New Webinar: A New Approach to Birth Advocacy – World Doula Week 2021
With this webinar, Birth Coach Method celebrates World Doula Week of 2021
Author: Neri Life-Choma
I am the founder of Birth Coach Method and am celebrating 20 years of leadership in the field of childbirth support. Throughout my career, I have been honored to provide doula support and teach childbirth ed. classes to hundreds of expectant couples, as well as to direct two birth resource centers. I am also a doula leader in my community in the South Bay area of Silicon Valley in California.
Navigating the Epidural Dilemma Before and During Childbirth
What’s the Epidural Dilemma?
Pregnancy and childbirth are the most profound experiences in human lives. It is the utmost transformation. However, in our culture, the conversation about these meaningful experiences has been reduced to one topic: labor pain – the fear of it, coping with it, and praising or cheering those who succeeded to avoid it and had a ‘Natural Birth’. The cultural idealization of those who gave birth using no pain medications has had its emotional toll on birth givers. A 2018 study found relationships between an increased chance to develop postpartum depression when birth givers took epidural to alleviate pain in childbirth and did not meet their goal to avoid it. These birth givers experienced “negative emotions related to unmet expectations or a sense of personal failure”. These findings suggest that decisions about coping with labor pain have social and personal values attached to them, presenting individuals with ‘The Epidural Dilemma’. This dilemma is fervent and can be navigated with coaching strategies.
The decision about coping with labor pain has social and personal values attached to it
For many decades, maternal care agents are addressing the topic of labor pain mainly in two ways – informing and supporting. Informing usually takes place prenatally. Childbirth educators and doulas are informing expectant individuals about the benefits of unmedicated birth and the potential risks of getting an epidural. On the other hand, medical caregivers are leaning toward providing proof that epidural analgesia is safe for both the birthing individual and the baby. Therefore, there is no gain or benefit for being with labor pain. For their part, labor pain is pathological as any other pain. In correlation, during the birth process, medical caregivers are promoting the use of epidural as a coping strategy, while doulas are providing labor support that relies on natural pain control techniques, such as breathwork, visualizations, hydrotherapy, positioning, acupressure, and more. Neither the birth support practitioners nor the medical agents have tried using coaching strategies prenatally to help expectant individuals navigate the epidural dilemma, as I’m about to suggest here.
The Limitations of Informing about the Potential Risks
The context of the epidural conversation is not ‘pain medications’, nor is it ‘possible medical interventions in childbirth. The context of the epidural conversation is the fear of labor pain. For most birthing individuals, the fear outweighs the risks, hence the dilemma. When childbirth educators and doulas inform individuals about the possible complications and risks of having an epidural, their students and clients are left in a pickle. “What scares me more, labor pain or the potential risks of epidural?” They can be led to believe that their choice is between bad and evil. Whatever their decision will be, it is based on fear. The motivation for their actions, in this case, is negative – running away from something, rather than a positive one – an aspiration or a goal. A decision to avoid an epidural that is based on a negative motivation is weaker than a motivation based on will and aspiration.
Individuals are left in a pickle: what scares me more, labor pain or the potential risks of epidural?
What should the coaching conversation around the epidural entail?
- Clarifying individuals’ perception of labor pain and their ability to cope with it.
- Inquiring about the sources of their beliefs – how did they get to adopt this perspective? Any birth stories of relatives, evidence-based resources? Past trauma that included pain?
- Checking the alignment between individuals’ concept of labor pain and coping with it, and their desired birth experience. If there is a lack of alignment – meaning that their perception is not serving them well in achieving their desired birth, then you’ll have to reflect on it and suggest exploring their concept of labor pain. (The next step)
- Exploring new ideas, such as distinguishing truth from myth about labor pain in a way that will help them adopt a better perspective. A perspective that will support and serve their desired experience.
- Designing a call for action – what do they need to do in order to own this new perception? What actions can they take that will bring them closer to achieving their goal? Some possible examples are writing an affirmation and reciting it, enrolling in a childbirth education class that emphasizes labor support techniques or writing a birth plan, and communicating it with their medical care provider.
