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Who is the Birth Expert Here?

Thursday, July 6th, 2017

This New Method Will Make You Give-Up Your ‘Expert Position’ and Hand it to Your Birth Client.

 

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”. However, I urge you to rethink your position: Can you be an expert about how any woman, other than yourself, is giving birth?

I recently finished reading the book “Childbirth and Authoritative Knowledge; Cross-Cultural Perspectives,” a collection of cross-cultural essays on reproduction and childbirth, edited by R. E. Davis-Floyd and C. F. Sargent, which extends the work of childbirth anthropologist Brigitte Jordan. I was deeply impressed by the authors’ understanding that since the establishment of Obstetric Gynecology in the middle of the nineteenth century, the experience of childbirth has been controlled and shaped by “those who know”; those who are considered an authority of knowledge, and whose ideas about childbirth shape and control our decisions and actions in maternal care, as opposed to the only expert in the room- the birthing mother.  “Authoritative knowledge is persuasive because it seems natural, reasonable, and consensually constructed. For the same reason it also carries the possibility of powerful sanctions, ranging from exclusions from the social group to physical coerciveness” (Jordan and Irwin 1989). who is the expert

After practicing from an authoritative position in L&D for so long, no wonder we ended up with a generation of birthing mothers who come into L&D unit and completely hand their lives over to the professionals, fully trusting them to make decisions for them. One would have assumed that birth activists and birth keepers, like childbirth educators and birth doulas, practice from a different position. However, I find that this is not the case. In nearly two decades of practice as both childbirth educator and doula, I admit that only after becoming a life coach, eight years ago, I finally stepped down from the “expert” position, and began seeing my students and birth clients as experts in their own lives, and therefore as experts in designing and achieving their desired birth experience.

I believe that for many decades now, even after the establishment of birth activism, women were caught between two types of “experts” – the “medical experts” and the “natural birth experts.Seeing the client as an expert in her own life, as well as the expert of the situation she is coached in, is a basic principle in coaching, and is manifested in The Art of Coaching for Childbirth, a guide I recently published introducing the Birth Coach Method motivating birth professionals of all kinds to integrate the coaching tools and strategies into their practice. This basic principle was first stated by two of the founding fathers of the coaching profession, Sir John Whitmore, who recently passed, and Robert Dilts. According to Dilts, coaching starts from the assumption that people have answers, and the coach’s role is to help them to overcome internal resistances and interference, give feedback on behavior and give tips and guidance (Dilts, 2003). So if the client is the expert and has all the answers, what is the coach’s expertise?  Here we can use Whitmore’s observation that : “The effect of coaching is not dependent on “an older, more experienced individual passing down his knowledge. Coaching requires expertise in coaching but not in the subject at hand. That is one of its great strengths” (Whitmore, 2002) 

front-cover

What does it mean to hold our client as an expert in the field of childbirth? How do we manifest this principle when leading birthing mothers towards a safe and physiological birth, and how do we trust the birthing mothers as experts when they don’t trust themselves at this point in human history?

Here are five steps I suggest we all take, and I mean all of us – physicians, midwives, nurses, doulas, and childbirth educators: 

 

  1. Work with questions: Instead of telling her or teaching her, ask the expectant mother more questions about herself. When she says: “I would like to give birth naturally”  do not assume you know what it means and you trust yourself to lead her there. Ask: “Can you clarify for me what is your vision for natural childbirth? How does it look? What happens in a natural childbirth? How does it feel? Strive for clarity. When she talks about her fear of pain, ask her: “What do you do when you are in pain? What do you know about labor pain? How do you usually overcome your fears? For more practical tools and a wealth of coaching questions for childbirth, I recommend reading The Art of Coaching for Childbirth.  
  2. Trust the mother as the expert even if she currently does not trust herself: As a coach, your most valuable asset is that you believe in her potential. This is true empowerment. When she says “I need to push”, reassure her “I’m here for you, follow your body, be with it for the next ten minutes while I’ll be here quietly, and just ask your body what it wants to do, I am right here.”  
  3. Encourage the mother to set-up a clear vision for herself and then ask: “how can I best support you in achieving this vision?”  Whether you are a doula holding your first coaching session with your client, or an L&D nurse who was just handed your patient’s birth plan, please initiate a conversation about it beginning with the same question.
  4. Coach the mother and support her towards her vision with no attachment to the manifestation of her vision. I know, this is a tough one! But hey, in childbirth, just like in any other area of life, there are no guarantees. What matters is the process. As long as you lead your client to be accountable for her birth experience, and have helped her to align her beliefs with her goals and her actions, it doesn’t matter if in reality there was a deviation from her vision due to medical impositions. Ideally, she will be satisfied with how she conducted herself through the process, and will own it as her journey. This change of perspective begins with you as her leader.  
  5. Be an authentic role model and practice observation without judgment: In order to lead, we have to be in touch with our personal truths. If you don’t trust your patient’s body and the process, and you practice from fear, please take the time to heal yourself and understand that your fear is in the way of your patient’s safe childbirth. Meanwhile, please step down from supporting a patient who envisions a physiological childbirth for herself. If you are a doula who lost faith in the good intentions of the medical system, please heal yourself, and meanwhile step down from assisting a hospital-based childbirth, as your lack of trust might sabotage your client’s childbirth experience. If you are disappointed by a woman who “tries for a natural childbirth but is open to the possibility of asking for pain meds”,  then you are practicing judgement and rigidity. Heal your wounds and work your way back to love and acceptance.

