Accountability Vs. Responsibility in Childbirth

This post is dedicated to my recent birth client Greta – as committed and accountable of a mom can be. (Shared with her permission after changing her name)

Let me begin by sharing that one of the last births I have attended left me with a heavy heart. I have coached my client Greta for about 3 months toward achieving her goal: a VBAC for her second birth. During our prenatal coaching sessions, I came to respect her as one of the most committed, mindful, and accountable birth clients that I have had the honor of working with. I was looking forward to cheering her on during delivery, but we never got there. In fact, I did not even get to coach her through her birth.

As a birth professional, I trust you to know how hard it is nowadays to accomplish a VBAC. Greta was well aware of the challenge but remained committed to her wish for a vaginal birth. Her commitment was reflected in the long list of actions that she took in order to accomplish her goal:

  1. Greta’s first step was to establish her support group; she received support from her doctor, husband, family of origin, and me, as her birth coach.
  2. Greta is a working mom in the high-tech industry of Silicon Valley. Nevertheless, she was committed to making lifestyle changes in order to prepare her mind and body for the birth. She took prenatal yoga classes, swam until her 8th month, used her lunch break to hike every day, and watched her diet carefully. She also signed up for a hypnobirthing class and practiced the scripts.
  3. From the very beginning of our coaching relationship, it was clear that Greta was very knowledgeable about  childbirth and was in constant  search of more knowledge. In fact, she would take the lead in our discussions in regards to any type of remedy or alternative medicine support; she initiated emails and discussions about evening primrose oil, aromatic oils for birth, perineal massage, homeopathic tinctures, etc.
  4. During the last three months of her pregnancy, Greta and I met every other week for a prenatal coaching session. During these meetings, we worked on leaving her first birth experience behind and practicing forgiveness and acceptance. We practiced breath work and relaxations and wrote her an affirmation to attract the birth experience she wished for. We exchanged knowledge and distinguished truth from myth about childbirth. We wrote a birth plan, practiced positions, and addressed her fears and doubts that she might not be successful in her efforts to have a VBAC. It is the last point, coaching my client through the uncertainty of the outcome; pushing through one’s doubts and fears about not giving birth the way one wished for, that brought me to the write this post.

With the high rates of cesareans nowadays and the fact that we were having a TOLAC (Trial of Labor After Cesarean), we both knew what Greta was up against. So how can one persevere against the odds? It is almost as if no expectant mom these days can avoid preparing herself for a cesarean meanwhile preparing for her vaginal birth, and even more so, a mother who has already given birth once in a cesarean birth. So how do we coach mothers around these fears and help them push away the doubts? How do we not let these get in the way?

From a coaching point of view, we are talking about accountability Vs. responsibility. The major difference between these two concepts, and this is true in every field of coaching, is in the attachment to the outcome of our efforts. Accountability is the obligation of the individual to account for one’s actions, and accept the responsibility for them. Responsibility is the obligation of the individual to perform or complete a task. Do you see the difference? Being responsible means that you are accountable for the outcomes whereas being accountable means that you are responsible for the actions you take in the process of working toward achieving your goal, with no attachment to the outcome.

In childbirth, we can only be accountable for the process, for the actions we take towards a conscious and mindful birth. There are so many agents involved in birth; our physiology, our anatomy, the baby, the birth environment, our support group, the medical staff’s training and their reading of the situation, our stamina, our mental and emotional state before and during the birth, the list goes on. The bottom line is – doulas and birthing moms cannot be responsible for the outcome of a birth, only accountable for the actions taken.

As I coached Greta through her doubts, I chose to share these concepts and the difference between them in order to help her push through the uncertainty and leave her first birth experience in the past. During the prenatal coaching, it became clear that she was still angry with herself for not being accountable for her first birth. In fact, only while preparing for her VBAC, she acquired closure for her first birth and was able to generate a coherent and clear memory of what had happened the first time around. I can clearly remember three different opportunities where I brought the difference between accountability versus responsibility. I used it during prenatal coaching in order not to drag her past experience into the present by acknowledging the higher level of accountability that Greta was demonstrating now. I also used it in order to push through the fear of the possibility of a repeat cesarean by pointing out the inevitable of  what we can’t control.

