# confidentiality with doulas/midwives- vent/question



## KellyandKatie (Sep 19, 2004)

so... I have been bothered by this for a while, I am not asking about any one specific person or any specific thing- just generically

I love birth- nothing makes me happier than to hear about a wonderful birth - in fact I can think of few things I love to talk about more than birth

but on facebook, on blogs, on forums etc etc - it bothers me when some doulas and midwives take it upon themselves to share someone's birth announcement or someone's birth story, or some tidbit about how their care is going.

I never see my nurse or doctor friends posting "wow, kidney stones on a patient today the size of a pea- seriously!" or "my heart patient got their transplant today!"

but I see some doulas and midwives sharing this stuff all the time "welcomed baby at such and such time, mom did great" or "on my way to another birth" etc etc and then on blogs even more so
its a small birthing community really and usually it is only a few clicks away from figuring out who they are talking about even if no names are mentioned
I don't understand why this is considered okay
and considering that it is not just one or two doulas or one or two midwives who post the 'hooray for this persons birth' and the friends list read like a directory of doulas and midwives it seems very accepted

now- again- I love birth and I love to celebrate for others- but I just feel it would be up to that person to share that info if she felt like sharing that info

I am sure after going to a birth each doula and midwife has a story they want to share- I am sure that birth high really is like no other- but I think it would come with that professionalism and the job that part of it is keeping it ones self, or keeping it to a doula/midwife board to discuss how it could have been done differently- but to see someone's birth experience shared and critiqued on a blog or on facebook just bothers me so much

to compare again to the medical field- if a patient has some procedure and the doctor thinks others could learn from the story- they have to ask the patient to sign off on sharing their story to be published in a medical journal etc etc

but if a story or important info is needed to be shared- it just does not seem like personal blogs and facebook is the place for that- and if celebration is the reason- again, isn't that the families place?

is there a clause of confidentiality ? or as long as full names are not listed, it is not considered an issue?

I may just be being a giant itch about this, and it is just my own pet peeve- that could be the case too








or maybe the phone conversation goes like this
"please come, I am in labor"
"great! I will get my bag, tweet this, and then be right over, okay?"
"oh yes please, could you post to twitter and facebook as well- and I have a few buddies on myspace I want looped in too"


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## cileag (Aug 16, 2008)

I think it's a fine line---you're right that in some instances, in small communities, it could be pretty easy to find out who they were talking about, but I also keep in mind that those social media sites sometimes do serve a purpose and it's useful to know that a doula friend is at a birth so I won't bug her--or that my midwife is recovering after an all nighter, so I'll wait to call her with my random question.

And as a nurse, I DO see a lot of my MD/RN friends post things just like you mentioned btw. It's a slippery slope, but as long as there are no patient identifiers, it's legal. I think people just want validation and support in most situations and they're just trying to share their day with their "network" whomever that may be.


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## MidwifeErika (Jun 30, 2005)

The birth announcements that I post on Facebook and my website, I get written consent from the families to do so. It is similar to hospitals posting birth announcements on their websites or to the newspaper.


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## Riverbeauty (Apr 2, 2008)

During my care I was happy to have my Doula post updates. I knew that she was keeping people informed so that I could focus on my work. Sharing the entire birth story was for me to do afterward and she didn't cross that line.

In the end, I think it is a decision best made between the provider and her client.


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## KellyandKatie (Sep 19, 2004)

so, my understanding then is that there is a code or rule, and the families know about the sharing? Or the professionals are just choosing to walk the line on the side of legal?
I have never had the issue with the doula and midwives I have used personally , but with as many messages as I see from doulas and midwives in other states, counties etc etc - not even specifically my own local area- I just wonder-
I can see a full celebration post- like an actual birth announcement, but that would not be a cryptic tidbit- that would be welcome baby John Johnson - not a 'I caught another baby' -- I get it
that is a cool idea- birth announcements on your site

I can see that there is sharing to celebrate that family - like the announcement idea- or like you said Riverbuety







when premission has been given and hoped for community sharing
and there is sharing to celebrate one's personal experience as a part of that families birth
and sharing to gain more professional knowledge
and that there must be a fine line

thanks for the perspective- I appreciate it


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## Romana (Mar 3, 2006)

I personally am with the OP. If *I*'m not sharing with my online "network" when I'm having a baby or how it went, why on earth is it okay for my doula or midwife to be doing it? Even without specifically naming names, people can piece things together. I think midwives and doulas should ask permission before sharing that kind of information in anything but a completely professional setting, and even then must be careful to safeguard patient privacy. Consent to the midwife's knowledge of a medical event or complication does not equal consent for 10 of her closest midwife and doula friends to have the same.


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## Happeesupermom (Jan 5, 2010)

How do you know she *doesn't* have permission to mention something (even general) about those particular families on her blog?


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## Romana (Mar 3, 2006)

If someone has permission, that's fine. But my doula certainly hasn't asked for my permission (in her contract) and she seems to be commenting every time she goes to a birth. I assume if she were going to ask permission, she would have already, since I'm 36 weeks.

In any case, I didn't specifically criticize anyone. I just said that I think any midwife or doula sharing that kind of information on a social networking site or otherwise publicizing it to a small or large group of people *should* obtain permission first.


