The Doula-Midwife Relationship 1 - training & boundaries

I am in the unusual position of being a trained midwife (no longer practising) as well as a currently working doula and doula trainer (or 'course leader' as I prefer to say) at Mindful Doulas. This has given me much cause for reflection lately regarding the issue of boundaries between the two roles and how this is being presented to student doulas during their 'training' course.
 

Although I have always supported the idea that doula courses are most appropriately led by working doulas, for we are lay people and do not require to be 'trained' in the same way as a midwife, I guess this is because I do have the experience of having been a practising midwife. I do therefore fully understand the working boundaries between the two roles. 

How can a doula, generally speaking, be in a position to comment from a truly informed position on the midwife's role? How can she fully understand the way the midwife is bound by policies and the pressure to conform to a system of care, or how if she steps out of the box, she can be ostracised from her own professional community? Or how the boundaries of this 'box' can vary so drastically between trusts/units, with much depending on the support the midwife receives from her senior colleagues?

This is not a failing of the doula, simply a fact that doulaing and midwifery are different roles. And therefore, I believe that, rather than focusing on any 'bad midwife' or 'unsupportive NHS' stories, it is more relevant and useful for the doula course leader to keep clarifying with her students the working boundaries of the doula, to reiterate that while she is there to protect the mother's birthing environment, a part of this includes striving to ensure a harmonious relationship with the attending midwife. 

So perhaps there is a place for inviting a midwife speaker in to the doula course, as some already do, to share exactly what her working boundaries are? Working together does require respect and integrity between us, but I believe this is helped hugely if we are well informed about and have had a good experience of each other's role.
 

Regardless of whether she had completed a course or not, a doula may be very experienced in supporting birthing families as a lay companion. And yes, her role is to protect and promote normal physiology, but often the reason why the doula is enlisted in the first place is because the mother feels her voice was not heard during a traumatic birth experience the last time round. The doula develops a close trusting relationship with the mother and her partner through pregnancy and works on sharing resources with the parents to enable them to make their own informed choices about the maternity care that feels right for them.

If things start to deviate from the norm during labour, the birth doula can only be led by the parents on how best to support them and the midwife's advice will also enter this equation. However, the doula also knows (or should know) that sometimes, disturbance of the birth space (through noise, lack of privacy, stressed or fearful supporters, strangers entering the room) can be the very reason why the birth process starts to deviate from the norm in the first place. If the parents also understand this and have prepared well to minimise the risk of this, then it is likely that in view of her own role in supporting the couple's wishes, the attending midwife will be mindful of limiting disturbance in the birthing room too. 

Indeed, many doulas and midwives are working amicably and effectively together in this way to support normal physiology right now - for example, supporting a mother to birth her twins in water!

In the same way that the midwife may feel caught between her employer's rules and regulations and the choices of mother or couple she is attending, the doula may feel caught between her client's wishes and medical advice. Of course it is not her role to defy professional opinion, but it is the doula's role to support the mother if the mother chooses not to accept medical intervention. 

Since the biggest impact on the doula/midwife relationship is likely to be established in the clinical area, and since the doula may be perceived as the ‘newcomer’ on the scene, I feel we have a responsibility to take the initiative towards establishing a harmonious working relationship. However, this does not mean that I would encourage a doula to coerce with the midwife if the mother's wishes were not being heard. And let's face it, despite the best will in the world, there is evidence to show that this does happen, as indeed there are doulas who equally inappropriately cross their working boundaries.

We are all only human, but one thing we do all have in common is a passion for supporting women, men and families to enjoy the best birth and early parenting experience possible. I believe that if we both, as doulas and midwives, truly have the mother or couple and their baby's best interests at heart, most times we will do our utmost get it right between us, and doula course leaders can do much to mindfully promote this good intention.