Why I Dropped the Phrase "All Births For All People"

Up until recently, I believed that I was willing and capable of supporting all births for all people. However, a client and I recently ended our relationship and it made me realize that boundaries that I have set in place for the overall health and happiness of myself and my family mean that I cannot support any and every person or birth setting. Oftentimes, I can sense whether a client is a good fit before we even meet (enter a dash of expert level internet research). Other times, it takes the consultation to know whether I want to work with them. During most of the pandemic, I’ve chosen to be a little loose with my boundaries and occasionally ignored my intuition about folks. It hasn’t worked for me or for some clients, so I’m making a change.

One thing that I think a lot of folks, including myself, do not always consider when entering a relationship with a doula is that it is just that, a relationship. Yes, the client pays me to provide a service, but I cannot do that well if boundaries are not well established (on both ends) and one another’s humanity is not respected. While ours is one relationship, we have others that we must attend to with equal or more love and time.

On my end, a couple examples come to mind. I have two children who are the most important people in my life. If they need me, I’m going to be there for them, which is one reason I have backup doulas available. I also value my relationship with self which is why I find that my “built of straw” pandemic boundaries were a terrible idea. Having attended 80-something births is enough to know that I cannot support you without fear or a protective response with any provider or in any birth setting that you choose. And while most people that I work with are different than me and make different choices than I’d make (back to my focus on one another’s humanity), there are some folks that I cannot enter into a business+personal relationship with.

So, I want to apologize to people I’ve unintentionally, but undoubtedly, misled with the phrase “all births for all people.” I also apologize to myself for not seeing how that led to crossed boundaries and near burnout. I’m looking forward to being a better doula for you. Not for everyone, but for you and for me.

2020 Reviewed

21 births

15 hospital births, 6 home births

20 vaginal, 1 Cesarean

1 VBAC (vaginal birth after Cesarean)

14 unmedicated, 7 epidurals

9 inductions

15 with midwives, 6 with OBs

Smallest baby: 5 lbs, 9 ozs

Biggest baby: 9 lbs, 1 ozs

Shortest labor support time: 3.5 hrs

Longest labor support time: 34 hrs

Average labor support time: 13 hrs

Longest gestation: 41 weeks

First birth: 10

Second birth: 9 (6 repeat clients!)

Third birth: 1

Fourth birth: 1

Location of births: Baptist Health Lexington 1, UK 9, Ephraim McDowell Regional Medical Center 1, Frankfort Regional Medical Center 2, Norton Women’s & Children’s 1, St. Joe’s East 1, Home 6

Individual provider who caught the most of my clients’ babies: Sarah Hood, Home Sweet Home Midwifery Services (4 babies)

Practice whose providers caught the most of my clients’ babies: UK Midwife Clinic (7 babies)

Professional development: Became an NRP Provider (Neonatal Resuscitation Program) and started childbirth educator training with Birthing Advocacy Doula Trainings

2020 ended up being my busiest year yet. It started off beautifully, with my first repeat client giving birth at home (her first baby was born at a hospital) under the care of a midwife. Three more babies came before the pandemic, with one being born the week before everything started shutting down in KY. I had planned off call time in April due to a spring break trip (that got cancelled), so thankfully I was not dealing with the initial insanity caused by frequently changing hospital policies and had time to prepare for the possibility of supporting clients virtually. Thankfully, I was able to support ALL of my 21 clients in person. I had one client switch from hospital to home birth because of the pandemic, but others considered it.

My clients’ induction rate went down to 43% (9 of 21) after last year’s 50%. Not surprisingly, my longest continuous support time of 34 hours was at an induction. Even though I tell clients to expect inductions to last days, it’s hard to wrap your head and body around what that feels like until you’re in it; exhaustion is typically a huge factor in the process. Out of the nine inductions, there were only two that I would consider elective (although I don’t know that that is how they were labeled by the providers).

Some other stats that I want to highlight are that one of my clients had a VBAC (100%) and that six were born preterm (2) or early term (4). Both of the preterm births were originally planned home births, but transferred to hospital care- one for hypertension/preeclampsia and the other for imminent preterm birth at 35wks 1day. Not surprisingly, I had a COVID exposure at one birth (that I know of). The hospitals stopped rapid testing at some point and unfortunately, we found out that a client was positive two hours after baby was born. Thankfully, I did not get infected and the mom and her baby are healthy! Also, I had a Leap Day doula baby this year! He was born at 12:48am on February 29, 2020.

