The Role of the Doula: An Interview with Toronto Doula Amanda Spakowski

I recently had the opportunity to interview Toronto doula Amanda Spakowski of The Nesting Place. We talked about the role of the doula and the importance of maternity care professionals working collaboratively as opposed to competitively (two issues that I wrote about in an article that appeared in yesterday's Toronto Star. I also interviewed Amanda for that article.

What follows are Amanda's comments.

The role of the doula

Amanda Spakowski: As a doula I don't have the medical background or the scope of practice to recommend treatments, diagnose conditions, or to give an opinion about what the 'right' choice would be. So naturally, advocating for or against a particular medical support would be inappropriate and would trigger a practitioner who understands that a doula doesn't have the background to make such claims.

Instead, what I can do is help my clients to ask clarifying questions [such as]

• is this recommendation being made because it is necessary?
• if it is necessary, do we have to do it right now or can we have an hour to try something else first? (we want to be sure that it's safe to take the time to try it)
• is this recommendation being made because you simply want us to know it's an option (we don't have to use it if we don't want to).

These distinctions are not always clear to parents, who tend to be a bit frazzled during birth, and who may have a difficult time interpreting the urgency in conversations with their health care team.

Once we have an idea of how necessary a recommendation is and how the recommendation might support the parents' birth, it's up to the parents to take the next step, whether that is moving forward with the recommendation or taking time to try other things.

As a doula, I'm not there to tell parents how to birth: I'm there to help them navigate birth. While upholding their birth intentions (commonly known as their birth plan) is something that everyone on the team strives to do, at times we need to stray from the parents' ideal scenario into something unexpected. Even during the unexpected, the questions above help parents to understand if the unexpected procedure is something that would support a more positive birth outcome given their situation or do they have time to continue to try to support their plan.

As a doula, it's not in my control to adhere to their birth plan. I can only help them to understand when we might need to stray from it, how to cope with those unexpected events, and when we might be able to keep going as is.

How parents benefit when maternity care professionals work collaboratively

Amanda Spakowski: Creating more opportunities for birth professionals to collaborate outside of the birth room, where we can take time to understand one another in a deeper capacity, would make a world of difference in the way we're able to understand one another and draw on each other's skill and education for the better care of our clients.

The benefit to parents would be immense when we see a team working with (a) a more accurate perception of the good intentions each person has in their work; and (b) actively drawing on the skills of each person in the room.

I currently sit on a committee working on a program to develop better collaboration and communication between maternity professionals. We're composed of ob/gyns, family doctors, nurses, RTs, anesthesia, doulas, midwives and ICU nurses. In one of our meetings, we were discussing situations where we would draw on another practitioner for advice or care and not once did someone mention a situation where they consulted the experience of the doula in the room. When I inquired as to why that might be it came out that no one there really knew that a doula had training that they could draw on!

As a doula I am familiar with many non-medical ways to influence the position of baby, the effectiveness of contractions, the effectiveness of pushing and the comfort of the mother. If I'm not asked about my experience directly and I feel that I have something to offer in a birth management situation, I will offer it to the group myself. However, at times it can be hard to speak up for fear of being interpreted as 'confrontational.'

This brings us back to the importance of better communication between practitioners outside of the birth room. When we have the opportunity to teach each other about our roles, the level and likelihood of collaboration in the birth room increases. Many parents feel more at ease when they see their team working smoothly and happily with one another which has a direct effect on the ease with which their labour can unfold and their emotional experience of their birth (whether birth occurs vaginally or by cesarean).

Of course, when we actively draw on our varying skill and training, there are more options on the table to consider, which can influence the clinical outcome of births as well.

While we strive to create more opportunities to connect with each other outside of the birthing room, It can be immensely useful to always keep each other's best intentions in mind. One of the most important character traits a maternity care professional needs to develop is that of empathy and understanding for his or her colleagues. In what can be a high intensity environment, it's important that we learn to control our triggers to avoid escalating intensity or conflict between practitioners (especially in front of the birthing parents).

Instead, validating the difficulty and importance of each person's experience can go a long way. While we're all there to support the parents, we can offer each other a lot of emotional support during the birth too and an empathizing ear in the hallway can do wonders for how grounded and calm someone can be when in the room with a client. And our demeanor with our clients goes a long way in how parents remember their birth (as being satisfying or traumatic).