Archive for November, 2014

Hey Doula, Can You Handle My Husband?

Friday, November 14th, 2014

Were you ever hired by an expectant mom to “handle her husband”?  In my sixteen years of practice I certainly have had a few clients who wanted to hire my doula services for that. There could be different explanations that come along with this request, such as:  “I do not want him in the room at all, but I don’t want to hurt his feelings, so please make sure he is busy, give him tasks” or “My husband is taking over any situation, I can’t have him take over my birth”, as well as “He thinks he can take it, but I know him, he can’t, so I need you to be his doula and keep him calm”.

Coincidentally enough, my students and I have had more than a few encounters with the request to ‘handle husbands’ lately, and I believe many other doulas might have too.  Couple’s dynamics can be challenging in childbirth; it can interfere with our doula support, and can have an impact on the couple’s level of satisfaction from their birth experience. By fully understanding the situation at hand, and acquiring coaching tools to deal with it, doulas can be ready for the challenge, and reduce its impact on their support, resulting in higher levels of satisfaction for the couple.BLOG BOX2

From a coaching perspective, doulas are in the business of group coaching. If it is more than one, it is a group, and a couple is definitely a group. Doulas are trained to focus on the mom’s needs, their feelings and physical comfort, but nevertheless we cannot ignore the dad, nor can we team up with the mother and “handle him”.It is not healthy for us, and its harming for our clients.

For the purpose of handing doulas the coaching tools for dealing with this challenge, I want to share an actual case study, with the permission of my doula student.  A couple of months ago my student met with her second client, and was asked by the mother to “watch” him during labor and redirect him, “take him away” if he gets to be too much in my way.” (This is taken directly from the student’s notes). My student agreed to her client’s request, believing that she was doing her good, and here is what she wrote in her supervision report: “When faced with this request, I suggested to [mom] that we come up with a secret sign that would let me know to redirect [dad]”.

During our supervision session, following her meeting with the client, I asked her how she thought this agreement served the mother. I pointed out to her  that from a coaching perspective, our role is to empower the mother to express herself, her wishes and needs, to her support group. If we do this for her, we are depriving her from opportunities to grow. Similarly, doctors wanted to rescue women from labor pains, and offered them different types of pain management options.  What might have begun with good intentions, ended up with mothers being disempowered during childbirth. As doulas we sometimes feel the need to rescue the mother as well, but only because we fail to perceive our clients as competent, which is one of the basic premises of coaching. Here are my student notes, concluding  this supervision session: “As birth coaches we want to empower the mom. The mom needs to vocalize herself to her partner… that she needs space, having the birth coach do that for her is not empowering. To help the mom, the coach can suggest: would you like for the 2 of us to practice this? Can you find the words to express the fact that you need a change? The bigger the coach, the smaller the mom.  The more we do for her or take from her, the less she is empowered.”

In her following meeting with the client, my student never went back to revise her client’s request to “handle the dad”. After the birth she texted me: “I had the feeling that my client did not want me there at all, did not want me at the birth”. As her trainer, I was concerned about that, and asked her to try and explain the source of her feeling. Here is what came up: Surprisingly the dad did a very good job supporting his wife during labor, and she seemed happy with what he was doing. I was more in the background suggesting and preparing things for them. She never talked to me directly or engaged with me.”

From a coaching perspective, the doula failed to do what the client hired her for, because she never clarified her role with the client. Looking back to what the client has asked, the doula did not ask her client what she meant by: “If he gets to be too much in my way”, and therefore she couldn’t “redirect him”.  The doula could have asked clarifying questions such as:

  • Can you give me some examples for what you mean by “Gets to be too much in my way”?
  • How does it look like when he is in your way?
  • How does it make you feel when he is in your way?
  • How do you react when he is in your way?
  • How do you suggest that I redirect him?
  • And the $1M question that could have evoked a change in the couple’s relationships: Would you like us to practice some ways for you to express how you feel and what you need from him?

Instead, the doula felt that the partner did well. My poor student did not hear from this couple again, although she tried to reach out to the couple after the birth by phone, and facilitate a closure. It was also difficult experience for both the mother and the doula, as after many hours of contractions, the mother ended up needing a cesarean section.

As a doula, I encourage you pay attention to explicit and/or implicit signals that you get about the couple’s dynamics. If there are issues with their dynamics,  don’t ignore them, as they will almost certainly emerge during the birth, and can sabotage your efforts to help the couple achieve the experience you were hired for.  Of course it is not your role to facilitate a change in their relationships. After all you are not a marital relationship counselor or therapist. However, you can coach them gently, and empower them to reach some agreements for the sake of a healthy and good childbirth. Imagine how valuable it would be for them to communicate in a respectful manner, to establish teamwork, to work out their differences, or to express their needs to one another during childbirth. This experience will leave its mark on their relationship, and will empower them to create the change needed.

Here are some tools for coaching the couple around thier dynamics:

  • Reflect on the explicit and/or implied message that has alerted you with questions like: ” Did I understand correctly that you are …”
  • If your impression is confirmed, ask for examples and clarifications until you are clear on the matter. “Can you give me some examples?”, “How does it looks like?” Or “How do you feel when…?”
  • Try to make the couple observe the problem. You may ask: “Do you see any problem with this? “ Or “Can you think of any impact this might have on your birth experience?”
  • Explain your position as their birth doula – focus on the fact that your role is to empower and support both of them. Explain what might be the impact of the issue, or how their dynamics might be in the way of achieving the positive birth experience they hired you for.
  • When there is agreement about the problem, we can try to facilitate a solution: “What are you guys willing to do about it?” Or “Can you think about a different way to do things for the sake of a positive childbirth experience? “
  • Create or look for opportunities for the couple to practice the new communication skill or pattern.
  • During childbirth, if there is a need, remind them of their commitment to practice new coupling skills for the sake of their childbirth experience.

