Want To Change Birth Tomorrow?

Mar 16, 2015 by

TeenPhotoTalk to the teens in your life today.  From what I can see, the decision about where to give birth and how to cope with labor is made long before conception.  Unlike previous generations, teens today are exposed to media misrepresentations of labor and birth on multiple television shows (Elson, 2009).  Based on a recent literature search (Toohill, 2014), it seems that more young women and men today are afraid of birth than at any previous time.  While the issue is multifaceted (Laursen, 2008; Saisto, 2001) the simultaneous rise in birth “reality” shows and studies of birth fear doesn’t feel coincidental.

Developmentally, girls aged 12-14 begin to ponder their adult future and consider what it means to get pregnant and give birth.  So naturally they turn to TV and to Youtube.  While many home videos are intended to show the raw power and coping potential of women, to an unknowing teen they can be downright scary.  Even videos posted to humor (Two Men Watch  Childbirth For The First Time] – can validate the fears that young people of all genders may have.

As birth professionals, we know the truth.  Given the right circumstances, labor can be coped with.  For the most part, labor is boring, with not much happening for hours at a time.  So TV producers create drama with music, narration, and selective editing.  Women’s bodies know how to create and grow a human being and get them out.  The more we interfere with that process, and that includes TV cameras and lights, the harder it can be on the mom.  Like any major undertaking, including moving house or completing a science project, labor and birth requires planning and support to do in a satisfying way.

Teens need our messages about the real nature of birth and manufactured depictions they see on TV and some uploaded videos.  They need to be engaged with, not talked at.  Even twelve year olds have critical thinking skills and despise being treated as if they are only passive consumers.

So how do you have a conversation with a teen about birth?  Make sure you are having a discussion, not a lecture.  Listen to their answers, and build upon what they share with you.  If possible, let them lead the discussion.  If teens are shy or used to being talked at, your conversation starters may be met with silence.  Use your doula skills to observe their “nonverbal leakage”; people don’t always need words to communicate!

You can start a conversation by responding to a family walking by with a baby, seeing a pregnant woman in a magazine, or even without any reason to at all.  Let your passion give you courage, and proceed from there.  “Hey, you know I’m a doula, right?  Do you know what I do?  Do you know why I do it?”

Another approach is to build on teachable moments.  “Remember that birth scene in ——-?  Did that seem realistic to you?” Build on what was valid in their comment or the scene, but don’t bash if their answer is “yes”.  Say, “I’m concerned when people see that, they’ll think that’s what labor is really like.  Because it scares people/makes birth seem dangerous/makes it seem like its painful for hours without ending.  That’s not the way that I experience it.”  Be REAL – so many people tell teens what they ought to think or do, rather than realizing they are thinking human beings making important life altering decisions almost every day.

Make sure to emphasize that both men and women need support in birth.  This is absolutely critical.  We place a disproportionate burden on men to do labor support and deny their own feelings and the developmental processes of fatherhood.  This is in the process of changing, but only if we continue to hammer home the message that men matter too.

Offer to speak to Girl Scouts (Cadettes, Seniors, and Ambassadors may have health badges), Boys and Girls Clubs, and church teen meetings.  Using the first fifteen minutes of Vicki Elson’s video, Laboring Under An Illusion, can be a great conversation starter.  It’s engaging, to the point, and it will make them laugh.  People remember more when they laugh and that helps to break the ice with groups of adolescents.

Keep your message basic, simple, and repetitive.  Labor and birth aren’t scary.  Ninety-five percent of births are normal and nothing bad happens.  Some people see birth as so safe and normal, they give birth at home and in birth centers.  Pregnancy and birth are wellness conditions, not illnesses.  Given enough support, women’s bodies function well and coping with labor is possible without resorting to medications and interventions.

Young adults will often do what feels right to them and that depends on what perspectives they’ve been exposed to previously.  If we want more informed consumers, we need to start at the most impressionable time: in adolescence when they first see themselves as potential mothers and fathers.

Like what you read?  Please subscribe!  The box is below on your right. Thanks!