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## KellyandKatie (Sep 19, 2004)

I am not referring to any specific comment, but the general acceptance of this habit

there is a difference in posting a full birth announcement, and there is a difference of coarse if permission is given
I am talking about all the
"caught another baby this morning before breakfast, hope I can catch a nap"
and the
"what an amazing mother, what an amazing birth! Now off to another appt with another amazing mother"
"wow, I can not wait to see how big this one is going to be - tiny mom measuring huge"
etc
again, these are generic examples- but soo common

who is on the 'friend's' lists? (who is reading the messages) The family of those families or more birthies? It is not for the family's benefit - at least it does not feel that way to me, it feels more like "I love my job! I am so excited about birth!"
and rightly so- it is such an awesome job and such an honor to be at someone's birth
but... it seems to be a breach of trust to share that with their own friends and family to meet their needs to celebrate their awesome job

thank you again for the interesting perspective - I will be sure to add it to my list of things to discuss- 'are you going to tweet/socially share MY birth experiance?'


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## _ktg_ (Jul 11, 2008)

I understand I think what you are trying to get at, and perhaps this is better suited for the birth professionals forum.

Personally I have MD/RN friends and we all know the rules of HIPAA which strictly forbids the disclosure of "identifiers" plus health information.

Now the other posts - I think its like any other person with a job giving an update and sharing bits of their life with their friends. My favorite is my friend who is an ob/gyn who just gave out props for delivering her 2nd set of twins vaginally (and huge props to the mom!). There are no identifiers to directly link somone to that health outcome, and I would say 90% of her friends are other doctors or nurses. Those types of posts are to me for instance my posts about to a huge application that I just sent in for work. I didn't say to who (because of confidentiality reasons) or when exactly. Just that I got it done.

Its not like they're in the OR tweeting


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## beckyand3littlemonsters (Sep 16, 2006)

As long as names and identities are not disclosed it's just like talking about any other job imo.


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## KellyandKatie (Sep 19, 2004)

ooo I will see if I can ask a mod to move it over there


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## 98741 (May 17, 2006)

I agree, I know some birth pros that get permission before sharing anything. Others I know don't, but keep it very general, but as you said, it is often easy enough to figure out of you wanted to.

Honestly, it bothers me when it's people I don't think have consent. Part of it is that whole, "It's *their* news!" and the other part "What if they don't want all these people knowing that!?"

I personally don't post anything about clients at all, though there are many times that I want to!


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## Romana (Mar 3, 2006)

I have a job that requires confidentiality similar to the medical profession, and I would never tweet or post FB updates regarding work that are of that nature. I think it's unprofessional and on some level, disrespectful. Like the OP, I think it's wonderful when birth workers are excited about the work they do (or anyone, really), and I understand the desire to share it, but I don't think that's an appropriate venue (without consent). Especially since the time proximity of sharing on twitter or facebook further reduces the patient's/client's anonymity.


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## MidwifeErika (Jun 30, 2005)

I guess I don't see the problem with posts like, "another beautiful day of prenatals!" or "3 births in 2 days" or those really general ones. It does not violate any laws or rules. I don't even think they are that easy to piece together since many of us also may be assisting other midwives in their practices, have many women we see each month, and may not even be friends with any clients at all. I have a facebook friend who is a doctor and it is not uncommon to see him post "another great day in general surgery" or "I am so tired after working 26 hours without a break" I am sharing about my job in a similar way. Of course, I also have written consent to share a birth announcement, so that may make me feel more ok about posting a "I should take a nap.... I think a baby may be coming soon" because pretty soon I will be posting a birth announcement anyhow.

I guess this is a really good issue to bring up with your doula or midwife though! If you don't want any posts made, even if they do not identify you in any sort of way, then it may be wise to say so.


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## dynamicdoula (Jun 11, 2004)

Doula here:

I've definitely facebooked that a baby was born, a VBAC was a success, etc. I think this is one of those things where it's a 'new' way of communicating and our communication is happening faster than the rules around it are being developed. We're finding out the consequences and having to make adjustments rather than adhering to a set of established rules, if that makes sense.

I had one scenario where I posted something and a friend who knew the mama recognized the situation and recommended I check with her as she was a bit of a private person. It hadn't occurred to me before that that I would be crossing any lines by saying someone had given birth and it definitely caused me to pause. Now I check with my clients first. Lesson learned!

What makes me think it's okay to begin with? No one is being identified and the women I work with hold vigil for the laboring mama in their hearts, we all do this. We all think of her and send her love and positive birth energy- it never occurred to me until the situation above that someone might be upset by it.

I'll add that when I mentioned to that client that I had posted to my Facebook about her birth (nothing terribly detailed), she didnt' care a whit- but I learned from my friend that every client has a right to be ASKED first.

I think if you have a doula and you know this dynamic exists that you can take the reins and just be very specific about how you feel about it. 'In this age of instant tweets and facebook and text messaging, I need to know your attention is fully on me, and to please not be posting progress reports online unless I specifically ask for you to do that.' I would appreciate that kind of clarity from my client, AND I also make sure to ask as well.


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## broodymama (May 3, 2004)

It's something that I would not feel comfortable with, and I would want to know ahead of time if it's something any of my birth team would do. I'm very private about birth when it's happening and few people actually know when I go into labor. Occasionally a close friend may know and even my family doesn't know, and afterward nobody knows about the baby until I choose to share. Generic details (long night/beautiful birth/etc.) would be fine but sometimes even the little details can be identifying, especially in small communities.


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## CherryBomb (Feb 13, 2005)

I don't have a problem with them sharing generic news, provided there's no identifying information give (unless mom has okayed it).







When I met with my doula for the first time the first thing she did was ask if it was okay for her to discuss me and my pregnancy with the other doulas in her group (without identifying me by name) and I signed a paper saying it was okay.


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## April422 (Nov 28, 2007)

I don't see a problem with posting things such as:
Going Birthin'
A sweety baby arrived earthside today.

I often post when I'm off to a birth to my personal FB page. I have a business FB page I use for clients and out of state or other community doulas that are not a part of my personal circle.

Posting that I'm at a birth is a great way to communicate my lack of availbility.


