Who is Accountable for Your Client’s Positive Birth Experience?

Is your birth client as accountable as you are for her birth process?

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 the 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 polarity here is between two types of clients- Iris’s clients are committed to their own journey and to the choices they make. They hire a doula to get the support needed in order to achieve their desired birth experiences. Whereas Lily’s typical client is holding the doula accountable for her healthy process.

Who is holding who accountable in these relationships?

Doula benefits statistics might be misleading if we forget to mention they work only when the birth giver is accountale for her own healthy and positive process

From the client’s perspective, it totally makes sense to assume that the doula is accountable for the birth experience. After all, for decades we have been using doula statistics to promote our services, spreading the notion that the presence of a doula will reduce the need for pain medications, inductions, and the chances of needing a cesarean. From the doula perspective, this promise stands the risk of professional burnout if medical interventions, unfortunately, appear 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. 

Can prenatal coaching elicit clients’ accountability for their healthy birth process?

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.  

Eliciting clients accountability is a coacing competency, and is crucial for successful coaching relationships

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

Gaps between clients’ goals and the actions they take signal low level of accountaility

Students who join our Birth Support Coaching Course learn to conduct a series of prenatal coaching sessions in which they implement coaching strategies that assess and elicit their birth clients’ accountability for their desired experience, and for their health.  In turn, this higher level of accountability leads to a higher satisfaction level from the doula-client relationships and from the experience as a whole.  


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

DONA, doula profession, prenatal, training

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