I have developed this three-part blog series with the intention of trying to provide some answers to three questions that are posed to me on a regular basis by other doulas. First, as a doula, what can I do to help minimize the risk of birth trauma; Second, How can I best support my client after they have had a traumatic birth experience; and third, how can I protect myself, as a birth professional, from vicarious trauma? There are no quick, easy answers, but I will do my best to share what my experience has taught me, beginning with how a doula can minimize the risk of birth trauma.
My own research, inquiries, and experience has taught me that one of the biggest influences in birth trauma is the focus, attitudes, and preparation of the birthing person/couple.
How outcome-focused are they in their vision of their birth experience? Are they rigid in their birth planning? Do they express an unwillingness or resistance to acknowledge and appreciate the ‘unknowns’ in labor and birth? Are they open or closed to learning ways of coping with a deterrence in their birth plan (for example, are they skipping the chapter on cesareans because “that won’t happen to me”)?
It appeared to me that the more attached a person was to the outcome of their experience, the more likely they were to feel traumatized after the fact if it didn’t go the way they hoped. I consider rigid expectations and lack of well-rounded preparation to be seeds of birth trauma. Once planted, they can take root and grow if other unexpected events are added to the mix – like the client who is adamant that she will give birth at home but ended up needing a transfer; or the client who refuses to acknowledge the possibility of a cesarean, and yet fails to progress.
What is a doula to do?
So, as a doula, what can you do to help minimize the risk of birth trauma? First of all, it is important to emphasize that, as doulas, we are not responsible for outcomes. We cannot make promises to clients that hiring a doula will mean less interventions, a natural birth experience, a shorter labor, etc. Sure, the research suggests that we can make a difference, but in the end, our role is to provide support and encouragement, to facilitate good communication, and to assist in comfort – NOT to guarantee a client gets what they hope for. Doulas new to the profession are particularly more likely to feel the pressure to promise a certain experience and to feel responsible when they cannot deliver. Be conscious of this impulse.
Here are some things you CAN do:
- Facilitate discussions with your clients about the things they have control over (care provider, place of birth, classes they take, books they read) versus the things they cannot control (how long labor will be, when labor will begin, how baby will cope with labor, how their bodies will respond).
- Take a non-outcome-focused stance in prenatals – acknowledge what their wishes are, but also emphasize the importance of planning for how to cope with those unwished-for events, should they arise. Focus on how they can feel satisfied and supported no matter what the outcome.
- Prepare them for the possibility of a cesarean birth or the use of pain medication, even if they believe they will not need the information. I call this the “it won’t happen to me” phenomenon. It is a breeding ground for trauma.
- Suggest they take a non-outcome focused childbirth preparation class. Birthing From Within™ is a good example of a class that focuses on preparing for all possible outcomes.
- Explore not only their hopes but also their fears when it comes to birth. Ask solution-focused questions like “How would you cope if that were to happen?”
- Assist in the development of a clear but flexible birth plan. Watch for unrealistic expectations and address them as they arise.
- Avoid using clichéd affirmations like “Trust Birth” or “Trust your Body” that are outcome-focused and absolute– these can imply to the birthing person that if they just trust enough, they will get the outcome they wish for. This is often not the case, and can lead to feelings of failure and shame when their birth does not go the way they hoped.
As doulas, we have a lot of influence over our clients. They often see us as being ‘in the know’ and look to us for guidance and support. We have the opportunity to make a significant difference in how our clients perceive their birth experiences based on how we approach the preparation phase of our work together. Prepare them. Tackle the hard topics. Encourage them to keep an open mind. Otherwise, I believe we do them a disservice.
Stay tuned for parts two and three of my Birth Trauma series. .
Jillian is a certified birth and postpartum doula through both Doula Training Canada and DONA International and has a Masters Degree in Social Work She is one of the original founders of the Doula Collective of Newfoundland and Labrador. Over the years, Jillian has been actively involved in the doula movement both at a local, national and international level. As a Certified Birthing From Within® mentor and doula, and she facilitates childbirth preparation classes that embrace birth as a rite of passage. You can find more information about Jillian here http://www.handtoheart.biz