Who is the Birth Expert Here?

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) 

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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