Archive for May, 2014

Imagine Re-Birthing the Doula Profession, What Would You Change?

Wednesday, May 28th, 2014

 

     Imagine that we, the doulas of the world, were given the opportunity to go back in time and give birth to our occupation again. What would you change? How will you make things different this time? This thought came to mind as I was reading the very insightful and comprehensive book by Christine Morton, Birth Ambassadors. After fifteen years of practice as a birth doula, I am so clear about what I want to change: it is a paradigm shift that is both conceptual and practical.

    The first thing that I will do is to dismiss the term ‘Doula’, which implies servitude, and replace it with the term ‘Coach’, which has the connotations of ‘leader’ and ‘expert’ in a certain field. Mazel-Tov! I just re-named the ‘baby’ – Birth Coach!  There are coaches for every field of human performance – sports, acting, singing, career, executive, relationship, life…you name it! Why not for the performance of birth then?

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Coaches not only help their clients to prepare through practice for their upcoming performance, they do much more than that: they provide them with theoretical knowledge about the field of their performance. They are a resource of knowledge, they empower, and they provide emotional support and cheer for them.

    The next thing I will do is go back to what motivated me to give birth to this baby in the first place.  It was my passion to support and lead expectant mothers towards and through healthy and vaginal births.  However, I feel that it was also a circumstantial birth; that it was brought to life as an opposition to the medical paradigm, and the maternal care it provided for birthing moms. I sympathize with this pioneering stand, this opposition to a dominant ideology is the beginning of many new ideas, and can be the origin of new concepts of care; however, I am not a pioneer any more.    The doula caregiver has been around for three decades already, and it is time to take it to the next level: professional standardization of knowledge and practice. To achieve that I will shift the focus of my philosophy and my training from the medical care to the essence of childbirth itself, and I will explore the essence of the birth experience.  

While doing that I will notice that:

  1. Childbirth evokes fear and pain in women: The first birth stories that were told in Western culture, whether I find them in the Bible* or in the Greek Mythology**, had implanted the seeds and tied the knot of fear and pain that are deeply associated with our concept of birth.  For thousands of years, before medical inventions like contraceptives, blood transfusion, sanitation, antibiotics and more were available; giving birth in fact was a life threatening experience for our female ancestors.  This kind of fear can be hereditary, meaning that women nowadays can still carry the fear and threat in their cellular memory***. Therefore, I will define it as the role of the birth coach to explore the belief system of her birth client, and help her to distinguish fear from reality, truth from myth, and facilitate the expectant mom in forming a positive and healthy concept of birth which will be aligned with a healthy birth experience, and with her ideal birth.  This coaching will allow a new way of  ‘being‘ with the birth experience.  It will allow the acceptance of the experience rather than rejection and fear, and will empower the mother to be present and cope with the sensations and emotions during her birth experience.

 

  1. Birth is a performance: When observing mothers giving birth I noticed that giving birth in a way nature indented it for women, is quite a performance! It requires expectant mothers to perform physically, mentally and emotionally in a way that is so different from their everyday life. From this observation  I will draw the conclusion that in order to increase their chances of having  healthy births, expectant mothers have to acquire a new set of labor support tools and skills, which they need to practice a lot with, until these tools  become their habitual response to labor and birth sensations.  This type of coaching will allow a new way of ‘doing’; a new way of responding to labor, which will be aligned with the new way of being.  When practicing these labor support tools, like relaxation, breathing techniques, visualization, massages and vocalization, mothers will be empowered to respond to labor sensations and strains with skills that are supporting the progress of their labor, reducing levels of fear and pain, and that can increase their chances of giving birth in a healthy manner.  My role definition will include practicing labor support tools with birth clients on a regular basis, and assigning areas of practice for them.

 

  1. The coach’s goal is to bring the coachee to high level of performance with no need for the coach’s continuous presence: Child birth IS a performance, and one that takes time I must point out. To borrow from the world of sport, birth is no 100 meter run; it is more like a marathon.  Is there an obligation or a need for the coach to run alongside the runner and provide continuous coaching through the marathon, from beginning to end? No, absolutely not. Coaching and empowerment take place before the performance, and at times during its course.  Providing continuous support for the whole process of birth, regardless of how long it is, bares a risk of disempowerment, of the coach becoming the savior, and implying a need to rescue the mother. This is not valuable coaching. Therefore, in my training and my philosophy, I will focus on the importance of continuous prenatal coaching rather than the continuous presence of the coach.

