I attended my first birth as a doula almost 27 years ago – a 16 year-old African American girl living at St. Anne’s Maternity Home. She was tough as nails, and would jump up and pace back and forth during each contraction, then rush to the bed to lay down in between. She didn’t need my words or my touch, but my presence was felt. The result was an extremely happy unmedicated birth, a clear sense of empowerment that I hope she carried with her into motherhood. Years later, I was doula for a 14 year-old, whose mother cried to me in the hallway “she still plays with Barbies!” I was struck by how the body of a 14 year-old was that of a childbearing woman, while developmentally she was still a pre-teen, emotionally, mentally.
Most of my current students are in their mid-thirties to early forties, married, with careers. The challenges of birthing and mothering will be different, but just as enormous. In fact, their fears and worries seem to be greater than the younger, arguably more blessedly “naïve” women.
In Supported Birth Doula Training, we attempt a non-judgmental “assessment” of the client, her readiness for labor and parenthood, and not just her stated wishes or desires for her labor. I stress to the doula that her job is not to try to control or “prevent” the unknown from unfolding, but rather to simply be aware of the things that might manifest themselves during this woman’s labor. Gayle Petersen, author of Birthing Normally, writes: “From a holistic standpoint, we can perceive the woman’s feelings and internal statements such as ‘something is wrong; I can’t do this; I’ll never make it through’ as a reflection of her state of readiness for motherhood – the end result of labor. ‘Motherhood’ relates to all perceived changes in life associated with being a mother on intimate and personal levels, not just the mother-child relationship.”
If a woman knows herself to be “unready” before birth, she has the opportunity to engage in problem-solving, and confront emotional issues prenatally – increasing the likelihood that that perception of pain in labor will reflect positive belief in herself (everything will be all right. I will make it through; just keep breathing… etc). Labor serves to further the emotional work of pregnancy to a greater state of readiness for meeting her child. The labor experience is influenced by many things, including the woman’s state of “readiness.”
A holistic practitioner recognizes that all possible factors are synthesized in the actual outcome of a birth. We can never know all the factors creating a complication, nor can we always assume that a complication is bad. Labor and birth is the process through which a woman becomes a mother. We are not wise enough to claim to always know the “right” or the “best” way a woman should give birth. We work toward what we perceive as harmony with nature in every way possible. We accept that all women are doing the best for themselves that they can possibly do at any given moment in time. All parts of the system cooperatively work together to create the best possible synthesis at any moment in time. When we improve the woman’s resources and views of herself, the cooperative and creative balance within her system can change, and a better synthesis can result.
- Was this a planned pregnancy?
- How will a baby fit into her current lifestyle and plans?
- How has the pregnancy affected her relationships with her partner, family, and friends?
- Will the baby significantly alter her long-term plans? Is she aware of this?
- What are her expectations of a newborn?
- Who will help her and share responsibilities for the baby during the first year?
- Does she feel satisfied with her current plans for this childbirth?
- How does she envision the birth? What is she doing to make that possible?
- Does she seem to like her body? Trust it’s changes? Seem comfortable with sexuality?
- What are her particular concerns or fears about this birth or this baby?
- About the postpartum period? Where do they come from?
- Is she able to open up to others?
- Is she overly needy, clingy, or worried? Is she counting on you or someone else to make everything okay?
- How is her relationship with her husband/partner? Stable? Happy? Realistic?
- How does she feel in regards to readiness for motherhood?
- How is her support system?
- How has she handled any other major life transitions?
Hopefully she can acknowledge wherever she is at in any of these areas.
Christianne Northrup, in Women’s Bodies, Women’s Wisdom, outlines potential “risk factors” in childbirth in more specific ways. “High-risk” features might be” passivity, dependence, inability to accept support from others, rejection of womanhood/sexuality, childlike, limiting beliefs about birth, non-conducive prior acculturation, dishonest, manipulative communication, self-image of weakness, split of mind and body, conflictual relationships, complete discrepancies in birth plan, fears not being worked through, sedentary or frail, rigid and resistant to change and new ideas, chaotic home, does not want child, lack of control of own life, denial of the reality of birth pain. “Low-risk” features include: independence, self-reliance, ability to accept support from others, acceptance of womanhood/sexuality, adultlike, facilitative beliefs about birth, conducive prior acculturation, clear, honest communication, self-image of strength, integration of mind and body, loving relationships, realistic and flexible birth plan, fears being worked through, physically active, yielding in accommodating to change, comfortable home, wants child, internal control of own life, acceptance of the reality of birth pain.
Lamaze / Supported Birth classes offer the opportunity for much more than the labor tools or techniques that couples think they need. In fact, to me, the “techniques” are not really the key at all. Exploration of beliefs and fears, understanding the system within which they will be birthing, UN-learning inaccurate and untrue information, and learning concepts about birth conditions/environment and support, as well as working toward the open flexibility that will be needed for parenthood, are core elements in preparing for the life change. Doula training in Los Angeles is available, with part of the curriculum being attending classes with pregnant couples.