What's Goin' On

I taught Kim's Bradley class, cycle 4 class 11, while she was in Williamsburg, VA; it was the "Are you ready?" class, so we finished watching Orgasmic Birth, went through the workbook materials (especially the Bradley Energy Saving Techniques article), and talked about what to pack for the hospital. Today was class 12, so cycle 4 is over, now. I'm sort of sad. Of the five cycles I've attended, even though each one is unique, this one was so inspiring. All four couples started out reluctant to speak up in class and brought with them a general air of confusion. By the end of the cycle, their final labor rehearsal was incredible - each couple was in tune with their partner, moms were relaxing beautifully and everyone left their final class with a quiet air of confidence.

Two of the four couples are due in February; both of them have approached me about doula services, but only one actually contacted me after the class ended. I'd love to attend all of their births, I think they're all going to have beautiful labors, but I'm trying to stick to one client per month. So, it'll be interesting to see what happens if both February couples want to hire me...

Oh, and I busted my ankle again leaving Kim's house - it was really dark on her front step and I couldn't see - but fortunately, it was a light sprain. It's almost healed, just a little bruised, now.

My March mom and I went to Molly Shaker's prenatal breastfeeding class, which was great. What I don't get is: why would you pay $35 for a class and then not ask any questions at the end?... There were a lot of people who just looked clueless and scared in that room; all of them were first time parents. (After Molly took that poll to see who was a first timer, I wished she would've polled the dads and other support people to see how many of them had attended a birth, that would have been interesting.) One of the great things about Molly is how her communication style is so matter-of-fact but doesn't sacrifice tact. She and Melissa are both really good at that, and I try to emulate them when I talk about birth-related stuff.

Respecting the Toes

A doula recently posted this link in a yahoogroup I read from the BBC News site about doulas entitled Doulas: holding hands or stepping on toes?.

The gist of the article is pretty much that medical care providers in the UK are agitated because they feel doulas are intervening in a negative way during the course of medical care provided to moms across the pond.

There's been a lot of criticism locally about doulas, too. A DONA doula was asked to speak at a monthly meeting held by the OBs in our area, because the doctors are worried about the effects of a non-medical person in a labor room, advising moms. Our representative made sure those doctors understood the DONA scope of practice for birth doulas states the following:

Whenever possible, the doula provides pre- and post-partum emotional support, including explanation and discussion of practices and procedures, and assistance in acquiring the knowledge necessary to make informed decisions about her care....The doula advocates for the client's wishes as expressed in her birth plan, in prenatal conversations, and intrapartum discussion, by encouraging her client to ask questions of her caregiver and to express her preferences and concerns. The doula helps the mother incorporate changes in plans if and when the need arises, and enhances the communication between client and caregiver.

She also explained that there's a process for issuing a complaint with our certifying organization if a care provider believes a DONA doula has acted in a manner that's outside of our scope or ethics.

It seems like everyone feels like they're being attacked. Care providers feel like their patients have no confidence in their services when a doula is brought in; doulas feel like the care providers refuse to recognize the validity and benefit of their services. Caught in the middle are mothers who want to have the best births possible.

The issues that arise among birth team members are ultimately no different than any other team's issues. A corporate guru named Patrick Lencioni wrote a book called The Five Dysfunctions of a Team, and named the cornerstone of most team's problems to be an absence of trust. When team members don't trust one another, actions on the team's part are foundationless and fall apart; the team's mutual goals degrade into self-serving motivations.

So, when...

• care providers try to convince moms to have interventions that make the care provider feel better and no one else;


• moms hire doulas to "run interference" and make sure the care provider doesn't do what mom doesn't want during labor;


• doulas try to countermand care providers' directives in offensive and emotionally-charged ways;

...then you know there's an absence of trust on the birth team.


The unifying goal and reality of birth teams is this: everyone wants mom and baby to be healthy, and while there are common aspects to all births, all of us are working with a unique mamatoto (that's the Swahili word that describes mother and baby as one entity) who has idiosyncratic feelings, needs, and expectations to be addressed. But without trust, no one sees the unifying goal in one another's actions.

So, how do we promote trust on the birth team? If we follow Lencioni's model...

• Ask for help. It's not an admission of incompetence to say, "I don't have the resources. Can you help me?"


• Don't conceal weaknesses and mistakes from one another. Anyone can say "I don't know" when asked a question - it's when that admission of weakness is followed by, "but I can find out!" that trust blooms. Then it's important to sustain that trust with follow-through by obtaining and providing the information requested.


• Provide constructive feedback. No one can make improvements who doesn't know there's an improvement to be made. If your care provider is rough during exams, say something! If your patient is always late, say something! If your doula has bad breath, say something! Just remember: the best way to make sure a criticism is received and change is implemented is to communicate constructively. Be kind, be tactful, be empathetic.


• Offer help. No one is an island. We all need to feel connected in order to create the necessary buy-in that links team members. If when you're talking with your care provider and she seems distracted, ask what's up; maybe she'll mention how her house painter quit and apologize for being only half there, and maybe you happen to know a good house painter - that's your opportunity to say something!! Even if they decline your offer for help, you'll be remembered as someone who's altruistic, and who cared enough to ask, "What's up?" Furthermore, you won't leave your care provider's office thinking, jeez, I have a crappy provider, I was so rushed through my appointment, she didn't listen to me at all...


• Don't jump to conclusions about the intentions and aptitudes of others without attempting to clarify them. This one is SO important. It's up to each of us to communicate effectively, but sometimes we unknowingly blunder when trying to verbalize our ideas. (There's a whole blog dedicated to the things care providers say badly.) Try to further communication efforts by repeating back those words, or rephrasing them and asking, "Is that what you meant to say?"

Building a team requires effort on each team member's part. When everyone is on the same page, we all sing beautifully together!

---
Edited to add: here's another article - this one's an opinion piece with an interesting take.
The mother of all rows breaks out over doulas, Doctor questions benefit of female supporters at births