The Doula: Peer, Companion, Lay Woman or A Birth Support Professional?

I wanted to quit, but I discovered coaching and got excited again about being a doula.

After a decade of practicing as a doula and childbirth educator, I was about to quit. I was burnt-out. The rising rate of medical interventions led me to doubt my ability to fulfill my role and facilitate healthy and positive birth experiences. Additionally, the growing gap between doulas’ approach to childbirth and the approach held by the medical caregivers that our clients trust for their journey, triggered a lot of tension in me. These circumstances, in addition to the given hardship of the doula practice, made me reconsider my career path. Ten years have passed since I felt under-resourced and I still enjoy practicing as a doula and training doulas. How did this happen? I discovered coaching! In the last couple of years, I have come to learn that I am not the only one to have gone through this professional struggle. In spite of  ACOG’s recognition of doulas’  benefits and some big headlines reporting the many celebrities who hire doulas for their birth,  doulas experience a few major dilemmas that cause great hardship.
This uneasiness reflects in social media and doulas’ blog posts, and I can sense the confusion, frustration, and disputes that percolate within the doula community. Being passionate about doulas and our valuable stewardship position,  I’d like to share my  personal path that helped me resolve the three major dilemmas doulas face: 

Continue reading

Resolving the Advocacy Dilemma in the Doula Practice – Webinar

The advocacy dilemma in the field of childbirth support is a tough one to crack. The dilemma lies in the tension between certain components of birth support practice, such as serving and supporting, and other components such as being a change agent in our society and a birth activist. By relying on coaching principles and strategies, I suggest that you can be sure to practice within your scope of practice and to refrain from projecting or engaging any ‘activists agenda’ in your relationships with your birth clients. Coaching is the pathway to client-centered relationships and care.

Continue reading

Hey Doula, Can You Handle My Husband?

Were you ever hired by an expectant mom to “handle her husband”?

In my sixteen years of practice, I have had a few clients who hired me in order to do just that – handle their husbands. There could be various different explanations that come along with this request, such as:  “I do not want him in the room at all, but I don’t want to hurt his feelings, so please make sure he is busy, give him tasks” or “My husband is taking over any situation, I can’t have him take over my birth”, as well as “He thinks he can take it, but I know him, he can’t, so I need you to be his doula and keep him calm”.

From a coaching perspective, doulas are in the business of group coaching. If it is more than one, it’s a group!

Coincidentally enough, my doula students and I have had more than a few encounters with the request to ‘handle husbands’ lately, and I believe many other doulas might have too.  Couples’ dynamics can be challenging in childbirth; it can interfere with our doula support and can have an impact on the couple’s level of satisfaction from their birth experience. By fully understanding the situation at hand and acquiring coaching tools to deal with it, doulas can be ready for the challenge, and reduce its impact on their support, resulting in higher levels of satisfaction for the couple.

From a coaching perspective, doulas are in the business of group coaching. If it is more than one, it is a group, and a couple is definitely a group. Doulas are trained to focus on the mom’s needs, their feelings and physical comfort, but nevertheless we cannot ignore the dad, nor can we team up with the mother and “handle him”.It is not healthy for us and it’s harming our clients.

Can we really manipulate the birth partner and ignore his emotional needs in the service of the birth giver?

We cannot ignore the dad, nor can we team up with the birth giver and “handle the partner”. It is unhealthy for us and for our clients

For the purpose of handing doulas the coaching tools for dealing with this challenge, I want to share an actual case study, with the permission of my doula student.  A couple of months ago my student met with her second client, and was asked by the mother to watch” him during labor and redirect him, “take him away” if he gets to be too much in my way.” (This is taken directly from the student’s notes). My student agreed to her client’s request, believing that she was doing her good, and here is what she wrote in her supervision report: “When faced with this request, I suggested to [mom] that we come up with a secret sign that would let me know to redirect [dad]”.

During our supervision session, following her meeting with the client, I asked her how she thought this agreement served the mother. I pointed out to her that from a coaching perspective, our role is to empower the mother to express herself, her wishes and needs, to her support group. If we do this for her, we are depriving her of opportunities to grow. Similarly, doctors wanted to rescue women from labor pains and offered them different types of pain management options. What might have begun with good intentions, ended up with mothers being disempowered during childbirth. As doulas we sometimes feel the need to rescue the mother as well, but only because we fail to perceive our clients as competent, which is one of the basic premises of coaching. Here are my student notes, concluding this supervision session: Birth Support Coaches empower birth givers to vocalize their beliefs, needs, and goals and share them with everyone involved – partners and medical caregiverspartner… that she needs space, having the birth coach do that for her is not empowering. To help the mom, the coach can suggest: would you like for the 2 of us to practice this? Can you find the words to express the fact that you need a change? The bigger the coach, the smaller the mom.  The more we do for her or take from her, the less she is empowered.”

