confidentiality with doulas/midwives- vent/question

[KellyandKatie]

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"

[cileag]

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.

[MidwifeErika]

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.

[Riverbeauty]

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.

[KellyandKatie]

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

[Romana]

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.

[Happeesupermom]

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

[Romana]

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.

[KellyandKatie]

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?'

[_ktg_]

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

[beckyand3littlemonsters]

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

[KellyandKatie]

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

[sarahn4639]

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!

[Romana]

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.

[MidwifeErika]

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.

[dynamicdoula]

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.

[broodymama]

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.

[CherryBomb]

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.

[April422]

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.

[KellyandKatie]

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