 

  1. It takes a village to support a woman in childbirth: When recalling my own birth experience I will acknowledge my partner, the father of my daughters, as the main source of my emotional support during birth. Therefore, I will conclude that a birth coach is in the business of group coaching, as two people are already a group by definition.  I will then open my eyes and look around to see who else was supporting me during my birth, who else was present in the room and in what role? The support group just grew bigger to include the nurse, the midwife, and the OB/GYN.  To each their own way of making sure me and my baby are safe and are being cared for, they just practice within different paradigms, practice different modalities of care. I will then conclude that the role of the birth coach is to facilitate decision making and team work among all the parties present in the room. Using coaching skills and tools, the coach can and should facilitate team work in the best interest of the mother’s birth experience and for her to be able to experience her ideal birth.

 

  1. Birth is unpredictable; there is no clear route, only a destination: Looking at the body of knowledge I hold about birth, I can’t avoid noticing how unpredictable birth in its essence is. Yes, I have a chart of labor phases and stages, and I know the symptoms by heart, and there is a so called normal unfolding of birth, but all in all I have to admit that there is so much we can’t predict about birth.  As a childbirth educator I can only prepare my students to some prototype we invented in order to talk about birth, and I stopped using the term ‘birth plan’ long ago. There is no plan or route, only a destination – healthy birth. And the birth coach is the travel agent and the tour guide. With this recognition I will conclude that the role of the coach is to model and facilitate flexibility and acceptance.  To enable the client to recognize possibilities and options during the birth, and facilitate the acceptance of what was maybe perceived as unacceptable for their clients.

 

  1. A mother’s childbirth memory is as important as her own birth:  Looking back at my birth memories, I notice how present they are in my life. My childbirths were transformative in essence, and with each baby that I gave birth to, something new was born in me. This transformative essence of birth could be found in many birth stories.  From this I conclude that the role of the birth coach is to coach the mother after birth to reach a closure, to process her birth experience and make it a coherent and clear memory, which she can feel comfortable recalling and telling, and from which she can grow.

 

Imagine giving birth to the doula profession all over again. I just did it, and I will continue to do so. Will you join me in this transformation? Let me please introduce The Birth Coach Method, a paradigm shift in the doula role and practice.

 

   Birth coaches:

  • Coach the expectant mother to form a healthy positive concept of birth.
  • Prepare the mother for the performance of childbirth by practicing labor support tools and assigning areas of practice for her.
  • Aim at empowering and preparing the mom to embark and perform with confidence during her childbirth with no requirement for the coach’s continuous presence.
  • Facilitate team work and agreement reaching among all the caregivers and members of the mom’s support group.
  • Model and practice flexibility in order to facilitate acceptance of the unpredictability of birth and allow the mother to be in peace with circumstances which might not be aligned with her ideal birth.
  • Coach the mother after the birth to reach closure, process her childbirth experience, and form a positive memory which she can recall and tell with clarity and positive emotions.

 

As always, I invite your feedback and impressions. Email me at neri@BirthCoachMethod.com

    To Healthy Births on Earth!

      Neri L. Choma,  Birth Coach Method founder

 

 

References:

*Genesis, chapter 3: “Unto the woman he said: I will greatly multiply thy pain and thy travail; in pain thou shalt bring forth children;”

** Homer, The Iliad, around 750 B.C, “”Then rays of pain lacerated Agamemnon comparable to the throes a writhing woman suffers in hard labor, sent by the goddesses of Travail, Hera’s daughters.

***http://www.cellularmemory.org/about/about_cellularmemory.html

The Misleading Concept of ‘Natural Birth’ ; Let’s talk About Healthy Vaginal Birth

Tuesday, May 13th, 2014

The dichotomy of Natural Birth vs. Medicalized Birth had been established in the discourse about birth for the past 30 years, and has been accepted by both birth professionals and moms. The most obvious and urging question expectant women are concerned about is whether or not they will take epidural or will try for ‘Natural Birth’, and in accordance with what the expectant mom is inclined to, she will then educate herself and prepare for her birth; decide on a childbirth education class and make decisions regarding her care givers and support group for the birth. A woman who gave birth vaginally will almost always be asked whether or not she took epidural, or in other words “did you have a natural birth’? This situation is reflected also in birth stories we read on-line; where we can always find statements in this spirit:  “I decided not to take epidural and try for natural birth…and here is what have happened…or “So I decided it was time for my epidural…”.

