Doulas are in a service business. Our success depends largely on how we manage our relationships with others. Many of us have excellent communication skills when things are going well. It’s when things don’t go so well that we can become mired in self doubt and uncertainty. Doula work offers many opportunities to learn and improve our conflict resolution skills, including when we are the source of the conflict.
Try as we might, doulas are no better or worse than other humans at making mistakes. It’s how we behave when we do that defines us. Having a workable Code of Ethics and Standards of Practice can provide an essential guide in setting a standard. However, doulas also need to develop trustworthiness and to take responsibility for the impact of our actions despite the intentions. These are the hallmarks of a mature adult. This article covers some common incidents that require action and possible amends on the part of the doula.
In this first instance taken from my doula interviews, the doula wasn’t sure if there was even a problem.
- Did you or didn’t you?
In this situation, the doula is asked to leave by their clients because a couple wants “more privacy” or a “couple experience”. This can be awkward because you don’t know if that’s the truth or if that’s what they’re saying because they don’t want to deal with what’s really bothering them. Most experienced doulas would tell you to follow your client’s cues without any pressure or questioning. Just do what they ask and let them know you’re still available if needed. One of my interviewees said:
“I once had this happen at 7 cms, +1, and 90%. Of course I left. No arguments. We’re about 100% support no matter what. I waited outside in the family waiting area just in case they wanted me back, but they never did. They said it was my decision to stay, they would have just sent me home. But birth is too unpredictable for me to do that.
In postpartum, they had several opportunities to discuss the birth with me. I never asked if I’d done something because this was a professional relationship, not a friendship. My written review was stellar. In retrospect I can see that I provided exactly what they needed. I soothed their anxieties during pregnancy and got them through the most difficult parts of the labor (in their eyes). Once they felt “home free” at 7 centimeters, their priorities changed.”
- You did and the client feels the impact was minor.
In this instance the doula made an error but it didn’t matter much to the person or the outcome. For example, you missed a communication from the client and arrived later than expected to do labor support. In these instances, go back to your outline of responsibilities, whether this is a Letter of Agreement or legal contract. What does it say? Do you guarantee an arrival time? The key question to ask is, “How different is what you said you were going to do from what you really did do?”
Another way of thinking about it is, what percentage of the labor did you miss? If it’s 20% or more, you do probably need to make that up to them. Try to find a “feel good” solution – one that makes them feel good and cared for AND costs you time rather than money. For example, you may offer a few hours of general postpartum support. This is more likely leave them with a positive feeling about you than a refund check.
The next two situations are more serious and involve the need for an apology and authentic action to make amends. This can take time. Healing from a breach of trust is a process that moves through several stages towards completion; it does not happen quickly.
- You did make an error and the impact was moderate to major (but is not seen as causing harm).
Examples in this category are totally missing a prenatal visit, or missing a critical discussion because the doula was late arriving at the labor. Because of the doula’s absence, the client’s labor is negatively affected.
- Your actions caused harm.
Sometimes out of ignorance, exhaustion, or poor choices, the doula’s actions can cause harm to the client, partner, family member, or relationship with a medical staff member. Sometimes it is saying the wrong thing, at other times doulas may inadvertently omit a loved one from participating in the labor support. The doula may not even know about the harm until much later.
With these situations, a violation of trust has occurred. As a doula, you didn’t behave according to an accepted standard.
What To Do First: Do what you need to do in the moment. Own the action, own the impact on them that they have described, and shut up. Don’t explain yourself. It rarely matters and comes across as an excuse. Take in their disappointment and say you will follow up with a deeper apology later.
Here’s why. In the moment when it happens, people’s greatest need is to have their feelings received and their experience validated. They need to hear “yes” from you no matter how hard it is for you to say it. Remember this is your job, your professional role. This is not personal - as much as you might care for this family in your heart. Once they feel completely received just as they are – they are then free to move on.
Second, they need time. They can’t be curious about why the incident happened the way it did until their initial feelings have dissipated. Once they are curious, then you can share minimally about your intentions or what led to your late arrival. This may take hours, days or weeks.
