Tag: doula profession

How can a doula make a difference at another doula’s birth experience?  

I am called to support my colleague and friend. How do I step up for her?

I have been practicing as a doula for almost three years. I love this role of supporting families. My main goal is for them to feel supported and loved as they welcome their baby to the world. I was a teacher for over ten years prior to launching my doula career, so planning and organizing was a big part of what I did. I like structure. As a doula, I try to structure my prenatal sessions. It helps me get to know the needs and goals of my clients in a systematic way and to understand how to support them and meet them where they are at. As part of my service, I also fill in any educational gaps as needed. I want to help them understand their options.

But what happens when I have a client who is a doula? How do I inform her? Do I just offer labor support and skip all my sessions with her? I usually offer each client three to four sessions. This client didn’t need to practice the tools of labor support with me since she is a trained doula and prenatal yoga instructor. She also had taken a childbirth class with her partner. So I felt like the bulk of what I usually offer my clients was off the table. Now what? I needed to go beyond informing and all the way to coaching. 

 Highlights from my coaching process

I already had a good rapport with my client. We had built trust by sharing our experiences as doulas and attending a doula training together. I needed to challenge myself and be open to supporting her in a different way. I believe this was a real opportunity for me to focus on using my coaching tools. The process was messy. I felt like I had to wait for the moments to coach, but I also learned that coaching is not as structured as teaching, so I was allowing it to happen organically. Here is how the process unfolded and my reflections.

Step #1: Saying ‘goodbye’ to old ghosts & ‘hello’ to current goals and wishes

In our first meeting with my client and her partner, we talked about their first birth experience. This conversation was unavoidable. It was a cesarean birth because the baby was in a transverse position. My client knew she had only one option: a cesarean section. At the time, she was okay with the option. She did not think much of it. Later, she learned more about birth and realized that she did have more options that the doctor did not communicate to her. She felt cheated. I actively listened to her story and the feelings it brought up. We explored what her options were now. I was hearing a lot of what she did not want for the upcoming birth, and I knew we needed to create clarity on what she wanted. So I changed the focus to creating a list of priorities – what was important to her and what was important to her partner. This then led to envisioning her ideal birth experience. We set up some action items for her and her partner to complete. The top action items were creating a birth plan and attending a childbirth class to explore the option of using self-hypnosis and relaxation techniques during pregnancy, labor, and birth.

Step #2 – Reviewing the birth plan; communicating her desired vision

In the second meeting, we reviewed the birth plan that she created. Some important highlights from the birth plan that surfaced included to give birth at a very specific hospital location due to access to midwives, to hold off on vaginal exams until there was an urge to push, to perform monitoring only intermittently, and to avoid IVs.  

I got an impression from my client that it was going to be a fight. She felt like she had to fight for specific wishes that don’t follow hospital protocol. This is the last thing that I want my client to feel going into her upcoming labor and birth. What a buzz kill. We want oxytocin flowing not adrenalin. My client decided to tackle her requests ahead of time. Her next step was to present this plan to her doctor and start a conversation about her desired birth experience. This was an important action to ensure that her birth plan would be respected and honored when giving birth.

Reflecting back on this experience with my coaching mentor, Neri Choma, I now recognize that this session had a theme to explore. Does advocating for ones’ wishes have to be a fight? How does fighting serve you in this situation or any situation? Can your needs be met without a fight? Can you make a request? Fight or flight is a hormonal experience that should be avoided during pregnancy and birth. A way to shift the focus and avoid the fight or flight response is to explore the possibility that no one will fight or that the medical staff will just be okay with it.

 

Step #3 – Coaching around doubts and fears

After our second meeting, I was sensing a lot of fear going into the birth but I didn’t know how to address it in our session. She had doubts that weren’t being voiced about giving birth. I sensed it in her tone and body language. I am a novice at incorporating coaching tools and didn’t know whether I should be the one to open this discussion. This encouraged me to be creative with strategies on how to coach my client. I might have been drawn toward informing in order to reduce fear. Instead, I facilitated a ceremony to release fears. We had a small gathering with close friends and doulas, women who are supportive of my client’s journey. The gathering was very nurturing and supportive. As a group, we wrote down fears and shared them out loud. We named them and released them by burning the written fear. This process helped my client to explore her current reality, namely doubting her ability to give birth vaginally. The ceremony inspired her to take action and to prevent her fears from sabotaging her goals. Just talking about fears is very abstract, going a step further and performing a tangible action benefited my client. I observed a release in her tone and body language. She was going into labor and birth with confidence. Or was she?

