Let’s Talk about Accountability for One’s Healthy Birth

A couple of days ago I had a beautiful mentoring session with two local doulas; we will call them Iris and Lily.  We were going over some challenging cases they experienced recently and exploring how the Birth Coach Method’s strategies and tools help.  Pretty early in our discussion, I learned that their typical birth clients represent some degree of polarity: Iris works only with clients who are strongly committed to an unmedicated birth.  She feels that potential clients who are “willing to try [birthing] with no epidural but leave themselves open to option of taking it” are not a good match for her.  Lily said that her clients are hiring her in order to “Check the box” of doula services; meaning that they read the statistics showing doulas reduce cesarean rates and they are hiring her to avoid a cesarean.  


The reason I say that their typical clients represent a polarity is that Iris’s client, as described by her, is personally  committed to her own journey and to the choices she makes, and is hiring a doula to get the additional support needed in order to achieve her desired birth experience- unmediated physiological birth, whereas Lily’s typical client  is committing her doula to her wish to avoid a cesarean.

From the client’s perspective it totally makes sense to feel the doula is accountable for the birthing experience; after all for decades we have been using the doula statistics to promote our services, spreading the notion that the presence of a doula will reduce need for pain medications, inductions, and the chances of needing a cesarean. From the doula perspective, this promise stands the risk of professional burnout, because if medical interventions that you promise to reduce unfortunately take place in your client’s’ birth, you risk feeling that you didn’t fulfill your role.  You could feel that you failed in leading your client toward her desired birth and could even lose confidence in your professional validity. This is absolutely one of the areas in which I mostly appreciate the contribution of integrating the coaching principles and strategies into the field of birth support. This area is called client accountability, and it equally serves the client and the coach. 

As coaches, we ask ourselves, who is holding who accountable in these relationships? Is she holding you accountable for her desired birth experience? Is this arrangement truly working for you? Do you really want to be committed to your client’s journey more than she is? When you demonstrate a higher level of accountability to your client’s vision than hers, do you empower her or rescue her? Are you her support figure, her leader, or her savior; taking charge of her? Maybe you serve a ‘camouflage effect’ where she is convinced that she hired you in order to avoid a cesarean, and unconsciously avoids dealing with her birthing fears.  

Coaches in various fields lead their clients closer to fulfilling their potential and achieving their goals by holding their clients accountable; it is build-in in the coaching relationships.  When I asked Lily how does she know her clients are hiring her to “check the box of hiring a doula” she immediately pointed out the “inconsistencies” in her word: those gaps between what the clients say that they hire her for, or what they describe as their desired birth experiences, and the actions they take prenatally and during the birth to achieve their goal. That’s exactly it; coaches  evaluate a  low level of commitment when the clients resist taking the actions which will bring them closer to what they state as their desired goals

Prenatal coaching sessions conducted by a doula, or by a childbirth educator, can elicit the mother’s accountability for her desired birth experience and to her journey, and therefore has the potential not only to protect the birth professional from burnout but to lead the expectant mother closer to fulfilling her birth vision.


More Resources:

To learn how doulas can elicit accountability

To learn more about the client’s accountability vs. responsibility

To learn more about the client’s accountability

To learn how to integrate coaching into birth support.


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.
Neri Life-Choma

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