Posts Tagged ‘coaching’

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. 

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.


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 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 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.