Step #4: Coaching for the WIN – facilitating alignment

Usually, I spend the last prenatal meeting with my clients practicing coping techniques and positions and doing a test run for the birth. This client did not need this, as she is already an experienced birth professional. Instead, something very rich came up for her and it was an excellent opportunity for me to practice my coaching tools. I found an OPENING to coach!

My client shared that her OBGYN offered to do a membrane sweep in her last prenatal. My client was seriously considering it. Her partner and I were surprised that she wanted a membrane sweep. There was a lack of alignment with her priorities. Her thinking was not aligned with her birth intentions, nor with her beliefs. At this moment, I observed her being very uncomfortable.

I inquired trying to understand why she wanted to get a membrane sweep. Her partner started asking excellent search questions. I was giving him a thumbs up on the side. It took some time for her motivation to surface, but then it did. We all discovered that she did not want her baby to be born on December 24. Why? Where is this going? I asked: “What happens if your baby is born on December 24? What does that mean to you?”
In her mind, it is the biggest holiday of the year. She would be robbing her daughter of a special day because it would be overshadowed by the biggest holiday of the year in her country. I asked her, what if your baby is born on December 24? Can you accept that? A plan had to be made in order for my client to accept this possibility. And so, she came up with a plan: If my baby is born on December 24, we will celebrate her birthday in the morning with a cake. And what about the decision about the membrane sweep? We did not pressure my client to make a decision on the spot. Based on our discussion, she was going to decide what to do in her upcoming appointment. 

Would I have discovered this if I only educated and informed my client? I highly doubt it. To me, this session was a breakthrough. It taught me how valuable it is to be with my clients in the moment and wait for those coaching openings. Look for the opening! Go beyond informing and coach your clients to a healthy birth experience.

My client decided not to have a membrane sweep. She went into spontaneous active labor on December 23 and met her baby girl on December 24 in the early morning hours. My client had a vaginal birth after a cesarean section. This was her goal and she achieved it. And I got to offer her new insights about herself as her coach and doula! 

 

Becoming a Doula: A Good Career Choice or a Community Service?

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.

Continue reading

Is the Doula Profession at Risk?

Doulas’ Dilemma #2: The Doula Scope of Practice

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.

Continue reading

Birth Support Coach vs. Doula

Since the seventies, those who provide education and support to birthing individuals have all been called ‘Labor Coaches’. In that group are childbirth educators who teach about childbirth and deliver a body of knowledge, usually in a group setting. Also in that group are doulas who are trained to provide emotional, physical and informational continuous support throughout the birth. We all got used to thinking about childbirth as an event in which our role is to help the birth giver cope with labor strains while providing information, reassurance, and applying comfort measures.

On the other hand, coaching, a growing industry generating $11 billion in the USA, is an entirely different practice that stands by itself. It is the practice of leading competent and healthy individuals to optimally perform in order to achieve their goals.

Birth support coaches that are trained here at the Birth Coach Method, likewise, are also trained to coach expectant individuals towards achieving their desired birth experience. 

Continue reading

Doulas’ Professional Status: Peers, Companions, Lay Women or Birth Support Professionals?

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: 

Continue reading

Resolving the Advocacy Dilemma in the Doula Practice – Webinar

The advocacy dilemma in the field of childbirth support is a tough one to crack. The dilemma lies in the tension between certain components of birth support practice, such as serving and supporting, and other components such as being a change agent in our society and a birth activist. By relying on coaching principles and strategies, I suggest that you can be sure to practice within your scope of practice and to refrain from projecting or engaging any ‘activists agenda’ in your relationships with your birth clients. Coaching is the pathway to client-centered relationships and care.

