Keeping A Vision of Birth Support: Cradling Change

Doulas cradle the twins of Support and Vision. We support the mother within her current views and needs. We also keep a vision of what is possible in a community with healthy birth practices. This can, at times, be a delicate lullaby. Obstetrics has swaddled our culture with the fear of impending emergency. Fewer American women are dying in childbirth. American women are better fed in general, and water and hygiene have improved over the last century. Antibiotics and blood replacement improve outcomes for women who get into danger. Yet women seem to be more afraid of birth today than in the 70's and 80's when the natural childbirth movement saw a small but well publicized surge.

Taking our cues from evidence based studies and the midwifery model, doulas see birth as an emergence. The maiden emerges into mother. The girl into woman. The mystery into the known. The dream baby into the greeted child. We are concerned with that emergence. Support is a powerful antidote for fear. Courage is the cure. In our caring for a mother, we hear her fears as much as we see her strengths. Re-framing the culture of fear around birth, we seek to help the mother see her potential in her own emergence through birth.

We present her with healthy visions of birth. Yet at the same time, we can not push her beyond her awareness. If we do so, we we will force ourselves further away from her goals for a healthy birth, and also from her as she moves toward her goal.

Consider a common scenario: the doctor suggests a routine "convenience" induction. By the third trimester, she has established her pace, coping methods, and support. Her birth attendent, doctor or midwife, is part of her support system and she trusts them. The mother may stumble emotionally in her path to her goal; she may accept the induction with ease or with grief. In this example there are no specific medical indications, only cultural ones.

We, as up-to-date doulas, may feel an urge to educate the mother about the pros and cons of routine induction. Perhaps we do this in an appropriate way. The mother is somewhat open, but she also wants to protect her baby from the emergency the obstetrician is warning her may happen. We feel some hope for avoiding unnecessary meddling, but we also are frustrated because of the mother's response to fear tactics. So we educate a little more. We get the mother's attention, but she feels drawn into the induction.

Gradually, our education borders on persuasion. At this point the mother may feel an uncomfortable pressure coming from the doula. If we continue trying to persuade her, it is felt as an "agenda." She will feel the need to reduce her emotional connection to the doula in order to sustain equilibrium in her relationship with her medical provider. If she also wishes to avoid the induction, the doctor steps up the fear tactics. She dares not rebel.

Pulled between to perspectives the mother will choose her medical provider who she has entrusted with her health and reduce her trust in the doula just to reduce her stress in dealing with the difference in viewpoints. Even if she grieves or resents the induction, she will still feel forced to align with the medical provider. This may not be apparent to the doula until active labor when the reduced reliance on the doula is now not enough to get the mother past her fear of increasing labor pain.

For the doula, revealing an agenda has compromised our closeness to the mother and we are at a disadvantage in helping her obtain her goal -even if we were "right" about the statistical chance that an un-indicated induction would decrease the well-being of mother and baby! Why? Because the mother has to be more loyal to her doctor than to her doula. She seeks the doctor's medical advice and care in an emergency and the doctor has just presented an impending emergency.

There comes a time when a doula's advice could disempower. Disempowerment always follows a breakdown in trust. Communication fails when trust is weakening. The doula has to dare to work her strengths of supporting the mother where she is, not rescuing her from where she might go.

To cradle a mother's empowerment, we must also nurture the birthing community. Over the years the Childbirth collective has nurtured the birth community through Parent Topic Nights, the newsletter, and setting standards for and nurturing new doulas and each other. Other community groups such as International Cesarean Awareness Network, Minnesotans for Midwifery, International Childbirth Education Association, and many more groups and individuals have played a role in nurturing healthy birth images.

But how do we get a healthy image of birth into the monopolistic institution of mechanized birth, the hospital? Of course, dedicated nurses, nurse-midwives, and doctors struggle to enlighten and improve obstetric practice. But realistically, in 40 years what changes have we seen? Women may be conscious at the time of birth, but with soaring rates of epidurals as the norm, how aware of birth are new mothers today? Cesarean rates are inching back up, VBAC rates are slipping, certain doctors are proclaiming surgery as the natural evolution of birth, and we're little closer to keeping newborns and mothers together than 20 years ago, in spite of overwhelming encouragement from top pediatricians and psychologists. It will take something more than the internal actions of the clockwork itself to change the time.

The doula introduces change by keeping the Vision of Birth. We go with the mother's flow while we are with her. But community activism is also the domain of the doula. We clarify our vision with continuing education. We read and participate in doula discussions. And we bring our vision to the medical community as an external motivator.

Change can bring resistance. Change can bring anger. Unfortunately, anger and resistance temporarily slow down the changes we seek, but the reactions show that we have the attention of the established medical community.

We must remember, support is the opposite of management. Why work to introduce improved management practices? This is not the strength of the doula. We're not into management! Let's go in the direction of support and we'll find ourselves moving beyond fruitless debate. We offer love and support, and love follows love. Believe me, those left out will see our modeling and seek to come closer themselves. Ask the doulas who actually go into the hospital doula programs to tell you about significant improvements in practices since their programs started. There are nurses and doctors happy to use the support of an external agent to help alter the status quo.

We can carry the vision to the birth practitioners, educating not only the parents before birth, but the nurses and doctors as well. Providing loving support is attractive. It's contagious. Not our insistence, but the smiles of the mothers and the health of the babies will convert. It takes all of us on working on many levels:

To cradle our birthing culture in loving arms, let's be aware of our strengths as doulas. Let's set a course, not only with our scope of practice but with where we are willing to go with our efforts. Keeping our eyes on the goal doesn't mean we have to push against what we dislike. It means nurturing what we believe in and know. Let us honor the gravity of our commitment to healthy birth with the love needed by one and all.

Blessings to all in the Nativity of New Birth.

Copyright 2001 - Gail Tully

back to Articles