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## KellyandKatie (Sep 19, 2004)

thanks for all the replies, I have been thinking about it- and why it bugs me... not sure if I have a total grasp on why it bugs me as much as it does- but I do appreciate bouncing it around with you fine ladies.
I have confidentiality with the job I do too- and it would ruin my repore and reputation I worked hard to earn with my families to post such casual reference to how I help people. It is too personal to them what I would be casually posting. Legal, sure as long as I dont mention names, but still - so tacky that it would make me ineffective - no one would trust me- if I casually shared such personal information about others that way( I am not a birth professional)
I guess I would think it some what differant than with other professionals- because trust is KEY in birth, if I can not feel safe and secure with the woman who is with me, and I am wondering how much she is gossiping about me- how could I feel secure in her care? Not all jobs require establishing that trust and repore to be effective... maybe I am putting midwives and doulas on too high a pedasol, I tend to do that a lot too-
I know how private I am about what I share and when I share it- I don't fully understand why this habit is condoned - but again, that is just my perspective - that it is the family's info- not the doula's info to share-

and the families have no idea it is being shared if it is just for a doula's personal sharing, and not on a client website to see- why would a family sign off on that? I can see please sign so I can share your story so others may learn from it- I can see a public client website for birth announcments, I can not see please sign so I can chat with my friends about what I am doing- maybe it is not against the rules, but here is what I am thinking- it is about trust- it appears that that the doula community condones this- that puts me on guard with what kind of info I would share then- not what would be helpful for me anymore- but what would I be okay with them sharing as they please on their social networking sites

I don't want people to know when I am in labor- the whole private birth is sort of a big part of a homebirth to me personally, I want to tell people when I have my baby and I want to share my own birth story
and I want to trust that I can share this info with my birth professionals without them sharing it for me-- I don't know why this would have to be said, to me it would seem like this would be the norm, not the other way around, that I would have to make extra sure I mentioned 'please don't blog about this'

This thread has been really helpful to me - thank you ladies- who would have know that I would find a tiger here- but that is what it feels like to me- some thing that makes me uneasy that I can not quite put my finger on
thank you - thank you

and I do love the birthing community- and I can not imagine the birth high and I have no idea how anyone could contain that wonderful miracle they got to be a part of- surely there are doula and midwifery professional boards though- professional formats for brainstorming ideas?

again, thank you for listening to me and helping me process


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## MsBlack (Apr 10, 2007)

This is something that really bugs me, too. I don't even 'do' facebook, for various reasons but in part because of just the issues mentioned here: potential HIPPA violations as well as privacy concerns that are far greater for some clients than for others--and we don't always know for sure as well as we may think we do about that.

As a birth professional, over the years I've had some struggles w/confidentiality in just the ways the OP mentioned--saying what seem to be very general or oblique things about a client, meaning to conceal identities, only to find that the person I'm speaking to knows who I mean. It is a very small world! Even if you don't live in a small town, it's a small world. Remember that homebirthers/mws and even doulas/clients are a small population, often somewhat isolated because of that--we tend to connect with each other from all over. I know that I have stepped on or over the line a few times, quite unintentionally--fortunately with no ill results that I know of--and it made me really really wary of confidentiality.

Of course, such talk about 'work' seems only normal. Sure, 'Goin' Birthin' or 'Up all night with a family, going to bed now", these comments are so very general that they are innocent. If someone figures out 'who' from those kind of comments, then they are probably close enough to the situation that it's ok if they know.

Awhile back, I heard a tidbit from a BP elsewhere...that she had gone to her state's mws assoc. mtg, and one of the big items on the agenda was a discussion of using fb to ask for advice from other mws about a particular birth that was presently ongoing. I was fairly stunned that the question even needed to be asked....seemed WAY too close to HIPPA violation to me. I was glad to hear that those mws came to agree that they should not do this.

A couple years ago, I sought advice from a national mw forum about a postpartum situation that had gone south--not my client, but I had consulted w/mw and fam in person, was concerned and needed more input. I did all I could to mask the 'players', focussing on the bare essentials of the problem instead. But it blew up anyway into a major gossip fest all over the region/state--all because of 2 ppl on that list, one a mw and one an apprentice. The mw was not in our area, but knew another mw here and called her to get the skinny. The apprentice was local, and figured out the 'who'--spoke to the primary mw involved in that birth, who got mad at me for 'dissing her on a national forum'. In the end, and certainly not ONLY because of my post, the family was essentially harrassed about the whole thing (by their primary mw's friends and followers, who didn't like the family having a complaint about their beloved mw--no matter how justified). It also drove a wedge into the mw community here.

Just saying here that it IS a small world. The above situation is really NOT just about internet posting--even the primary mw involved agreed that my posts and the responses were not what she'd thought from hearing about it (I got permission to copy/paste to her, so she could see for herself, in hopes of sparing our relationship--she did agree that I hadn't dissed her, but in the end that didn't save our prof. relationship anyway). It was more about lack of boundaries among some of those who saw my posts--and poor boundaries among those who were told about it (or otherwise were told about the situation). I was quite surprised to eventually discover who the apprentice was, that had shared the info w/the primary mw--didn't know her well, but thought from my own experience w/her and comments from others, that she was rather more discreet/non-gossipy than most--but she totally violated confidentiality of the list (and worse, though she was a member, she was a total lurker who'd never posted to that list in her 2yrs of membership). As for the mw from afar who called a 3rd mw here to discuss it--well I was beyond shocked at that (it wasn't like she called to see if everyone was ok, and offer advice--but to launch a sort of drama-attack).

Ok, well not to go on all day about it. Just saying, again, it IS a small world. And this means that you can inadvertently tell people things you don't realize you are telling them. And it means that even if you think you know and can trust everyone listening, that just ain't necessarily so. People talk! And that talk can start out innocently enough...but if word gets to just ONE 'wrong person' (a gossip, or someone w/an axe to grind), things can go bad quickly and widely.