Continue reading

Who is the Birth Expert Here?

Does an ‘Expert Position’ serve professionals in the field of birth support? 

Do you consider yourself an expert in ‘how to give birth’? If you are a childbirth educator, a birth doula, a midwife or a labor and delivery medical staff member, I’m almost certain that there is a confident voice inside your head saying, “Yes, I know all about giving birth, it’s my profession and what I do for a living”. I believe that since the seventies, with the beginning of birth activism, birth givers have been torn between two types of “experts” – “medical experts” and “natural birth experts.
Maybe it’s time to rethink our position: Can anyone be an expert and say how another person should give birth?

Continue reading

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.  

Continue reading

The Trauma of a Doula who Witnesses Abuse in L&D

I wish I would never have to write this blog post, but I am afraid it is the only way for me to heal my own trauma. I witnessed abuse in the L&D room. I felt helpless. I felt I had to remain silent in order to stay in the room. This experience made me think of all my doula sisters who are witnessing abusive experiences all over the world.  They must remain silent in order to stay in the room. I want to be the gatekeeper in L&D. I am like the news reporters who report crimes against humanity and wake the world up to take action.

Can birth support become a traumatic experience for doulas?

Verbal abuse in L&D: threatening, scolding, ridiculing, shaming, coercing, manipulating, mocking, dismissing…

The terms Vicarious traumatization (VT), Secondary Traumatic Stress (STS) and Compassion Fatigue, are professional terms describing the trauma of caregivers. The trauma results from empathetic engagement with traumatized clients and their reports of traumatic experiences. Even this term cannot describe the trauma of the doula who witnessed her birth client being abused. I did not hear the traumatic birth story, I was present when it happened.

I want to stress the fact that this childbirth could have been considered a beautiful, healthy and positive birth process if it weren’t for the abusive behavior of the doctor. In order to convince you of that, I ask that you read the birth story below twice- on the first reading, read only the black text; on the second, read the parts that are in green italic letters as well. The birth story is at the bottom of this post.

I am not the first one to report abusive behavior in L&D. As part of my healing process, I searched for articles about abusive expressions in L&D and found them in the two languages that I speak and read: English and Hebrew. A few months ago, an article came out in one of the most prestigious Israeli newspapers describing the horror and abuse of Israeli birth givers experience in L&D.

We (doulas, patients, L&D nurses) tend to feel helpless, so we rationalize and accept these behaviors while denying our experience of them.

The topic has been researched and studied

I discovered this article: Abuse in Hospital-Based Birth Settings, by Susan Hodges, MS, to be very helpful in achieving my goal – defining the trauma of the doula who witnesses abuse.  Hodges describes the expressions of labor and delivery abuse as well as the dilemma of the abused patient: Verbal abuse includes behaviors such as threatening, scolding, ridiculing, shaming, coercing, yelling, belittling, lying, manipulating, mocking, dismissing, and refusing to acknowledge—behaviors that undermine the recipient’s self-esteem while enhancing the abuser’s sense of power, typical of bullying. Most of us would recognize these as abusive behaviors in just about any other setting. However, because we are socialized to both expect trustworthy and professional behavior in the hospital setting and to be “compliant” with medical directives, these behaviors are seldom recognized and interpreted as abuse. Furthermore, staff and doctors are the authorities in the hospital, while the pregnant and laboring woman is merely a “patient.” Such a huge power imbalance allows, even encourages, bullying and abuse. We tend to feel helpless, so we rationalize and accept these behaviors while denying our experience of them.

By using the word ‘we’ in the last sentence Hodges implies that patients and doulas, or other witnesses, are in the same position – feeling helpless and rationalizing this behavior as ‘poor bedside manners’ – which we tend to be more forgiving towards, as a society. How many times did you hear the sentence, “He has poor bedside manners, but he is a great doctor”.

