November 24, 2014

Birth: Don’t Push the River, Let It Flow

I will rarely make a blanket statement about birth. However, one thing I can say with certainty is to be open to the unexpected. Recently, I have been having an ongoing conversation with a student who has presented me with her very well laid out birth plan. It is detailed and very specific. I offered her the feedback to perhaps scale back her plan and pick the top 3 or 4 priorities. Then, use these ideas as a jumping off point for a conversation with her care provider about her general intention and direction she would like for her birth. I am not sure if I sold her on this idea.

I am so happy she is excited about the birth of her baby, but it is vital that she keeps an open mind to the many possibilities that may unfold. Birth reminds me of white water rafting; you are riding a powerful river with the bumps and turns you may not have expected. Even with the guidance of an expert, birth is a force that has it’s own path. Pam England, author of Birthing From Within, states “Birth is what happens when you are busy writing birth plans.” If you have only one vision, there is a strong likelihood of being unprepared to divert into another direction.

This attachment can also come in terms of pain management tools. Very early in my doula career, I had a client who studied a particular birthing methodology. She diligently practiced the techniques nightly with her husband. As a member of her birth team, I was also given the CDs and scripts I should be familiar with to help guide her during her birth. As a new doula, this was very intriguing to me since it was rather different preparation then I had been taught or seen before.

Once labor started my client went straight for her CDs and settled into a very relaxed state. This seemed to be a wonderful coping mechanism for her at this time. Hours later when I arrived, labor had progressed and the same guided meditation tool that worked in early labor was not serving her as well in active labor. We switched gears and started to explore other tactics of pain management. At first there was a little hesitation and nervousness to changing methods, but fortunately we were able to find other options of pain management. My client was a marathon runner and we tapped into some of the techniques she used when she raced. Terry Richmond, labor support doula and childbirth educator, believes “I have learned that the tools that will be strongest for you are the ones that you have reached for in your life – what do you do with your breath, how do you quiet your mind, how does your partner help and comfort you?” In the case of my client, as a seasoned runner, she already had established her own methodology for sustaining mental and physical endurance, finding relaxation within the work and working through discomfort, she just didn’t realize it.

I learned a very important lesson as a new doula from this birth. I learned that I need to listen to the wishes of my client and honor her preparation, but it is my responsibility to dig deeper and find out how she already relaxes and come prepared with many options for pain management. Just relying on the ones we discussed may not be enough. If the mother does not already relate to some coping mechanisms, I need to be ready to introduce new ideas and see what resonates with the mother. The mother may not even realize what she needs until she is face to face with the current of labor. This is why I believe attaching one’s self to a specific method of philosophy can leave one unprepared and often disappointed.

At the postpartum visit with my client, we discussed how it felt to deviate from her plan. She explained that her resistance to try other options was a combination of losing the image she had of her birth, but she also felt overwhelmed because she was unsure of what else to do. Fortunately, she navigated through the change with relative ease. There are many scenarios in birth that this applies to; women who want a natural birth and end up with a cesarean birth, others who want an epidural but end up with such a quick labor there is not an opportunity to get the pain medication. It is important to sit and think of what you may need and want. Map out some tools, discuss your ideas with your birth team, and then be ready to throw it all away. Remember, don’t push the river, let it flow.




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