A couple of weeks ago, I had the pleasure of connecting with a fellow doula, Kate Goodwin (check her out here: https://www.intothewonderbirth.com/ ). Our conversation quickly moved to the topic of client advocacy – specifically, what conditions allow birthers to feel truly empowered and autonomous in their decision-making throughout pregnancy and birth.
She said something that really struck me. She explained that the disconnect between birthers and healthcare providers isn’t actually about end goals – because ultimately, everyone wants the same outcome: a healthy baby and a healthy birther. Instead, the mismatch lies in how each side defines “safety.” For many healthcare providers, control = safety.
Doctors, midwives, and nurses are highly trained professionals who are paid to provide their expertise, guidance, and recommendations. Many are deeply skilled at what they do, and modern medicine has saved countless lives and provided options that can make birth safer, easier, and more comfortable for families.
I absolutely believe families should have access to the full spectrum of medical options. But I also believe those options should remain just that – options – with the family deciding what feels best after weighing benefits, risks, and alternatives.
The challenge is that healthcare providers are trained to minimize risk at almost any cost. Obstetricians in particular come from a surgical background, so their training is centered on managing complications and intervening. Their focus is often on what could go wrong, rather than on how to support a healthy, physiological birth process.
This mindset makes sense in a hospital environment, where surgical rooms and emergency resources are right down the hall. But it also increases the likelihood of interventions being suggested, even when they might not be strictly necessary. These interventions can create a “cascade” effect, where one leads to another, ultimately raising the chance of a cesarean birth.
Meanwhile, birth itself is not an illness. Pregnancy is not a crisis. Given the right conditions, birth unfolds safely and beautifully, often requiring little to no intervention. That’s one reason cesarean rates are higher in hospitals than in planned home or birth center settings, where surgery is reserved only for true emergencies.
This doesn’t mean I discredit healthcare providers – far from it. I believe in their work, and I especially believe Georgia needs more midwives (including homebirth midwives, but that’s another topic for another time – if you’re curious, check out the Peach State Birth Coalition to learn how to support their cause at https://www.peachstatebirthco.org/ ). But sometimes the goals of the client and the goals of the provider simply don’t align.
For the family, safety may look like autonomy, informed consent, and respect.
That’s where doulas come in. Our role is not to speak for clients or make decisions on their behalf. That’s not our place. Instead, we stand at the intersection: we know the family, and we know birth. We understand the medical language and the family’s values, and we can help ensure both sides stay connected. We can remind healthcare providers that while they may attend multiple births a day, for the family, this is their one birth. It’s a life-altering experience they’ll never forget.
Because the truth is, it’s not enough to say, “Well, mom and baby are healthy, and that’s all that matters.” That’s simply not true. Anywhere from a quarter to half of birthers report experiencing birth trauma. Yes, sometimes that trauma comes from circumstances no one could control. But often, it comes from feeling unseen, unheard, and disempowered – from experiencing birth as something that was done to them instead of something they actively participated in.
I don’t believe most providers set out to create that dynamic. The gap is systemic. But it’s a gap we need to bridge. And that starts with recognition, advocacy, and respectful conversations. Conversations that honor both the expertise of healthcare providers and the values and autonomy of families.
For birthers: Know that your voice matters. Your preferences, values, and intuition are valid. Don’t be afraid to ask questions, seek options, and remind your care team that this is your birth.
For doulas: Keep showing up as that bridge. Listen deeply, translate when needed, and hold space for families to feel powerful and informed. Advocacy doesn’t always mean being loud – it means keeping the family at the center of every decision.
Together, we can shift the culture of birth. Because healthy babies matter, and so do healthy, respected, and empowered birthers.