“Being Who She Needs You To Be” Part Two: When It’s Difficult

Aug 12, 2013 by

Most of us are concerned about mothers not being able to use the bathtub, take a fetal monitor break, delay cord clamping, or get a VBAC.  Beneath all of this is the fundamental truth of doula work:  we enter a woman’s life being a guide as she finds her way through one of her life’s most challenging journeys.  For our clients, birth can be physically, psychologically, mentally, and spiritually challenging.  It may be full of anxiety and conflicting messages from family members and medical caregivers.  We have agreed to provide support that is unencumbered by past history or future expectations.  We desire little but that she be true to herself – as she defines it.  That is what doula work is all about.

Some clients keep us at a distance.  Others bring us into their drama and thrust us into playing a part we would not have chosen for ourselves.  We become what they need to get through labor.  This can sometimes be awkward, unexpected, and challenging.  Have you ever been to a birth and wondered, “What is going on here?  What does she expect me to do?  I’m not sure how to handle this or what to say.”  Odds are you are being thrust into a role where ‘being who she needs you to be’ is uncomfortable.  Sometimes it is painful the way some situations turn out – especially when the doula hasn’t done anything wrong.  This can happen to all doulas no matter what their experience level, if they have prenatal visits or meet their clients in labor.  It is the laboring mother who chooses the depth of the contact and meaning of her doula in her life.

I came to these conclusions after analyzing dozens of formal research interviews and then checking out my ideas informally with other doulas.  Here doulas describe some situations where meeting the mother’s needs was difficult.

Family Member:  “She told me at the beginning that I reminded her of the sister that she never had.  Meanwhile she does have a sister so I don’t know what it was.  I think she just took me on as the role of a family member.  She saw me more of a friend than as a doula.  I was invited to her birthday party and she’d just stop by my house.  ‘I was just seeing if you were home’, kind of thing.”

This doula was cast in the role of family member during her client’s pregnancy.  This situation can be awkward and uncomfortable.  The doula needed to figure out where the boundaries needed to be but also needed to understand whether her client was lonely and what was going on. It is really hard to set a boundary after its already been breached especially if the mother is emotionally fragile or needy.  Figuring out the appropriate response requires good observation on the doula’s part plus sophisticated communication skills.  Another possibility is that the doula likes the mother too and wants to become friends.  But if they became friends could she be a good doula?  With friends one is emotionally involved and there are future expectations.

Hostess Mom:  “My client says, “Did you all have a good time at my birth?”  And I said, “A good time at your birth?  What would it be to have a good time at your birth?”  She says, “Well, did you all eat anything?  Did you have fun?”  Then I kind of thought, ‘Hmm, did she want to hostess?  Did she want us to have a party and have a good time?’  So I said, “When you were laboring in that other room, we were in here having a slumber party.  It was like a group of girls having this wonderful slumber party.”  And the delight came out.  “Oh!  I’m so glad, I so wanted you to have fun at my birth!”

Although the Hostess mom is rare, I have run into her a few times. She may have difficulty getting into her labor.  She wants to make sure the people she cares about are settled and enjoying themselves.  Do they have food? Something to do?  Will they nap?  She may have packed food for the hospital to please everyone else.  Instead of focusing inward, she becomes overly concerned with what’s going on in her environment.  This mom requires patience, reassurance about her loved ones and doula’s state of being, and refocusing on laboring.  She may be overly quiet because she doesn’t want to disturb someone else (part of her “be a good girl” upbringing).

Permission Giving:  “There are a lot of people who kind of just need someone to tell them that getting some kind of help or accepting some intervention or pain medication is not a sign of weakness.  For someone to say, “You know what? A really strong person does whatever needs to be done to get the job done.  And I understand how you didn’t want an epidural, but I’m wondering if you are at your limit and feel bad saying so.”