 

Resources:

  1. Dilts, R. (2003), From Coach to Awakener, Meta Publications, California.
  2. Irwin S. and Jordan B., (1989) “Cosmopolitan Obstetrics: Some Insights from the Training of Traditional Midwives, Social Science and Medicine,  28(9):925-944
  3. Whitmore, J. (1992) Coaching for Performance: Growing Human Potential and Purpose – The Principles and Practice of Coaching and Leadership, Nicholas Brealey Publishing, Boston

 

Are your clients hiring you to avoid a cesarean?

Tuesday, May 2nd, 2017

No, there is nothing wrong about it from their end, but how do you feel about it? Are you at risk for a professional burnout?

 

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 unmediated birth.  She feels that potential clients who are “willing to try [birthing] with no epidural, but leave themselves open to 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.  

benefits-of-a-doula

The reason I say that their typical clients represent a polarity is that Iris’s client, as described by her, is personally  committed to her own journey and to the choices she makes, and is hiring a doula to get the additional support needed in order to achieve her desired birth experience- unmediated physiological birth, whereas Lily’s typical client  is committing her doula to her wish to avoid a cesarean.

From the client’s perspective it totally makes sense to feel the doula is accountable for the birthing experience; after all for decades we have been using the doula statistics to promote our services, spreading the notion that the presence of a doula will reduce need for pain medications, inductions, and the chances of needing a cesarean. From the doula perspective, this promise stand the risk of professional burnout, because if medical interventions that you promise to reduce unfortunately take place in your client’s’ birth, you risk feeling that you didn’t fulfill your role.  You could feel that you failed in leading your client toward her desired birth and could even lose confidence in your professional validity. This is absolutely one of the areas in which I mostly appreciate the contribution of integrating the coaching principles and strategies into the field of birth support. This area is called client accountability, and it equally serves the client and the coach. 

As coaches we ask ourselves, who is holding who accountable in these relationships? Is she holding you accountable for her desired birth experience?who-is-accountable Is this arrangement truly working for you? Do you really want to be committed to your client’s journey more than she is? When you demonstrate a higher level of accountability to your client’s vision than hers, do you empower her or rescue her? Are you her support figure, her leader, or her savior; taking charge of her? Maybe you serve a ‘camouflage effect’ where she is convinced that she hired you in order to avoid a cesarean, and unconsciously avoids dealing with her birthing fears.  

Coaches in various fields lead their clients closer to fulfilling their potential and achieving their goals by holding their clients accountable; it is build-in in the coaching relationships.  When I asked Lily how does she know her clients are hiring her to “check the box of hiring a doula” she immediately pointed out the “inconsistencies” in her word: those gaps between what the clients say that they hire her for, or what they describe as their desired birth experiences, and the actions they take prenatally and during the birth to achieve their goal. That’s exactly it; coaches  evaluate a  low level of commitment when the clients resist taking the actions which will bring them closer to what they state as their desired goals

Prenatal coaching sessions conducted by a doula, or by a childbirth educator, can elicit the mother’s accountability for her desired birth experience and to her journey, and therefore has the potential not only to protect the birth professional from a  burnout, but to lead the expectant mother closer to fulfilling her birth vision.

 

More Resources:

To learn how doulas can elicit accountability

To learn more about client’s accountability vs. responsibility

To learn more about client’s accountability

To learn how to integrate coaching into birth support.

 

A New Guide from Birth Coach Method!

Sunday, November 6th, 2016

The Art of Coaching for Childbirth

Integrating the Principles of Coaching into the Field of Birth Support

Scroll down for the reviews  

The Art of Coaching for Childbirth is a practical guide inspiring and leading every professional in the front-coverfield of birth support to integrate the coaching tools and strategies into their practice. 

From one blog post to another and throughout my webinars, Birth Coach Method has become a paradigm shift in the field of childbirth support. It has drastically changed the conversation from teaching about childbirth to coaching the mother-to-be as an individual toward an optimal performance in childbirth. Birth Coach Method inspired birth doulas to shift from telling clients what they think is the best childbirth experience for them to asking questions, listening and exploring their belief system about childbirth, about themselves and their bodies, their strength and more.

While my book The Art of Coaching for Childbirth has been reviewed by top notch professionals and scholars in the field of birth support, I have come to the understanding that the Birth Coach Method is about to create a paradigm shift not only in the doula practice, but in the way childbirth educators approach their role. 