Elson, Vicki (2009) Laboring Under An Illusion. DVD, BirthMedia.com 

Laursen, M., Hedegaard, M., Johansen, C. (2008) Fear of childbirth: predictors and temporal changes among nulliparous women in the Danish National Birth Cohort, BJOG, 115 (3), 354-360

Saisto TSalmela-Aro KNurmi JEHalmesmaki E. (2001) Psychosocial characteristics of women and their partners fearing vaginal childbirthBJOG 108:4928.

Toohill, J., Fenwick, J., Creedy, D., (2014) Prevalence of childbirth fear in an Australian sample of pregnant women. BMC Pregnancy Childbirth. 2014 Aug 14:14:275

read more

Responses to “What If ACOG Certified Doulas?” Post

Nov 18, 2013 by

It is difficult to pose these hard questions and I’ve enjoyed reading your responses and thinking together more deeply about these issues.  In many cases we’ve ended up with more questions, but that is a good thing.  Doulas brought up both practical and philosophical considerations. To begin with there is little doubt among you that a medical organization could decide on a uniformly enforceable and restrictive doula policy.  No one liked this idea.  Several of you brought up childbirth education and lactation consultants to illustrate what happens when independent professions get co-opted by hospital systems.

  1. Overall people are pretty positive about the idea of an organization that would recognize doulas with different types of training and offer universal certification.  Doulas with work experience in other careers view this as inevitable progress and reflecting the maturity of the doula movement.  The group that feels most positively is already affected by hospital or MCP restrictions.  They are experiencing what I predict will spread across our countries.  Some doulas have local organizations that have negotiated successfully with their hospitals.  In listening to these stories success is dependent on an individual in the hospital who wants doula support available. In a lot of cases, these people move on and the agreement weakens or momentum crumbles altogether.  I do believe in the power of the local model, but it seems to be unusual for it to be sustainable long term.  In addition, a local approach isn’t viable in many places nor does it solve other issues.
  2. Some discussions centered on whether a voluntary registry rather than a certification process would be sufficient.  I understand the appeal of a registry – we could do it quickly and people could sign that they agree with what was presented.  However, a registry has no teeth; there is no consumer protection, no vetting of doulas, everything is between a doula and her own conscience.  It doesn’t solve the issues before us.
  3.  When I consider a certifying organization I would absolutely hate to see the division that has occurred among midwives occur among doulas.  This fear was a part of several conversations.  Doulas are not the same as midwives.  We don’t compete with physicians for business.  Our social and political histories are different and so is our future.  It is dependent on holding our leadership accountable and creating systems and communities that lessen the possibility of divisiveness.  In midwifery, it was the leadership of different organizations that caused the current fracture.  I am adamant that we intentionally continue to create an environment where all doulas are welcome.  We need our family doulas, the doulas who only do four births a year, the ones who do doula work as their way of changing the world and reversing disparity.  However, we also need professional standards and a way to teach and enforce those standards for doulas who want them.  We can create unity while still acknowledging differences in goals, approach, and the women we serve.  If anyone can do it, doulas can.  Yes, there will be differences between professional and non-professional doulas.  But there is room for us all and we need each other – if we forget that, we’re already lost.
  4. Additionally, there were doulas who stated “we serve the mothers, not the doctors”.  This is true.  Others were concerned that the “spirit or soul of doulaing” would be tainted by universal certification standards.  Yes, the sacred nature of our service is our connection to a woman and creating the space for her birth to unfold as she wishes it.  It demands that we give of ourselves, of our essential nature, of what we cherish.  We are changed by the work we do.  When done in honor and service to the mother, it has the potential to heal.  Simultaneously, many doulas work in environments where they interact with physicians and nurses.  Can we create a system that honors the true nature of doula carework and has a good possibility of being respected by medical staff?  I think we can.  However it would be voluntary.  If this certification process doesn’t fit your paradigm of doulaing, then don’t do it.
