Between the Shades of Gray in Childbirth Education
by Kathie Neff
Childbirth educator Nicole Green remembers the first time she faced a class of pregnant parents preparing for birth. She recalls feeling pressure to “know all the answers,” since couples searched online, read reviews, and selected her to help them to learn what they needed to know to “get this right.”In the seeking stage, often strong in the newly pregnant person, they wonder who holds the hidden treasure that they need to know? What is the birth philosophy that can put them on the path toward their safe, trouble-free birth?Deidre Coutsoumpos, a doula since 2005, has observed that what parents really want, when seeking out childbirth education, is certainty. “There is a tendency to equate certainty with safety, when in fact one can be safe in the midst of uncertainty.”
A fact that is worthy of consideration is that the bulk of childbirth education that most parents receive from professionals comes from non-doula/CBE professionals, and understanding this may help all perinatal professionals practice with more awareness and intention.
So where or how is this happening? Those in the helping professions, especially those in support capacities for pregnant people, often choose their line of work in hopes of making a difference in the lives of others. Therefore, advice is regularly offered by prenatal yoga/fitness instructors; therapists or social workers who happen to be seeing a pregnant parent; nurses, OBs, or midwives at prenatal appointments; auxiliary medical staff like ultrasound techs, nurses in the labor room during birth, and so on.Lisa Cryderman, a labor and delivery nurse, sees a lot of “advice being given based on the individual’s belief system,” and patients “blindly following anyone,” without truly knowing if the advice is offered from a place of fear, “even from birth professionals. The patient has no idea whether we are sharing our opinion or facts.”If you are reading this and you are not a doula or childbirth educator, you probably already know that you are, in effect, a childbirth educator. If you are an OB, midwife, RN, LCSW, yoga/fitness instructor, etc, you may wish to think about whether you're clear on how to provide childbirth education that truly prepares parents for whatever type of birth they may end up having—which may, of course, be distinct from the type of birth they say they want to have.
If you are a doula or childbirth educator, you might find it worthwhile to remember that you are NOT your client's only professional source of childbirth education—even if your client thinks that you are.
Of all the tools that we utilize to support pregnant people and their partners, either formally or informally, it may be helpful to consider how the intangible tool of humility helps to smooth the path for a birthing family. When we consider our own self-importance, how might humility contribute to a seamless experience between childbirth educators, doulas, nurses, docs or midwives? How does true humility fit in? An article for physicians offers the following: “Excellent physicians [and, I would add, birth professionals] are compassionate and understand patients’ fears and anxieties. They recognize that they are fallible and thus continue to learn and improve themselves. They are willing to ask for help and work in a team. You can be none of these things without humility.”Building a relationship of mutuality with any professionals that offer perinatal services can bring non-doulas and doulas and birth workers of every kind to function as an eclectic team for birthing parents. Humility means not playing savior. Humility can’t be taught, but it can be caught as we model it in our interactions with one another.“When I teach doulas, midwives and nurses,” says instructor and midwife, Nicole Morales, “I emphasize it’s the tools that are uniting us: awareness of consent, awareness of physiology of birth, awareness of birth trauma prevention, and awareness of why we may be drawn to one thing or another.”
A key takeaway from Birthing From Within training is the importance of telling the truth with compassion and sensitivity.
It serves no one to pretend that there is only one way to birth, or only one person, philosophy, or teaching that holds all truth. Kindly and compassionately speaking truth, and consciously broadening expectations, is one way that anyone working with birth givers can help them avoid emotional birth trauma.“I think it’s important to state things with no more passion than you’d say ‘pass the salt,’” Lisa adds. “Your tone of voice communicates your disapproval, your fears, your demands. I see many doctors who do this - often male, but not always. They feel they have presented options but the tone of voice says: ‘You will do it my way.’”For as long as she continues to practice, Nicole Green will regularly face pregnant parents whose eyes display high hopes and dreams. As they come to her, some seeking certainty or guarantees, some looking for a map that factors in their secret hopes and fears, most dwell in a liminal space of possibility. “I try to help them to understand that there are many shades of gray and avoid using a language of absolutes…allowing words such as ‘maybe’ or ‘some parents’ to keep things real.”The central back-and-forth of opposing birth philosophies is generally between the concepts of “hands-on birth” versus “hands-off birth.” Lisa offers a final comment on this opposition: “The truth is seldom in these extremes of total intervention or total hands-off, but in all the shades of gray in between.”