healingGoing back to my heavy heart, I assume you guessed that the birth ended with another cesarean; it was a pretty traumatic one. Greta texted me around 11pm on Sunday night about a pain in the lower abdomen waking her from her sleep and that she thought her water broke. There were no contractions at that point. After 10 minutes or so, I got another text saying that the contractions had begun, strong and steady and 5 minutes apart, each lasting for a minute or more. I texted back that I was getting ready and would soon be on my way to her. Ten minutes later, when I had just gotten into my car, I received another text from the dad this time, telling me that Greta was shivering and that the contractions were 3 minutes apart, lasting almost 2 minutes each. The intensity of her state prompted me to call and ask them to meet me at the hospital. I arrived there first and was still thinking, “what if she is at the very beginning and will be upset with me for not supporting her in laboring at home longer.” After all, our coaching agreement was to labor at home for as long as possible.

Their car rushed into the hospital’s parking lot. Greta’s husband jumped out and so did her mom. Greta could hardly stand, could not breath, and was in extreme pain. We entered L&D with Greta in the wheelchair. The nurse led us to the observation room and monitored the baby’s heartbeat. Five minutes later, I was left there all alone as my client was rushed to an emergency cesarean due to a very low fetal heart rate. During these five minutes, the medical staff commenced their fervent evaluation at the midst of an emergency –  vaginal exam, internal monitor for verification, declared code C, inserted IVs, withdrew blood, verified allergies, gave verbal explanations, and established consent.

As a doula, I often hear the following saying “what matters is that you have a healthy baby and healthy mom.” We use this saying to comfort mothers that did not have the birth experience they wished for. While this is the absolute truth, it is beside the point. It addresses the outcome of the pregnancy and not the birth experience. Therefore, it is not the best coaching strategy to resolve any bad feelings that the mothers might have regarding her birth. The mother was not only accountable for having a healthy baby but also for having a vaginal and healthy delivery. I find that the ‘Accountability Vs. Responsibility’ coaching discussion is a good strategy that can support both the mother and her doula.   I know it helped me in my healing process, along with a local online doula support group (Yes, doulas are online at 2 in the morning, thanks sisters!)

When I got back home I sat down to practice breathing and meditate. The morning came, and I decided to make Greta a card. I searched on the internet and found the image shown above. I actually made two cards, one for her and one for me. I went back to the hospital around 10 am. Greta hugged me and asked how I was. I replied by asking how she was doing,  but  she kept reassuring me that she is fine, that she has no remorse, and that she is in full acceptance of the circumstances. “This must have been really hard for you, Neri; emotionally, your work is so hard,”she said.  For a moment I was not sure that I had made the card for her, it might have been for my own well-being. Greta felt that she did everything that was in her power to have a healthy childbirth. Even though this time  it was an emergency cesarean under general anesthesia, she shared that she was more at ease with it this time because she felt mindful and accountable, and it empowered her to accept the inevitable. Her words helped me be grateful for taking part in this birth and being there to guide her with my coaching skills and experience.

If you enjoy reading this post , and you find this terminology and coaching strategy valuable to your practice,  please consider studying The Complete Coaching Tools Kit for Doulas,

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 is 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?

“Take him away if he gets to be too much in my way”, she said to her doula

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]”.

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.

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: “As birth coaches, we want to empower the birth givers. They need to vocalize themselves to their husbands, partners, other members of their support group,  and the medical caregivers who take care of them.  partner… 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 to their husbands, partners, other members of their support grop,  and the medical caregivers who take care of them.

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  specific agreements for the sake of healthy and positive childbirth

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 of these are core concepts in coaching. I am committed to enriching my doula sisters with the coaching tools and strategies, and if this blog post made you feel like you want more of it, consider studying the ‘Complete Coaching Tools Kit’ for doulas, which I plan to launch before Thanksgiving.  There is still time to sign up for the promotional offer in the ‘coming soon’ box here.