  5.  There is a lot of diversity among doulas.  That is because there is a lot of diversity among women.  We all need different things and no one is everyone’s best doula.  Some concerns were raised about whether all philosophies could truly be respected.  Can someone who views pregnancy and birth as one of the most sacred acts in life be equally honored as someone who sees them as mostly physiological processes?  Our strength is that we’re doulas – we’re accepting and empowering of the mother at all times.  We create opportunities for her to find her own way.  Can we not use those same skills with one another in this co-creative process?  Maybe I’m idealistic.  But I trust us.
  6.  The medical system most of our clients give birth in and that we interact with is imperfect.  It isn’t optimal for mothers, babies, nurses, doctors, or midwives.  Some doulas asked, “If we choose to participate in the systematic ritual of certification, aren’t we just embracing and internalizing this broken (or patriarchal or classist) system?”  We want to use this system to our advantage without being tainted by it. The paradox is that we don’t want to perpetuate this broken system but we want to be recognized by it to gain legitimacy, power, and privileges.  “Isn’t the very existence of doulas a bandage on this broken system?”  Of course it is.  To me, this is the dilemma of our times.  We face a version of these conflicts in education, our food supply, human rights, almost anyplace you bring conscious awareness.  If this issue has meaning to you, you will need to use your own values to weigh what is gained and lost by participating.
  7.  Others said, “I don’t want to be like providers; I want to us to be ourselves!”  What needs to be repeated is that I don’t think we are going to be allowed to continue the way we have been.  And I mean “allowed”.  We don’t have power and once the people that do decide they want to do something, it is too late.  We can only react.  Just ask the doulas who are already operating in areas where the hospitals have restrictive doula policies.  Some are in rural areas and some are in large cities – but each is finding its own solution to their “doula problem”.
  8. “Certification doesn’t make me a better doula.”  I have a few responses to this.  One, the certification process we’re discussing doesn’t have to look like anything we’ve seen before.  What would we dream of having, being, doing?  At what stage in their career do we envision people going through this process?  Could we offer mentoring groups?  Right this minute now my husband is Skyping with his certification mentor to meet his supervision requirement for sex therapy.  We have different technological tools, years of experiences, and vivid imaginations.  There is a new generation of doulas who can contribute to crafting a different process.  We could devise a system that could make you a better doula.  My second response is that maybe certification isn’t about making you a better doula.  Maybe it is about legitimizing what you do and what we all do.  Maybe it is about offering consumers some protection and recourse.  Maybe it is about making a statement to medical careproviders that we take our role seriously and that we are professionals.  Third, we have the opportunity to define the meaning of certification and why it is preferable for parents to choose a certified doula.  We can create a system that has benefits to other stakeholders as well as ourselves and market that.
  9. Looking ahead, those who are positive about this system have also posed other possibilities.  According to a research project I am in the midst of, almost every woman who wants to be a professional doula or a midwife also “wants to make money in a profession I enjoy”.  With the current system that is not possible unless you have clients that are paying out of pocket.  Even so doulas are not charging what their services are worth.  They charge what the market will pay.  The new health care legislation will no longer allow for doula support to be paid out of flexible health care accounts.  If we want to be paid a wage by third parties that supports our families, universally recognized certification will be the minimum requirement.  (IBCLCs created their own certification years ago, and are now pursuing state licensure in order to ensure insurance and Medicare reimbursement and recognition.)  If we can get our services covered by health insurers, the market for our services could expand exponentially.  But we can’t lobby for that without a universal standard for certification and professionalism.

