Posts Tagged ‘birth doula’

How Doulas Can Align the Vision, Thoughts and Actions of Expectant Moms (or How to Close the Gaps? )

Tuesday, September 1st, 2015

Doulas often feel that they are accountable for their client’s positive and healthy birth experience. While this is somehow true, it certainly does not dismiss the couple’s efforts to achieve their desired birth experience. The presence of a doula at the birth should not by itself be perceived as a guarantee to a healthy and active childbirth. When couples choose not to engage in other types of labor support and preparation activities such as pregnancy physical activity , prenatal yoga, or childbirth education classes, there is a high chance that the doula will be the only one accountable for their positive birth experience. In this case both parties risk a complicated relationship which might involve disappointment and lead to a non-satisfying birth experience.  By providing prenatal coaching sessions the doula can help the couple to be better prepared and more accountable for their positive childbirth experience.

With prenatal coaching sessions, the doula can help the clients close some un-noticeable but harmful gaps; the gap between what they say they want and the actions they take toward achieving it, the one between the birth experience they wish for and their belief system or concept around childbirth, the gap between the two belief systems- the mother’s and her partner’s, and so on. Doulas can facilitate alignment; a position of agreement between all parts. Doulas can align the couple’s vision, their thoughts and belief system around childbirth, and their actions towards achieving their desired birth experience. Everything should be aligned in order to invite a healthy and empowering birth experience.

Let’s look into some examples in order to understand what these gaps look like:   out of alignment

  1. Your client tells you that she wants to have a natural childbirth, but she does not sign up to any childbirth preparation class (a gap between your client’s wish and her steps towards achieving her goal).
  2. Your client wants an unmediated childbirth, but she does not look for a care giver that shares her philosophy (a gap between your client’s goal and her understanding of how to get there).
  3. You client shares that she is very concerned, even scared of an episiotomy, yet when you refer her to resources about perineal massage, she does not find the time to read them (a gap between client’s fears and her motivation to reduce and resolve them, demonstrating a helpless behavior).
  4. You clients both share a vision of natural childbirth, every time that you open options and mention alternatives to the medical paradigm the partner chooses to blindly follow the medical advice (a gap between the clients’ goals and their belief system, as they perceive childbirth as a medical procedure).
  5. You client keeps telling you that it is her priority to do everything possible to avoid a cesarean operation, yet she “leaves herself open to the idea of epidural” (a gap between her goal to avoid a cesarean and her will power or motivation to do what it takes).

These gaps can be hard to notice if you have only two prenatal meetings with your birth client, as recommended by most doula training programs. These ‘holes’ cannot be resolved by taking a childbirth education class because these classes do not address the challenges or misconceptions of the individual, and the instructor has to deliver a lot of information and is not practicing careful listening and coaching. The only one who can address these is a doula who holds valuable prenatal coaching sessions with her clients.

alignment

When a doula learns to conduct prenatal coaching sessions and provides a series of them, both her and her client are inviting a better performance – the doula as a professional in the field of birth support, and the client as a birthing mom. Furthermore, the coaching language and techniques that were used prenatally, will make a real difference in your ability to coach your client in moments of tension or stress during her birth. As a coach you can resolve the advocacy dilemma and lead your client to make informed decisions while working with strong questions, and avoiding the risk of giving medical advice. With coaching strategies you can also establish collaboration and team work in L&D, and lead the medical staff to meet your client’s needs. The Art of Coaching for Childbirth is a one day workshop, approved for DONA International continuing education contact hours. and designed to enrich doulas and other professionals in the field of birth support with coaching tools and strategies. I can assure you that it will take your practice to the next level of performance.  Look for one in your area, or email me at neri@birthcoachemthod.com to arrange a workshop in your area.

To Healthy Births on Earth!

 

Neri Life Choma

Webinar: Coaching Your Client through the Dilemma of Epidural

Saturday, March 21st, 2015

How to Coach Your Birth Client through the Dilemma of Epidural- Before, During and After Childbirth

This one hour webinar first aired in celebration of World Doula Week, March 2015.  In light of the high percentage of birthing moms who ends up using epidural in their childbirth, it is time doulas learn to conduct the epidural conversation. This conversation should take place prenatally. It is also important for every doula to know how to coach her clients through moments of doubt and crisis in order to avoid epidural during birth. However, when the mother exhausted her ability to cope with labor pain, it’s time for her doula to make a shift in her coaching strategy. Learn how to best coach and support your client’s progress after the administration of epidural, and how to facilitate acceptance and clarity about the mother’s decision to use epidural, during the postpartum visit.

