Your Client Chose A Hospital-Based Birth: Now What?

Whether you are a childbirth educator or a birth doula, you know that most expectant couples you’ll teach and support plan a hospital-based birth. The statistic is that out-of-hospital births are less than 5% of all births. I trust you to be deeply invested in your clients’ well being as they prepare for their nearing birth, and that’s why I am going to teach you how to lead them with respect to their choice of birthplace. I intend to show you how to do these two things:  

  1. Recognize your client’s context around the place in which she chose to give birth.
  2. Lead her in a way that doesn’t evoke internal conflict and resistance between her choices.

When your client plan a hospital-based birth, there are some presuppositions that you want to listen to and respect. The nature of presuppositions is that they are not stated explicitly, but rather are being implied. For example, when I say:  “Breathing techniques are probably the best labor support tools that help you cope with labor strains”, I presuppose the existence of labor strains and the need to cope with them. I feel pretty comfortable when I share this presupposition, even when I become aware of the implication of it – this presupposition implies that I do not believe in a childbirth experience in which labor strains do not exist, and in a birth experience in which there is no need for coping tools.

My actions, just like my choice of words, manifest some presuppositions that I hold around childbirth. Choosing a career in the field of childbirth support, I revealed to hold the following presuppositions:

  • Laboring women need doula support (presupposition of necessity). 
  • Doula support throughout labor leads to less medical interventions and lower cesarean rates (presupposition of cause and effect).
  • Practicing as a birth doula will allow me to spread the importance of physiological, active and healthy birth and will make me feel fulfilled. (presupposition of possibility and awareness to my feelings).

Just as my choice of words and actions demonstrate my presuppositions, so do the ones my clients chose. So what are the presuppositions that your clients demonstrate when they choose a hospital-based birth? Here are some options:

  • I can give birth at a hospital. (Presupposing the existence of the hospital and the possibility of giving birth there)
  • I must choose a hospital-based birth according to my insurance. (Presupposing lack of other options)
  • When I choose a hospital-based birth, I am _______________or I get ________________(Presupposition of cause and effect)  
  • When I choose a hospital-based birth, I feel _______________ (Presupposition one’s needs, values, feelings)

I leave the blank lines so that you’ll play with optional words that can complete these sentences. I trust that throughout your career you have heard many presuppositions like these from clients, and maybe neglected to pay the close attention they deserve. These presuppositions represent your birth clients beliefs, decisions, challenges, and areas of strengths. Neglecting them might prevent you from understanding their model of the world, and you risk disrespecting this model. You are not required to accept their model, but to respect it and lead them in accordance.

For the purpose of teaching, I am going to risk a broad generalization and say: When your student or client chooses a hospital birth, it presupposes that: 

  1. She believes that it is a safe place for her to give birth in. AND
  2. She believes that the hospital has something to offer her that she needs for her birth. And/Or
  3. She believes she has no other options available for her.

Therefore, any choice of words or actions on your behalf, that implies that your client is not as safe as she might think, or/and that her choice is in conflict with other needs and wishes she has for her birth, can potentially harm her well being. In other words: Expressing any lack of trust in her medical team or the medical system in general, will increase her fear or even elicit her conclusion that childbirth in general, isn’t safe.

Since I trust it is not your intention, I suggest investing a few moments prenatally,  inquiring about your client’s choice of a hospital-based birth. Simple questions like the ones below can lead her to beautifully conduct herself and communicate with the hospital staff :

  1. When you choose a hospital-based-birth, what do you expect the hospital to provide you with? 
  2. Would you like us to explore ways to resolve this conflict in order to get it out of the way?
  3. What are your hopes and expectations of the medical staff?
  4. How will you know when the staff actually meets your expectations and needs, how will that feel?
  5. Do you feel that the choice of hospital-based birth is aligned with other wishes and goals you have? Are there any potential conflicts?
  6. Would you like us to explore ways to resolve this conflict in order to get it out of the way?

I hope that you see how these coaching questions allow you to respect and learn your clients’ context; her beliefs, values and emotions, around hospital-based birth and lead her toward autonomy and ownership of her choices. You can begin coaching your client, or even suggest it as a group exercise in the childbirth education classes you lead, right away! Just download the coaching handout and begin to lead clients with respect to their model of the world.

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

hospital birth

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