Become a Patient Advocate

Birth workers, especially doulas, have a problem on their hands.

They are often the sole witnesses to obstetric violence, coercion, lack of informed consent, or medical negligence. They are often the sole support person for a family navigating the medical system in the perinatal period (before, during, and after birth), and the only person on their team with no obligations to the hospital.

But no one trained them for this. Doulas often report that they were taught in their original trainings not to advocate; that it is inappropriate for them to speak to hospital staff; and that it is “out of scope” to inform clients about medical options and alternatives. Midwives transferring to the hospital are rarely equipped to step into the role of patient advocate, and their clients can experience a sense of abandonment as a result.

The alternative to advocacy is trauma for families, for midwives and doulas, and for hospital staff. When communication breaks down, everyone suffers. Many intentional doulas around the world have realized this, and have been trailblazing advocacy in the birth rooms where they work.

But there’s still a problem!

Hospital care providers don’t understand the doula role (and no wonder when doulas themselves disagree). They generally see doulas as physical and emotional support people only, and feel uncomfortable when doulas provide medical information to their clients. They are prone to suspect doulas of unduly influencing clients, and it’s not infrequently that we hear of a doula who has been accused of “interfering with care” when she simply proposed alternatives to her client (in support of the client’s legal right to informed choice). Community midwives are similarly looked on with suspicion, and not given the opportunity to participate in the integrated care their clients need.

We think we have one solution.

It is time for doulas and midwives to claim the title and the training for the work they are already doing—as patient advocates. Hospitals and care providers are likely to understand the role of a patient advocate. (Here’s a handy government definition: does it sound like what you do?) You can still wear your doula hat, supporting your client in body and spirit, while you greet the staff as her patient advocate.

Patient advocacy is not a licensed or regulated role (in any country, to our knowledge): if you are helping your clients navigate the medical system, communicate with care providers, and understand their options, then you can call yourself a patient advocate without further ado. It can look like this. “Hi, I’m Neisha. I’m Mary’s doula and patient advocate. I’m here to help facilitate strong communication within the team, and to support Mary in understanding her options and expressing her needs. I’m looking forward to working with you today!”

You will walk into these spaces with greater confidence when you are fully informed about patient rights, hospital culture, and policy, and when you have practiced advocacy tools and strategies in a learning setting. So while certification is not necessary, advocacy training is highly recommended for anyone engaging as an independent support person for patients in the clinical setting.

Bringing transparency to the advocacy role is a critical act. It reduces or removes the tension of suspicion from the birth room; it encourages collaboration between team members; it is self-respectful and respectful of medical staff; and it boldly expresses that the client’s experience and autonomy matter.

Read about how to become a certified Perinatal Patient Advocate.