I like to talk! In case you hadn't noticed that...







And I like to talk about my work, for sure. I've just learned to talk only to certain people about my work. Personally, I think fb is NO place for any professional to discuss clients, no matter how masked or oblique--I say, keep it entirely to those very general 'going birthin' kind of comments.


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## honeybee (Mar 12, 2004)

My current mw is VERY aware of HIPPA. She will not say anything about a client or make posts on FB. Nor will she talk about it. I actually don't know how she does it, as a large number of her clients are all part of the same NP group, she only takes a birth a month, and it would be quite easy to piece together information.

I do know some doulas who mention things on FB that make me cringe... they mention names, and I HOPE they have permission from the mothers ahead of time, but with as many posts as they make, I kind of have my doubts.

And I know quite a few mws who do make those general statements that are iffy, but also include more formal announcements with details, and I assume those are w/ permission. It IS a really small community, even in our urban area.


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## Joyster (Oct 26, 2007)

I have a couple of doulas and a midwife on my FB. I'm hoping/assuming that when they're posting names, they're getting permission for the babies they've helped delivered.

They often post something like "Going to a birth, need some coffee", very vague and general, mind you, I'm in a large city, so I wouldn't figure out who even if I were inclined. But to me, that's fine in terms of confidentiality. Something a little more specific like "Going to a birth with an anemic mom, with pre-eclampsia" might be a little more pushing it.

A lot of people think that if there is no name involved, it's confidential. If I were to talk to some of my friends about a case I'm working on, I have a pretty good expectation of maintaining that confidentiality without a name because they are so far removed from my field. Whereas with other friends who are social workers if not in the same area, not so much. FB is a medium where it seems like everyone knows somebody so I'd probably err on the side of caution. So I can definitely see your concern and I think these people might want to take better care in protecting themselves and their clients.


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## MsBlack (Apr 10, 2007)

It definitely doesn't take an actual name to violate--or skirt very close to violating--HIPPA. People make connections mentally--as my little sad story was trying to illustrate.

I think if I did do fb, I wouldn't post birth announcements even with permission. If various clients on my page know each other, then one of THEM can post an announcement (with permission) on their own page.


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## Banana731 (Aug 4, 2006)

Quote:


Originally Posted by *MsBlack* 
A couple years ago, I sought advice from a national mw forum about a postpartum situation that had gone south--not my client, but I had consulted w/mw and fam in person, was concerned and needed more input. I did all I could to mask the 'players', focussing on the bare essentials of the problem instead. But it blew up anyway into a major gossip fest all over the region/state

That really stinks. Isn't that type of forum designed so that you can discuss cases? Talk about what went right or wrong, and how to handle difficult situations or continue to to be the best provider you can be. Doctors have things like this with their peers. They review "case studies" with no names, but very specific info about conditions. Do all of those case study patients sign waivers? How are you supposed to grow as a CP if you can't talk about that sort of thing (and I mean without identifiers) with your peers?


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## MsBlack (Apr 10, 2007)

Yes--the forum is meant to be one where we can share joys and sorrows as well as advise each other. Don't know about any other member, but my contract with clients clearly states that I will consult as needed with other pros about their care (maintaining confidentiality). And the forum has a confidentiality rule. That incident led to a discussion about what exactly confidentiality means on the list: you can share what you learn with others not on the forum, keeping posters identities to yourself; you can even share a post with permission from the author. You can't talk to anyone (nonmember) about a topic onlist if you suspect they may be involved! You can't go calling people in the area, to find out more just for prurient interest!

I would say that most people on such lists can be trusted to be confidential, kind, commonsense about this. But it only takes a couple of people to be careless (as I believe the apprentice was, don't believe she was intending harm but didn't think it through), or just gossipy (as seems certain about the out-of-region mw who contacted mw here to dish dirt. Again, just pointing out the need to be careful with our public postings--connections that get made you didn't intend/foresee, by your readers; sloppy or even malicious comm that can result-- and lead to problems none of us need.


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## KellyandKatie (Sep 19, 2004)

It is very much the same in the area that I work in, there are very few people that I can discuss how I am helping families and what role I am playing for who- professional networking is important, but even there when folks are supposed to all have confidentiality- you still have to watch what you say and how- its military, so the 'need to know' thing totally applies. I ask myself if it will help the families or help me to help the families if I share that info- and generally, I can see the line- is it just interesting and I want to talk about it becuase I really do enjoy my job, and really the stories I deal with are very interesting-- or is this something that will make a differance to the care my families get if everyone knows this, will it save someone else from having the same experiance, etc etc--
posting something like 'going to a birth' does not help anyone's families
I think that translates loosely to 'I LOVE MY JOB! I LOVE BIRTH! YEAH ME!' and yes that is all good and great- except that it is counter productive to me, it does not further make me love home birth, and love the birth professionals- it is too familiar and I do not know these strangers whose so personal information that I just read, and that makes me feel very uncomfortable

I do love birth, and I do think doulas and midwives are so so amazing and wonderful- and I have such a strong wonderful place in my heart for the birth profession- becuase birth is so so special - it is NOT like any other job, it is NOT like saying "had a busy day at the office today"

I liked some of the doula's ideas of having their own client web pages where they do celebrate births- that makes sence that is for the families and for the people who know that woman- facebook is not for the families- it is for the doulas and birthing community that is networked there - it feels like to me anyway

thank you again for discussing this with me and hearing me out


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## MidwifeErika (Jun 30, 2005)

Quote:


Originally Posted by *KellyandKatie* 
posting something like 'going to a birth' does not help anyone's families
I think that translates loosely to 'I LOVE MY JOB! I LOVE BIRTH! YEAH ME!'