‘Birth Ambassadors’ by Christine Morton – A Book Review

Recently  I have read the wonderful book  Birth Ambassadors, which I find to be the most comprehensive and eye-opening study about doulas and birth support in North America.The book is a genuine presentation of the doula role, ways of birth embassadorspractice and training system in America from a sociological point of view. As such, it is free of any judgments about the dilemmas in the field, and views them from the perspective of sociological interests, such as professional status, the emergence of occupational niche, change agents in maternal care, community service, income level and even organizational developments. This point of view allows the author to also question, or re-open for discussion, some of the most common assumptions doulas and birthing moms ascribe to, including the benefits of doula care in terms of increasing normal births, and the doula’s agenda favoring natural birth, as well as doula advocacy in labor and delivery.

   To me, the most urgent dilemma is the one regarding doulas’ professional status. It is my understanding that this is also the core dilemma, the one that originates the others. In literature and doula guides, one cannot escape the choice of words used to name and describe this role by those who are perceived as the biggest doula advocates. Morton describes doulas for her readers using a typical definition, “Doulas are birth companions…The word doula comes from the Greek and refers to a woman who personally serves another woman.”  Neither a ‘companion’ nor a ‘doula’ implies any professional position—the latter evokes servitude rather than social change agents that come from being a mentor, a teacher, a coach or a leader. Yet, doulas are trained to believe that they can and do make change. Morton’s discussion of Klaus and Kennell’s book “Mothering the Mother,” the book that still, three  decades after their emergence in America, provides doulas with the scientific data of the benefits they bring, provides additional food for thought about how doulas are described. The title “Mothering the Mother” is another poor choice of words. As we all know, mothering is considered to be a non-professional position, and although everyone agrees that it is the hardest and most valuable work of all, mothers do not get paid for all they do.

The non-professional status of doulas in North America is reflected in the current training and certification system. Morton points out that research findings regarding doula benefits were actually based on a control group comprised of inexperienced and untrained women who sat in the delivery room and took notes.  Most doula trainings in North America are between a two-four days’ workshop. In comparison, I was trained in Israel, where doula training programs last a year and are usually affiliated with an alternative medical college and/or hospital. Trainees are required to have an internship inside Labor and Delivery.  As a sociologist, Morton points out the dilemma of doulas as being committed to providing humanistic and affordable childbirth support within the community, similar to what existed in a more tribal society before women began giving birth in hospitals, and the current situation of low status, low income and low professional standards for doulas as working women.

Morton continues to point out another motivation to maintain the non-professional status of doulas, which is closely tied with the circumstances of doulas’ historical origins. As Morton observes: “Doula care emerged as a unique response to the changing social and medical context of childbirth support in the United States” and “…the fragmentation of childbirth support [that] began with biomedical experts claiming authority over pregnant women’s health and childbirth outcomes and moving birth to the hospital…it is in this period we see the emergence of the doula as a particular, specialized role in providing non-medical support to pregnant women. “ In other words, doulas emerged in the United States as a reaction to the medicalization of birth, yet they are largely practicing within the medical system, holding to a philosophy of care and birthing model that are alien and unfamiliar in the medical paradigm. It is my assumption that doulas organizations are confusing professional status with medical status. If doulas were to claim medical authority they would not be able to practice within labor and delivery. While it is important to keep doulas as non-medical care givers, it is most important to elevate and state their professional status as coaches and care givers in the field of birth. Until then doulas are left with being viewed as community service or support figures whose motivation for their work ‘comes from the heart’.

Morton goes on to explain the controversy, facing doulas in terms of how they advocate in birth. In their current status as non-professional community service workers, how can doulas be an authoritative source for evidence-based care and empower their clients to question the medical staff and the care they provide?

I can see how some doulas and doula trainers in North America might feel challenged by this book, but I believe that this challenge is an invitation to initiate a healthy change in our occupational niche. Morton contributes to the well-being of doulas and birthing moms, by opening our eyes to the reality of birth support in North America. As a birth coach trainer, I would like to encourage all doulas to abandon the term ‘doula’ and the connotations attached to it over the past decades.  I recommend that we begin a new era of re-defining doulas as birth coaches, who can acquire coaching tools and skills, and enjoy the accreditation experienced by coaches in many other fields (such as life coaching, executive coaching etc.)  The coaching model and practice standards can resolve some of the dilemmas Morton identifies as problematic for doulas and their organizations, such as the advocacy dilemma, or practicing within the territory of doula support  without wrongly step into the medical territory, as well as coaching the mother prenatally for the performance of childbirth.  To read more about the coaching model, read my  blog post on  birth coaches vs. doulas at: https://www.birthcoachmethod.com/imagine-giving-birth-profession-doula-profession-change/.