I believe that that the doula position is different in regard to an abusive environment in two aspects:

  1. Doulas know better than their clients on what to expect: While the doula and the expectant couple can both equally recognize rude behaviors such as “ridiculing, shaming, coercing, yelling, belittling, mocking, dismissing…,” the doula is more knowledgeable and experienced in the field of birth support and is far more equipped to recognize threatening, manipulation, and lying.  Identifying these in Labor and Delivery will require basic knowledge of the field terminology, ‘evidence-based care’, and a basic understanding of causality in childbirth. This means that the doula can detect and identify abusive behavior that her clients may perceive as an act of care. Hodges points out the need to educate birth givers in order to reach an informed consent:Women who are well-informed and ready to ask questions about procedures, treatments, and interventions during labor can address some deficiencies of “informed consent” and not be hoodwinked into unnecessary interventions.“ However, this kind of education breaks the rapport and trust between birth givers and representatives of the medical system. This situation is described by Christine Morton as the doulas’ advocacy dilemma in her book ‘Birth Ambassadors’, and there is a general agreement among doula certifying organizations doulas should avoid initiating a tug-of-war in L&D.  Additionally, this type of education seems to work prenatally, but is flying out the window when birthing individuals are overwhelmed with fear.

A doula who speaks-up is taking the risk of becoming an unacceptable or unwelcomed at this facility in the future

  1. Doulas lack the ability to file a complaint or take any affirmative action: Several organizations, such as CIMS, LAMAZE, and Citizens for Midwifery, encourage birth givers, who suffered abuse in L&D, to file a complaint following the birth. According to Hodges, this action is not only with the purpose of reducing the expressions of abuse in L&D, but instead is perceived as an act of empowerment. “Filing complaints alone will not solve the problem. However, women, I’ve spoken with who did so felt empowered, and it helped them acknowledge to themselves that they had been mistreated and were not at fault. Well, here lies a big difference between the patient and the doula. Doulas remain silent.  A doula who shares her negative experience with a caregiver or with hospital staff is taking the risk of becoming an unwelcomed persona in this facility.  We are lucky to have our doula support circles, and we can always cry on our peers’ shoulders and get their support, but this is equivalent to the birth giver sharing her trauma with a friend, and this might not be enough for true healing and empowerment.

Please read the story twice

Now that I’ve shared some general insight about abusive behavior in L&D, here is the birth story that I promised to share with you. For your own benefit, please read twice as previously requested.