You are correct. Of course, I believe that pretty much every aspect of Facebook is fairly narcissistic. It doesn't really help anyone in any way when I post that I took my kids swimming or that I am tired or whatever.... it is just me talking about me. Facebook is just a place of people talking about themselves and showing off photos of themselves looking awesome. So, when I post that I am heading out to a birth or a day of prenatals, it is just me talking about one more aspect of my life. I try to be very aware of privacy and I never post any details other than just that I am on my way out or that I love what I do. Although, I do think it helps to educate others about what a midwife is or that there are homebirths still happening (not to my birthy friends but my high school classmates, cousins, etc). The birth announcements I make are on my business fan page, which is public and more focused on that rather than on my life.

This is an interesting conversation, for sure! I never in a million years would have thought someone would feel uncomfortable about a status update of "on my way to a birth, I love my job!" so it is good to hear other perspectives!


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## mizznicole (Feb 13, 2007)

Unfortunately I know for a fact that two mw's in a certain area of FL do not respect privacy. I know because I shared information with one (in a completely different practice) that got back to the other, who talked about it in an appointment with me. I felt violated even though we did not talk in a strictly clinical setting (it was an initial interview). Ugh. That area of FL does not have many options.


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## KellyandKatie (Sep 19, 2004)

I am not saying that midwifes/doulas/birth professionals should not post 'hooray I love my job- birth is awesome' posts- but it can be done without sharing other's personal information
a lot of my doula/midwife friends do post stuff all the time that celebrates birth - but has nothing to do with 'going to catch a baby' - they post birth affrimations, they post 'hooray I love my job' without using someone eles info to reflect how they feel about their job- they share resources and educate - that rocks!

A lot of my birth professional friends do post WONDERFUL information and articles- that kind of stuff does educate and encourage that birth is alive and wonderful- one does not have to share 'headed out to a birth - I love my job' to convey that message

I get that everyone wants to be validated- I get that- but it is a profession- and a huge part of that profession is trust and security
you won't get that pat on the back- that validation- for saying that you just helped a mama in birth- but you can still share education and resources without sharing that personal tidbit of information - if the reason is to truly help encourage the birth profession, that can still be done too


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## CI Mama (Apr 8, 2010)

Just weighing as a mom who is "friends" with my doula on FB...

I had a long, difficult labor that ended in c-section. Probably not the kind of experience that would make anyone feel like she loves birth & loves her job. More of the kind of thing that might make her feel like "my job sure can be hard and is sure is a drag when things don't go right."

But if she had posted something of that nature on FB and I had seen it, I would have been devastated, even if no one but me could tell who she was talking about.

She did NOT do that! Thank goodness. I was so fragile after the birth...still am in many ways...and it would have been hard to see ANY commentary that I connected back to my birth in such a public place.

I'm just saying...if your clients can see you on FB and they connect the dots, it may not matter whether or not anyone else does.


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## _ktg_ (Jul 11, 2008)

One of the points I am walking away from this thread (which has been quite insightful!) is to develop standards or criteria if you are interacting on a social networking site. For instance - have a separate business page vs. conducting business and personal updates on 1 page.

I wonder if we will see this topic pop up more with the national conferences and how to maintain confidentiality.


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## April422 (Nov 28, 2007)

Quote:


Originally Posted by *KellyandKatie* 
posting something like 'going to a birth' does not help anyone's families
I think that translates loosely to 'I LOVE MY JOB! I LOVE BIRTH! YEAH ME!'

Actually when I post "Off to a birth" it's a notification to my grandmother that I won't be at her house the next day and if it's during the school year she knows she should plan to pick up my little one from school and that the older one will be driving herself over after school. It also alerts the doulas in my practice that I am unavailable by phone and to only call me in an emergency, otherwise text me and I'll answer when I can.

It depends on *how* the individual uses FB. For us it's a communication hub. But again that's my private FB account. On my client account I don't post about going to births, etc. If I need to notify one client that I"m at a birth of another client I will text or email them from my phone during the evening/night hours. If it's during the day I leave a voicemail or tell them directly while en-route so they know to call their backup for any concerns for the next 24-48 hours.


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## KellyandKatie (Sep 19, 2004)

'need to know' would apply, but when most have 200-300 people on their networks- its a far stretch that many 'need to know'

if I am working or busy, sure they need to know that- but I can say I am busy without saying I am busy becuase I am working with one of my families - I can say that I am not aviable without it being a reflection of others personal information
when something does happen that my job requires me to spring into action, I need to move fast and immediatly- and I need to let the ten people know that I am busy, I can do that professionally by not telling a few hundred people, I can let those who need to know know what they need to know

when you need to not get calls- you put your phone on vibrate
when you need one person to honestly pick your kids up from school, I have to question if anyone would really just rely on ' gramma saw facebook, I am sure she will be there to get the kids' and not call- that is kind of a stretch I have to say

for me it goes back to intimate personal information being used casually- FB is very casual, there is not a lot that is professional about FB or myspace or twitter etc

if a doula has lets say 5 clients that are due that week- how is it even hard to figure out who is in labor- and again, if they have no idea who those five clients are- why are they in the need to know of complete strangers personal information

I know confidentiality is defined differantly for differant professions- but wow- when I say I have confidentiality- it does not mean I just dont tell my family members that I work with - it means I do not tell anyone who is not in the confidentiality circle- heck, I can not even tell my husband stuff- this is what I mean about the birth community condoning it- it is okay as long as the families don't find out?
that makes me think twice about what I can trust to this level of professionalism


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## Jane (May 15, 2002)

I sometimes see stuff that makes me pause - I HOPE the midwife/doula has permission! Many of my local collegues are posting birth times & pics on their business facebook page with explicit, signed permission. The latter doesn't bother me, b/c it's with permission.
My facebook is more about me, than my clients or my job. I do post up interesting articles about parenting or birth, but I also post videos from YouTube that have baby lambs jumping on them. Or vacation pictures.


