Monday, September 19, 2011

Doulas & social media use - what are your rules?

My apologies for the looong blog silence. Note to self: just because you CAN go on a week-long trip and take no time off of work, by working 6 out of 7 nights when you get back...well, that doesn't mean you SHOULD. Especially when those 6 nights are very very busy! But I am (mostly) recovered and ready to get back to writing.

A topic that's been rolling around in my head since my trip was the question of doulas & social media. This has been brought up recently with doulas I know locally to me. I also had a conversation with a doula friend who I visited with while traveling. Apparently it's been a subject of debate/discussion in the doula community in her area as well.

I have always felt very scrupulous about HIPAA and protecting patient privacy. My first experience in clinical care was interning at a reproductive health clinic. We specifically asked clients if we could call them at home; if we could say we were calling from the clinic; and if we could leave them messages; and if we could say the messages were from the clinic. Some of our clients were getting care without the knowledge of their families and/or partners, and preserving their privacy was important to their safety. That experience made me cautious from the beginning about anything that could identify people I worked with in a healthcare capacity. I will only talk about stories of births, or breastfeeding situations, with the details changed, de-identified, without any way for someone to trace the story back to the person.

But our conversation made me think twice about posting even the very general statuses that I have posted about attending births on Facebook (like referencing that I've been busy because I just attended several births, without any specifics about who/where/exactly when). No matter if you live in a very populous area or a big city - communities are still small! I worked with a family recently thinking that we didn't know anyone in common on places like Facebook or blogs. Just before the birth, it turned out that couple were friends with an acquaintance (and social media "friend") of mine. It was a neat connection to discover, but I could have written (although I never did) even general things about them or their birth assuming we had no friends in common, and been very wrong.

My doula friend also pointed out several things I hadn't thought of that could become an issue, including the idea that even when clients are OK with us writing about their births, we have to think about the messages we are sending. She talked about a doula who had worked with a client and posted something lovely and positive on FB like "Beautiful vaginal birth! So honored to be there." This client's friend hired the same doula, and after her (long and difficult) birth she was expecting the doula to post something similarly celebratory about her birth...and the doula never did.

Now we know that the doula may have run straight to another 40-hour labor, or been trying to catch up on the rest of her life, or just not thought to post this time... she probably had no idea this mother was looking for that kind of affirmation (having already seen her friend get it.) But it made the mother wonder whether her friend had a "better" or more "beautiful" (perhaps more "vaginal"?) birth that was deserving of an update.

Another issue is that while one client may have no issues with it, and even be excited to be part of a doula's post, another client may not. Seeing a doula post about attending births and sharing details may turn potential clients off, because they don't want to be part of the news feed.

When this comes up I have heard other doulas defend their use of social media. They feel that their use is appropriate, and/or that they get permission from their clients for all posts, and/or that they work in large enough areas that their social network circles don't overlap. Many doulas use social media as one of their marketing tools. I was actually surprised to hear about the number of doulas who post far more personal detail on Facebook than I would ever dream of doing.

What are your thoughts on this issue? What are your personal rules for social media posts about doula clients?


Elita said...

I'm not a doula or a midwife but this has been on my mind a lot lately. You want to talk about small communities, I live in a big city and looked my midwife up on Facebook. We have FORTY EIGHT friends in common, including some of my "professional blogging" friends, as well as local birth/breastfeeding advocates and other random folks. I've never talked to her about my blog and I have no clue if she knows I have one, but if she does, she's never mentioned it. Thankfully, my midwife's page is private so if she decides to post something about my birth I won't see it and I am sure she won't mention me by name, even if she does. She has lots of photos of her babies on her Facebook fan page, but I am 100% assuming she has permission to post those from the families and I love to see those pictures. However, I have seen some FB pages of local doulas and midwives who don't have their walls locked down (maybe they don't realize this, Facebook privacy is a tough thing to stay on top of)and I've seen things posted that if it were *my birth* would make me mad. Not necessarily negative, but too much information. I've even seen cryptic statuses making fun of the name a family has chosen-- NOT COOL.

I think if you want to have a social media presence, then you need to keep your clients totally separate from your friends. Do not friend them on FB, ask them to "like" your professional page. Keep your personal page private so if you just have to vent about a birth you can do so without hurting anyone's feelings. Then ask permission before posting anything on your professional page.

