“Impression without Expression Causes Depression. Study without Service Leads to Spiritual Stagnation”. I recently came across this saying by Rick Warren, and it has reminded me of how depressed I was some years ago. I was feeling that my birth support practice is no longer impactful, nor sustainable. I wanted to quit because I found it impossible to provide the service I was trained to provide. As a doula trainer, it made me think of all my lovely doula students who had never established a doula practice or served birth givers because they found it to be irrational in its demands and not sustainable. This is not longer the case. I was blessed to reinvent and reclaim my passion for birth support by developing transformational birth support coaching. The miracle grew even bigger when my students began offering transformational birth coaching exclusively, without being hired as a doula. Some decided to stop providing doula services completely. Naima Beckles is one of them. Soon after Naima graduated from the course, she wrote to me thanking me for the inspiring training and shared that she was now exclusively coaching birth clients. I felt inspired and interviewed Naima to learn about her professional revival.
Pregnancy and childbirth are the most profound experiences in human lives. It is the utmost transformation. However, in our culture, the conversation about these meaningful experiences has been reduced to one topic: labor pain – the fear of it, coping with it, and praising or cheering those who succeeded to avoid it and had a ‘Natural Birth’. The cultural idealization of those who gave birth using no pain medications has had its emotional toll on birth givers. A 2018 study found relationships between an increased chance to develop postpartum depression when birth givers took epidural to alleviate pain in childbirth and did not meet their goal to avoid it. These birth givers experienced “negative emotions related to unmet expectations or a sense of personal failure”. These findings suggest that decisions about coping with labor pain have social and personal values attached to them, presenting individuals with ‘The Epidural Dilemma’. This dilemma is fervent and can be navigated with coaching strategies.
The psychological birth of a mother, similar to adolescence, involves hormonal and identity shifting.
Listen to my interview with Maureen McGrath where we discuss Matrescence
January 24, 2021
Throughout this profound identity transition, an expectant individual undergoes an average of about 13 doctors’ appointments during pregnancy, 3 urine tests, 4-5 blood tests, 4 ultrasound tests, 2-3 vaginal exams/swabs, and 2 monitor exams. That is if they are healthy, give birth before or on their EDD, and do not need further diagnostic or screening exams. Then, they will go through the childbirth experience. An experience in which the transparent fabric of one’s routine is disturbed by pain, fear of death, and temporary loss of control. Their body expels a new human being while they are under the care of medical caregivers – most of them practice from an “expert” position. This abundance of encounters with medical maternal healthcare providers amplifies the neglect of expectant individuals’ emotional state and mindset during this profound transformation. Not even one behavioral assessment is routinely recommended for this individual. Instead of focusing on individuals’ well-being and mental health as they transition to parenthood and prepare for the profound transformation of childbirth, maternal caregivers and researchers tend to focus on how the baby is doing.
When doulas provide prenatal coaching sessions they can help clients be better prepared for the birth of their child and demonstrate a higher level of accountability for their childbirth experience. This is not done by means of education. Prenatal coaching goes beyond teaching and delivering evidence-based knowledge.Its purpose is to help couples discover hidden gaps, resistances, or inner conflicts, and work together as a team to resolve them.
Just like prenatal coaching, transformational postpartum coaching shifts the focus from helping or informing to elevating new-parents’ performance level, self-confidence, and well-being.
Most of my writing has been dedicated to pregnancy and childbirth support. During the pandemic, I’ve been thinking a lot about the challenges of new parents or parents who have expanded their family recently. I want to share how transformational coaching during the parents’ postpartum period can enhance their experience.
Twenty years ago, when I was nearing the end of the yearlong doula training program in Jerusalem, my trainer advised us all not to quit our jobs in favor of establishing a doula practice. Regardless of the fact that we enrolled in a yearlong program with a commitment to give 100 hours in hospital shifts, Shoshannah guided us to view the doula role in terms of community service rather than a career path.
A doula for every woman is not just right; it’s a valuable asset
This perspective is reflected in the well-known saying “A doula for every woman”, a motto I trust was carved with noble intentions but prioritizes the welfare and empowerment of only one woman – the birthing woman, at the cost of disempowering another woman – the doula. It should be noted that the topic of doulas’ monetary compensation, just like the other two dilemmas I addressed before it, has also caused some turbulences within the doula community. This can be read in Penny Simkins’ Real Talk from Penny Simkin, in which she responded to the disagreement with this motto as expressed by a ProDoula member.
This is the second blog in a series of three that I began writing in November. I am very passionate about the doula profession. That’s why I feel called to write this series before it is too late. And by “too late” I mean that I think our profession is in danger. Being a doula trainer and at the same time an approved continuing education provider for obstetric nurses, allows me to be connected and empathetic to both sides of the conflict – doula and medical caregivers. On top of listening to nurses’ pain points in their relationships with doulas, I recently have been invited to speak at a few OBGYN and midwives’ practices and heard that they are on the verge of banning doulas
Additionally, recent events confirm what I have been fearing – the current practice of doulas’ who share evidence-based information that supports better obstetric practice (while not being medically trained and bearing no liability for their clients’ health) is going to hurt us.
It puts our relationships with medical caregivers at risk.
It will lead more cities to follow New York in attempts to license doulas.
It will lead our best friends – hospital-based midwives – to ban doulas or have blacklists of unwanted doulas that they don’t trust.
It might also make it harder for us to find paying clients because they hear more and more stories about doulas who break the trust and rapport that couples have established with their medical providers.
I wanted to quit, but I discovered coaching and got excited again about being a doula.
After a decade of practicing as a doula and childbirth educator, I was about to quit. I was burnt-out. The rising rate of medical interventions led me to doubt my ability to fulfill my role and facilitate healthy and positive birth experiences. Additionally, the growing gap between doulas’ approach to childbirth and the approach held by the medical caregivers that our clients trust for their journey, triggered a lot of tension in me. These circumstances, in addition to the given hardship of the doula practice, made me reconsider my career path.
Ten years have passed since I felt under-resourced and I still enjoy practicing as a doula and training doulas. How did this happen? I discovered coaching!
In the last couple of years, I have come to learn that I am not the only one to have gone through this professional struggle. In spite of ACOG’s recognition of doulas’ benefits and some big headlines reporting the many celebrities who hire doulas for their birth, doulas experience a few major dilemmas that cause great hardship.
This uneasiness reflects in social media and doulas’ blog posts, and I can sense the confusion, frustration, and disputes that percolate within the doula community. Being passionate about doulas and our valuable stewardship position, I’d like to share my personal path that helped me resolve the three major dilemmas doulas face:
Recently I watched the movie ‘Trial of Labor’, and listened to the stories of three women who wished for a VBAC (Vaginal Birth After Cesarean). It made doubt the approach we, birth activists, take in our efforts to improve maternal care. Especially our continuous attempts to educate and empower expectant individuals by pointing out the flaws of the medical system and its representatives.
What did birth activism look like in the 90s?
I gave birth to my oldest child in 1995. I often say that she was my muse since my first pregnancy and birth experience led me to pursue a career in the field of birth support. I was lucky to go through this journey in the 1990s, as it seems that these years offered women a wealth of information about natural childbirth: Barbara Harper first published Gentle Birth Choices in 1994, the same exact year that Michel Odent published his book – Birth Reborn. Janet Balaskas published Active Birthin 1992, and Marshal H. Klaus published Mothering the Motherin 1993. Henci Goer closed the 1990s by publishing The Thinking Woman’s Guide to a Better Birthin 1999. All of these authors were, and still, are my teachers and mentors, not to mention idols.