Sometimes a mother refuses pain medication when she is obviously suffering because she is holding on to some ideal.  She does not give herself permission to shift from the vision she set for herself of how she was going to respond in labor. Often we reassure, validate feelings, and reframe.  We subtly try to help the mother to find her own truth and make her own choice.  But sometimes what she really wants is her doula telling her it’s okay with us.  This can be uncomfortable for the doula because we don’t want that kind of power.  Remember it is the mother who looks to the doula for permission – not the doula who feels she is in the position of giving it.  It has been assigned to us – we did not seek it out.

Scapegoat:  “Second stage was very confusing.  At one point, she had said something like my mom should leave.  I looked at her and said, “Do you want your mom to go now or do you want her to stay?”  And she said, “Well I think she ought to go.” I said, “We can have the nurse say something.”  I looked at the dad and said, “You heard her.  Do you want to talk with the nurse?” So the nurse comes over and they tell her quietly.  I didn’t say anything.  The nurse said to the grandmother, “Why don’t we all kind of chill out and you go get some drinks or something to eat.”  So she missed the birth.  Then at the postpartum visit, the mom says, “I never said I wanted my mother to leave. I wished you hadn’t told the nurse to tell her to go.”  There was another doula there too and she was shocked.  After trying to explain what happened from my perspective, I realized I should just shut up and apologize.  Basically in order for her and her husband and the mother to all come out okay with one another they had to blame it on me.”

Unfortunately I have heard more than one version of this story.  It is much easier to blame the doula than it is to take personal responsibility.  We all know people who don’t take responsibility for their own behavior.  People don’t stop being who they are just because they are in labor.  As doulas we have very little power.  We are also leaving that family’s life.  So scapegoating the doula can be a mechanism for making the family members feel safe with one another again.  Other scapegoating examples:  The partner remained uninvolved with labor support no matter what strategies the doula used to involve him or her.  The partner showed no initiative and resisted the doula’s overtures.  Then the doula gets blamed for the partner not behaving as desired.  In another case, an intervention does not turn out favorably.  The doula may hear:  “Why didn’t you make sure I knew that could happen?” or “You should have told me not to do it – that’s why I hired you.”

Someone she can say “no” to:  No matter what you suggest, she says “no”.  As in, “No, I don’t want to ask any more questions.  No, I don’t want to move.  No, I don’t want to drink anything.  No, I don’t like the way you’re touching me.”  As doulas we sometimes feel frustrated because of the mother’s contrariness and our inability to please someone.  Sometimes, this mom is testing your support or begging for acceptance.  She wants to know that no matter how obstinate or uncooperative she is, you will be there for her.  Perhaps she has been let down in the past and really needs the experience of unconditional support.

Another possibility is this mom feels she has little power in her everyday life.  She may have to compromise for everyone else and do what others want.  However, in labor this mom has permission to say “no”.  But she may only be able to do that to someone who has no authority and where will be no consequences afterwards.  In effect, she engaged your services in order to be able to use you to meet her psychological needs.  Which in this case is to have some power over somebody else – even if her choices are not leading her to the kind of birth experience she previously said she wanted.

People are complicated psychological creatures.  When we enter into this path of service for them, we are entering into a relationship where the mother has control.  This is necessary in order for us to be effective as doulas and to individualize the care she needs.  But it doesn’t always feel good to be in the role where mom has cast us.  Sometimes it feels icky or that we’ve been misunderstood or betrayed in some way.  We may end up not liking this birth very much.

This is usually a shock for newer doulas.  Often they haven’t heard these kinds of stories or never really believed them.  A new doula may think, “If I only doulaed correctly, then I would not feel inadequate or be blamed.”  She is not likely to say anything to her doula friends because she thinks there is something wrong with her. But that isn’t true here.  In this way our discussion about doula work needs to shift.  This is caregiving work that can involve a deep intimacy with our clients and their psychological needs.  We become mirrors for their deepest selves.  But when they don’t like what they see, we may be told it is us that is wrong.

For more information about the concept of “Being Who She Needs You To Be”, read Part One.

Note:  I’d love to hear your comments about your own experiences and with what you think about this part of doula work.


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