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## April422 (Nov 28, 2007)

Quote:


Originally Posted by *KellyandKatie* 
'need to know' would apply, but when most have 200-300 people on their networks- its a far stretch that many 'need to know'

if I am working or busy, sure they need to know that- but I can say I am busy without saying I am busy becuase I am working with one of my families - I can say that I am not aviable without it being a reflection of others personal information
when something does happen that my job requires me to spring into action, I need to move fast and immediatly- and I need to let the ten people know that I am busy, I can do that professionally by not telling a few hundred people, I can let those who need to know know what they need to know

when you need to not get calls- you put your phone on vibrate
when you need one person to honestly pick your kids up from school, I have to question if anyone would really just rely on ' gramma saw facebook, I am sure she will be there to get the kids' and not call- that is kind of a stretch I have to say

for me it goes back to intimate personal information being used casually- FB is very casual, there is not a lot that is professional about FB or myspace or twitter etc

if a doula has lets say 5 clients that are due that week- how is it even hard to figure out who is in labor- and again, if they have no idea who those five clients are- why are they in the need to know of complete strangers personal information

I know confidentiality is defined differantly for differant professions- but wow- when I say I have confidentiality- it does not mean I just dont tell my family members that I work with - it means I do not tell anyone who is not in the confidentiality circle- heck, I can not even tell my husband stuff- this is what I mean about the birth community condoning it- it is okay as long as the families don't find out?
that makes me think twice about what I can trust to this level of professionalism


While I have over 300 FB friends, there is this nifty privacy control that allows you to post updates to everyone, or just to certain groups that you've established. So anyone with any net savy can control WHO they post status updates to if they so desire.

Does your job take you from home to various otherwise undisclosed locations for an indeterminate amount of time? Mine does. Sometimes into the ghetto and other times into the upper class burbs. I never know when I'll be able to walk back into my life. FB is just one way to coordinate everyone who should be in the know, especially since you can't schedule my work in google calendar and have it sent out to everyone who needs to know. Grandma checks her facebook every morning. If I head to a birth during the night, I know that she'll see my post first thing. If I call her, she'll wake and not be able to go back to sleep, so it makes sense to let her know in the least disruptive way. If I head to a birth during the day, I just pick up the phone, no worry about waking her.

Doulas should never walk out their doors without **someone* knowing where they are going. Laboring at home with clients is generally safe but any law enforcement officer will tell you to let **someone** know where you are going. For me, that's my backup. If I vanish, she's obligated to tell my family where I was going, morally.

It's all well and nice to just "say" let the phone go to vibrate but when you are carrying more than 1 client a month you never know when someone due weeks or months down the road might need you. Since I don't have clients on my personal FB I don't notify the next 9 clients that are on my books that I'm at a birth. But even though I'm at a birth I'm still responsible to them. So I much prefer to minimize the calls I get by letting those who call me on my cell the most (family and the doulas in my practice) that I'm gone.

If I have 5 clients due in a week only my backup needs to know which birth I"m at, so she'll know to be on call for the other 4. However, when you run a doula practice you need to be available to ALL your doulas and due to the nature of our work we are expected to be generally readily available and it's a pretty common assumption that if you give us a call a timely reply should be in order, that's just how we operate. I like to let those that I'm responsible for and to know that I'm out of the operational loop. They don't need to know with who but if they have an urgent question or need it's nice to know to call another person instead of waiting and waiting for me. FB update allows that to happen, instantly.

Saying "off to a birth" is no different than a DR, Psych, social worker, hit man saying "off to work." It discloses nothing except for the fact that the individual is AT work. "Off to the birth of ..." or "off to the birth of a client due . . ." or even "off to a birth at . . ." would be way too much identifying info for me. But I can not, no matter how I look at it, see how saying "off to a birth" is a violation of my client's (many many of them at one time) privacy.

When my good friend who is a L&D nurse posts "off to work the night shift, full moon= lots of babies" is she violating the privacy of every patient she works with that night?
When my husband posts "back to the grind" is he violating the trust and privacy of the client that owns every car he works on that day?

Heck most people list at least their general occupation on their FB profile. They may not give specifics but you can almost always distinguish what their occupation is in general. Dr, RN, mechanic, librarian, truck driver, Midwife, Pastor, the list goes on and on.

Oy!! That feels all disjointed, but there it is.


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## KellyandKatie (Sep 19, 2004)

thanks for bouncing this around with me
its unsettling, but good to know that is just how it sits
I appreciate you guys listening to me and bouncing this around- thank you thank you


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## MsBlack (Apr 10, 2007)

Yes, lots of good points raised on all 'sides' of this issue!


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## Romana (Mar 3, 2006)

I think that a midwife or doula can also undermine or invalidate a mother's feelings about her birth by doing this. I understand that for my doula, my birth may be awesome. But for me, it may have been awful and traumatic. In the latter case, the last thing I want to see, the last thing I need as a newly-postpartum mother, is a FB update about my "beautiful birth." In fact, one of the most hurtful things the MW asst at my last birth said to me, after I expressed disappointment and distress with the birth, was: "But you had a beautiful home waterbirth!" Sorry, but there was nothing "beautiful" about it to me and saying so was a rejection of my experience, which had only ended about 2 hours prior.

