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?
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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
*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.