Visit our store here to purchase the webinar 

Testimonial: “I absolutely LOVED your “Epidural” webinar!  Thank you, very much!  There were amazing tips I’ll want to use… Half of my clients had epidurals, and I’m afraid that I didn’t do everything for them that I could have.  After the epidurals were administered, I wasn’t much use to them, and I think my closure visits were weak.  At any rate:  THANK YOU, VERY MUCH!  In the doula spirit, Britt Hatch.

Here is what you can expect to learn when joining me for this webinar:  coaching with epidural

1. Learn how to recognize and create the opening moments for a coaching conversation which will evoke a change.

2. Learn how to structure your coaching conversation, following the GROW model of coaching.

3. Study potential scenarios in which the dilemma of epidural might show up, and learn how to tap on your Client’s motivation and commitment in order to lead her through them,

4. Become familiar with the different domains of coaching for childbirth – the prenatal domain, the hands-on coaching and the domain of closure.

5. Learn how to integrate the BRAIN model of medical interventions into your prenatal coaching.

6. Don’t miss my very own coaching technique around pain, a complete refute of the horror myth of ’24 hours of pain’ by using 3rd-grade math 🙂

In addition to the information regarding epidural, you will learn the basic terminology and principles of coaching, which you can integrate in your doula practice.

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?

blogbox

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 a 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 was accepted by both birth professionals and moms. The most obvious and urging question expectant woman is concerned with is whether or not she will take epidural or will try for a ‘Natural Birth’,  and in accordance with what she feels inclined to, she will then educate herself and prepare for her birth. She will decide on a childbirth education class and make decisions regarding her care givers and support group for the birth based on her decision for or against taking epidural. 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…”. What I find even more concerning, is the shower of praises and cheers that the mother who went ‘naturally’ will perceive, vs. the mother who helped herself cope with an epidural.

I think that that the concept of Natural Birth is so misleading that while preparing for this experience, a women might find herself giving birth in a way that cannot be farther away than what nature planned for women- a rather medicalized birth. 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’s on our mind when we think ‘Natural Birth’? Which pictures come to mind? Which words are associated with it?  Which scenarios do we envision and are they really ‘Natural’ for the women we know and support?

   I argue that there is nothing natural in the process of giving birth for Western women, and therefore the concept ‘natural birth’ by itself presents women with a dilemma: Giving birth is part of our nature, this is how we procreate, and yet as an occurrence in the life of modern western women, there is nothing ‘natural’ about childbirth. 

To support my argument, I checked the dictionary for the definition of ‘natural’, and found the following definition:

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.

My understanding is that when we oppose ‘Natural Birth’ to ‘Medicalized Birth’, we probably mean to say or imply that this kind of birth occurs and unfolds with no humankind intervention. Well firstly we need to recognize that this concept tells us what Natural Birth is not, and not what it is. Secondly, I want to point out the misleading implication of this definition- that when we think about something that happen naturally, with no humankind intervention, the connotations that comes to mind  is of something ‘simple’ or ‘effortless’,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”. Really? Would you agree that in terms of ‘the character of life circumstances surrounding women’ nowadays, nothing about birth is natural for the modern western woman? Do you feel the tension? There is also a conflict between the two optional meanings of the concept ‘natural ‘. I think that healthy vaginal birth, which we refer to as ‘natural birth’, has become so rare because of the dilemma that the word ‘natural’ presents. Here is the dilemma of the modern in regards to childbirth:

   “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 why childbirth 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.

 To summarize my argument, talking about natural birth is misleading. In a subconscious matter, which women are unaware of, thinking about ‘natural birth’ lead women to either think about something as natural as a sneeze or a yawn, something that happens spontaneously with no investment or effort, and therefore needs no preparation or intentional engagement. Ironically, expectant mothers 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 should we talk about natural birth. 

I

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