Monday, 7 September 2015

CUPCAKES; Bribes and Ethics

As doulas we beat the drum for caregivers and systems to adhere to good evidence.  We help our clients locate and use evidence based information to make their decisions and we benefit from good science that shows why we make a difference. 

The Cochrane update by Hodnett et al, 2012 confirms that continuous labour support has a positive effect for mothers and babies and the best results occurred when mothers had the support of a doula who was not part of the mothers’ social network or an employee of the hospital.    (   This is a vital distinction.  When the support person’s allegiance is in question, i.e.: she is employed by or somehow aligned with the hospital or the caregiver, the effect wasn’t as great.

Let’s imagine that you spend time and money winning over caregivers in order to secure referrals.  The caregivers, who you bribed with gifts, meals or more, then assumes you'll influence the mothers’ choices in exchange for those referrals. Who do you REALLY work for? If you are counting on the referrals from that physician or that midwife you could be taking a risk by not doing as they ask.  If your client has the perception that you are aligned with their caregiver, this can zero out the “doula effect” and negate the very thing that makes you effective. 

Not only is woo-ing caregivers with gifts and goodies distasteful, it ignores the current evidence. Until we have some good data on what happens when doulas use these types of marketing practises it’s vital that we do what we expect of caregivers and follow the current evidence.

Think long and hard before you, as a doula, engage in bribery of caregivers in any way shape or form. It doesn’t foster the type of collegial respect that we’re all working so hard for.  In the end, it may cost your clients the support they deserve and you run the risk of “being for sale”.  Earn respect the right way, with hard work and tenacity and never, ever, be co-opted by back door deals and un-ethical pay offs.   

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