Buy Here

Scroll down for reviews 

The Art of  Coaching for Childbirth is more than a practical guide; it is an introduction to coaching. I dedicated the first part of the guide to establish the value of implementing the principles and strategies of life coaching into the field of birth support.  This part begins with a thorough introduction of the history and principal of the modern coaching professions, and continues with a presentation of the structure of the coaching process. While reading this part, you will get acquainted with the basic terminology of coaching like goals, inquiry, strong search questions, opening options, clarity, distinguishing truth from myth, accountability and more, as it being implemented into the field of birth support to lead birth clients to optimally perform at their birth.  To use the words of my friend and colleague Michal Klau-Stevens, The Birth Lady, this part will convince you of the value of incorporating coaching into birth support by healthcare workers, childbirth educators, doulas, and other birth workers.”(See below)

In the second part of my book I gathered all the coaching questions, which I presented at the theoretical part, and added hundreds of other questions and coaching exercises, which you can begin coaching with right away. This part will equip you with coaching strategies to tackle various scenarios and situations across the spectrum of birth support.

 

Read the Reviews:  back-cover-snip

“…The Art of Coaching for Childbirth, while compact at just over 70 pages, nonetheless packs in an incredible amount of practical information and useful tools.  She has skilfully transferred classic coaching strategies and made them totally applicable to birth educators and doulas. These strategies enable us to transfer the power back to the birthing woman, encouraging her to take responsibility for her own birthing journey. Empowerment, as we know, is not something we can give another person. It is something that originates from within….Neri’s book set off some real “light-bulb” moments for me and will definitely change the way I approach topics such as fear, pain and interventions in my Lamaze childbirth classes.”  Tanya Strusberg, LCCE, FACCE, Director, Birthwell birthright Childbirth Education, Lamaz-accredited and CAPEA, Australia.  http://www.capea.org.au/Resources/Reviews/ArtMID/589/ArticleID/62/The-Art-of-Coaching-for-Childbirth

 “…The coaching method, as applied to birth support, becomes a viable and vibrant path through the unwinnable culture wars that surround birth, which focuses on questions like, “Is birth safe?  Is it dangerous?  Where should it take place?  Who should attend births?”  One question that Life-Choma addresses head on, though, is “Whose birth experience is it?”  Because the answer to that question is the pregnant woman herself, then the coaching approach, as outlined in this wonderful book, is an optimal approach for those seeking to enhance women’s birth experience.  Coaching for Childbirth is an important contribution to childbirth preparation and support and this book, and the method, will be a valuable resource to childbirth educators, doulas and others seeking to support birthing women…”  Christine Morton, a former distinguished member of Lamaze International and current manager at the California Maternal Quality Care Collaborative
“Coaching for Childbirth is an innovative guide for professionals who serve pregnant women and want to integrate coaching techniques into their work. Neri has done a wonderful job of clarifying the coaching role and distinguishing it from therapeutic care and teaching. The exercises and scripts Life-Choma offers are excellent resources, and she constructs a convincing case for the value of incorporating coaching into birth support by healthcare workers, childbirth educators, doulas, and other birth workers…”  Michal Klau-Stevens, The Birth Lady
 “…The Art of Coaching for childbirth” provides nurses with the concrete coaching tools and approaches which can be quickly implemented  in labor and delivery. Teaching nurses to ask strong questions which help clients clarify their goals and priorities, while using pacing and leading strategy will make client-nurse interactions insightful…” Olga Libova, DNP, CNM, RN, Perinatal Nursing Faculty, De Anza College Nursing program, Silicon Valley, Ca
Coaching for Childbirth; a Practical Guide for Integrating the Principles and Strategies of Coaching into the Field of Birth Support” is required reading for all individuals in the field of birth support… Doctors, nurses, midwives and doula’s, new mothers and fathers, will all discover a plethora of valuable information within these pages. Dr. Rosie Kuhn, The Paradigm Shifts Coaching Group

 

 

Coaching for Building the Best Support Group for the Birth

Saturday, November 5th, 2016

First published in Nov. 2016 as a free webinar celebrating the release of :

The Art of Coaching for Childbirth

Integrating the coaching principles into the field of birth support. 

To listen to this webinar please buy it here, and we will send you the password and the downloadable PPT.

 

 

Six Habits of Thinking that can Sabotage Your Client’s Birth

Tuesday, June 28th, 2016

For the past six years, I have practiced prenatal coaching with my birth clients. By incorporating between four to six prenatal coaching sessions into my doula practice I was able to identify six habits of thinking, or repeating themes, which could harm your clients’ birth experiences. Whether they are aware of these thinking habits or not, these themes run like an underground stream that will find any possible ‘crack’ to emerge and surface. This blog post is dedicated to these six habits of thinking and the coaching strategies you can apply to address them:

1. Perceiving childbirth as dangerous.   thinking habits
2. Confusing discomfort with pain and avoiding both these sensations.
3. Avoiding information that challenges her mentally and emotionally.
4. Adopting the cultural dichotomy of natural childbirth vs. medicated childbirth.
5. Perceiving childbirth as a project rather than a process.
6. Confusing the unpredictability childbirth with the inability to prepare for it.

