Posts Tagged ‘healthy birth’

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. 

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 caregivers 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 online; where we can always find statements in this spirit:  “I decided not to take epidural and try for natural birth…and here is what has 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 woman 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 for modern women, there is nothing natural in the process of giving birth 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 happens naturally, with no humankind intervention, the connotations that come 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, the spontaneous motion of the body like spiraling, and other types of behavior that are not considered to be attractive or feminine, and therefore 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.