The year was hard for lots of reasons, but I feel that it was the one in which I’ve grown the most as a doula. It no longer feels difficult to share confidently about my value when talking to potential clients; I’m really good at doula work. Thank you to the providers and nurses who provided over-the-top excellent care to my clients during some seriously stressful times. Thank you to the six families that allowed me back into their birthing spaces this year and to the fifteen others who welcomed me for the first time. You all have provided some of the brightest moments of 2020!

Attracting doula clients that are unlike me

I’m not the doula for everyone, but I am the doula for a lot of you. I was looking back at birth data for my clients and thought, “I wonder how many of these people have ever or will ever cross paths? How many of these people would I have ever met or supported had it not been for doula work?” Not many was the answer to both, but especially the second question. I am not a social butterfly, so that’s a factor for sure, but also the majority of my clients have been so much different than me.

The reason that I attract such a varied population is because I know that your birth experience is not about me and everything that I do is in accordance to this belief. This is not to say that I have no beliefs, preferences, or personality of my own. I seek to be myself always.

Thank you to all of my previous (and future doula clients) who’ve shared pieces of themselves with me and trusted me with their stories and care. Our relationships have been examples of health and growth, where we both give and both take and both end up better because of them.

Condescension and Dismissal in Pregnancy and Birth

Being a doula and someone who cares about the emotional, informational, and physical support a birthing person receives, so many of the Lexington, KY, moms’ group Facebook posts about pregnancy and birth light me up! Like right now, I’ve got that temples-about-to-burst feeling from reading through a post about how to manage discomfort in labor without an epidural. A couple commenters wrote that their providers reminded them that they wouldn’t receive a medal for unmedicated labor and that they should do what’s “easiest” and not try to be a superhero. The condescension in those remarks is repulsive.

The overused comment about a medal for forgoing pain medication does not even make sense and is demeaning to all birthing people. One choice doesn’t get some sort of reward that the other does not. Both are valid and can be the best option for any individual or situation.

Anyone who dismisses your preferences or belittles you for the decisions you make is not providing respectful care. In labor, as in every other moment of your life, it is your body. When you are pregnant or laboring, you don’t suddenly lose control over making informed decisions about yourself and your baby. 

A respectful provider should listen to and answer your questions. Yes, they know more about pregnancy and birth than you do. They study and train and practice their work for years. They can understand your medical history and determine your and your baby’s health. But what they are not is YOU. You are a unique human being with experience, values, and thoughts that they may not ask about or may not understand (or that you choose, for one reason or another, not to share). Expecting this level of care is not unreasonable and there are midwives, OBs, and family practice doctors in our area who provide it.

If your provider is demeaning or doesn’t take time to answer your questions, that’s likely the type of care you’ll receive during your labor and birth. And if a friend, family member, or stranger is going to make judgments about you based on your choice to receive pain medication, they’re probably not the ones to go to for advice or pregnancy support. I have seen firsthand how much the birth experience affects the emotional well-being of the birthing person and their family immediately postpartum and months/years afterwards. Please take time to create a birth team that will meet your needs and provide respectful, evidence based care. You are absolutely worth it.

In birth, ignorance isn't bliss

The exact path your birth will take is unpredictable. With so many variables in the process, it can feel overwhelming to attempt preparation for all of the possible twists and turns you’ll encounter during pregnancy, birth, and postpartum. While it may seem like the best (only?) option is to go in without expectations and follow the lead of your care providers, I want to encourage you to take the reins on your body and your birth experience. You absolutely cannot control every aspect of your birth, but you can educate and prepare yourself for the experience.

When meeting a potential client, I always ask what your plans are for childbirth education. I want to know what you’re going to know about labor and birth. I provide informational support during pregnancy and birth, but that does not replace childbirth education. And not all childbirth education courses are created equally. If you haven’t already booked classes, I’m happy to provide referrals to instructors/courses that will meet your needs.

One of the advantages to preparing yourself for childbirth is that you’re more likely to have an empowering experience when you feel confident about your decisions. You’re in a totally different state of mind during labor, and having to learn about an intervention for the first time when you’re laboring can be distracting and unnerving. It’s hard to really take in the information that’s being shared (or ask for it if it’s not being shared) when you’re laboring. If you’re prepared for what may come, you’ll be clearer on what’s best for you in the moment and in the long run. And all of that education and preparation will hopefully lead to a more positive birth experience and a stronger start into parenthood.