Perceiving Childbirth as dangerous: Childbirth used to be a dangerous event in women’s lives and was associated with fear of death. Thanks to many developments in Modern Medicine, such as blood transfusion, antibiotics, sanitation and cesarean operations, and due to a healthier lifestyle, which includes better nutrition, plumbing, and family planning, this is no longer the case. A lot people die in car accidents each year, yet it seems that every day driving does not evoke fear in most women. However, the fear of dying in childbirth is still common and can be explained as a genetic memory, or in Carl Jung’s term as a “collective unconscious, a broader concept of inherited traits, intuitions, and collective wisdom of the past. If this fear is at the back of your client’s mind while she prepares for her childbirth and while she makes her decisions during her birth, it can explain the gap between what she says is her desired birth experience and the actions she takes toward achieving it. As her birth coach, your role is to help your client reveal this fear, get in touch with it, and then foster new habits of thinking which will replace it, like mantras, affirmations, or hypnosis suggestions. These new ways of thinking will have to be practiced on a regular basis in order to become her new habits of thinking about childbirth, and thus, will help reach alignment between her beliefs, her wishes and the actions she takes.

Confusing discomfort with pain and avoiding both these sensations: Our modern society associates birth with pain. homer From Homer’s poetry in 750 B.C, to Judaism and Christianity, birth is associated with horrific pain. In addition, modern culture is geared toward eliminating pain and discomfort. The expectant mothers of today were once little girls who were offered pain meds from a very young age. Being in pain during childbirth might be your client’s first time experiencing pain. As a birth coach, it is your role to recognize the openings in the coaching conversations in order to coach your clients through labor pain. You may conduct a discussion about the different concepts of discomfort and pain and explore labor pain with her using the PAIN acronym with the goal of distinguishing fears from realities. (PAIN; Purposeful, Anticipated, Intermittent, Normal.) You can assign your client the task of inviting mothers to describe labor contractions in as many words as possible other than ‘painful,’ in order for her to have a wider terminology to talk about labor contractions. It is important to establish the connection between all the labor support tools and coping with discomfort or pain.

Avoiding information that challenges her mentally and emotionally: The notion of avoiding health-related information has a long history in psychology. In the beginning of the 1900s, Freud’s theories about psychological defenses (repression, suppression, and denial) shed light on psychic mechanisms that people employ to censor uncomfortable thoughts. The questions of health information avoidance have also been studied from the viewpoint of ‘fear appeals.’ Studies conducted in the 1950s showed that extreme attempts to lead people to practice health habits by frightening them, with graphic pictures of mouth or lung cancer, were not very effective. On the contrary, such provoking images lead people to ignore the threat. Childbirth is depicted in all types of media as a threatening and dramatic event, involving a sense of medical emergency, tremendous pain, and a loss of control over one’s discharges and body in general. This scary depiction leads expectant couples to avoid acquiring information about evidence-based maternal care and to avoid all types of presentations of childbirth, including the healthy ones. As a birth coach, your role is to help your client form a positive and healthy concept of childbirth. This can be done by exposing her to different presentations of childbirth, as well as to statements of world health organizations that perceive childbirth as a healthy event. thinking is a habit

Adopting the cultural dichotomy of natural childbirth vs. medicated childbirth: I have discussed this topics in many of my previous blog posts and webinars. This dichotomy is strongly present in the way we talk about childbirth and is held by birth professionals and activists. I believe that it leads expectant mothers to think that they have to choose between these two very different experiences, and most often, the fear of pain will push them in the direction of choosing the medical experience. I urge you to drop the phrase ‘Natural Childbirth’ and use the concept of ‘Healthy Birth’ or ‘Physiologically Sound Birth’. In its essence, childbirth bears many characteristics which pose great challenges to modern women and prevent this experience from being ‘natural’ to them. Women need to prepare mentally and emotionally to these challenges, and that’s why your coaching is so needed. Our role is to help your client acknowledge the overall challenges, as well as the unique challenges childbirth poses on her, and to reassure her that with new strategies and tools, she can overcome them and achieve the goal of a healthy and physiologically sound childbirth.

Perceiving childbirth as a project rather than a process: To borrow from the world of business management, project management has emphasis process vs event

on getting the task done and achieving the end result. A project management has an objective or outcome to be accomplished, and the project ends when that objective is completed. Process management focuses on repeatability, efficiency (decreasing time needed and reducing cost), and increasing quality. A process management has an objective that is typically defined around the ongoing operation of the process. The unpredictability of childbirth makes it impossible to apply the project approach to it. There are so many variables involved in childbirth which we cannot control – the physiology and anatomy of the mother, the quality of contractions, the coping of the baby with the birth process, fetal position, and many more. When we apply the process management approach to childbirth, it becomes clear that we are coaching our client toward their optimal performance in childbirth with the goal of eliciting their accountability to the process of childbirth. Childbirth is then being perceived as a self-growth process rather than as an event.