- Once the beliefs and perceptions are aligned with their goals and wishes around labor pain, design an action plan for achieving the desired decision.
- Assessing your client’s commitment level by holding them accountable to follow the action plan.
“I want to avoid taking an epidural, but I leave myself open to…”
Yes, I know. This is the most common scenario that you come across when you conduct the epidural conversation. And if you ask me, rightful so. How can anyone commit to not getting an epidural before they get to experience labor contractions and see if they can handle them or not?
Why do we cheer for those who went ‘naturally’ and subject those who change their mind during childbirth to self-criticism or judgment?
In coaching, we have a saying – be accountable to the process, regardless of the outcomes. I often wonder how birth professionals became so rigid, and sometimes even judgemental when holding birth givers accountable to avoid getting an epidural. In all other life situations, a change of mind when facing reality would be considered pragmatic. How is it different when we experience labor pain? Why do we cheer for those who went ‘naturally’ all the way and subject those who had a change of heart to self-criticism or judgment?
In terms of the coaching process, it is essential to clarify what is this opening about? Ask them: Do you know what makes you leave it open? What scenarios is it open for? Be curious about this imaginary scenario that your client fears will lead them to deviate from their decision and ask for an epidural. Go back to the coaching steps above and try to align the beliefs with their desires and actions. And always model flexibility and pragmatism, inspiring them to strive for an optimal decision and performance, regardless of the outcomes.
How do you clarify your clients’ context around labor pain?
Since clarifying your clients’ beliefs about labor pain is crucial to their ability to optimally navigate the epidural dilemma, it is only fair that I give you some tools to accomplish it. One strategy is to ask your client to write 3 to 5 statements that begin with ‘ Labor pain is …” while looking together at these statements, be curious and ask:
- How did you reach this conclusion?
- What proof do you have?
- Does this perspective serve you? (alignment)
- Is there a chance that your perception of labor pain is partially based on myths and false beliefs?
- How does your current perspective on labor pain impact the choices you make?
The value of Coaching when Resolving the Epidural Dilemma
Does your perspective on labor pain serve you in achieving your desired birth experience?
Can you feel the lack of expectation or judgment of this type of conversation? Can you appreciate the intentional avoidance of any standard or expectations? Can you also appreciate the partnership position of the coach who doesn’t perceive themself as an expert, knowing what is best for the client or what an ‘ideal birth’ is, but rather see the client as an expert in their own lives, their truths, and their desires? This is the biggest value that I find in integrating coaching principles and strategies into birth support.
This blog post manifests core concepts and terms of transformational coaching. Coaching invites a change of perspective. Clients are led to form a new concept, clarify belief systems, goals, and motivations. In coaching sessions, clients adopt and practice new skills. They learn how to align their beliefs, goals, and actions. The coach in turn assesses the client’s level of commitment and strength of their convictions and accountability to the process rather than the outcomes. If you’re intrigued to learn how to provide transformational coaching for expectant and birthing individuals, visit my website.
Matrescence: Coaching During a Time of Life Transition
What is Matrescence?
(pronounced ma tres ens).
The psychological birth of a mother, similar to adolescence, involves hormonal and identity shifting.
Listen to my interview with Maureen McGrath where we discuss Matrescence
January 24, 2021
Throughout this profound identity transition, an expectant individual undergoes an average of about 13 doctors’ appointments during pregnancy, 3 urine tests, 4-5 blood tests, 4 ultrasound tests, 2-3 vaginal exams/swabs, and 2 monitor exams. That is if they are healthy, give birth before or on their EDD, and do not need further diagnostic or screening exams. Then, they will go through the childbirth experience. An experience in which the transparent fabric of one’s routine is disturbed by pain, fear of death, and temporary loss of control. Their body expels a new human being while they are under the care of medical caregivers – most of them practice from an “expert” position. This abundance of encounters with medical maternal healthcare providers amplifies the neglect of expectant individuals’ emotional state and mindset during this profound transformation. Not even one behavioral assessment is routinely recommended for this individual. Instead of focusing on individuals’ well-being and mental health as they transition to parenthood and prepare for the profound transformation of childbirth, maternal caregivers and researchers tend to focus on how the baby is doing.
