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.