I think that that the concept of Natural Birth is so misleading that while preparing for it the mother might find herself giving birth in a way that cannot be farther away than what nature planned for women, and will be medicalized birth. Since I suggest that the proposition of ‘natural birth’ is misleading, It will be in place to talk a little about concepts and propositions in general. We use words as a way to describe concepts; they are used as labels for concepts. ‘Dog’, ‘Table’ and ‘tree’ are example of words that are labels for objects. The universe consists of objects and events that are needed to represent knowledge about the universe and its contents. We usually think of events as happenings such as a “party” or a “meeting”. This means that Natural Birth’ is a proposition which describes the conceptual event of some sort of birth that the speaker or listener have in mind. But what type of birth is it?  What is in our mind when we think ‘Natural Birth’? Which pictures? Which words comes to mind? What scenarios? And, are they really ‘Natural’ for us?

   I argue that there is nothing natural in the event of giving birth for the modern woman, therefore the proposition ‘natural birth’ by itself presents women with a dilemma; yes, giving birth is part of nature, this is how we recreate as species on earth, but as an occurrence, as an event in the life of modern western women, there is nothing ‘natural’ about birth. 

To prove my argument I went to the dictionary to look for the definition of ‘natural’, and this is what I found: nat·u·ral Natural, adjective 1. Existing in or caused by nature; not made or caused by humankind. 2. Or in agreement with the character or makeup of, or circumstances surrounding, someone or something. So now let’s take the propositions of ‘Natural birth’ and read these two definitions with it: Natural birth is: 1. Natural birth is caused by nature, not made or caused by humankind. 2. Natural birth is in agreement with the character or circumstances surrounding expectant moms. So my guess is that when we opposed ‘Natural Birth’ to ‘Medicalized Birth’, we probably meant to say or imply that this kind of birth occurs and unfolds in mothers’ life with no humankind intervention. Well first we need to recognize that this is telling us what Natural Birth is not, and not what it is. Second, I want to point out the misleading implication of this definition- that when we think about something that happen naturally, with no human intervention, the  following connotations come to mind – ‘simple’ or ‘with no human  investment or effort’,which are not at all true when it comes to giving birth. Let’s take a look at the second definition and see how it resonates with us: “Natural Birth is in agreement with the character or circumstances surrounding expectant moms”. How does this feel to you? Would you agree with me, that in terms of the character of life circumstances surrounding women these days nothing about birth is natural for the modern western woman ? Do you feel the tension? Not only we can’t be in agreement with any of these definitions, there is also a conflict between the two optional meanings of the concept ‘natural ‘. I think that healthy vaginal birth, what we refer to these days as ‘natural birth’ has become so rare because of the dilemma that the word ‘natural’ presents when describing birth. Here is my dilemma as a modern western woman:

   “It is in my nature to give birth, yet there is nothing about birth that is natural for me”

     Here are some of the reasons that birth can’t be or feel natural for us:

  1. Birth is unpredictable and impossible to plan for. (How many of you already planned their summer vacation? Christmas vacation?)
  2. Birth requires us to agree to be in pain, and we live in a culture that is obsessed with alleviating pain. We also lost all our coping pain techniques and skills while being born in this culture.
  3. Healthy birth is a process that lasts an average of 18 hours for first time moms, and we live in a fast pace culture; we use instant coffee and instant pudding and order food in drive through…We like our results fast! In movies and TV sitcoms birth takes five minutes max.
  4. Being a long process, birth demands physical and emotional performance, it demands strength and stamina which the modern woman who drives her car, uses elevators, sits in a perfectly air-conditioned office, uses washing machines and dishwashers, and does not squat down the river every day, absolutely lost.
  5. Our cultural inhibitions, which are the cultural circumstances surrounding expectant moms, are in conflict with our primal and intuitive response to birth.  The progress of labor depends on the release of hormones like Oxytocin and endorphin, that are being released by the part of our brain that is called ‘primitive brain’. The primitive brain activates primitive and uncontrolled  reactions and behavior like moaning and groaning,  crying and screaming, throwing up, spontaneous motion of the body like spiraling, and other types of behavior that are not considered to be attractive or feminine, and therefor are in conflict with our cultural inhibitions.

     Now let’s take a look at what is ‘natural’; what is  in agreement with the character of the circumstances surrounding modern women.  Here are some examples:

  1. Wearing a bra every morning is ‘natural’ for us.
  2. Putting on make up
  3. Texting on mobiles
  4. Face-booking on IPad and laptops, and reading digital books
  5. Using tampons
  6. Drive Through food or coffee orders
  7. Birth control elements

   To summarize my argument, talking about natural birth is misleading. In a subconscious matter which women are unaware of, when thinking ‘natural birth’ women either think about something as natural as a sneeze or a yawn, something that happens spontaneously with no human investment, and therefore needs no preparation or intentional engagement, but they fail to understand that this kind of birth is not aligned, or is in disagreement, with their life circumstances. Ironically, expectant mothers these days must have a thorough and deep preparation in order to give birth spontaneously, in a healthy vaginal way. For the modern woman, giving birth in the way nature planned for her, is quite a performance.  It requires her to perform physically, emotionally and mentally in a way that is much different from her everyday life circumstances. And just like no one says ‘natural marathon’ or natural success, nor can they talk about ‘natural birth’. 

