Choosing a care provider that is on the same page as you and your birthing wishes is one of the first steps in preparing for the birth you want.  The questions you ask when interviewing a provider can offer some insight into their beliefs surrounding birth and the care that they provide but it's important to look deeper than simple questions about statistics.  Here are some ideas to get you started.

1.   Look out for always and never.  If the response you get to a question about episiotomies is "I never cut episiotomies," that should be a big red flag.  Not only could that not possibly be true, but that could also put babies at risk.  By no means should interventions be routine but if they are never used than that brings up concerns regarding well-being also.  If your provider says "Yes, my patients always move around in labor," then that sounds quite promising.  But, again, how can that be true when many providers in our area have epidural rates that hover around the national average of about 76%?  Bottom line: if you're getting answers that are so black and white, either ask more questions or interview someone else.

2.  Ask "What" questions.  This is a great follow-up to the "always/never" response.  "What would be a situation where you may do an episiotomy?" "What would be a situation where a woman is not encouraged to move around?"  "In what position do you encourage women to push their babies out?"  "What" questions will get you a lot more info than simple yes and no questions.

3.  Explore the philosophies of others in the practice.  Follow-up your previous questions with inquiries as to how the other providers in the practice tend to feel.  Ask your provider what they love about the practice that they're in and, if applicable, what drew them to working at the hospital or birth center that they are in.  How likely is it that they will be at your birth versus another provider in their practice?  

4.  Watch their body language.  Is your potential provider quick to pack up your chart and look at the door?  Are they checking their watch or did they leave their previous engagements at the door, providing you with full attention?  Do they respond to your questions before you're even finished asking?  Or do they take a moment to absorb what you've said and offer a thoughtful response?  Pay attention to the details and the way you feel about your meeting, aside from simply the responses to your queries.

5.  Ask if they have any questions for you.  Providers should always have questions for you.  They should, in an ideal world, also want to make sure that what they have to offer matches up with what you desire for your birth.

Social media is an incredible tool for anyone building or maintaining a business, particularly a business that is as community based as that of the birth professional.  The ease with which one can connect to other birth workers in outlets such as Facebook and Instagram, share resources and research, and seek guidance and support is unprecedented. And the ability to stay in touch with clients while enabling them to be part of a larger sense of community - both on and off-line - does wonders for surrounding new families with other like-minded individuals in an unpressured environment.  As with any form of social connection - be it conversations at the playground, playdates with other parents in the community, or get-togethers among birth professionals - there is an unspoken code of ethics that guide the conduct of behavior, commentary, and sharing within the realm of the outlet.  

Interestingly, Facebook is full of articles decrying the judgment parents cast upon one another both in online commentary and in real-life situations.  The social media outlet allows for actions and comments that one may never actually do or say in real life.  The internet abounds with humorous satire on this topic, such as this recent article on HexJam.  Although some may be a bit far-fetched, the idea is that social media subconsciously allows a bit of leeway when it comes to appropriate or acceptable behavior.  But where is the boundary when it comes to professional conduct on social media, particularly in a career field where intimacy, confidentiality, and privacy are at the heart of the work?

Most well-respected doula training and certification organizations, such as Childbirth International, DONA, Lamaze, and CAPPA to name a few, have strict codes of conduct and ethics that their members are expected to uphold.  Whether a birth worker chooses to certify with an organization or not, upholding an ethical code of conduct allows a client to feel confident and secure in the working relationship with her doula.  CAPPA even goes so far as to have a specific section on social media conduct in the outline of their birth worker policies.

According to the policy statements of the above listed organizations, as well as a general code of conduct that transcends most professions, providing client information that is not relevant to the care that they receive or that provides personal information to anyone other than the back-up doula without the client's consent is unethical.  Perhaps the most important ethical code, particularly as we discuss social media, is the maintenance of confidentiality - discussing only the amount of information necessary to provide appropriate care.  

Birth work is exhilarating, emotional, and energy-investing work that often thrives when shared among a strong community of individuals sharing the same passion and love for the work.  However, as birth workers strive to build community that reaches beyond in-person meetings and geographical boundaries, the sharing of what should be confidential client information is often easily done, perhaps even without specific intention.  The excitement of heading off to a birth or being called by a client who has managed to stay home well into labor as she had originally planned is what birth workers live for.  And when this happens, it's a completely normal response to want to share this excitement with those who can recognize and embrace it.  Quite often, this translates into a quick status update, perhaps even with a last minute request for guidance, "Headed to a birth!  Any pointers for a mom with a doc at Lankenau?"  Without even realizing it, the client's right to confidentiality is breeched without necessity.  Whether the client has seen this post or not, someone has.  And whether that person is another birth worker, a nurse at that hospital, or the person that referred the client to the doula, information about that client's birth has been exposed without the person's consent.  This is a breech of appropriate ethical conduct and weakens the sense of security and trust between the client and non-clinical provider.

So what can a birth worker do?  

Build real relationships.  Develop a close-knit network of two or three birth professionals that can be counted on to provide sound advice, guidance, and a listening ear.  Call or text these people when something needs to be discussed or a burst of excitement needs to be recognized.  And let the client know ahead of time that there are a few people who may gain a bit of insight into the client's information in the attempt to provide appropriate and optimal care.  Rather than sending out a general post to a support group page when in need of back-up, use these people or other colleagues whose professionals standards are known to be concrete, if unable to tend to a client's needs.

Write it out.  Keep a well-documented litany of one's thoughts, feelings, and the insights gained through experience.  A journal devoted just to the birth work journey can go a long way in developing one's own philosophies of professionalism and doula support.

Obtain consent.  If it is really pertinent that the question or concern be brought to a larger audience, such as an online doula support group, obtain the okay from the client prior to asking the question.  Leave out any potentially identifying information unless it is specifically pertinent to the question at hand.

Have a confidentiality clause and stick to it.  Every doula contract should include a clause of confidentiality.  This is the perfect place to write a statement or two on what this means to the professional, including with whom information may be shared without further consent (for example, a back-up doula).

When birth workers break codes of conduct that are integral to the entire career field - regardless of certifying organization or type of training - a disservice is done to the entire community and the credibility of the profession is lost.  Doulas offer a type of service that is incredibly unique and rewarding for both the professional and the client.  A working relationship built in trust during such vulnerable and transcendental experiences such as pregnancy, childbirth, and parenting deserves the utmost respect, integrity, and value and the doula has a crucial role in upholding those ideals.