UK, which means committing to a Code of Conduct, Continued Professional Development and accessing ongoing support and a mentorship programme, then we can choose to undertake training. We also have incredible debriefing opportunities for each of the births we attend within our network meaning that we are not burned out, we do not carry excess baggage, we reflect on each birth we attend and consider whether we could have done anything differently.  We try to make sense of where and why birth sometimes follows a different pathway.  We read lots of evidence based documents and guidelines and we guide our clients to do the same.  I wonder whether you were genuinely interested in me and my job, or if you had a different goal?  Were you trying to highlight your academic qualifications and reveal my lack of them?  Trust me – I understand and respect your expertise and knowledge within your work.  I chose this different pathway for many reasons.  Please do not think that I want to be a midwife but can’t be bothered to do the qualification.  I dont want the difficult job of balancing evidence against your hospital protocols and having little ability to work differently to the protocol or policy.  I don’t want to read monitors and fill out endless paperwork whilst observing a birthing mother. I understand how difficult it must be to support people without influencing them and without your own agenda within a hospital setting.  I know how much the role of midwife has changed over the years.

Later on, when my client was crying – scared that she might not be able to do the next part – after you’d ramped up her Syntocinon drip without asking her if she wanted you to – and whilst I was soothing and comforting her, saying I understood – that what she’d been through was overwhelming – my heart swelled and as I told her how strong she was, and how strong she had been and hugged her – we shed a few silent tears together. We’ve all been through a lot together.  Part of my job is to hold her space, to understand her, to create moments that make it ok for her to express her sadness and let it out.  The emotional investment I had in my client must have been uncomfortable for you to see.  I wished I had felt your next actions had been out of genuine concern, however I am still wondering why you felt it was necessary to give my client a pep talk – immediately dismissing her feelings, telling her that she needed to get her confidence back because evidence showed that if you were not being positive then you are even more likely to fail to progress.  You continued to tell her husband and I that we should leave her to sleep for the next hour.   As it turned out we were all wanting to take a break anyway.  As it turned out it allowed me to offer my clients husband the opportunity to debrief what had happened so far.  However you hadn’t just utilised that time to let my client sleep….had you?

Upon our return, as I listened to you again I sensed how you had used the time that Doula and husband had been out of the room, learning about my clients mother recently arriving in the local area- and once we had returned continued to spend a fair amount of time convincing my client of how wonderful it would be for her to see her mum, and that if she wanted to call her mum to join her then she would advise she do it soon.

I wonder exactly why you and a couple of your colleagues then felt it was necessary to reiterate your hospital policy that states a birthing mother may only have a maximum of 2 birth partners? Claiming that if my client chose to see her mother, that one of her other birth partners would have to leave, knowing that would be me?  I wonder why when we suggested that I, their doula could leave for a few hours, and then return to support after she’s spent some time with her mum, that you felt it necessary to say that hospital policy would not allow the swapping of birth partners?  I wonder if that was a true reflection of your hospital policy or a reflection of your discomfort and lack of confidence within the room whilst a Doula was present?

I’m so sorry you felt so threatened by my presence.  I hope in the future, and over time you learn to have confidence in your expertise and understand that the relationship a couple have with their Doula does not undermine the relationship with their Midwife.  That every person the birthing mum wishes to have in her room is an incredibly important piece of the puzzle.  A birthing family should never have to choose between their Doula and their Mother and if there is a policy to have 2 birth partners – with the right Midwife – discretion can be applied to such a policy.  I’m so sorry you felt it was necessary to add a clause to the policy that reflected your lack of confidence and understanding of that.  I’m so sorry that feeling threatened by my presence caused you to remove choice from the birthing couple you were supporting, and to collaborate your feelings and that removal of choice with your colleagues.  It was such a shame for my clients whilst they struggled to make a decision t0 choose between the birthing mother’s own mother and the woman they had employed to support her throughout her labour.  The removal of choice was a massive contrast to our experience with your colleagues the day before.

In the end we are all working towards the same goals, there should be no room for egos within the role of supporting birthing families.  We all want families to have a positive birthing experience, to feel supported, listened to, understood and included in the decisions around her care.  We all know that a positive birth experience can lead to a positive start to becoming a parent, better breastfeeding experiences and happier babies.  We are often many Woman, working together.  Surely we shouldn’t be tearing one another down, we should be building one another up.  When we collaborate and understand and respect one anothers roles – wonderful things can happen for the families we support.

I feel incredibly sad that so many midwives seem to misunderstand our role.  We are not there to challenge your knowledge, tread on your toes or prevent you from doing your job.  We are wanting to draw information out from you, and we want our clients to know why certain suggestions and choices are being offered to them, we are there to create space for our clients so they don’t feel pressured or rushed.  We know that woman that feel involved in their care, and the decisions that are made are much more likely to have a positive view of their birth experience and therefore a more positive postnatal experience with their new baby.

I hope you felt satisfied with the support you gave my clients? I wonder if you and your colleagues felt happy with your collaboration against me returning?  I wonder if it felt like you had maintained satisfactory control of the birth experience?  I wonder if you will spend time de-briefing and talking your decisions over with someone that supports you to reflect. I hope you take a small chunk of the conversations that we had away with you.  We did agree wholeheartedly that birthing mums should feel supported to make informed choices.  Maybe you will reflect on that a little more and what that actually means before you remove choice due to your discomfort.

In the end I was left with 2 choices, either I cause a scene and act in a completely unprofessional way – risking my clients potentially positive view of her experience or I graciously walk away.  I obviously pushed my ego aside, and graciously walked away.  I did my best to hold my tears in as I approached the Midwives hub and offered some feedback to the Midwife Ward Manager about their policy and the illogical discrepancies within it.  I felt proud that I had done so in a professional way, without losing my temper.  As I got to my car, I let the tears flow.  Tiredness overwhelming my body, my whole body sobbing for the loss I felt, for the rage I felt but mostly for the feeling of disrespect. Reminiscent of similar experiences as a school girl being excluded from a group of female friends.  I sobbed for the Doula discrimination I see and hear about often.  It hurt to have invested so much time in my clients worlds to have an interpretation of a hospital policy and challenging feelings prevent me from being with them until their baby was safely in their arms, as my contract states.

As I spend time with my clients over the next few weeks, de-briefing their experience, supporting them with their new baby – I will find out how they felt about their care.  I mostly hope they felt happy with the support they had been given and I hope they didn’t notice the difficulties between the staff members supporting them, although I know they they sensed it at times and found it incredibly unnecessary.

I am almost certain that the part they will have found most challenging was being told they had to choose between their Doula and their Mother…………..

3 thoughts on “An open letter to Midwives struggling to work with Doulas…………..”

  1. When Maddie and I were training doulas we taught them the first thing that should go was ego. I saw this scenario time and time again, first as a student midwife from more senior midwives and then from midwives as a doula. I realised that it was not me who had to look back on this experience as positive but the parents. When I made the films for discovery health, maddie could read the anger on my face when wrong choices were being made. I knew the parents had to watch these films and look back with a positive view. We can’t expect midwives to fall in love with our clients and not resent their love for us when they are ignorant of our place in the parent’s lives. At first I was mad about this attitude but now I just smile gently knowing that I get to walk away xxxx

  2. I am so sorry this happened. Sometimes I’m ashamed of my profession. As an IM I know that a good supportive doula is worth their weight on gold, especially for families trying to negotiate policy, rather than evidence based care. Keep fighting the good fight. x


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