In order to give birth in a healthy and vaginal way, the modern woman needs to practice and be coached. Just like in any other field that requires us to perform- acting, singing, career, and off course sports. A birth coach will coach expectant moms for the performance of  healthy birth. Coaching for healthy birth is different than other options expectant mothers have these days to prepare for their birth. Childbirth classes are a great way to learn about birth, they are not personal, and can’t address the mom’s agenda. They also leave very little time to practice. Hiring a doula is highly recommended, but doulas are coaching their clients during the performance- that might be too little and too late. Doulas are also considered support figure and not a coach, and therefore are never trained with coaching skills and techniques. If we can agree that birth requires women to perform emotionally, physically and mentally in a way that is much different from their everyday life,  then we can all appreciate the contribution of working with a birth coach towards achieving healthy and vaginal birth.   This suggestion is a paradigm shift in the field of birth. To look at a birth as a performance, to think about natural birth as performance that is not natural, as it is not aligned at all with the character of women life circumstances, to hire a birth coach that will lead you towards healthy birth, not natural birth, this is a new perspective, a paradigm shift, and after being a childbirth educator and a birth doula for 16 years now, I believe it has the potential to increase the rates of healthy vaginal birth.

   The role of your prenatal coach is to:

  1. Facilitate Clarity:  it is important for the mom to be clear about her wishes, her vision, and to form a positive concept of birth that is aligned with healthy birth. This could be achieved with coaching conversations, affirmations and positive suggestions.
  2. Inform: informing the mom help reduce fears and concerns. Coaches distinguish truth from myth and fears from reality, by means of knowledge, resourcing, and self – empowerment.
  3. Practice: coaches will practice labor support tools like breathing, visualization, relaxation, positions, and more, and assign areas of practice between sessions. These labor support tools use to be natural for women before the era of pain medications. but today women need to practice them as much as they can to make them their habitual response to labor and birth.
  4. Empower: coaches will empower the mother to share her vision for her birth with her support group and care givers,  and make explicit requests. It is always better for the mother to advocate for herself before the birth than during.
  5. Coach throughout the labor: birth coach will certainly coach the mother throughout the birth and support her similar to a birth doula.

I am committed to train birth douals as coaches. The Birth Coach doula training is already up and running with students in the States, Canada and Israel as well. It’s exciting! I keep guiding my students to no longer use the term ‘Natural birth’. We coach our clients to achieve healthy and vaginal birth. I am currently in the process of creating the complete coaching tools kit for birth professionals, so if you are one visit my homepage and don’t miss on the opportunity to sign-up to get the promotional deal in Fall of 2014.

Practicing for an Active Birth

Monday, May 5th, 2014

   I have been a childbirth educator and a birth doula for the last 14 years. During the first year of my doula practice I realized there is a difference between Knowing about birth and Being in birth. With no exception, all of my birth clients took childbirth education classes and read pregnancy and birth guides. Most of them were also committed to have a natural birth, to avoid medical interventions as much as possible, and to design their birth experience according to their belief system and their emotional and physical needs. While supporting them in birth, their knowledge did not serve them well enough. The mothers whom I have worked with were missing tools for labor.

   So I have decided to begin my support earlier than the birth, and became a childbirth educator. As an instructor I teach the Active Birth philosophy, mostly affiliated with Janet Balaskas.  In my classes I always focus on practicing  labor tools. My perception is ,that in the Google era ,couples are exposed to so much information and knowledge, that my special contribution is in teaching them the hands-on practice of being with the birth.  I have created the Practicing for an Active Birth workshop especially for clients who wanted more hands-on practice. I taught this workshop for ten years in Palo Alto. My students were raving about this class, and the local midwives were continuously recommending it to their birth clients. On November 2012 I launched the DVD “Practicing for an Active Birth; The Most Comprehensive Hands-On Guide for a Healthy and Active Birth”. This DVD presents 2.5 hours of labor support tools and comfort measures for birth, and many coaching tips for both birthing mothers and their partners In accordance with different phases of the birth.