I really feel this is one of those situations where the actual legalities are less important than the other impacts of this kind of information-sharing, and as such, women should have the opportunity to refuse consent for that kind of sharing. Anytime confidentiality issues are being skirted, it shouldn't be about "how much can I legally share" but rather "what is the very good and rational justification for sharing this information." Even if that information could be shared legally, due to the fact that we're even talking about confidentiality, there should be some necessary, important and rational justification for any sharing.

I also agree with the OP that in fields where trust is paramount, it's not just the legal minimum for sharing information that's the bar, but a much higher bar that allows clients/families/patients to feel comfortable, safe and respected.


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## KellyandKatie (Sep 19, 2004)

Romana said:


> I think that a midwife or doula can also undermine or invalidate a mother's feelings about her birth by doing this. I understand that for my doula, my birth may be awesome. But for me, it may have been awful and traumatic. In the latter case, the last thing I want to see, the last thing I need as a newly-postpartum mother, is a FB update about my "beautiful birth." In fact, one of the most hurtful things the MW asst at my last birth said to me, after I expressed disappointment and distress with the birth, was: "But you had a beautiful home waterbirth!" Sorry, but there was nothing "beautiful" about it to me and saying so was a rejection of my experience, which had only ended about 2 hours prior.
> 
> I really feel this is one of those situations where the actual legalities are less important than the other impacts of this kind of information-sharing, and as such, women should have the opportunity to refuse consent for that kind of sharing. Anytime confidentiality issues are being skirted, it shouldn't be about "how much can I legally share" but rather "what is the very good and rational justification for sharing this information." Even if that information could be shared legally, due to the fact that we're even talking about confidentiality, there should be some necessary, important and rational justification for any sharing.
> 
> ...


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## April422 (Nov 28, 2007)

Quote:


Originally Posted by *KellyandKatie* 

I am surprised how much room for interpretation there is about what confidentiality - or security means- 'as long as the family does not see it and it is just my personal friends and family and network' kind of idea is not confidentiality at all in my mind- it is not even being sensitive even if the code of confidentiality is not being broken
do different certifications have different standards of professionalism? Like DONA or CAPPA - is it written differently?

Is it in that code that all doulas are in that ring or circle of confidentiality- so all clients can just expect that every doula is going to share whatever with their birth network? I know with my birth professionals they told me who their back ups were- they told me who all might be involved as additional support or in the event that they could not make it- I assumed that these were the only other birth professionals that would be hearing about me and my pregnancy and birth

to say that 'going to a birth' is the same as 'going to work' just does not seem accurate. The professionals that I know put in an amazing amount of hours - for every one hour of actually helping at a birth compared to how many hours of support, education, resource, training etc etc hours - it seems to me that the birth is obviously the coolest part of what they do with any one client, but they do seem to put in so many hours upon hours during that time with each client prior to the actual main event


The three points above I wanted to address.

Point 1:
I wouldn't have a problem posting what limited info I post on my personal FB to my Business FB, "Off to a birth." , "A new baby has arrived earth-side" etc.

Point 2:
When a client hires me, or one of the doulas in the practice they sign a confidentiality release form. This form allows the doula to have full disclosure with her her backup, and allows us to discuss births at our staff meetings without any identifying information. We model our discussion about births around the "Obstetrical Grand Rounds" that our local hospital holds for the OBs and Midwives to discuss births for learning opportunities. We hold to the same confidentiality standards they do when discussing births. That's an accepted and commonly used set of standards, all across the US.

Point 3:
I spend on average 9 hours with my clients prenatally face to face in prenatals. I spend an average of 12 hours per birth with clients. Some being shorter others longer. There are days when I post "Full day of prenatal visits tomorrow, can't wait!" or something to that effect, but it's not often.

I've spent a great amount of time in the past day thinking about this whole topic. I still can't convince myself that saying "Off to a birth, baby born, etc" is a violation of conf. or trust.

However, the deeper question I've been mulling over is, why do I feel inclined to share that I'm going to a birth, specifically instead of "going to work" as a generality.

What I've settled on is "off to work" doesn't convey the power, sanctity, miraculous-ness of what it is I do and bear witness to while I'm at work. This isn't a "job" for me. It's so much more than that. To call it "work" devalues it for me.

I don't "go to work" every day. My "work" isn't something I dread doing."

"Off to a birth" or "A sweet baby just arrived earthside" conveys just a tiny tip of the iceburg of the amazing events that I'm about to participate in the unfolding of. The power, the softness, the flow, the trust, the vulnerability, the empowerment and the victory and miracle that is birth.

I've been a doula for over a decade, and I still have passion, wonder, amazement, stand in awe as life is given wings with which to go forth and fly with. How many people truly feel that kind of passion and awe at their "jobs"? OBs, Midwives, labor nurses, most start out that way, but how many maintain that feeling about their "work"?

So, for me, to say "off to work" isn't to honor the event I'm about to participate in, or have participated in. It's not about "coolness" it's about acknowledging the sacred, the miracle, the power of what it is I am allowed to participate in when I go to a birth. It's so much MORE than a "job" or "work". When it becomes a "job" or I feel like it's just another day at "work" it's long past the time for me to find another path.


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## shruley (Aug 26, 2006)

I am friends with several doctors on Facebook, including my old OB/GYN who has now moved but we still keep in touch. She posts medical updates all the time...that's how I know she had 2 twin NSVDs in the last 2 days! She also posts when she's waiting for a VBAC and other things, such as just did a (insert some kind of gyn. surgery) on someone with BMI of 34 (or whatever a really high # is.) Lots of my Intensivist friends routinely comment when they're having a bad night, a slow night, or any particularly exciting updates -"just had 2 codes in the last hour" kind of thing. I'm not saying this is or isn't ok, but I think it's unfair to single out midwives as the only professionals that do this!!