Rebecca said...

@Elita: Interesting point you're making about not staying on top of FB privacy. A lot of doulas and midwives may have enough tech-savvy to write statuses but not have a clue how to monitor who can see them. Maybe that's just a need for more education in these communities.

But a status making fun of a name? NOT COOL EVER. That definitely falls under the kind of thing that would turn me off working with that person, because I would wonder "What are they going to make fun of me about?" It's OK to joke or let off steam with friends offline, but to put it out there for everyone to see it, is very very different.

Kristen said...

When I do update about a birth, it's mostly limited to which "number" doula baby I've welcomed. (#20 is coming up!) If I add anything else (for instance, I mentioned something about the song playlist a mom used during a birth this summer), I always ask the mom's permission first. And if we are social media "friends" too--and ESPECIALLY if we have mutual friends--I won't update anything until she does. It's not my place to announce her birth to others--even if I don't mention where the birth occurred or what it was like in my post, her mutual friends will know that her baby was due!

On the other hand, sometimes I'll use Twitter to ask other doulas for advice. I try to make the questions as generic and theoretical as possible so as to avoid any identifying information, of course, but I do find the #doulaparty conversations to be helpful sometimes.

Rebecca said...

@Kristen: I like your idea of updating with #s! (It would sure help me keep track of which # I'm on...) And I think it's an important rule to wait to update until you know the mother has done the announcements herself.

Do you use Twitter on the fly, like while you're at a birth and need suggestions?

Emily said...

I have a professional doula facebook page, and I hope that's where my clients and potential clients find me, and not anywhere else. But I still don't post anything too detailed or personal, even about timing of a birth, because it could give too much away or offend someone who didn't want to be mentioned. And I stopped announcing births or how I felt about them, because if I have a really difficult birth I won't have anything to say, and I wouldn't want anyone to speculate (as you mentioned in your post above)!

I also use twitter to solicit anonymous advice about clients or births I'm at, again with my blog persona, not my personal one. I keep my fingers crossed that the two don't overlap, except among my friends who know me in person. But I did have a client find my mention of her birth on my blog in the past and e-mail me about it, which was mortifying. So since then I've been super careful to say nothing or say very little and wait until an appropriate amount of time has passed!

Rebecca said...

@Emily: It is hard with blogging...there are so many stories we want to tell that really illustrate points we are trying to get across, and you are most likely to want to write it when it is fresh in your mind. But you have to be so careful about those worlds overlapping and as you pointed out, people can find out more than you realize. I not only change details and identifying information, I also will write the post when it's fresh, but then try to save it for a while until no one can identify the timing. Sometimes it ends up being more a composite of different situations and that's OK with me.

Susan said...

So far, I'm friends with all of my former clients on FB (many of them friended me first, but I also took the first step with a couple of them, figuring that if they were uncomfortable with the idea, they could reject the request). Partly it's because I'd like to see pictures of the babies/the parents want me to be able to see pictures of the babies; partly it's because I've only attended 5 births and they feel special because they were pre-certification births (getting the paperwork finished now!). I did think pretty long and hard about doing this, though, especially since the ball - and idea - was first put in my court by my second client who sent me a friend invite. I had to think about it for a little while before I accepted it. I guess my current hard rule, until I'm established in a particular area and getting regular doula work (at which time I'll have a website/professional FB page where clients can interact with me), is to not friend clients until after the birth (and preferably not until after the postpartum visit). That just feels more professional to me - we can become friends AFTER I've served you in my professional capacity, but never during.

Also, my FB is super locked down. I'm a paranoid little thing with social media. There have been enough problems with people getting fired from jobs for posting things that they probably shouldn't have; I don't care to count myself among them, or to jeopardize my reputation and dignity in any way.

Rebecca said...

@Susan: I am friends with one former client, which started after the birth, but I don't think with any others. I guess the advantage with the "new" FB (isn't there always a new FB) is that with their groups you could theoretically put your clients into a certain group so that they would only see certain posts, or parts of your profile. Like you said, some things just shouldn't be a part of a professional relationship and sometimes the silly photos from your beach trip (or whatever) might not feel quite right. That would help with the "locked down" aspect of things.