   Labor tools are in support of the progress of your birth as well as your ability to cope with labor pains.  Labor tools are relating to the physiology and anatomy of birth, and when you practice them, you have better chances of having a healthy birth which progresses in a timely manner (Off course it takes some collaboration from your baby too). It is hard for me to accept philosophies of childbirth education which deny the presence of pain in labor. Contractions are strong cramps of our uterus, and when a muscle cramps, pain is present. So how are you being with that pain and what are we doing when you are in pain? 

When we are in pain, our habitual instinct is to react with fear and tension.  We refer to these phenomena as the Fear-Tension-Pain syndrome. This is our survival mechanism.  Pain is a signal our brain translates as:  “Something is wrong; there might be a risk to the organism”. Neglecting the pain might lead to a serious threat on our survival.  Therefore, we emotionally react with fear and alert; we activate our Fight –Or – Flight syndrome, a remaining of early phase in our evolution and the number one cause of tension and stress. The Fight or Flight syndrome is a set of physiological symptoms, designed to enable us to fight a source of danger or flight when fighting is not optional.  Both these reactions will take: lots of adrenalin, shallow breathing, tightening of the muscles, fast heart rate, and an alert somatic system.

   Now going back to the birth experience, when we react to the pain of contraction with our habitual instincts described above, we are in the way of a good healthy birth.  The uterus works on two kinds of “fuels” –oxytocin and oxygen, both are in charge of effective contractions. In the presence of high levels of adrenalin, the release of oxytocin is inhibited, and our contractions are not becoming stronger and closer together, meaning- Failure to Progress.

We can summarize it this way:  FTP leads to FTP.  Meaning- The Fear –Tension- Pain reaction in birth leads to Failure To Progress.  Labor tools are related to the physiology and anatomy of birth since they allow the mother to de-activate the fight-or-flight syndrome, and by practicing them the mother is suppressing the release of adrenalin, increases the release of oxytocin and the flow of oxygen to her uterus, and reacting to her contractions with acceptance.  Here are some of the labor tools we practice: breathing techniques, massaging, positioning, several visualization techniques, positive affirmations, relaxation, and hydrotherapy.

About four years ago I studied to become a life coach. The coaching practice brought up a new understanding in the way I think about labor tools these days, and led to the development of the Labor Practice.  In coaching we are supporting potent clients in making a change in their lives.  The change can be in the way they act or in the way they are being with something.  A very central term in coaching is the change of the habit. As a life coach I encourage my clients to explore and distinguish habitual ways of doing and being, which do not serve them any more.  These old habits are in the way of getting what we say we want and doing what we say we are committed to.

With this understanding, I was able to see that acquiring the labor tools as part of the childbirth education class is not enough. That if our reaction to pain is indeed a habitual instinct, then it takes a lot more practice for the mother in order to break the habit and rely on a different set of tools. With that thought in mind I developed the Practicing for an Active birth  DVD. This is the most comprehensive Hands-On Visual Guide you can find !  Now couples can watch this DVD at the comfort of their home,  and practice labor tools as many times as they want, until the mother really fells she owns this set of tools.

   The DVD presents a wealth of labor tools – Positions for birth, Breathing techniques, different techniques of visualization – like spiraling of the body and expansion of the belly, Massaging techniques, hydrotherapy and more.  You will learn these tools in accordance with the different phases of the birth. In each phase of the birth, a different progress needs to take place, and I introduce the right tools to invite this progress. Whether it is a release of oxytocin in Early Phase or the engagement of the baby in Active Phase, you will understand the logic behind the tools and how they can best support you in achieving a healthy and empoweirng birth.

Here is a clip you can watch

Birth Coach Method Introductory Series – Part 1

Monday, May 5th, 2014

The first book I ever read about doulas, ‘Mothering the Mother’ by Marshal Klaus, inspired me at the beginning of my career. But today I have a different perspective on the book. I think that the title implies that doula is a non-professional role, because mothering is an important role that comes with no professional requirements, certification, or a body of knowledge. Another popular doula guide, ‘The Birth Partner’ by Penny Simkin, also implies unprofessional collaboration, as though doulas and mothers have the same degree of knowledge about childbirth. In addition, the title ‘Doula’ means ‘Servant’ in ancient Greek.” The preconceived notions of a Birth Doula are degrading. It’s no wonder that I still hear moms saying ‘My mom/sister/best friend will be at my birth, so I don’t need a doula.’ This situation greatly motivated me in creating the Birth Coach Method training program.
This video is about the need to empower birth doulas and establish their professional status. Doulas should be trained as birth coaches. Their role is to coach the mother prenatally, assist her in practicing for her birth, and only then coach her during her birth. This is the goal of the Birth Coach doula training program. Watch this video, the first in my introductory series of the Birth Coach Method