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.
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. 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.
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
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.