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## Carita (Mar 3, 2008)

Its not just FB, but I think this applies to everywhere and more than birth professionals. I had a childbirth class w/another couple and the doula and the doula asked me if she could tell them about the birth. And she would always follow HIPPA - if she told me something medical, it was w/out names. my MW did the same since she taught my yoga class & asked if she could pass it along.

in my own profession I am bound be the same sort of confidentiality w/my students. i do FB and talk about my teaching or what a student said, but don't use identifying info when i do so...


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## sondancer (Jul 2, 2010)

Your comfort level and what is legal and appropriate are VERY different things. First of all, saying "I'm going to another birth" is not illegal or inappropriate. It's basically like saying "I'm going to work" because that is what doulas and midwives do!
I agree that names shouldn't be mentioned but if you are on doula forums and midwive forums stalking them for the info they relate to other birth professionals, than I think that is a larger issue. I am a doula and I am on those forums. Doulas and Midwives NEVER share identifying information about clients but they share birth successes and sometimes processes difficult births with other doulas and midwives and there is NOTHING wrong with that. Social workers share information with other workers (nonidentifying info) about difficult cases to get feedback or new strategies and doctors do the same with colleagues, informally, and also at formal events like conferences and paper presentations.

If you are upset that people mention they are on their way to a birth, that is really your issue not the issue of the person who posted it. Also, I respect that you are pregnant and obviously a very private person. If you want your doula NOT to mention anything related to your birth, simply tell her ahead of time and be specific! Don't say, don't facebook about my birth because if she tweets or facebooks "I'm going to another birth" NO ONE is going to know she means you except you, so let her know you don't want her to even say that, otherwise you are setting yourself up for a reason to be angry with her and a tense situation.


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## MsBlack (Apr 10, 2007)

Quote:


Originally Posted by *sondancer* 
Doulas and Midwives NEVER share identifying information about clients but they share birth successes and sometimes processes difficult births with other doulas and midwives and there is NOTHING wrong with that.

There is nothing wrong with that IF the providers don't do this on fb or other, more public forums. Really, nothing online is entirely private--but at least on a professional forum with restricted membership and confidentiality agreements, you have a better chance of affording clients privacy.

Except now I remember another privacy violation that occurred for me: it was on a prof. forum, and the issue was that a member in all innocence copy-pasted remarks made by some of us, to her personal blog. She did not ask permission to do so, nor did she remove identifiers from our posts. It was 'innocent' in that she meant no harm, hadn't thought about the privacy ramifications (it was political commentary--so not identifying clients, but posed a risk for the mws practicing under-the-radar). I woud not have minded if she had at least removed names and places in order to conceal identities. So, even the presumably 'restricted and confidential' forums are open to 'leaks'....it is SO easy to copy/paste!

And see, I've found that when you are discussing a difficult birth--and for meaningful feedback, that will have to include details of the birth (even if you never mentions names/places). JUST those birth details can 'identify' a client to others.

I do think it's a good thing for clients to avoid taking things too personally--worrying too much about general comments like 'off to a birth'. But I also think that practitioners need to be VERY wary of what they say, and where they say it, and how they say it, on public forums--even supposedly 'restricted/confidential professional' forums.


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## Schae (Oct 6, 2006)

what an interesting thread. many pertinent points raised on both 'sides'.

I think in general people are 'okay' with generic comments such as 'off to a birth' or 'off to do my 20th major brain surgery' - it's a big deal in their lives and they want to share it. I don't see it as a violation of trust. But obviously there are people who are more private than the majority - and those people need to be catered for as well. Not sure who to bridge the gap there.

I have no problem with my MW posting on her fb that she's off to a birth. When I go to my prenatal appt with her and she looks exhausted and tells me that she had 4 births in 3 days - that isn't a violation of privacy, it's her sharing why she's tired.

Different strokes for different folks I guess.


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## sweet.p (Jul 31, 2009)

Without clear consent from a client the doula should not post publicly about a clients labor and delivery.
It's not appropriate and it's an invasion of the clients privacy.
It reflects poorly on all doulas as unprofessional.

FB, blogs and tweeting without client permission has become a big issue for doulas!

There was a doula on one of my professional lists whose client was furious the doula did updates on FB about the birth. The family reported her to DONA when the client read the doulas FB page and recognized the dates and circumstances as her labor and saw the doula was putting updates about the client while the doula was at the birth taking breaks.


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## sweet.p (Jul 31, 2009)

Quote:


Originally Posted by *MsBlack* 
This is something that really bugs me, too. I don't even 'do' facebook, for various reasons but in part because of just the issues mentioned here: potential HIPPA violations as well as privacy concerns that are far greater for some clients than for others--and we don't always know for sure as well as we may think we do about that.

As a birth professional, over the years I've had some struggles w/confidentiality in just the ways the OP mentioned--saying what seem to be very general or oblique things about a client, meaning to conceal identities, only to find that the person I'm speaking to knows who I mean. It is a very small world! Even if you don't live in a small town, it's a small world. Remember that homebirthers/mws and even doulas/clients are a small population, often somewhat isolated because of that--we tend to connect with each other from all over. I know that I have stepped on or over the line a few times, quite unintentionally--fortunately with no ill results that I know of--and it made me really really wary of confidentiality.
.

I completely agree with you.
Doulas need to think of FB, blogs and Twitter exactly like their clients neighborhood supermarket or kids soccer games .
It becomes gossip about your clients births when you talk or post about them!
Exactly as if you are telling your clients neighbors about the labor /delivery / breastfeeding.

Doulas Writing on their blog or FB that you attended a "difficult birth" is insulting to clients, since they likely viewed thier birth as a magical moment in there life, including it ending in an unnecessary cesarean after 24 hours of interventions!!!!
This is not your birth!


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