Birth Support Coaches empower birth givers to vocalize their beliefs, needs, and goals and share them with everyone involved – partners and medical caregivers

In her following meeting with the client, my student never went back to revise her client’s request to “handle the dad”. After the birth, she texted me: “I had the feeling that my client did not want me there at all, did not want me at the birth”. As her trainer, I was concerned about that and asked her to try and explain the source of her feeling. Here is what came up: Surprisingly the dad did a very good job supporting his wife during labor, and she seemed happy with what he was doing. I was more in the background suggesting and preparing things for them. She never talked to me directly or engaged with me.”

From my perspective, the doula failed to serve the clients because she never clarified her client’s request or the motivation and beliefs the client had around this request.  The doula could have asked clarifying questions such as:

  • Can you give me some examples of what you mean by “Gets to be too much in my way”?
  • How does it look like when he is in your way?
  • How does it make you feel when he is in your way?
  • How do you react when he is in your way?
  • How do you suggest that I redirect him?
  • And the $1M question that could have evoked a change in the couple’s relationships: Would you like us to practice some ways for you to express how you feel and what you need from him?

It is not your role to provide couples’ therapy, but you can coach them gently and facilitate joined agreements in specific areas relating to the nearing birth

Instead, the doula felt that the partner did well. My poor student did not hear from this couple again, although she tried to reach out to them and facilitate closure. It was an unsuccessful experience for both the birth giver and the doula that ended p in a cesarean.

As a doula, I encourage you to pay attention to explicit and/or implicit signals that you get about the couple’s dynamics. If there are issues with their dynamics, don’t ignore them, as they will almost certainly emerge during the birth and can sabotage your efforts to help the couple achieve the positive experience they desire. It is not your role to facilitate a change in couples’ relationships; you are not a therapist. But you can coach them gently and facilitate specific agreements for the sake of healthy and positive childbirthImagine how valuable it would be for them to communicate in a respectful manner, to establish teamwork, to work out their differences, or to express their needs to one another during childbirth. This experience will leave its mark on their relationship and will empower them to create the change needed.

Here are some tools for coaching the couple around their dynamics:

  • Reflect on the explicit and/or implied message that has alerted you with questions like: ” Did I understand correctly that you are …”
  • If your impression is confirmed, ask for examples and clarifications until you are clear on the matter. “Can you give me some examples?”, “How does it looks like?” Or “How do you feel when…?”
  • Try to make the couple observe the problem. You may ask: “Do you see any problem with this? “ Or “Can you think of any impact this might have on your birth experience?”
  • Explain your position as their birth doula – focus on the fact that your role is to empower and support both of them. Explain what might be the impact of the issue, or how their dynamics might be in the way of achieving the positive birth experience they hired you for.
  • When there is agreement about the problem, we can try to facilitate a solution: “What are you guys willing to do about it?” Or “Can you think about a different way to do things for the sake of a positive childbirth experience? “
  • Create or look for opportunities for the couple to practice the new communication skill or pattern.
  • During childbirth, if there is a need, remind them of their commitment to practice new coupling skills for the sake of their childbirth experience.

Reflecting, asking strong questions, clarifying, practicing new skills, and empowering, all are coaching strategies. I am committed to enriching childbirth pros of all types – doulas, childbirth educators, prenatal yoga teachers, medical caregivers, and others, with the coaching tools and strategies. If reading this blog post inspired you to want to learn how to coach towards a healthy birth, I invite you to enroll in the Birth Support Coaching certification course

Imagine Re-Birthing the Doula Profession, What Would You Change?

 

     Imagine that we, the doulas of the world, were given the opportunity to go back in time and give birth to our occupation again. What would you change? How will you make things different this time? This thought came to mind as I was reading the very insightful and comprehensive book by Christine Morton, Birth Ambassadors. After fifteen years of practice as a birth doula, I am so clear about what I want to change: it is a paradigm shift that is both conceptual and practical.

    The first thing that I will do is to dismiss the term ‘Doula’, which implies servitude, and replace it with the term ‘Coach’, which has the connotations of ‘leader’ and ‘expert’ in a certain field. Mazel-Tov! I just re-named the ‘baby’ – Birth Coach!  There are coaches for every field of human performance – sports, acting, singing, career, executive, relationship, life…you name it! Why not for the performance of birth then?

Continue reading

0