Confusing the unpredictability childbirth with the inability to prepare for it: The unpredictability of the unfolding of childbirth and its outcome seems to oppose that idea of setting goals and preparing for childbirth. Many expectant mothers will avoid attending childbirth preparation class and acquiring knowledge based on the premise that the unfolding of their labor and the outcome of it is beyond their control. As coaches, we might be discouraged thinking that even if we coach the mother, empower her, and help her reprogram her mind, the unpredictability will remain in place. While this is true, it should not be confused with the inability of the mother to envision her desired birth experience and to work hard toward achieving it. When we perceive childbirth as a process, it becomes clear that there is no difference between coaching for childbirth or any other performance. Whether it is sports, acting, a career, an executive position, or a relationship, it is just an illusion to presume that we have the situation under control. Coaching for childbirth is a transformational process during which the client learns to be accountable only for what is possible for her, for the actions she takes in order to achieve her ideal birth, and not for the outcome. In this respect, it is a wonderful preparation not only for childbirth, but for what follows – parenting. In both childbirth and parenting we can only be accountable for the process. If you coach your client with this understanding in mind, there is a great chance that regardless of the unfolding of her birth experience, she will feel high levels of satisfaction toward the way she conducted herself all the way from conceiving to postpartum.

To Healthy Births on Earth!

Evidence in Support of Coaching for Childbirth; Reporting from the Field

Monday, April 25th, 2016

 

There is a buzz!!! “Coaching for childbirth is what everybody is talking about,” I was told a couple of weeks ago, when Betsy Schwartz invited me to co-host Birth Blab, and the Birth Lady,  Michal Klau-Stevens Joined us.  The raw and intuitive concept of coaching for childbirth, which I began developing two years ago, has evolved into a powerful method with solid theory and a substantial variety of techniques and exercises practiced by more and more doulas. The more doulas join the new paradigm of coaching for childbirth, the more evidence is being accumulated in support of the tremendous benefits of this practice.  This evidence shouldn’t be neglected, as it might just be the shift we have been waiting for, especially in light of the growing frustration of birth activists and birth professionals from the constant increase in medical interventions, such as inductions and cesarean operations. Therefore, I have decided it’s time for me share some of the evidence that comes from my own doula practice, as well as from the practice of a doula who attended my workshop – The Art of Coaching for Childbirth.

In this post I present three case studies which demonstrate the high level of leadership doulas and childbirth educators can practice, by integrating coaching principles and techniques into their work with expectant mothers.  In the first case study, one strong search question led an expectant mother to develop labor, fulfill her wish for a VBAC, and avoid a cesarean. In the second case study, a coaching question helped reveal and refute an old and harming myth regarding relationships in L&D, and in the last one a coaching conversation had turned the idea of losing control from a fearful experience to a possible pleasurable experience.

Case study no. 1: One strong coaching qucoaching couplesestion that led a mother into labor

Shelly, a member of my local community and an expectant mother in her 40th week, contacted me via Facebook messenger: “I posted my situation on our Facebook group, and everyone refers me to you, can you please help me?” Over a phone conversation she shared that she is hoping for a VBAC, and must give birth by the coming Friday (in three days), the day of her scheduled cesarean. She had already seen an acupuncturist, and her contractions kept coming and going. For the last ten days, she said, she was developing contractions and felt like she was going into labor, but they kept disappearing after few good hours.  We decided to meet that evening in order to explore what can be in the way of Shelly’s healthy labor.

Shelly came with her partner to the meeting, which confirmed her high level of commitment to her goal as well as a high level of support provided by her partner. I opened the meeting sharing that the situation can be explored from two angles: the physiology of childbirth and the anatomy of birth. By exploring the physiology of childbirth, I explained, I mean that Shelly’s hormonal system was releasing oxytocin to develop labor, but time and again there was something in the way, and her levels did not increase and even decreased. By exploring the anatomy, I mean that maybe the baby’s position is not optimal, and we might need to look into that and try to correct it with some exercises.

After about 40 minutes of demonstrating and practicing some positions, including the three sisters and the lunge pose, I instructed the couple to continue practicing these exercises daily until the birth. I then decided it was time to explore the physiological angel. I first talked about different methods to ‘ride the wave’ of the spontaneous contractions when they show up and help increase oxytocin levels and uterine cramps, such as nipple stimulation, sex and enema. Then I curiously asked: ”What is going to happen when your baby is finally here? Is there any concern or worry that can hold you back from releasing this baby to the world?”

Silence. The couple was looking into each other eyes and Shelly was in tears. Then both shared that they are only kids in their families, and they believe they are hurting their toddler by bringing another baby to the world. They both have careers and they felt sorry for their toddler for having to share the little and precious time with them with another baby. Then the dad added, addressing Shelly: “Remember last night your contractions were strong and steady and they disappeared immediately after he cried.”

So I set the couple down to make a list of all the benefits of having a sibling; from developing social skills to having a family when the parents are gone, and all the way to organ donors! There was laughing and crying, and then I shared my perspective that they are amazing parents giving the best gift to their toddler. I asked Shelly to read and recite this list to herself before bed time, first thing in the morning, and when she goes into labor again.

The morning after I was on my way to the airport, when I received the following Facebook message: “In hospital, fully dilated, baby is in +2, THANK YOU!”

 

Case study no.2: A coaching question leading to the annulment of an old myths  questions allow coaches

The following evidence was sent to me by doula Ellen LaVoie, from Redwood City, California: “ I asked my most talkative, well-researched client about what she was giving up in order to have an unmediated birth, and she was speechless! We explored her birth from a new angle. It was great! She soon went back to her big fear of battling with hospital staff. She believes she is giving up a smooth interaction with them. Then we worked on strategies for resolving that, many inspired by your workshop.”

