Navigating difficult client conversations

Learn how to with clarity, boundaries, and nervous system regulation

By Philippa Scott - Full-Spectrum Doula for 22+ years

When I started birth work over 22 years ago, I carried a belief that nearly destroyed me: I thought if I was present enough, skilled enough, and calm enough, I could protect women from what went wrong in the system.

I was absolutely exhausted by that belief.

What happens when you're carrying that weight is you arrive at birth thinking you're responsible for the outcome. You sit in medical rooms convinced that if you say the right thing the right way, you can change the trajectory. And when you can't, when the system moves anyway, or the body decides something different, or the family chooses a path you wouldn't choose, you carry that as failure.

Two decades in, I understand that my role is different. And in our recent Doula Network Australia webinar, I shared the shift that changed everything about how I practice sustainable, grounded doula care.

Patterns that lead to burnout

On the flip side, here's what I've watched destroy doulas' careers, and not because they're doing it wrong, but because they're trying to do something impossible:

Over-functioning: You arrive at a consult already two steps ahead. The client mentions her fear of intervention, and you're already thinking about how to prevent it, how to coach her, what to say to the doctor. You become the architect of her birth instead of the witness. That is exhausting, and it doesn't work.

Competing with other doulas: Instagram has created a tier system where doulas try to differentiate themselves by baking sourdough for clients or creating elaborate birth altars. If that's genuinely your model, beautiful! But if you're doing it because you're afraid your presence isn't enough, you've already lost. You will never out-cook the Instagram doula.

Avoiding hard conversations: This is where most conflict starts. Not in the birth room, in the lounge room. When something feels off but you smooth it over. When the first text comes in at 11pm and you respond because you're afraid of seeming unavailable. Each time you let a small boundary slide, you're building a case against yourself.

Sound familiar? Here's what actually works instead.

The three pillars of sustainable doula work

1. Clarity = compassion

The doulas who last aren't the ones who give the most. They're the ones who are relentlessly clear from the beginning about what their role is, what it isn't, what they will do and won't do, what money changes hands and when, and what happens if things go sideways.

Being this clear feels selfish when you're starting out. It feels rigid, cold, or uncompassionate. But actually, it's the opposite. 

Clear boundaries make it possible to give better care.

When your agreement is vague, the emotional labour becomes infinite. The client fills the gap with their own anxiety, they text more, they need more, they feel like you're not doing enough because you never actually said what "enough" looks like. They're not being demanding. They're just anxious, and they don't know the edges.

But when you say from the start, "Here's what's included, here's what isn't, and here's how we do this together," you're not closing the door. You're actually opening a door that can stay open for the long haul because nobody's quietly building resentment underneath it.

2. You influence experience, you don't control outcome

This is the one that will change your career if you actually internalise it.

I've seen beautiful births with 12 interventions, and traumatic births with none. I've watched women rewrite their birth stories six months later in ways that had nothing to do with what actually happened. And I've seen doulas carry shame and guilt for outcomes they had zero power over, and burn themselves out in the process.

Your job is not to deliver a specific birth story. Your job is to be present in whatever birth is actually unfolding, and to center the woman's autonomy, to offer information, to be steady.

Some births will be exactly how everyone hoped. Some won't. And that doesn't mean you failed.

3. Your regulated nervous system is your primary tool

Not the rebozo. Not your breathing scripts. Not the research you've memorised about cascading interventions. It's your nervous system.

When a woman is in labour and something shifts unexpectedly, maybe the heart rate dips, the progress slows, or that doctor she only met once walks in the room, what she needs is someone who is not panicking. Someone who's not mirroring the fear. Someone who can think and respond because they're not in fight or flight.

You can't give grounded support from a dysregulated place. It's not neurobiologically possible.

The question isn't, "How do I learn more?" The question is, "How do I stay steady?"

Real scenarios & solutions

In the full webinar, we dive deep into three specific scenarios that doulas face:

• Scope creep: When monthly antenatal visits turn into daily texts at 9pm, and you're starting to feel resentful
• Feeling judged: When a client says at the debrief, "I felt like you were judging me when I asked for the epidural"
• The refund request: When a client emails three months postpartum asking for 50% of your fee back because "you should have prevented intervention"

For each scenario, I walk through the internal framework I use, the exact language that works, and how to protect both the relationship and yourself.

Not every client is your client

You can be excellent at what you do and still not be the right fit for someone. Maybe your philosophy doesn't match theirs. Maybe they need more availability than you can offer. Maybe you're picking up that they hired you to fix something you can't fix.

If you try to work with everyone, you will have a portfolio of difficult relationships, and you will blame yourself for all of them.

But if you're willing to say early and kindly, "I don't think I'm the right fit. Let me refer you to someone who might be," you're actually protecting both of you.

The best doulas I know are incredibly selective. Not because they're snobby, but because they understand that by saying no to the wrong clients, they're saying yes to the right ones.

The bottom line

After 22 years and hundreds of women held, here's what I know to be certain:

The work that protects women must also protect the doula.

You cannot offer grounded, centered, truly present support from a place of chronic exhaustion, financial insecurity, or emotional entanglement.

• If you are overextended, you're not generous, you are exhausted. 
• If you're underpaid, you are not secure, you're anxious. 
• If you are not addressing boundary issues, you're not compassionate, you are complicit with your own depletion.

A regulated, resourced, boundaried doula is the most powerful thing a woman in labour can have in the room with her.

Watch the full webinar

This article only scratches the surface of what we covered in the DNA webinar series on managing difficult client conversations. In the full recording, you'll get:

• The exact scripts and language to use when recalibrating scope creep
• How to navigate projection and feeling judged during debriefs
• What to say when a client requests a refund based on birth outcomes
• Q&A with real scenarios from practicing doulas
• My framework for knowing when to walk away from a client relationship

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Philippa Scott is a full-spectrum doula, doula mentor, childbirth educator, trauma therapist, and life coach with over 22 years of experience. She is a mother of four neurodivergent daughters and grandmother to a homeborn baby. Her work combines decades of experience with trauma-informed care and deep human connection.