 

 

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?

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Coaches not only help their clients to prepare through practice for their upcoming performance, they do much more than that: they provide them with theoretical knowledge about the field of their performance. They are a resource of knowledge, they empower, and they provide emotional support and cheer for them.

    The next thing I will do is go back to what motivated me to give birth to this baby in the first place.  It was my passion to support and lead expectant mothers towards and through healthy and vaginal births.  However, I feel that it was also a circumstantial birth; that it was brought to life as an opposition to the medical paradigm, and the maternal care it provided for birthing moms. I sympathize with this pioneering stand, this opposition to a dominant ideology is the beginning of many new ideas, and can be the origin of new concepts of care; however, I am not a pioneer any more.    The doula caregiver has been around for three decades already, and it is time to take it to the next level: professional standardization of knowledge and practice. To achieve that I will shift the focus of my philosophy and my training from the medical care to the essence of childbirth itself, and I will explore the essence of the birth experience.  

While doing that I will notice that:

  1. Childbirth evokes fear and pain in women: The first birth stories that were told in Western culture, whether I find them in the Bible* or in the Greek Mythology**, had implanted the seeds and tied the knot of fear and pain that are deeply associated with our concept of birth.  For thousands of years, before medical inventions like contraceptives, blood transfusion, sanitation, antibiotics and more were available; giving birth in fact was a life threatening experience for our female ancestors.  This kind of fear can be hereditary, meaning that women nowadays can still carry the fear and threat in their cellular memory***. Therefore, I will define it as the role of the birth coach to explore the belief system of her birth client, and help her to distinguish fear from reality, truth from myth, and facilitate the expectant mom in forming a positive and healthy concept of birth which will be aligned with a healthy birth experience, and with her ideal birth.  This coaching will allow a new way of  ‘being‘ with the birth experience.  It will allow the acceptance of the experience rather than rejection and fear, and will empower the mother to be present and cope with the sensations and emotions during her birth experience.

 

  1. Birth is a performance: When observing mothers giving birth I noticed that giving birth in a way nature indented it for women, is quite a performance! It requires expectant mothers to perform physically, mentally and emotionally in a way that is so different from their everyday life. From this observation  I will draw the conclusion that in order to increase their chances of having  healthy births, expectant mothers have to acquire a new set of labor support tools and skills, which they need to practice a lot with, until these tools  become their habitual response to labor and birth sensations.  This type of coaching will allow a new way of ‘doing’; a new way of responding to labor, which will be aligned with the new way of being.  When practicing these labor support tools, like relaxation, breathing techniques, visualization, massages and vocalization, mothers will be empowered to respond to labor sensations and strains with skills that are supporting the progress of their labor, reducing levels of fear and pain, and that can increase their chances of giving birth in a healthy manner.  My role definition will include practicing labor support tools with birth clients on a regular basis, and assigning areas of practice for them.

 

  1. The coach’s goal is to bring the coachee to high level of performance with no need for the coach’s continuous presence: Child birth IS a performance, and one that takes time I must point out. To borrow from the world of sport, birth is no 100 meter run; it is more like a marathon.  Is there an obligation or a need for the coach to run alongside the runner and provide continuous coaching through the marathon, from beginning to end? No, absolutely not. Coaching and empowerment take place before the performance, and at times during its course.  Providing continuous support for the whole process of birth, regardless of how long it is, bares a risk of disempowerment, of the coach becoming the savior, and implying a need to rescue the mother. This is not valuable coaching. Therefore, in my training and my philosophy, I will focus on the importance of continuous prenatal coaching rather than the continuous presence of the coach.

 

  1. It takes a village to support a woman in childbirth: When recalling my own birth experience I will acknowledge my partner, the father of my daughters, as the main source of my emotional support during birth. Therefore, I will conclude that a birth coach is in the business of group coaching, as two people are already a group by definition.  I will then open my eyes and look around to see who else was supporting me during my birth, who else was present in the room and in what role? The support group just grew bigger to include the nurse, the midwife, and the OB/GYN.  To each their own way of making sure me and my baby are safe and are being cared for, they just practice within different paradigms, practice different modalities of care. I will then conclude that the role of the birth coach is to facilitate decision making and team work among all the parties present in the room. Using coaching skills and tools, the coach can and should facilitate team work in the best interest of the mother’s birth experience and for her to be able to experience her ideal birth.