 

Case study no. 3: Turning childbirth from a fearful experience of losing control to a pleasurable one

How many times did you hear expectant mothers sharing their fear of losing control during childbirth? There are so many different ways to explore this fear. You can ask “What do you mean by ‘Losing control’? Simply because it is not clear what they think about when the say ‘losing control’. Or “What happen when you lose control? How does it look like, or feels like?
A dear client shared this fear during prenatal session. I didn’t feel like exploring the fear will be beneficial for her, as I know her to be very prone to anxiety. Instead, I asked: “Is it possible that losing control over your body will be a pleasant and joyful experience? 
Silence in the room….and then “Yes, it happens in orgasm”. 
Me: Aha 
Together we came up with this list of wonderful experiences of losing control:

  • Falling in love
  • Free style dancing
  • Screaming on roller coaster ride
  • Feeling tipsy
  • Orgasm
  • and Childbirth

What have surfaced in the conversation as a fear ended up as a possible pleasant experience?

Interested in bringing ‘The Art of Coaching for Childbirth’ to your area? Contact me at: neri@birthcoachmethod.com

The Power of Prenatal Coaching

Monday, March 14th, 2016

 This webinar first aired in celebration of World Doula Week of 2016! 

In order to watch this 1 hour webinar, and to receive the downloadable guide

 Click here

Read this review: I just finished viewing it and there were a few things that stood out for me.  The first was the idea of changing our thinking from childbirth being a natural event in a woman’s life to it being a challenging event.  I had never thought of it that way before but it really makes sense and I think that if clients were to hear that and learn that they have the ability to rise to this challenge, it could be a very empowering thing for them.  I appreciated the coaching domains you set out and the the importance of the woman’s belief system, what she says she wants and her actions needing to line up in order for her desires in childbirth to be met.  I usually ask a number of the questions you outlined however I hadn’t really thought of asking more in depth questions of the partner and I will definitely make a point of doing that as I see huge benefits in doing so. Thank you once again for your insightful webinars and I look forward to many more.”  Kerri Oishi CD(DONA)

Please email your impressions, questions and feedback to neri@birthcoachmethod.com

Enjoy and be enriched!

 

Coaching Your Birthing Clients after an Alarming OB Visit During Birth

Monday, February 22nd, 2016

  Last week I was supporting a lovely client; an educated and committed mother who hired me as her doula for her first birth. We went through a series of prenatal coaching sessions and drew hera belly map. She was practicing the daily activities to encourage optimal fetal position, as well as labor support tools with the guidance of my DVD Practicing for an Active Birth’. She had prepared for her birth. As sometimes happen, the onset of her labor was unpredictably challenging; her water broke and after 36 hours- some spent at home and some at the hospital, she was mostly cramping, but not contracting. After about three hour in L&D, the on call doctor came into the room and began talking about administering misoprostol . When she called me she said that the doctor have explained to her that ‘taking the medicine will not impact her desire for a natural childbirth. Coaching my birth client after an alarming OB visit during her birth is a challenging situation for doulas.   induction

These situation do not emerge as an emergency situation during childbirth, but as a situation that calls for birth management: a symptom either appears during the birth, or some measurable parameters change, and the medical staff feels the need to actively manage the birth, which means they want to impose restrictions, administer drugs or perform a medical procedure. When our birth clients encounter a situation which bears the potential deviation from their desired birth experience, they need us the most. The clients require our support and guidance because they are afraid and stressed.

So why are we challenged?

  To begin with, we care and empathize with our clients; especially those clients who expressed their wish to have a natural, unmedicated childbirth. We feel their frustration when their birth does not unfold as smooth as they hoped, and a condition imposes some restrictions or medical interventions. Another challenge origins in our professional restrictions – doulas are not medically trained, and are prohibited from advising clients around medical complications or interventions. We can empower our clients to advocate for themselves; to ask questions regarding the benefits and the potential risks of the medical action, and to make sure that the medical care consists of evidence based research. However, almost all  doula training program fail to clarify how to empower clients without projecting our opinion on the matter. How do we avoid stating our opinion yet empower them to inquire and advocate for themselves? Logically, we would not encourage them to advocate unless we feel uncomfortable with what the doctor has just told them, right? In addition, although doulas are not medically trained, we are far more knowledgeable than our clients when it comes to medical conditions, complications and interventions in childbirth. While they have no knowledge base to help them navigate and make an informed decision, we do have a lot of knowledge and can actually tell when a doctor provides evidence based care and respects our client’s intelligence and personal requests or just instills fear.

  And there is one more reason for the challenge doulas feel in these situations, which I think is critical- it is the paradox of an act of empowerment which often results in a stressed and confused clients. When we guide client to question medical advice further, the clients are in fear because of what they heard from the OB, an expert and authority who just told them something was wrong and needed to be managed, and they are also confused because they do not know which leader to follow. You see, even when doulas refrain from advising, as they must, when encouraging clients to advocate for themselves, we instill enough doubt and skepticism to stress them out. We encourage them to talk to an authority and questions its recommendation; an authority who they hold responsible for the outcomes of their birth. We have good intentions to empower them, but often enough we feel that we impose additional challenges. As a result, we are trapped in a paradox between our wish to serve, lead and empower and our sense that by doing so we are triggering stress and confusion.

