I have been a doula in Toronto for many years and have had the honour of supporting dozens of families in their birth. I have seen births where everyone is supported and respected, but I have also witnessed many cases of obstetric violence, coercion, and disrespect. I have felt powerless witnessing these things and am grateful for the opportunity to share my experience. Out of respect for my clients, I cannot share details of individual cases, but I will write about the trends that I have noticed and ways I think we can do better.
With the exception of one example, every example I mention here I have witnessed with multiple clients at more than one hospital. I have served clients at all of the Toronto hospitals that have maternity wards. I have also attended home births and births at the Toronto Birth Centre, but I have not observed these trends in those spaces.
First and foremost, I need to acknowledge the fact that these are my own personal experiences and may not reflect the experience of other doulas.
I take a lot of pro bono clients and they are treated differently than the paying clients that I have. These clients are largely Black and Indigenous, people of colour, new immigrants, teen moms, single moms, and/or members of the LGBTQ community. They are all of lower socioeconomic status. The majority of the incidents of obstetric violence that I have witnessed have been with these clients.
As a doula, I notice everything that is going on in the birth room, even things that the clients don’t notice. One of these things is episiotomies without consent. I have witnessed obstetricians perform episiotomies on women without asking them first and often without telling them after. If they do tell them, it’s said very casually as they are being stitched up after birth. I have also noticed care providers increase the levels of Pitocin in inductions without communicating that with the client. I also have witnessed nurses conversing about starting Pitocin on sleeping clients who had IVs in. The conversations stopped when they noticed I was awake and paying attention. (This particular example happened to more than one client, but only at one hospital - St. Joseph’s Health Centre). I have also never witnessed a cervical check done with proper informed consent in a hospital.
Coercion is another problem that I witness. Clients have been told that their baby will die if they don’t follow orders, even when that is not true. There have been threats of calling Child Protective Services if they don’t do what they are told. There can also be a noticeable change in the way clients are treated when they ask too many questions, advocate for something that the nurses and doctors disagree with, or present their own research for choices such as eating during labour, water birth, and different pushing positions. The nurses and doctors treat these clients less pleasantly and are shorter and colder when speaking to them. I have also seen nurses mock and talk poorly about other patients in front of my clients, giving them the idea that if they are not “good”, they will be gossiped about as well.
As a doula, I was told in my training and by other doulas that we do not advocate for clients. That we encourage them to advocate for themselves. I understand why this is true for things like preferences, but I think we must make an exception in times of obstetric violence. We need to speak out when we see it and support other doulas to do the same. When we see a doctor about to perform an episiotomy and the client isn’t aware, we should feel comfortable saying to the doctor, “I see that you have the scissors in your hand” before saying to the client, “do you have any questions about the scissors in your doctor’s hand before consenting or refusing?”. We need to feel comfortable saying “Stop!” when we see cervical checks without consent. Our clients should be the ones to advocate for themselves whenever possible, but there are times when they can’t and we must.
There has been a push for doulas not to volunteer their services. I support the idea that we should charge what we’re worth, but the people who need us the most are marginalized people who can’t always afford that. There should be more programs in place to pay doulas to support more people in need, but there aren’t many and these people need us now. We need to come together as a community to find ways to support these clients and we need to stop shaming those who choose to volunteer their services.
Witnessing all of this has been really hard and there are ways that we can make a difference. I have a lot of hope that we can work together to change things.
Submitted by a doula
Are you a doula or healthcare professional with a story to share about mistreatment and abuse in the healthcare system in Canada?