 

  1. Birth is unpredictable; there is no clear route, only a destination: Looking at the body of knowledge I hold about birth, I can’t avoid noticing how unpredictable birth in its essence is. Yes, I have a chart of labor phases and stages, and I know the symptoms by heart, and there is a so called normal unfolding of birth, but all in all I have to admit that there is so much we can’t predict about birth.  As a childbirth educator I can only prepare my students to some prototype we invented in order to talk about birth, and I stopped using the term ‘birth plan’ long ago. There is no plan or route, only a destination – healthy birth. And the birth coach is the travel agent and the tour guide. With this recognition I will conclude that the role of the coach is to model and facilitate flexibility and acceptance.  To enable the client to recognize possibilities and options during the birth, and facilitate the acceptance of what was maybe perceived as unacceptable for their clients.

 

  1. A mother’s childbirth memory is as important as her own birth:  Looking back at my birth memories, I notice how present they are in my life. My childbirths were transformative in essence, and with each baby that I gave birth to, something new was born in me. This transformative essence of birth could be found in many birth stories.  From this I conclude that the role of the birth coach is to coach the mother after birth to reach a closure, to process her birth experience and make it a coherent and clear memory, which she can feel comfortable recalling and telling, and from which she can grow.

 

Imagine giving birth to the doula profession all over again. I just did it, and I will continue to do so. Will you join me in this transformation? Let me please introduce The Birth Coach Method, a paradigm shift in the doula role and practice.

 

   Birth coaches:

  • Coach the expectant mother to form a healthy positive concept of birth.
  • Prepare the mother for the performance of childbirth by practicing labor support tools and assigning areas of practice for her.
  • Aim at empowering and preparing the mom to embark and perform with confidence during her childbirth with no requirement for the coach’s continuous presence.
  • Facilitate team work and agreement reaching among all the caregivers and members of the mom’s support group.
  • Model and practice flexibility in order to facilitate acceptance of the unpredictability of birth and allow the mother to be in peace with circumstances which might not be aligned with her ideal birth.
  • Coach the mother after the birth to reach closure, process her childbirth experience, and form a positive memory which she can recall and tell with clarity and positive emotions.

 

As always, I invite your feedback and impressions. Email me at neri@BirthCoachMethod.com

    To Healthy Births on Earth!

      Neri L. Choma,  Birth Coach Method founder

 

 

References:

*Genesis, chapter 3: “Unto the woman he said: I will greatly multiply thy pain and thy travail; in pain thou shalt bring forth children;”

** Homer, The Iliad, around 750 B.C, “”Then rays of pain lacerated Agamemnon comparable to the throes a writhing woman suffers in hard labor, sent by the goddesses of Travail, Hera’s daughters.

***http://www.cellularmemory.org/about/about_cellularmemory.html

The Misleading Concept of ‘Natural Birth’; Let’s Talk About a Healthy Vaginal Birth

The dichotomy of Natural Birth vs. Medicalized Birth had been established in the discourse about birth for the past 30 years and was accepted by both birth professionals and moms. The most obvious and urging question expectant woman is concerned with is whether or not she will take epidural or will try for a ‘Natural Birth’,  and in accordance with what she feels inclined to, she will then educate herself and prepare for her birth. She will decide on a childbirth education class and make decisions regarding her caregivers and support group for the birth based on her decision for or against taking epidural. A woman who gave birth vaginally will almost always be asked whether or not she took epidural, or in other words “did you have a natural birth’? This situation is reflected also in birth stories we read online; where we can always find statements in this spirit:  “I decided not to take epidural and try for natural birth…and here is what has happened…or “So I decided it was time for my epidural…”. What I find even more concerning, is the shower of praises and cheers that the mother who went ‘naturally’ will perceive, vs. the mother who helped herself cope with an epidural.