  I found the coaching strategies and principles to be very helpful in these situations. From a coaching position, I partner up with clients, instead of being one more expert or another authority who knows best how to achieve a natural childbirth. This position frees me and my clients from the paradox of empowerment that triggers stress. In addition, coaching relies on questions, rather than answers, therefore it helps the clients find the answers within themselves. By asking strong search questions you can help your client distinguish truth from myth, and facilitate alignment between her belief system and the decisions she makes. Here is the coaching conversation that I conducted with my client after the OB told her that misoprostol won’t have any impact on her desire for an unmedicated and physiological childbirth.    

Me: “What do you think about what the doctor just told you about misoprostol?beleif system

Client:I don’t know, that’s why I called you”.

Me: “Let’s take it to a different but similar situation; imagine for a moment that you suffer menstrual  cramps pain. What are your choices when you have them?”

Client: “I can take a relaxing shower, go to bed and try to relax, or take Advil”.

Me: “OK, is Advil considered medicine?

Client: “Sure”.

Me: ‘When you buy Advil, does it come with a label stating all the potential side effect?”

Client: “Yes.”

Me: “ So when choosing to take a medicine like Advil, are you aware of some potential side effects?”

Client: “Yes”.

Me: “Now take it back to your current situation. Can you see some similarities?”

Client: “Yes. The doctor is recommending medicine, and every medication comes with potential side effects”.

Me: “Right, so what do you think now about what the doctor just told you?”

Client: “Well, I understand he can’t promise that misoprostol won’t impact the rest of my birth because we don’t know how I will react to it”.

Me: “So what would you like to do about it?”

Client: “I think that as long as it’s not medically necessary I would like to avoid the chance that I will not react well to the medicine.”

Me: “OK, How do you feel about sharing your understanding with your partner and with the medical staff?”

Client: “Good, I can do that. I’ll call later to to update you. Thanks.

When I look back at the way I practiced before integrating coaching strategies into my doula practice, I realize that I came from an expert position, which is not different than the doctor’s. In this situation, I would have said something like: The doctor can’t guarantee you that misoprostol will have no impacts on your desired birth experience. Every medicine comes with its set of side effects and risks”I see a huge difference in asking questions that lead the client to find the answer that is right for her. For example, in the scenario above, my client could have answered my question in a completely different way. She could have said: “Yes, but when I suffer menstrual cramps I do take Advil. I trust that I won’t develop all these scary side effects”This answer would have taken our conversation to a different direction which would probably ended up with a different conclusion. The shift here is that we invite our birth clients to connect with their belief system,  and we facilitate alignment between their beliefs and their actions. Therefore, our clients have more chances to conduct themselves well during childbirth, and to reach optimal performance based on their belief system,strengths and skills.  

In recognition of World Doula Week I will be leading a free webinar which you can now join : The Power of Prenatal Coaching. Please contact me to learn more about coaching for childbirth. 

Who Moved My Cheese: The Labor and Delivery Version

Saturday, November 28th, 2015

Thank you for joining Birth Coach Method’s 2nd anniversary celebrations! 

webinar image

This free webinar is my way of celebrating the new approach I am committed to lead in the field of childbirth support – Birth Coach Doulas. It is a transformation in doula’s role definition, in our scope of practice, and of our core competencies. I chose to center this webinar on the famous allegory Who Moved My Cheese by Spencer Johnson, because it is a beautiful allegory about change and our reactions to change. The allegory of childbirth as our professional maze, and the different types of birth experiences as the cheese we find in it, has enabled me to describe the historical changes that our field went through, and the reactions of the different agents in the maze to these changes. It also symbolizes the transformation I believe we should all strive for – transforming the doula from the warrior and the protector to the coach is inevitable in order for doulas to become a legitimate and welcomed support figure in the field of childbirth, as well as a service accepted and spread among all birthing mothers.

To Healthy Births on Earth!

Neri L. Choma, M.A

CD, CBE, CHT, Life Coach

Birth Doula Trainer

www.BirthCoachMethod.com

Who moved my cheese was written by Spencer Johnson, and published in the UK in 2000. The story is an allegory for change, and our reaction towards change. Cheese is a metaphor for what you want to have in life – whether it is a good job, a loving relationship, money, or peace of mind. Cheese is what we think will make us happy. However as we all know- shift happens! And when circumstances change and our cheese is taken away, we sometimes struggle. Different people deal with change in different ways. In the story, four characters represent parts of ourselves and our reaction whenever we are confronted with change. These characters are mice, leaving in a maze. The maze is where you spend time looking for what you want –or metaphorically – your cheese. It may be the organization you work in, the relationships you have in your life, or the community you live in.  Our professional maze is childbirth, and our cheese is a certain type of birth experience we wish to find in it, or a cetain type of maternal care we strive for.

