Why are hospitals asking doulas to sign agreements that silence them?
Over the past few years, a troubling trend has emerged in some hospitals across Australia and beyond – the requirement for doulas to sign “agreements” that restrict what they can say or do while supporting their clients during birth.
On the surface, these agreements may seem harmless or even reasonable. Hospitals frame them as ensuring patient safety, limiting the possibility of doulas giving medical advice or interfering with clinical care. But when you look closer, they raise some deeply concerning questions about the erosion of a woman’s right to informed support, and the role doulas play in modern maternity care.
Let’s break it down.
What’s actually in these agreements?
These hospital-doula contracts often include clauses that state the doula:
- Must not offer any suggestions that contradict hospital staff or policy
- May not question medical recommendations or procedures
- Can be removed from the birth space if deemed to “interfere” with patient care
- Is there only at the discretion of the medical team
On paper, that might sound like it’s protecting the woman from unqualified medical advice. In reality, it’s often used to intimidate and silence doulas – and by extension, women themselves.
So what’s the real issue here?
The fundamental problem is not doulas “overstepping.” It’s a lack of trust.
If a woman trusts her doula more than her provider, that’s not a doula issue – that’s a red flag on the provider.
Instead of building trust over the course of pregnancy, too many providers rely on fear-based tactics, dismissing concerns, pushing interventions with limited evidence, and hiding behind phrases like “birth is unpredictable” or “a healthy baby is all that matters.” This approach shuts down dialogue, disrespects autonomy, and fosters mistrust.
Let’s be honest: doulas aren’t there to replace midwives or doctors. They’re not there to give medical advice. They’re there to support women emotionally, physically, and informationally – and sometimes, that means helping a woman understand her rights, ask better questions, or request a second opinion.
That’s not interference.
That’s advocacy.
Who holds the real power – and accountability?
Here’s the uncomfortable truth: no one is asking doctors to sign a document saying they’ll provide accurate information about birth options, respect bodily autonomy, or refrain from coercion.
Where are the hospital policies that penalise:
- An obstetrician who pressures a woman into a repeat caesarean without medical indication.
- A midwife who tells a woman she “can’t” decline an induction or a vaginal exam because it’s hospital policy?
- A provider who gives false statistics or omits important risks from a conversation about VBAC?
When a doula is punished for “creating barriers to care,” but no one holds the clinician accountable for misleading or coercive practices, we have to ask: whose interests are really being protected?
Let’s be fair – accountability must go both ways
Like any profession, birth work is not immune to individuals who step outside their boundaries. Yes, there are stories of support people who allegedly remove medical equipment, turn off machines, lock women in the bathroom or tell women exactly what to say or do or even speak for the woman. But could this be more urban legend or third-hand hearsay than reality – possibly shaped by a handful of misguided midwives or care providers who, for whatever reason, feel uncomfortable or threatened by the role of a doula? The doulas I know – and the doulas I’ve trained – would never do anything that could compromise the wellbeing of the women they’re there to support, and who have entrusted them both professionally and financially to do just that. But a doula would absolutely be right to suggest that a woman ask more questions, or gently prompt with, “Does that feel right for you?” or “Do you feel like you have enough information to make that decision?” That’s not interfering – that’s encouraging informed decision-making. Supporting a woman to pause, reflect, and make choices that align with her values is the very essence of respectful birth support. It’s not about telling her what to do – it’s about helping her feel safe, heard, and in control of her own experience.
But hypothetically, if we did have someone doing all those negative things that have caused care providers to form a negative opinion of doulas, I’d argue they’re not a doula at all. They’re more like a rogue birth saviour– charging into the birth space on a mission, but forgetting that the real role is to support, not to rescue or micro-manage care providers. True doulas understand their role: they provide calm, continuous, and informed support – not chaos. Just as one “rogue birth saviour” shouldn’t tarnish the entire profession, neither should a rogue or coercive obstetrician be considered as a reflection of all care providers. There are many clinicians doing the hard work of building trust, offering respectful care, and supporting genuine informed choice – but what happens when others don’t? Where is the system of accountability for those in positions of power who repeatedly dismiss, pressure, or mislead women in the birth space?
Red flag alert: when an obstetrician won’t work with doulas
Women need to be aware: if an obstetrician refuses to work with doulas or makes sweeping statements like “I don’t allow doulas in my births,” that is a major red flag. This kind of attitude often signals a deeper issue around control and a lack of respect for a woman’s right to choose who supports her. A confident, evidence-based provider should not feel threatened by a doula. In fact, they should welcome the extra layer of support that benefits not only the woman, but the birth environment overall. If your care provider is unwilling to collaborate with the people you have chosen to support you, it’s worth questioning how they view your autonomy and role in decision-making during birth.
The fear of informed birthing women
Make no mistake – these agreements are not about safety. They are about control.
Because when women are supported to understand their rights, question outdated protocols, or say “no” to something that doesn’t feel right – the system loses its power to dictate and manage birth on its terms.
Doulas guide women with knowledge, connection, and confidence so they feel more empowered. That’s threatening to a medical model that still, in many places, treats birth as something to manage, not honour, and the woman is expected to be a passive bystander, not an active participant.
So instead of working collaboratively with doulas – who often fill the emotional and informational gaps in maternity care – hospitals would rather silence them.
Prepare with purpose, not to battle
To the women reading this: please don’t walk into your birth space expecting a fight. That mindset puts you on the back foot before labour has even begun. Instead, focus on preparation. Attend independent childbirth education classes – not just the hospital ones. Learn about your rights, the physiology of birth, and what questions to ask in your appointments. Surround yourself with a trusted support team who align with your values. Practise saying phrases like, “Can you explain the benefits and risks of that?” and “No, I don’t consent to that.”
This isn’t about being difficult, it’s about being informed. You have a voice, and it matters. Birth should be a collaborative experience where your preferences are acknowledged and respected, not something that simply happens to you. When you enter the birth space grounded in knowledge, confidence, and clarity, you’re more likely to be heard, respected, and supported, and less likely to be blindsided by fear-based pressure or policy-driven decisions.
Where do we go from here?
It’s time for providers to do the hard work of rebuilding trust.
That starts with listening to women, respecting their choices, and engaging in genuine, informed consent – not tick-the-box consent or fear-driven compliance.
It also means welcoming doulas as part of the support team, not as adversaries.
The solution to medical mistrust is not removing the doula.
It’s providing respectful, transparent, evidence-based care.
Until then, doulas will continue to walk beside women, agreements or not, because we understand the value of being seen, heard, and supported – and we will not quietly step aside while that is taken away.
Other related posts:
All that matters is a healthy baby! | Back to Basics Birthing
Choosing a care provider for your birth can be a daunting task | Back to Basics Birthing
Your Birth Plan Is More Powerful Than You Know | Back to Basics Birthing
Doulas: She is the author while you’re just helping her hold the book – Doula Training Academy
Student midwife versus doula – how to choose? – Doula Training Academy
What is the difference between doulas and midwives? – Doula Training Academy