My client, Beverly, woke up at 4 am in a puddle. Her first labor began with a rupture, and her contractions began shortly after. By 7  am her contractions were around 50 seconds long and about 5 minutes apart. At 10 am, her contractions intensified and occurred every 3 minutes for about 1 minute at a time. At that point, Bev noticed that she was bleeding and decided to meet me at the hospital.  Upon arrival at the hospital, she was vaginally checked and measured to be 4-5 cm dilated and 90% effaced, and after a 30 minute EFM, we went to the shower. Bev was breathing beautifully and handling her birth with grace and confidence. Her OB was out of town, and the on-call OB from his group showed up and went into the shower to listen to her lungs. After the OB visit, Bev’s partner came out of the shower and shared that the doctor was commenting on the couple’s request to delay the cord clamping, by saying that he can wait only 90 seconds, as too long of a wait can lead to disasters. He shared an article he has just read about the baby’s leg amputation due to a cord clamping delay. I went back to support Bev in the shower, and she shared her disappointment that her OB was not the one to see her through her birth. After a long hour in the shower, Bev felt some pressure towards her anus and was asked to come out and be checked. She was 6-7 cm, 100% effaced, baby in a station (-2).  It felt for her like the right time to get the epidural that she has planned on taking. At 4pm, the nurse started the drip of fluids. Coping with the contractions in the room Bev was convinced that taking an epidural is the right thing for her. She asked for a low dose epidural, but the anesthesiologist has said that preference is, to begin with, a good dose and then slowly lower it. Following the administration of epidural, Beverly’s contractions have totally stopped, her blood pressure went deeply low, and the fetal monitor showed a 4-minute deceleration, which was controlled and recovered with a change of position and oxygen. She had no sensation nor the ability to control her legs. While the nurse and the anesthesiologist were mainly occupied with recovering the low blood pressure and the baby’s FHR, I was concerned with the lack of contractions. I thought it will be wise to prepare my clients for the possibility of administrating Pitocin, reminding them that it is one of the possible side effects of epidural. After 3 hours wait, with no sign of contractions, The OB came into the room and began explaining to the couple that as for now, a process of deterioration of the baby’s brain has already begun. The OB further explained that if they do not manage the birth and bring it to an end than this deterioration can become brain damage. (I am sharing the nuggets of it, as he rambled on and on for a good 10 minutes, sharing ‘studies’ and medical schools ‘All in favor of the couple making an informed decision’. ) When the couple asked for a few minutes to think about all that they have heard, the OB looked me in the eyes and said: ”Just for you to know, under the law of California, any medical advice is considered practicing medicine and you will be in big trouble”.  The couple decided to follow the OB’s suggestion, who has inserted the IUPC and began Pitocin. Following the administration of Pitocin. Bev’s contractions have recovered; by 8 pm she was fully dilated, with the baby still in (-2). A dose of antibiotics was given to the birth giver due to maternal fever and the long rapture. By 10 pm, with the baby in (-1), she began to push. When the baby came down to (+1) Bev was able to feel the pressure building, and she pushed strongly, making progress with each contraction. The nurses changed shifts and we had a new, refreshed and very supportive nurse in the room. As the baby descended, there were a few more declarations that recovered after the contractions were over. The nurse kept encouraging and complimenting Bev for her effective pushing, and then the OB came again to the room and began talking to the partner. In his words, he said, “I know you do not like it when I bring things ahead of time, but I think it is important for you to make an informed decision, therefore I want to talk to you about choosing between forceps and vacuum”. Then he stopped because Bev felt the urge being built and we all attended to her as she pushed, the husband is next to her head and counting, the nurse at her perineum and I stood by her side supporting her leg. The contraction is over and the OB continues talking: ” I personally prefer the forceps, but it is a matter of medical schools, as most doctors these days will use the vacuum…..” and he stops again as Bev is asking for our attention and is pushing like a lioness, I swear. As he went out of the room, leaving the partner to make his decision, the partner asked me what was going on. He felt like one of us is lying to him, not telling the truth.  How can it be that the nurse and the doula are being all excited about the progress, and the OB is asking him to choose between the vacuum and the forceps? The nurse and I tried to reassure him that there will be no need for him to choose.  He was so terrorized and said:” I know the vacuum to be safer for the baby, but I’m afraid to choose against his preference, he might get really angry and decide to end it now with a cesarean”. In order to lead him back to his logical thinking, I began asking questions: ”What do you know about vacuum and forceps”? And then asking the nurse: “Percentage-wise, what would you say is used more here in the hospital?” The nurse was reassuring the dad that he needs to choose based on what he feels more comfortable with.  This coaching conversation took place between moms pushes. I went ahead asking the nurse: “Is there a medical reason that you are familiar with to end this birth with a cesarean now?”, and we both reassured the dad again and again, while all along the mother kept pushing, and — here comes the head!  The OB was called to the room and began dressing. While it was clear that in the next contraction the head was going to show up, he said “Well, because you were waiting so long since the water broke, and as I explained the deterioration has begun hours ago, and there is already maternal fever, your baby will go to the NICU and will stay there for two days for special care”. The NICU team arrived and a few minutes later we heard the baby crying his lungs out. The neonate doctor said: ”Why was I called? This baby boy is so strong, here mama” and she puts the baby on the mother’s chestBev’s healthy and strong baby boy was born at 12:30 am, and he nursed right away. The couple had two beautiful hours of bonding with the baby.

Does Birth Activism Lead Expectant Individuals to Demand Better Maternal Care?

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 Birth in 1992, and Marshal H. Klaus published Mothering the Mother in 1993. Henci Goer closed the 1990s by publishing The Thinking Woman’s Guide to a Better Birth in 1999. All of these authors were, and still, are my teachers and mentors, not to mention idols.

Continue reading

  • 1
  • 2
0