Reflecting, asking strong questions, clarifying, practicing new skills, and empowering ,  all of these are core concepts in coaching. I am committed to enrich my doula sisters with the coaching tools and strategies, and if this blog post made you feel like you want more of it, consider studying the ‘Complete Coaching Tools Kit’ for doulas, which I plan to launch before Thanksgiving.  There is still time to sign up for the promotional offer in the ‘coming soon’ box here.

‘Birth Ambassadors’ by Christine Morton – A Book Review

Monday, November 10th, 2014

Recently  I have read the wonderful book  Birth Ambassadors, which I find to be the most comprehensive and eye-opening study about doulas and birth support in North America.The book is a genuine presentation of the doula role, ways of birth embassadorspractice and training system in America from a sociological point of view. As such, it is free of any judgments about the dilemmas in the field, and views them from the perspective of sociological interests, such as professional status, the emergence of occupational niche, change agents in maternal care, community service, income level and even organizational developments. This point of view allows the author to also question, or re-open for discussion, some of the most common assumptions doulas and birthing moms ascribe to, including the benefits of doula care in terms of increasing normal births, and the doula’s agenda favoring natural birth, as well as doula advocacy in labor and delivery.

   To me, the most urgent dilemma is the one regarding doulas’ professional status. It is my understanding that this is also the core dilemma, the one that originates the others. In literature and doula guides, one cannot escape the choice of words used to name and describe this role by those who are perceived as the biggest doula advocates. Morton describes doulas for her readers using a typical definition, “Doulas are birth companions…The word doula comes from the Greek and refers to a woman who personally serves another woman.”  Neither a ‘companion’ nor a ‘doula’ implies any professional position—the latter evokes servitude rather than social change agents that come from being a mentor, a teacher, a coach or a leader. Yet, doulas are trained to believe that they can and do make change. Morton’s discussion of Klaus and Kennell’s book “Mothering the Mother,” the book that still, three  decades after their emergence in America, provides doulas with the scientific data of the benefits they bring, provides additional food for thought about how doulas are described. The title “Mothering the Mother” is another poor choice of words. As we all know, mothering is considered to be a non-professional position, and although everyone agrees that it is the hardest and most valuable work of all, mothers do not get paid for all they do.

The non-professional status of doulas in North America is reflected in the current training and certification system. Morton points out that research findings regarding doula benefits were actually based on a control group comprised of inexperienced and untrained women who sat in the delivery room and took notes.  Most doula trainings in North America are between a two-four days’ workshop. In comparison, I was trained in Israel, where doula training programs last a year and are usually affiliated with an alternative medical college and/or hospital. Trainees are required to have an internship inside Labor and Delivery.  As a sociologist, Morton points out the dilemma of doulas as being committed to providing humanistic and affordable childbirth support within the community, similar to what existed in a more tribal society before women began giving birth in hospitals, and the current situation of low status, low income and low professional standards for doulas as working women.

Morton continues to point out another motivation to maintain the non-professional status of doulas, which is closely tied with the circumstances of doulas’ historical origins. As Morton observes: “Doula care emerged as a unique response to the changing social and medical context of childbirth support in the United States” and “…the fragmentation of childbirth support [that] began with biomedical experts claiming authority over pregnant women’s health and childbirth outcomes and moving birth to the hospital…it is in this period we see the emergence of the doula as a particular, specialized role in providing non-medical support to pregnant women. “ In other words, doulas emerged in the United States as a reaction to the medicalization of birth, yet they are largely practicing within the medical system, holding to a philosophy of care and birthing model that are alien and unfamiliar in the medical paradigm. It is my assumption that doulas organizations are confusing professional status with medical status. If doulas were to claim medical authority they would not be able to practice within labor and delivery. While it is important to keep doulas as non-medical care givers, it is most important to elevate and state their professional status as coaches and care givers in the field of birth. Until then doulas are left with being viewed as community service or support figures whose motivation for their work ‘comes from the heart’.

Morton goes on to explain the controversy, facing doulas in terms of how they advocate in birth. In their current status as non-professional community service workers, how can doulas be an authoritative source for evidence-based care and empower their clients to question the medical staff and the care they provide?

I can see how some doulas and doula trainers in North America might feel challenged by this book, but I believe that this challenge is an invitation to initiate a healthy change in our occupational niche. Morton contributes to the well-being of doulas and birthing moms, by opening our eyes to the reality of birth support in North America. As a birth coach trainer, I would like to encourage all doulas to abandon the term ‘doula’ and the connotations attached to it over the past decades.  I recommend that we begin a new era of re-defining doulas as birth coaches, who can acquire coaching tools and skills, and enjoy the accreditation experienced by coaches in many other fields (such as life coaching, executive coaching etc.)  The coaching model and practice standards can resolve some of the dilemmas Morton identifies as problematic for doulas and their organizations, such as the advocacy dilemma, or practicing within the territory of doula support  without wrongly step into the medical territory, as well as coaching the mother prenatally for the performance of childbirth.  To read more about the coaching model, read my  blog post on  birth coaches vs. doulas at: http://www.birthcoachdoulatraining.com/imagine-giving-birth-profession-doula-profession-change/.