I’ve seen many internet posts recently on doula support platforms, discussing how doulas should deal with clients who make choices contrary to individual beliefs or strong biases. Topics such as circumcision, religious rituals, marijuana, and alcohol use are often the source of conflict in these posts. As I read through the MANY responses I was surprised by the variety of advice being given. “You can’t stay silent, you have to tell them”, “Advocate for what you believe”, “It’s their baby they can do what they want”, “Just present the facts”, “Don’t take those types of clients” …and so on.
While CAPPA doulas and educators are expected to share evidence-based information with clients in a loving & non-judgmental way, how do we live up to this expectation and authentically navigate our core beliefs and biases?
First, let’s explore the difference between belief and biases. The Cambridge dictionary defines belief as, “The feeling of being certain that something exists or is true.” We live our lives, often unconsciously, according to our beliefs. Beliefs shape our behaviour around topics such as healthy living, parenting styles, religious views, work-life balance, exercise and much more. Your beliefs shape who you are and guide the choices you make.
Problems arise when we develop biases. The Cambridge dictionary defines bias as, “The action of supporting or opposing a particular person or thing in an unfair way because of allowing personal opinions to influence your judgement.” “Unfair” is the key word which creates the distinction between belief and bias. However, because our biases are often rooted in our beliefs and opinions, it can be difficult to distinguish between them.
So, what can we do?
A good place to start is by admitting that we hold some biases and seek to shed a light on them. Have a friend or co-worker make a list of potential controversial topics or issues related to the prenatal, labour and postpartum period. (There is a great list on Page 64 of the CAPPA Childbirth Educator Manual.) Now, write one or two words about how each topic makes you feel. This should be a quick-thinking exercise, allow your bias to show itself by writing down the first thing that comes to mind. Review the list and see if anything stands out. What are the points of concern? What elements appear unfair or unreasonable? This healthy self awareness activity can be done every few years to help identify biases which have formed that we may not have been aware of.
Now that we are a little more self aware, what will it take to discuss or teach about those concerning subjects in a loving & non-judgemental way?
If you find yourself stuck, consider a “risk and benefits” style of teaching. Share just the risks and benefits for that hot topic in order to keep emotion and bias out. It can be helpful to practice this technique with a good friend and discover how deeply rooted a bias is and if there is a point when strong emotion starts to creep into the discussion. Our clients need to hear research from both sides of the issue, so they can make an informed decision. This brings us back to our primary job as doulas and educators, helping our clients make informed choices and supporting them once they have made a decision.
When you catch yourself asking, “But what do I do if they make the wrong choice?” Recognize that statement as a significant warning sign that your bias is alive and well, and not dealt with yet. It’s ok, change takes time. Bring your mind back to the four cornerstones of the CAPPA Approach:
- Positive mental attitude
- Evidence-based information
- Loving non-judgmental mindset
- Building bridges with others
Keep smiling, be encouraging and try to remember that while we may know much of the evidence-based information, we will never know or understand all the personal history this client carries with them into the decision-making process. Therefore, they are the only ones who are fully equipped to make this decision. Not judging other’s opinions and decisions may be difficult at times but it is crucial if we are going to offer effective care and support.
Remember, change takes time and intentional effort! Holding a strong bias may be a trigger from your previous traumatic experience and hold you back from fully supporting clients. If you are truly unable to work effectively with a client because of a belief or bias, consider doing both of you a favour and refer that client on. It is ideal to uncover issues prior to signing a contract, but when an issue grows into a roadblock, it’s in everyone’s best interest to lovingly refer them to another educator or doula that can better meet their needs.
“I have some personal issues that have come up which I need to deal with. I have arranged for Sarah to meet with you and see if she can continue with your support. Sarah’s a great doula who I’m confident will take good care of you. I apologise for any inconvenience this may cause.”
Please note this should always be a last resort and you should always aim to fulfill your contractual duties to the best of your abilities!
I encourage you to explore your beliefs and biases, raise your self awareness, and set yourself and your clients up for success.
CCCE, CLD, CPD, CAPPA Faculty
Teresa Maskery is a CAPPA certified Labour / Postpartum Doula, Childbirth Educator, and New Parent Educator. She has been serving clients across York Region since 2008 as the business owner of My Baby Bump and Stouffville Prenatal. Teresa holds a diploma in Early Childhood Education from St. Lawrence College in Kingston Ontario, and uses this combined skill set to support families through pregnancy, delivery, and parenting. Teresa’s passion to see women achieve their desired birth experience, extends beyond her business and into her volunteer role as a director on the board of the Markham Stouffville Crisis Pregnancy Centre. She became a doula because she believes there is a need for people to understand and experience labour and delivery rather than simply find a way to deal with the pain. Teresa currently resides in Stouffville, Ontario with her husband and four teenage children.