What To Do Next: Craft a written apology. Go to your training organization or use Doulaing The Doula’s Standards of Practice and Code of Ethics. They are easy to understand, serve as a decision-making guide, and are downloadable as pdfs from our web site. Find the section(s) that fit with the incident best. Use that as part of your apology letter. What you want to convey is very simple: “I didn’t live up to my own standards in this way. I apologize for the impact it had on you, your family, and your birth. I will strive to do better in the future.”
By owning the consequences, clearly stating that you understand what was wrong, and promising to do better, you begin the process of rebuilding trust.
Rebuilding Trust With Clients:
If the incident occurred before labor, rebuilding trust is critical. You’ve used up your free pass entirely. Before this, they were willing to trust you within limits and waited for you to prove yourself. Now they are wondering whether your behavior is part of a pattern or an isolated incident. You will need to redouble your efforts to ensure that you do what you say you are going to do 100%. Don’t oversell yourself. Don’t make promises or any agreements that you may not be able to keep. Make sure that you have a not one, but two back up doulas. Have two alarms set -whatever it is, have a back up plan for your back up plan.
If this is near the end of the client relationship it’s vital that you do your best to leave lasting good memories. Previous clients are your #1 source of referrals, but you also want to close a relationship with people feeling good about you. What people remember and talk about is how you made them feel. Typically, if you don’t have much time left together, it’s the trust you built up before the incident that matters. But people will surprise you by what they remember and think is important. Don’t think that because it’s near the end of the relationship what you did doesn’t matter, or that it’s balanced out by all the good that came before.
Writing an apology letter:
I wish I could say I didn’t have experience in this area, but I do. As a doula, as a colleague, as a business person, and as a human, I have written my share of apologies. Arthur C. Brooks and Oprah Winfrey’s 2023 book, How To Be Happy, includes a section on the research about saying you are sorry:
“How you apologize has a huge influence on your apology’s likelihood of success. To begin with, make it fulsome. A partial apology is worse than none at all…The acknowledgement of responsibility proves to be the most important ingredient of an apology…In other words, don’t say, “I’m sorry your feelings were hurt.” Say instead, “I can see that I hurt your feelings and I’m sorry I did that.”
Next in importance is the offer of repair, followed by an explanation of what happened. All three of these quite practical components are more effective than an apologizer’s more abstract options of expressions of regret, a declaration of repentance, or a request for forgiveness.”
As someone who has made an offensive comment out of my insensitivity as a white person, your apology may start to become a journal entry into processing your white guilt or good intentions. This is called whitespeak and is often part of our mental and emotional process of getting to a true apology. This is okay to do, just omit it from what you send to the person. People of color already know this and don’t need to hear it. What they do need to hear is our awareness of causing harm, that we understand why it was harmful, that they were negatively affected by our behavior, and what we are going to DO to make up for it beyond our words.
From an interpersonal neurobiology perspective, resolving conflict is a higher level brain function. People need to put effort into cultivating these skills, as most of us weren’t trained in conflict resolution in our families of origin. It’s more common to be conflict avoidant, which means doulas have to figure this out as they grow professionally. Apologies are challenging and complex, and are a learned skill. Arthur C. Brooks explains:
“From a neurocognitive viewpoint, apologies are extremely complex, involving at least three distinct processes. First is cognitive control, because you are making a choice to say you are sorry even though doing so is difficult and uncomfortable, which involves the lateral prefrontal cortex. Second is perspective taking, which involves thinking about how something you have said or done was experienced by another person and putting yourself in their position, implicating the temporoparietal junction. Last is social valuation, the way you calculate how much your apology will help everyone involved as opposed to just yourself, which mobilizes the prefrontal cortex.”
Learning to apologize well means you are actually growing your brain and becoming smarter. No one wants to find themselves having made a poor judgment especially when it had a negative impact on others. Yet it’s part of the human experience and being a doula. You are just not going to get it right all the time. Accepting one’s flaws is part of developing your identity as a doula, and so is taking responsibility for the impact of your actions. Hopefully this article will help to guide you closer to success.