How informing about Evidence Based Care Failed to Accomplish a Much Needed Change in Maternal Care or The Difference Between Informing and Evoking Change in the Field of Childbirth

Are you familiar with Albert Einstein’s quote: “Insanity: doing the same thing over and over again and expecting different results?” Lately, I have begun to think that this is what we have been doing all these years. And by we, I mean birth activists, birth educators, and birth keepers. This came to me after watching the recent movie ‘Trial of Labor’, and listening to the stories of three women who wanted to have a VBAC. (Vaginal Birth After Cesarean)insanity

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 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. In my eyes, they all dedicated their career to helping society perceive the experience of childbirth as a healthy and normal event in women’s lives.  As a childbirth educator, I was referring my students to the books mentioned above as resources. I was thinking – well, who can read chapter 2 in Harper’s book, where she describes The medicalization of childbirth and distinguishes myth from truth about birth, and still obey the medical authority? (Harper, 1994, pp. 51-91). Since 2002, I opened every class that I ever taught about ‘Common medical interventions in childbirth’ presenting Goer’s remarkable observation, at the beginning of her book, that “Obstetric practice does not reflect the research evidence because obstetricians actually base their practices on a set of predetermined beliefs”. (Goer, 1999, p. 3) Again, I was thinking: who can read this statement and the evidence-based information that follows, which refutes the notion that obstetricians practice is evidence-based, and still blindly follow medical advice? I was committed to dedicating a lot of time to the hands-on practice of labor support tools in my childbirth classes, following the Active Birth movement which began with Janet Balaskas. For ten years before I published my childbirth preparation DVD, I offered a complimentary workshop called ‘Practicing for an Active birth’, designed to encourage couples to go beyond learning about birth, to learning how to be with childbirth and go through that intense life event. As a birth doula I was, and still, am, celebrating every woman who has hired me to support her in having healthy childbirth, and I am committed to every couple’s positive and empowering experience, but cesarean rates and use of epidurals just keep going up, something is still missing…

In the first decade of the 21st century, we took the birth keepers agenda to the movies: Birth as we know it was released in 2006, Pregnant in America was released in 2008, at the same year as The business of being born. Laboring under illusion was made in 2009, and Orgasmic Birth was released in 2012. One would assume that movies are reaching the mass more than books, and expect better results in terms of educating couples about childbirth and leading them to make informed choices, and yet we saw no change in the anticipated direction. After 20 years of birth activism, the statistics of medical interventions in Labor and Delivery are disheartening; the high rates of augmentations and inductions, epidurals, cesareans, and the low rates of VBAC’s and home births break my heart. I believe that many fellow childbirth educators and doulas feel the same way when they think of all the couples they taught or supported that ended up with a cesarean or came back home from a long-lasting birth that strayed from their birth plan. So maybe it is time to take a different approach in order to create the change we strive for?

It wasn’t until I became a life coach that I was able to put the finger on what it is that is missing, or what it is that is preventing parents from making better choices, based on the evidence-based information we shared with them. However, it becomes clear when you focus on how one practices rather than on what one knows; it is not by sharing our knowledge that we can create a change, it is by evoking the change in others. I’m going to paraphrase here on Goer’s observation regarding obstetricians, and apply it to couples as they prepare for childbirth: “Parents’ choices in childbirth do not reflect the knowledge we share with them, because parents actually base their choices on a set of predetermined beliefs.” This means that just like the evidenced-based knowledge suggested by studies in the field of birth can’t lead obstetricians to change the way they practice, it can’t lead parents to change the choices they make. There is a need for a different mechanism than teaching evidence-based information in order to create change because change is not achieved by the practice of informing, but by the practice of coaching.

When looking at the differences between educating and coaching, here are a few noticeable ones:  tutoring-coaching

  • The educator is an expert in a field of knowledge, whereas the coach is an expert in an area of practice, or performance.
  • The educator is delivering a body of knowledge, informing, whereas the coach is providing tools and strategies to enhance the performance in the desired area.
  •  The relationship between the educator and the student is hierarchic, meaning that the educator is an authority, holding a body of knowledge that the student does not possess. In coaching, the relationship is more like a partnership, with the client’s goals, and her journey to reach them, being at the center of the partnership.
  • While educators are mostly sharing information students are interested in, answering students’ questions, coaches are mostly asking questions. The coach’s questions facilitate clarity about the client’s goals, needs, and belief system. The coach might also suggest options to reach these goals while staying in alignment with the client’s truth about the area of practice and about herself.
  • Both educators and coaches assign tasks to their clients, but of a different type. While the educator assigns tasks that will enhance a better understanding of the matter at hand and the expansion of knowledge, the coach assigns tasks that will evoke better performance and functioning in the coaching field.

Looking at these two developmental practices, which one do you think is a better practice in order to invite the change in the field of childbirth? Since we did not make much progress undermining the authoritative position of the medical paradigm in childbirth by educating and teaching, or by providing couples with evidence-based knowledge, maybe it’s time for coaching. Coaching makes so much sense when we acknowledge that women and partner’s choices in childbirth are based on predetermined beliefs rather than on knowledge.

Coaching is the art of reprograming the mind and leading clients to form new concepts. The old concepts are holding our clients back from achieving their goals, as they are based on predetermined beliefs and myths. In the field of birth, they are based on fear rather than on reality. These concepts were formed in the past, and they no longer serve our clients in the present. The new concepts will serve our clients better and will allow them to adopt new habits of behaving and responding. We usually want new concepts to be aligned with our client’s new belief about the matter. In our area of practice – leading women to healthy and normal births, accomplishing the change depends first and foremost on women’s ability to perceive childbirth as a healthy and normal life event. There are many predetermined beliefs, or myth, that can sabotage a healthy birth. Many of them are part of our collective unconscious, inherited from our ancestors through cellular memory. Yes, in the old days every birth was a risky experience for mothers and babies, but for so many reasons it is no longer so. However, it is not enough to teach couples about all the scientific inventions and lifestyle changes that made birth a pretty safe life event, nor it is enough to point out to them that their doctors are biased by non-scientific and predetermined concepts. It would be a better practice to coach them, and the medical staff together, in order for them to form a healthier concept of childbirth that will lead to better practice and better choices. In order to embrace the new concept, coaches will assign areas of practice for both expectant parents and obstetricians; new ways of responding and doing, new strategies and skills that they will need to adopt as their new habits. This process will allow both expectant parents and obstetricians to perform better in childbirth; obstetricians will be more open to base their practice on the belief that childbirth is a healthy normal life event, and couples will do the same. This utopia can become our reality when both obstetricians and couples will let go of the predetermined belief that birth is a painful and dangerous process.

What do you say? Shall we try a new way of leading the change? Prenatal coaching and coaching through childbirth is a new paradigm in the field of birth support, and I believe that it can lead the change.

Resource list:

  1. Balaskas, J., 1992, Active Birth, Harvard Common Press, Boston
  2. Goer, H., 1999, The Thinking Woman’s Guide to a Better Birth, Penguin Putnam Inc., N.Y
  3. Harper, B., 1994, Gentle Birth Choices, Healing arts press, Vermont
  4. Marshall, K., 1993, Mothering the Mother, Perseus Books, Cambridge
  5. Odent, M., 1994, Birth Reborn, Birth works,


Neri Life-Choma

I am the founder of Birth Coach Method and am celebrating 20 years of leadership in the field of childbirth support. Throughout my career, I have been honored to provide doula support and teach childbirth ed. classes to hundreds of expectant couples, as well as to direct two birth resource centers. I am also a doula leader in my community in the South Bay area of Silicon Valley in California.
Neri Life-Choma

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