One of the best ways to initiate impactful self-care is to begin setting boundaries. Boundaries help us determine what is our responsibility. Perhaps even more importantly, they delineate what is not our responsibility. In their classic book, Boundaries, Doctors Cloud and Townsend explain how boundaries help us keep nurturing things in our lives and harmful things out. Begin by considering your needs and the needs of your family.
- Put family first as much as you can. Our family should come before any client related matter that is not emergent. Consider, too, that family emergencies should come before client emergencies. There may be times when triaging these decisions will break your heart, times when there really is no answer to make it right for both family and clients. Get support from colleagues when you need it.
- Set boundaries that fit your life and change them as your life changes. Evening and weekend appointments may be more convenient, for example, when you have little ones at home; partners can care for the kids while you work. Additional charges for daytime appointments may encourage clients to choose evenings or weekends. If you prefer to schedule during regular business hours, consider free meetings during your business hours and an additional charge for off-hours. Maybe add a charge for after-hours or weekend classes, if business hours are most convenient for you. We are far less likely to feel resentful of working during inconvenient hours if we are being fairly compensated for doing so. I find, too, that even clients who express concern about business-hours meetings are able to find time in their schedule if it saves them money. Setting a financial boundary protects my time and helps me avoid the burnout that can come from feeling imposed upon.
- Set regular business hours. All my newly booked doula clients receive a document called “How to Get the Most out of Working with Your Doula,” but the real function of the document is to set boundaries for my business. It lists office hours and establishes expectations about communication. Emergent situations always indicate a phone call. Reports about care provider visits, requests for book recommendations, and processing who will be at a client’s birth are non-emergent and can be emailed or handled during office hours.
- Protect special dates. Put your family first by arranging backup for recitals, Boy Scout celebrations, birthdays, and anniversaries. The key here is to be as open and communicative as possible and to let clients know as far in advance as you can. Consider including the information on your contract and remind clients as the dates approach. Explain how backup works and, if possible, have a meet-the-backup opportunity and invite all your clients (Zoom is great for this).
- Set boundaries around your scope of practice. It is quite common for clients to ask “What would you do?” or “What is your opinion?”. As CAPPA professionals, we strive to provide our clients with evidence-based information, even if we have strong opinions on any given subject. Try setting a boundary with a simple response that includes a gentle reminder of our role and scope of practice. “This is your baby and only you can make the right decision for her.” “My opinion is not really important. What the data says is….”
- Set and stick to financial boundaries. A sure-fire pathway to burnout is to pour ourselves out, again and again, without being fairly compensated. Know your worth. Set your rates. Stick by them unless you choose to make exceptions.
- Protect your mental health. One of the most difficult and delicate boundaries to set is of particular concern to labor doulas. There is a link between burnout and maternity support workers witnessing traumatizing events, like obstetrical violence, and a larger percentage of cesarean sections. If a particular birth place or care provider has a history of such incidents, set boundaries about whether you will or will not work with that provider or at that birth place.
The setting of healthy boundaries is good for us. It is good for our family. Our children watch us and learn to set healthy boundaries for themselves. We model self-care for our clients, too. I once received a phone call from an upset client who was disappointed that I was not checking in with her as often as she liked and asked that I call her two to three times per week just to check in. I explained that this was not part of the service I provide. I reminded her that she was responsible for letting me know if she needed me. I suggested that she consider working on her support system by asking friends or family to call to check in and offer support. I was sure she would fire me. But she didn’t. We had conversations throughout the remainder of her pregnancy about boundaries, what they look like, how they serve us. She had a lovely birth and sent a gift and a kind letter after to thank me for my support and for teaching her what good boundaries look like. We both won. Boundaries gave us that.
 Cloud, H. and Townsend, J. S. (2017). Boundaries: When to Say YES, When to Say NO, To Take Control of Your Life. Grand Rapids, Michigan. Zondervan.
 Naiman-Sessions, Miriam & Henley, Megan & Roth, Louise. (2017). Bearing the Burden of Care: Emotional Burnout Among Maternity Support Workers. 10.1108/S0275-495920170000035006.
About the Author
Debbie Hull began learning about birth in 1996 after the birth of her first baby and has been serving Houston area families since 1999. She is certified with CAPPA as a new parent educator, labor doula, and childbirth educator and is honored to be on CAPPA faculty for both labor doula and childbirth educator. Debbie has been privileged to attend several hundred births in homes, birth centers, hospitals and, on one memorable occasion, a grocery store parking lot! She believes that it is the most precious and sacred of honors to be invited to care for a family during their childbearing season and is very proud to have the opportunity to speak into the work of the next generation of birth professionals. Her work has taken her places she never expected to go, including becoming a talk-radio guest-host (listen at wholemothershow.com). She also portrayed Jillian in all the Houston productions of Karen Brody’s play, Birth, but only with the fingerprints of her beloved midwife/friend all over her back. They say the birth sounds she made there, on a stage in front of hundreds of people, sounded real. She profoundly hopes so. Debbie designed and developed the curriculum for an innovative, interactive childbirth class and began offering classes that even dads report enjoying! Her minor in training and development and experience as an American Sign Language interpreting mentorship program manager perfectly prepared her for mentoring doulas and childbirth educators. She believes that we learn best when we are laughing, so her training is designed to be enjoyable and memorable. It should be noted that there have also been tears in training, when groups dive deep into the emotional side of birth work. Debbie is most proud to be the mother of two amazing formerly breastfed and homeschooled young adults, the youngest of whom has been on a 21 year nursing strike. When she is not working on her feelings about that, Debbie enjoys movies, reading, and game nights, even when she loses.