One of the best ways to start effective self-care is to start setting boundaries. Boundaries help us determine what our responsibilities are. Perhaps more importantly, they define what is not our responsibility. In their classic book, Boundaries,[1] Doctors Cloud and Townsend explain how boundaries help us keep caring things in our lives and harmful things. Start by considering your needs and the needs of your family.
- Put family first whenever possible. Our family must come first before anything related to the client that does not appear. Consider, too, that family emergencies must come before client emergencies. There may be times when trying to make these decisions will break your heart, times when there really are no answers to make it right for both the family and the clients. Get support from colleagues when you need it.
- Set boundaries that fit your life and change them as your life changes. Evening and weekend appointments may be more convenient, for example, when you have small children at home; partners can take care of the children while you work. Additional charges for daytime appointments may encourage clients to choose evenings or weekends. If you prefer to schedule during regular business hours, consider free meetings during your business hours and an additional charge for off-hours. A fee may be added for after-hours or weekend classes, if business hours are most convenient for you. We are less likely to feel resentful about working inconvenient hours if we are paid fairly for doing so. I have also found, that even clients who express concern about meetings during business hours find time in their schedule if they save money. Setting a financial boundary protects my time and helps me avoid the stress that can come from feeling imposed.
- Set regular business hours. All of my newly booked doula clients receive a document called “How to Get the Most Out of Your Doula,” but the real function of the document is to set boundaries for my business. It lists office hours and establishes expectations about communication. Emerging situations always prompt a phone call. Reports about care provider visits, requests for book recommendations, and processing a client’s birth are non-appearance and can be emailed or handled during office hours.
- Protect special dates. Put your family first by arranging backup for recitals, Boy Scout celebrations, birthdays, and anniversaries. The key here is to be as open and communicative as possible and to inform clients as early as possible. Consider including the information in your contract and remind clients as dates approach. Explain how the backup works and, if possible, have the opportunity to meet with the backup and invite all your clients (Zoom is great for this).
- Set boundaries around your scope of practice. It’s common for clients to ask “What would you do?” or “What is your opinion?”. As CAPPA professionals, we strive to provide our clients with evidence-based information, even if we have strong opinions on any given topic. Try setting a boundary with a simple response that includes a gentle reminder of our role and scope of practice. “This is your baby and only you can make the right decision for him.” “My opinion is not really important. What the data says is….”
- Set and stick to financial boundaries. A sure-fire path to burnout is to repeatedly push ourselves, without fair compensation. Know your worth. Set your rates. Stick to them unless you choose to make exceptions.
- Protect your mental health. One of the most difficult and delicate boundaries to set concerns labor doulas in particular. There is a correlation between burnout and maternity support workers witnessing traumatizing events, such as obstetrical violence, and a greater percentage of cesarean sections.[2] If a particular birth place or care provider has a history of such incidents, set boundaries on whether or not you will work with that provider or that birth place.
Setting healthy boundaries is good for us. It’s good for our family. Our children watch us and learn to set healthy boundaries for themselves. We do self-care for our clients, too. I once got a phone call from an angry client who was frustrated that I wasn’t checking in with him as often as he would have liked and demanded that I call him two to three times per week just to check in. . I explained that this is not part of the service I provide. I reminded him that it was his responsibility to let me know if he needed me. I suggested that she consider building her support system by asking friends or family to call to check in and offer support. I’m sure he’ll fire me. But he didn’t do it. We had conversations throughout the rest of her pregnancy about boundaries, what they look like, how they serve us. He had a beautiful birth and sent a gift and a kind letter after to thank me for my support and for teaching him what good boundaries look like. We both won. We are given boundaries.
[1] Cloud, H. and Townsend, JS (2017). Boundaries: When to Say YES, When to Say NO, To Take Control of Your Life. Grand Rapids, Michigan. Zondervan.
[2] Naiman-Sessions, Miriam and Henley, Megan and Roth, Louise. (2017). Bear the Burden of Care: Emotional Burnout in Maternity Support Workers. 10.1108/S0275-495920170000035006.
About the Author
Debbie Hull began learning about birth in 1996 after the birth of her first baby and has been serving families in the Houston area since 1999. She is CAPPA certified as a new parent educator, labor doula, and childbirth educator. and honored to be on the CAPPA faculty for both labor doula and childbirth educator. Debbie has had the privilege of attending several hundred births in homes, birth centers, hospitals and, on one memorable occasion, a grocery store parking lot! She believes it is the most precious and sacred honor to be invited to care for a family during their birth and is extremely proud to have the opportunity to speak to the work of the next generation of birth professionals. Her work has taken her places she never expected to go, including being a talk-radio guest-host (listen at wholemothershow.com). She also played Jillian in all the Houston productions of Karen Brody’s play, Birth, but only her beloved midwife/friend’s fingerprints were on her back. They say the birth sounds he made there, on a stage in front of hundreds of people, sounded real. He was very hopeful. Debbie designed and developed the curriculum for an innovative, interactive childbirth class and began offering classes that even dads report enjoying! Her training and development minor and experience as an American Sign Language interpreting mentorship program manager perfectly prepared her for mentoring doulas and childbirth educators. He believes that we learn best when we laugh, so his training is designed to be enjoyable and memorable. It should be noted that there are also tears in the training, when the groups dive deep into the emotional side of the birthing process. Debbie is proud to be the mother of two wonderful former breastfed and homeschooled young adults, the youngest of whom is on a 21 year nursing strike. When she’s not acting on her feelings about it, Debbie enjoys movies, reading, and game nights, even when she’s losing.
