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,

Neri Life-Choma

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