Why Transformational Coaching is Essential to the Vaginal Birth Initiative
As a seasoned birth support professional, I have witnessed the maternal care system implementing so many new procedures and clinical policies over the 23 years that I’ve practiced. Since 2010, new reforms in maternal care associate the quality and safety of care with the increase in vaginal birth rates and the reduction in cesarean rates. However, the origins of obstetric gynecology lead maternal care policymakers to search for new clinical reforms to resolve a problem that may have originated somewhere else. I believe that none of these reforms will be able to achieve the three major principles designing safety of care: patient- engagement, patient-centered care, and partnership among patients, their family members, and their medical caregivers.
Facilitating Alignment of Expectant Individuals’ Visions, Beliefs, and Actions
When doulas provide prenatal coaching sessions they can help clients be better prepared for the birth of their child and demonstrate a higher level of accountability for their childbirth experience. This is not done by means of education. Prenatal coaching goes beyond teaching and delivering evidence-based knowledge. Its purpose is to help couples discover hidden gaps, resistances, or inner conflicts, and work together as a team to resolve them.
Transformational Postpartum Coaching: Promoting New Parents’ Self-Confidence and Well-Being
Just like prenatal coaching, transformational postpartum coaching shifts the focus from helping or informing to elevating new-parents’ performance level, self-confidence, and well-being.
Most of my writing has been dedicated to pregnancy and childbirth support. During the pandemic, I’ve been thinking a lot about the challenges of new parents or parents who have expanded their family recently. I want to share how transformational coaching during the parents’ postpartum period can enhance their experience.
Revamping Labor Support with Transformational Coaching
You can learn to empower expectant individuals to perceive their own mindset and desires as the most valuable ‘data’ their providers should focus on, by doing so yourself! Learn to provide transformational birth support coaching, and you’ll get to see them conducting themselves brilliantly and with confidence throughout their birth experience, and celebrate themselves.
Being in Support of Vs. Supporting through Childbirth; What’s the Difference?
During this long-lasting period of social distancing, I find myself struggling when I can’t physically support my birth clients. I began searching for new meaning or a pathway to the concept of providing ‘continuous labor support’ and was reminded of two very different states that I already explored while becoming a transformational life coach: Being and Doing. I am so used to thinking about providing continuous support as an action-oriented practice, filled with hands-on engagement. But the need to practice social distancing doesn’t allow this type of support. There may be many birth support figures who feel the same, and I hope that this blog post will serve all those who serve.
Convincing Prospective Clients that Doulas are as Valuable Now as Ever
Doulas face a challenge: after many years of service and hard work, our value is finally recognized, but now with COVID-19, we find ourselves cast out of hospitals.
It took us a very long time to get public recognition. Until not long ago, only a minority of expectant individuals knew what a doula is. I believe that it took too long for two main reasons:
- The refusal of the health care system to acknowledge the value of a doula, which makes it an out of pocket service, and quite an expensive one.
- The affiliation of doulas with natural or unmedicated childbirth; an experience that doesn’t really resonate with the majority of birth givers.
Doulas finally received recognition and then came COVID-19. Our challenge is to convince prospective clients to hire us during this time
Is COVID-19 Doulas’ Opportunity to Achieve Work-Life Balance?
Some of the most heartbreaking news that doulas received along with the outbreak of COVID-19 was that we are banned from hospitals. Many of us were already committed to couples and families that we have come to love and care for, and with the increased level of uncertainty and fear, we knew that our clients needed us even more. As the numbers of COVID-19 cases continue to increase, it becomes clear that this crisis might last as long as a year or even more, raising a growing concern about doulas’ source of income. As upsetting and tormenting as this ban might be, the current crisis bears an opportunity; an opportunity to achieve work-life balance.