I think that that the concept of Natural Birth is so misleading that while preparing for this experience, a woman might find herself giving birth in a way that cannot be farther away than what nature planned for women- a rather medicalized birth. Natural Birth’ is a proposition which describes the conceptual event of some sort of birth that the speaker or listener have in mind. But what type of birth is it?  What’s on our mind when we think ‘Natural Birth’? Which pictures come to mind? Which words are associated with it?  Which scenarios do we envision and are they really ‘Natural’ for the women we know and support?

 I argue that for modern women, there is nothing natural in the process of giving birth and therefore the concept ‘natural birth’ by itself presents women with a dilemma: Giving birth is part of our nature, this is how we procreate, and yet as an occurrence in the life of modern western women, there is nothing ‘natural’ about childbirth. 

To support my argument, I checked the dictionary for the definition of ‘natural’, and found the following definition:

nat·u·ral Natural, adjective 1. Existing in or caused by nature; not made or caused by humankind. 2. Or in agreement with the character or makeup of, or circumstances surrounding, someone or something. So now let’s take the propositions of ‘Natural birth’ and read these two definitions with it: Natural birth is: 1. Natural birth is caused by nature, not made or caused by humankind. 2. Natural birth is in agreement with the character or circumstances surrounding expectant moms.

My understanding is that when we oppose ‘Natural Birth’ to ‘Medicalized Birth’, we probably mean to say or imply that this kind of birth occurs and unfolds with no humankind intervention. Well, firstly we need to recognize that this concept tells us what Natural Birth is not, and not what it is. Secondly, I want to point out the misleading implication of this definition- that when we think about something that happens naturally, with no humankind intervention, the connotations that come to mind is of something ‘simple’ or ‘effortless’, which are not at all true when it comes to giving birth. Let’s take a look at the second definition and see how it resonates with us: “Natural Birth is in agreement with the character or circumstances surrounding expectant moms”. Really? Would you agree that in terms of ‘the character of life circumstances surrounding women’ nowadays, nothing about birth is natural for the modern western woman? Do you feel the tension? There is also a conflict between the two optional meanings of the concept ‘natural ‘. I think that healthy vaginal birth, which we refer to as ‘natural birth’, has become so rare because of the dilemma that the word ‘natural’ presents. Here is the dilemma of the modern in regards to childbirth:

   “It is in my nature to give birth, yet there is nothing about birth that is natural for me”

Here are some of the reasons why childbirth can’t be or feel natural for us:

  1. Birth is unpredictable and impossible to plan for. (How many of you already planned their summer vacation? Christmas vacation?)
  2. Birth requires us to agree to be in pain, and we live in a culture that is obsessed with alleviating pain. We also lost all our coping pain techniques and skills while being born in this culture.
  3. Healthy birth is a process that lasts an average of 18 hours for first-time moms, and we live in a fast pace culture; we use instant coffee and instant pudding and order food in drive through…We like our results fast! In movies and TV sitcoms birth takes five minutes max.
  4. Being a long process, birth demands physical and emotional performance, it demands strength and stamina which the modern woman who drives her car, uses elevators, sits in a perfectly air-conditioned office, uses washing machines and dishwashers, and does not squat down the river every day, absolutely lost.
  5. Our cultural inhibitions, which are the cultural circumstances surrounding expectant moms, are in conflict with our primal and intuitive response to birth.  The progress of labor depends on the release of hormones like Oxytocin and endorphin, that are being released by the part of our brain that is called ‘primitive brain’. The primitive brain activates primitive and uncontrolled reactions and behavior like moaning and groaning,  crying and screaming, throwing up, the spontaneous motion of the body like spiraling, and other types of behavior that are not considered to be attractive or feminine, and therefore are in conflict with our cultural inhibitions.

 To summarize my argument, talking about natural birth is misleading. In a subconscious matter, which women are unaware of, thinking about ‘natural birth’ lead women to either think about something as natural as a sneeze or a yawn, something that happens spontaneously with no investment or effort and therefore needs no preparation or intentional engagement. Ironically, expectant mothers must have a thorough and deep preparation in order to give birth spontaneously, in a healthy vaginal way. For the modern woman, giving birth in the way nature planned for her is quite a performance.  It requires her to perform physically, emotionally and mentally in a way that is much different from her everyday life circumstances. And just like no one says natural marathon or natural success, nor should we talk about natural birth. 