We would not even be having this discussion without the path carved in the last 20 years by PALS, DONA International, CAPPA International, and ALACE with their certification programs.  They have led the way.  Doulaing another woman is an essential experience of existence for many of us.  It fulfills what it means to be a woman and it is ancient; coded in our DNA.  In some ways, the idea of codifying how it has to be done is upsetting.  If there were no external forces pushing the issue, I am pretty sure we could stay with the situation the way it is.  But I don’t want us to lose what we have and we don’t know when the window of opportunity will close.  With universal certification standards and a centralized organization, we are shaping the future of our profession for decades to come.  If we centralize our power we may gain more than what we lose.

 

Author’s Note:  When I started my inquiry about certification issues I had no idea it would lead me to this place. I’ve learned over the years that my voice is pretty direct and provocative.  I say things I see out loud.  What I’ve learned in 20 years is not to rush and to include lots of voices.  I value process. When the process of listening, hearing concerns, and building consensus works, the path to creating what you wish falls into place.  So let’s all reflect, talk, ponder, ruminate, observe and wonder.  Let’s engage with one another about the issues I’ve brought up in the last five posts.  Thanks to those who have already sent me proposals.  Email me with your thoughts – there’s no time limit.  Then let’s see what happens. 

If you want some provocative questions, here is a list to help get started.

 

read more

Related Posts

Share This

Why Not To Share Your Birth Story

Jul 31, 2013 by

A major part of our effectiveness as doulas is being authentically ourselves without revealing a lot of information about our lives.  We are most effective doulaing our clients when we can be whoever she needs us to be.  The less they know about us, the easier that is.  We are free to shape ourselves around our client and her family.  Good doulaing has much more to do with who we are being in the present moment with our clients than our lifestyle choices or personal history. 

The easiest way to start is to set good professional boundaries and not include personal details that aren’t important to your doula-client relationship.  Such as not having meetings at your home – have them either at the client’s home or a neutral place.  What your partner does or your children’s interests or even your housekeeping standards are all unrelated to your ability to be a good doula to her.  Yet, she will take that information into account in evaluating you and your abilities to assist her.  So my recommendation is to take it out of the equation.

After conducting my thesis and doctoral research, it reinforced for me that it is not a good idea to share your own pregnancy and birth stories with your clients.  None of my own clients has any idea what my births were like or the decisions I made.  It is completely irrelevant and gets in the way of her allowing me in.  As women, we can be notoriously self-judgmental.  We will compare ourselves to others to find out whether our own decisions are “better” or “worse”.  Our mothers do this – sometimes when we tell them the story or later during the labor as they make their own choices.  As doulas, our clients consider us experts – thus our choices carry more weight with them.  Many doulas have had a mother turn to them in labor and sob, “What will you think of me if I do this?”  So I keep silent about my own journey.

This can be a dilemma for doulas who are also childbirth educators (CBE).  Sharing about births in an education situation has a different purpose – “Learn from what I know”.  CBE’s are also freer to advocate for certain choices.  When the CBE is hired as a doula, she needs to be prepared to deal with this issue directly and be more aware of the potential impact on the mother during labor.  I heard this from every mother who hired her childbirth educator as a doula in my study: “I wondered what she was thinking of me”.

As a doula, when a mother asks me, “What were your births like?”  I turn it around.  For doulas who have not given birth, “What would you do?” is the same question.  “Tell me more about why you would like to know.”  It could be she is interested in getting to know me better; then it is easy to redirect to another topic to build intimacy.  It could be she is trying to figure out a dilemma.  In that instance, I can offer more information or some more emotional support.  In either case, asking about my births is often metaphorical; it is a question that indicates she is seeking care.  Her underlying needs will be better met in other ways than discussing my births.  In our own heads we need to understand that the question about our births may not be about our births at all.  It is an indicator that she has a need and isn’t sure how to express it.  Our job is to figure out what it is and how to meet it.

I’m not advocating you never say anything – there is no such thing as absolutes in the doula guidebook!  Sometimes it is very simple. “Did you have a long labor like I did?”  is just that – she wants to know if I have faced the same challenge.  “No, but I have attended a lot of women who did and helped them through it.”  Short answer plus emotional support – we aren’t dwelling on our stories, but meeting the underlying need as we perceive it.  However, we need to know that mom pretty well and sometimes we’re still wrong.  “Tell me more about why you’d like to know” can give us so much rich information about our clients!  It invites her to reflect on herself and learn something – sometimes something significant.  Rather than assuming we already know, her answer tells us so much more about how we can best meet her needs.

The really important thing is to be conscious about what you share about yourself and to make sure that information is in your and your client’s best interests.  You need to know her pretty well in order to choose what to say.  Remember this is a professional relationship, not a friendship.  You want to build intimacy and safety, but they are engaging you for a service.  Based on my research and years of experience, mothers and their families want be accepted exactly as they are – that is part of your support role.  Since people automatically compare themselves to others, you want to make sure that the information you share will soften those comparisons.

Now I know there are doulas who share their personal stories on their web sites – they feel it is honest and a significant part of the way they doula.  However it is likely that they attract clients who agree with their choices or feel attracted to the emotions expressed in their story.  This is not bad, only limiting.  People probably self select further contact based on reading the story.  It really depends on the doula, the kind of clients she wants to attract, and the kind of practice she has.  The key message I am making is to be conscious about your choices in what you share, to realize it has hidden impacts, and that mother’s questions are often not what they seem to be on the surface. 

read more