confidentiality with doulas/midwives- vent/question - Page 2 - Mothering Forums

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#31 of 48 Old 06-22-2010, 04:25 PM
 
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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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#32 of 48 Old 06-22-2010, 04:49 PM
 
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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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#33 of 48 Old 06-22-2010, 07:58 PM
 
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Originally Posted by KellyandKatie View Post
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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#34 of 48 Old 06-22-2010, 09:08 PM - Thread Starter
 
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'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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#35 of 48 Old 06-22-2010, 09:23 PM
 
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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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#36 of 48 Old 06-22-2010, 10:36 PM
 
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'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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#37 of 48 Old 06-23-2010, 03:27 AM - Thread Starter
 
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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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#38 of 48 Old 06-23-2010, 07:58 AM
 
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Yes, lots of good points raised on all 'sides' of this issue!
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#39 of 48 Old 06-23-2010, 02:22 PM
 
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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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#40 of 48 Old 06-23-2010, 06:03 PM - Thread Starter
 
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[QUOTE=Romana;15550311]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.[/QUOTE

Well said! So well said!

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?

I am not a doula, but I do have a code of ethics - and confidentiality is something I thought I understood- I can understand that it would be diffreant with differant jobs- but it is still people's private lives with trust on the line

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

Im a Navy Family Ombudsman. I support the families of the sailors in my command. When my phone rings I don't know if it is going to be a family member bragging that their kid got a scholarship or if it is going to be the police because someone is in jail or worse- it is always interesting- it is people's private and personal lives that they trust me with- my code of ethics is written so clearly there is little wiggle room- but it would be technically legal for me to be a gossip and post junk about what I am doing without naming names. I would be sure my command would relieve me if that is how I defined my professionalism- not because I broke a rule- but because the families need to trust me and if I am not being professional and earning that trust - I can not be effective at my job

I am not trying to compare the two jobs directly- just saying trust is at the center of caring for other people in intimate situations

From what I am understanding though, it does not seem like it is the doulas or midwives that are out of the line- it seems like maybe there is not a line?

I feel like I am beating a dead horse here- but I am finding this very helpful and getting some good perspective
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#41 of 48 Old 06-24-2010, 08:11 PM
 
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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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#42 of 48 Old 06-30-2010, 03:06 PM
 
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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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#43 of 48 Old 06-30-2010, 09:05 PM
 
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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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#44 of 48 Old 07-02-2010, 03:16 AM
 
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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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#45 of 48 Old 07-02-2010, 10:00 AM
 
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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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#46 of 48 Old 07-16-2010, 07:36 PM
 
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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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#47 of 48 Old 07-17-2010, 08:08 AM
 
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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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#48 of 48 Old 07-17-2010, 08:30 AM
 
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Originally Posted by MsBlack View Post
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.
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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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