I

Practicing for an Active Birth

   I have been a childbirth educator and a birth doula for the last 14 years. During the first year of my doula practice I realized there is a difference between Knowing about birth and Being in birth. With no exception, all of my birth clients took childbirth education classes and read pregnancy and birth guides. Most of them were also committed to have a natural birth, to avoid medical interventions as much as possible, and to design their birth experience according to their belief system and their emotional and physical needs. While supporting them in birth, their knowledge did not serve them well enough. The mothers whom I have worked with were missing tools for labor.

   So I have decided to begin my support earlier than the birth, and became a childbirth educator. As an instructor I teach the Active Birth philosophy, mostly affiliated with Janet Balaskas.  In my classes I always focus on practicing  labor tools. My perception is ,that in the Google era ,couples are exposed to so much information and knowledge, that my special contribution is in teaching them the hands-on practice of being with the birth.  I have created the Practicing for an Active Birth workshop especially for clients who wanted more hands-on practice. I taught this workshop for ten years in Palo Alto. My students were raving about this class, and the local midwives were continuously recommending it to their birth clients. On November 2012 I launched the DVD “Practicing for an Active Birth; The Most Comprehensive Hands-On Guide for a Healthy and Active Birth”. This DVD presents 2.5 hours of labor support tools and comfort measures for birth, and many coaching tips for both birthing mothers and their partners In accordance with different phases of the birth.

   Labor tools are in support of the progress of your birth as well as your ability to cope with labor pains.  Labor tools are relating to the physiology and anatomy of birth, and when you practice them, you have better chances of having a healthy birth which progresses in a timely manner (Off course it takes some collaboration from your baby too). It is hard for me to accept philosophies of childbirth education which deny the presence of pain in labor. Contractions are strong cramps of our uterus, and when a muscle cramps, pain is present. So how are you being with that pain and what are we doing when you are in pain? 

When we are in pain, our habitual instinct is to react with fear and tension.  We refer to these phenomena as the Fear-Tension-Pain syndrome. This is our survival mechanism.  Pain is a signal our brain translates as:  “Something is wrong; there might be a risk to the organism”. Neglecting the pain might lead to a serious threat on our survival.  Therefore, we emotionally react with fear and alert; we activate our Fight –Or – Flight syndrome, a remaining of early phase in our evolution and the number one cause of tension and stress. The Fight or Flight syndrome is a set of physiological symptoms, designed to enable us to fight a source of danger or flight when fighting is not optional.  Both these reactions will take: lots of adrenalin, shallow breathing, tightening of the muscles, fast heart rate, and an alert somatic system.

   Now going back to the birth experience, when we react to the pain of contraction with our habitual instincts described above, we are in the way of a good healthy birth.  The uterus works on two kinds of “fuels” –oxytocin and oxygen, both are in charge of effective contractions. In the presence of high levels of adrenalin, the release of oxytocin is inhibited, and our contractions are not becoming stronger and closer together, meaning- Failure to Progress.

We can summarize it this way:  FTP leads to FTP.  Meaning- The Fear –Tension- Pain reaction in birth leads to Failure To Progress.  Labor tools are related to the physiology and anatomy of birth since they allow the mother to de-activate the fight-or-flight syndrome, and by practicing them the mother is suppressing the release of adrenalin, increases the release of oxytocin and the flow of oxygen to her uterus, and reacting to her contractions with acceptance.  Here are some of the labor tools we practice: breathing techniques, massaging, positioning, several visualization techniques, positive affirmations, relaxation, and hydrotherapy.

About four years ago I studied to become a life coach. The coaching practice brought up a new understanding in the way I think about labor tools these days, and led to the development of the Labor Practice.  In coaching we are supporting potent clients in making a change in their lives.  The change can be in the way they act or in the way they are being with something.  A very central term in coaching is the change of the habit. As a life coach I encourage my clients to explore and distinguish habitual ways of doing and being, which do not serve them any more.  These old habits are in the way of getting what we say we want and doing what we say we are committed to.

With this understanding, I was able to see that acquiring the labor tools as part of the childbirth education class is not enough. That if our reaction to pain is indeed a habitual instinct, then it takes a lot more practice for the mother in order to break the habit and rely on a different set of tools. With that thought in mind I developed the Practicing for an Active birth  DVD. This is the most comprehensive Hands-On Visual Guide you can find !  Now couples can watch this DVD at the comfort of their home,  and practice labor tools as many times as they want, until the mother really fells she owns this set of tools.

