What's between Pathologies and Pacing and Leading in the doula practice?

Only two classes into the birth doula training of 2010, and so much growth is taking place in the group.  We share a growing intimacy, and we support each other’s personal growth. Every year I am in awe of how fast these courageous and remarkable women, my students, are willing to commit to the process of growing and becoming a care-give and a leader.  A good birth doula is a care giver and a leader, a sister and a friend.  

The theory content of our first class meeting covered the Physiology and Anatomy of birth.  Then we all watched together a movie made by BBC called “An everyday miracle”, presenting the struggle the egg and sperm goes through on the way to become a human fetus and baby. It took us to a journey inside of the mom’s body from the moment she was trying to conceive, all the way to the successful homebirth and the embrace of the new baby.   Every time I watch this movie, I get this sense again of how privileged I am to take part in so many healthy births.

Then we had the coaching part of our meeting, an exercise in tows.  This time it was a fun activity which was an opening to understanding and practicing of the Pacing and Leading principle.

In this fun exercise I asked my students to partner up in twos. I gave every couple an eye cover, like the one you get in airplanes.  While one was covering her eyes, the other one had to guide her through drawing a picture on a blank paper, using whatever leading tools she needed. Then they switched roles, and the follower became the leader. There was a lot of laughter in the room, and many different styles of leadership that I could observe.  I sent my students home with a list of questions regarding this exercise and what they could learn from it.  Here are some questions the students were asked:

1. In which role did you feel better/more comfortable - the leader or the follower?
2. How was your leading style different than the one of your partner, or other members if you were watching them?
3. What was your leader doing that was beneficial for you?
4. What was missing? (Example: clarity, more confidence, more instructions, more encouragement…)
5. What kind of understandings can you reach from this exercise re the doula role? What can you learn from this exercise about yourself as you are becoming a doula?

Today was our second meeting, which covered pathologies. Needless to say not my favorite subject of all, but something a doula has got to be familiar with. Many of them I categorize as FYI – for your information only, b/c there is nothing for doulas to do other than be a resource to our clients. Some other pathogenic conditions might show up during birth – such as being over due, having prolonged early phase, failure to progress in active labor, OP baby or any other mal position, or  heavy bleeding,  and birth doulas  should be accountable for these, and know their Para-medical tools to deal with these.  After a long and exhausting theoretical part of the class meeting, we took our lunch break, and then there was time for coaching and growing. I tell my students when they inquire about the training that so much of the learning takes place in the informal part of the class- lunch break. Then it is wisdom time. :)

Today during lunch I used pathologies to refer to pacing and leading. How do we react as doulas when a birth client calls us with some new diagnose – breech baby, diabetes, need for induction, narrow pelvis etc. How do we not presuppose her emotional reaction to what she just heard from her OB and confuse it with ours?  How do we look for clues whether or not she is interested in more information regarding her options? How can we not judge her for not wanting more information? How do we become a resource for her, but still do not give her any medical advice?  How do we empower her to rely on her partner and friends, and not feel solely accountable for the decision? How do we empower her to go back to her OB with further inquiry, while being well informed, and present him/her with articles and evidence based information?

This whole process is relying on pacing and leading, or we are risking loosing our client, either because we impose our belief system on her, or we sound judgmental, or she feels like she is disappointing us, or she just realized we are not good support for her.  With good pacing this will not happen, and we will follow clues which signal that she is ready for our lead. 

During this conversation, and later when we shared the answers to the pacing and leading exercise, I was very touched by the growing intimacy and by the sharing. I feel so much respect when already at the second meeting students are observing areas which challenge them, and become clear about their need to practice new habit and behaviors and grow in these areas while becoming the excellent birth doula they want to become.

Namaste.

What a student can teach her mentor...

With my 14 years of experience, I feel pretty confident to joke around the pushing phase saying:

"No baby has ever fallen out of her mom's vagina". Well, no more jokes around it.

My wonderful student from last year, Dorit, called me on her way back from supporting a birth client, still under what may sound like panic reaction to what happened at the birth. I listened, I was shocked and amazed, I grounded myself  and helped her understand what happened ,and calmed her down. My advice was: Sit down now, as soon as you are home, to write this experience for yourself. It will help you not to forget details and time frames, and will assist with processing this experience.

Here is what she wrote to me and to her sister doulas the next day (posted her with her permission):

I got the first phone call at 4am. Alex (age 21, second birth) told me that her water broke and she is going to the hospital with her husband and will call me at the morning. Around 11:30 am I talked to her. She updated me that they just started the induction and she started to feel the contraction. I arrived at the hospital at noon. Alex was sitting on the bed. I encouraged her to take a walk with me (her husband told me that they all tried to convince her all morning) . We took a long walk and after that went to the shower, Alex was great with the contraction, and she planned to take an Epidural close to Transition phase.

From the minute I arrived, the nurses all the time asked her to take the big E (Epidural), they didn't know what was her dilation. Alex asked not be checked virginally until the E (she said that she can’t stand that). She got the E at 2pm, when she had a 6 cm dilation!

At 3:30 pm the nurses changed shifts. Around 3:45 we called them and asked to switch sides, Alex asked if it's OK to be seated for a while, since she was coughing heavily all day. We put her in a sitting position and continued chatting with a very nice student nurse, who attended L&D the first time in her life. About 10 min after, the nurse came back in and asked Alex to turn on her side in order to monitor the baby better. We helped the mom turn, and the nurse was looking for the baby's heart beat...nothing....for me it looks like for ever, she asked us to help the mother fix her position, and in that moment the student nurse picked- up the blanket and said "THE BABY IS OUT"!! We called for help and in seconds had 15 people in the room. Alex was in a big panic (me to). I was with, her holding her hand, trying to calm her down, until we heard the baby first cry and were relieved.

Little Julien delivered himself at 4:04, 6.30 pound.

So, want to be a doula? How amazing is our job? Having doula students is exposing me to so many situations in labor, I am enriching my knowledge and experience through mentoring. I love having amazing strong women like Dorit as my students.







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