 

Moral and Educational Dilemmas in Sharing Childbirth Videos – Who are we Serving, if we are Indeed?

Wednesday, October 21st, 2015

A couple of weeks ago, while I was using social media to spread the word about my new coming workshop, The Art of Coaching for Childbirth, I  shared on Facebook  a beautiful video of an Indonesian woman giving birth in nature. My goal was to raise awareness about the importance of prenatal coaching for the modern and western woman. It has been close to two years now since I wrote my blog post called The misleading Concept of Natural Childbirth  with the same goal – raising awareness about our typical birth client, who is a modern and  Western woman, for which natural childbirth does not feel natural at all. There is nothing in our client’s life style that feels or behaves like childbirth. The modern woman is required to perform in a life event  that is much different than her everyday life circumstances, and in some aspects is also in conflict with her belief  system around birth and pain in general.  Back to the video of the Indonesian woman’s birth,  I shared it on Facebook with a question: Is this your typical client?  Two days after the share I received a message from a mindful and caring midwife who wrote: “I am very uncomfortable with your exploitation of the New Guinea mother’s birth video to promote your workshop…Showing this video within a classroom exercise exploring natural birth and cultural traditions, while explaining that this woman probably was not even asked permission to film her is borderline “acceptable” only because it is common practice “.

WOW! So true! I feel embarrassed to have missed it. I did not ask for that woman’s permission. This video went viral on Facebook and YouTube, and being part of our social media culture, I made the mistake of exploiting this woman to make a statement. I thought I was using this video to teach and raise awareness, but –I did also advertise my workshop at the bottom of the post, and hence the context of the post had changed. context

Such moments of mindfulness are important to share with my community, in order to spread awareness. As I write these lines I am still confused with the moral dilemmas that this post sharing has evoked in me:

The first dilemma has to do with exploiting videos of women giving birth in an unassisted and natural childbirth without their permission. These videos of unassisted childbirth are uploaded on YouTube and Facebook on a daily basis. Sometimes they present women that are birth advocates, who decided to expose themselves and share their experience from a stewardship position, but other times they expose natives who do not share our cultural inhibitions, and probably did not give their permission to-be-looked-at. The moral dilemma is that if we do not use these videos in order to inspire the modern-western woman, and to make her see that this type of birth is indeed possible, it won’t be a possibility for her at all. Doulas, midwives, and birth workers of all kinds are trying to lead the modern woman to have faith in the natural unfolding of childbirth, as well as in her body, and to experience a normal and vaginal childbirth with minimal interventions, or none.  We know that interns, studying to become Obstetric Gynecologist, just like nursing students, almost never take part in an unassisted birth, and hence all they know is to manage birth. They are trained to manage childbirth, and with no context around natural and unassisted childbirth, they do not know how to allow this experience.  The modern woman is part of these circumstances, and she as well is not exposed to unassisted childbirth, or even stories about unassisted childbirth.

Birth workers, and activists like myself, would love to expose women in our culture to the possibility of a healthy and normal birth, but at the same time, the Indonesian woman did not give her permission for that.

The second dilemma involved here is that Indonesian natives are not our typical prospective clients, and hence they do not represent an option or an alternative for the modern woman. Or even worse – the videos might alienate the whole concept of normal and physiological childbirth because the viewers are absolutely aware of that native woman’s life style, and how different her life circumstances are from theirs. The question is – Are we really serving anyone by posting these videos if their viewers are  modern women that have access to the internet and to social media, but at the same time have very little access, if any, to normal and unassisted childbirth.

In my efforts to resolve these dilemmas I was reminded how important is the context. Just like in painting, when we are taught that the background is defining the foreground, in every discourse the meaning of a saying, or a statement, or a video share, is defined by the context.  If it wasn’t for my invitation to join my workshop at the bottom of the share, maybe the message had been perceived in a better way, and would have been accepted as mo1391994763484-666014968re legitimate.  We can all be more mindful about the context in which we use and share birth videos while trying to resolve these dilemmas. Our perception is dictated by the context.  This reinforces the importance of the context that our society has around childbirth. As a coach I believe that it is all about the context. I teach my doula students to give a fair amount of attention to the context, or the belief system, of their client around childbirth. The same goes for their context around western medicine, or being in pain, and other components of childbirth. I tell them that leading a conceptual and behavioral change in the field of childbirth begins with exploring women’s belief system around childbirth; distinguishing truths from myths and fears from reality. For most of our clients, the concept of childbirth consists of the dichotomy between components  that bear negative connotation like fear, pain, fear of pain, fear of death, medical emergency or care, losing control over our body, and the unknown, and between thrilling connotations like babies, motherhood, love,  growth  and a new beginning.  Be mindful of your client’s context around childbirth as this  is your client’s reality.

In order to serve my doula students and allow them to explore the context of our society around childbirth, I have created lesson number 10 in my program: Pain, Fear, and the Medicalization of Birth. It is a one  hour video presentation that all my students watch, presenting  you with the origins of our cultural context around childbirth all the way from the bible, Greek mythology and art.  You may consider watching it to become more mindful about the context of childbirth.