   The DVD presents a wealth of labor tools – Positions for birth, Breathing techniques, different techniques of visualization – like spiraling of the body and expansion of the belly, Massaging techniques, hydrotherapy and more.  You will learn these tools in accordance with the different phases of the birth. In each phase of the birth, a different progress needs to take place, and I introduce the right tools to invite this progress. Whether it is a release of oxytocin in Early Phase or the engagement of the baby in Active Phase, you will understand the logic behind the tools and how they can best support you in achieving a healthy and empoweirng birth.

Here is a clip you can watch

Birth Coach Method Introductory Series – Part 1

The first book I ever read about doulas, ‘Mothering the Mother’ by Marshal Klaus, inspired me at the beginning of my career. But today I have a different perspective on the book. I think that the title implies that doula is a non-professional role, because mothering is an important role that comes with no professional requirements, certification, or a body of knowledge. Another popular doula guide, ‘The Birth Partner’ by Penny Simkin, also implies unprofessional collaboration, as though doulas and mothers have the same degree of knowledge about childbirth. In addition, the title ‘Doula’ means ‘Servant’ in ancient Greek.” The preconceived notions of a Birth Doula are degrading. It’s no wonder that I still hear moms saying ‘My mom/sister/best friend will be at my birth, so I don’t need a doula.’ This situation greatly motivated me in creating the Birth Coach Method training program.
This video is about the need to empower birth doulas and establish their professional status. Doulas should be trained as birth coaches. Their role is to coach the mother prenatally, assist her in practicing for her birth, and only then coach her during her birth. This is the goal of the Birth Coach doula training program. Watch this video, the first in my introductory series of the Birth Coach Method

Birth Coach Method – A Paradigm Shift in Birth Support

What happened the first time I introduced my  coaching method

Last week I had my very first public speaking introducing the Birth Coach Method to a local audience of birth professionals at the South Bay Area California. It was a moment of truth, and I have to confess – I was crazy stressed. It is one thing working diligently on my laptop in the comfort of my home, being fully convinced that integrating coaching strategies into birth support practice is the right direction and another thing to stand and talk in front of birth professionals. An hour before the talk there was no sign to my strong convictions.

My local community is the warmest, most engaged and fun audience I could have asked for. In just a few moments,  I was able to connect to my motivation and strong found conviction, and confidently introduce Birth Coach Method philosophy using the PowerPoint presentation I made.

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Practicing for an Active Birth; Learn a New Set of Responses to Labor and birth.

I have been teaching a childbirth education workshop called “Practicing for an Active Birth ” for ten years in Palo Alto. My students were raving about this class, and the local midwives were continuously recommending it to their birth clients. On November 2012 I launched the DVD “Practicing for an Active Birth; The Most Comprehensive Hands-On Guide for a Healthy and Active Birth”. This DVD presents 2.5 hours of labor support tools and comfort measures for birth, and many coaching tips for both birthing mothers and their partners In accordance with different phases of birth.

After becoming a Life Coach I could reflect on my work in the field of birth from the coaching perspective, and  I realized I want to find a way to encourage my birth clients to practice their labor support tools more than just a couple of times in childbirth education class. I wanted clients to understand that their habitual reaction to pain is in their way to a good healthy birth. Our habit is to respond to pain with rejection and contraction, tightening the muscles. Labor support tools were designed to help birthing moms cope with labor sensations and pain and to invite progress at their birth. But they need to own them, to make a new habit out of them so that in labor they will respond with them to labor contractions and strains. This apparent need for changing the habitual response to pain motivated me to publish this DVD  which allows couples to practice labor support tools at the comfort of their home until they own them. Since its launch, the DVD has been sold on Amazon and getting great reviews.

As a student of the  Birth Coach Training program, you will watch clips from this DVD in accordance with the phases of the birth. This will enable you to practice all the breathing techniques, positions, massage techniques, visualizations and other coaching tools that you want to implement when your client goes through this phase.  The same is true if you are registered to the “Hands-On Series” membership level.

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