BELLY UP - Tell me what to do!

Is there any problem with answering her, telling her the choices you made? In this issue we will explore the impact recommendations and advice can have on the birthing family and whether or not it is the role of the doula and childbirth educator to give advice.

We live in the information age. Anything you want to know, a quick search on Google is likely to find it. Parents often feel overwhelmed by all the information available, and the host of choices open to them. Without medical knowledge and an intimate understanding of the potential impact of their choices, how do they find their way through the maze of options? They will often turn to their doula or childbirth educator and ask for advice. What do you think? What did you decide to do? These are common questions that are asked in the hope of gaining some insight and finding a solution.

It can be very tempting to share the decisions that you have made as a parent in order to help others. It is worth examining though why there is such a temptation to do this. What are you hoping for when you tell parents the choices you personally made? If a mother asks you what tests you chose in pregnancy, or whether you vaccinated your own children, do you share this information with her? Are there any problems with doing so? We believe that the answer is a resounding YES.

When we make health choices for our families, they are based on a number of factors. These include our previous experiences, our own knowledge base, biases and belief systems, our partner's feelings, personal attitudes towards the medical fraternity such as doctors and pharmaceutical companies. Our views are a combination of all that we are and all that we have experienced. Our choices will change throughout our lives depending on where we are in our own personal journeys. Our clients are not in the same places as we are – nobody is. For each individual the "right" choice is only right for them individually. It is the right choice because it is right for who they are, where they are, and what they are experiencing right now.

What is key in sharing with other parents is not the decision itself, but how we came to the decision. It is the decision making process that is most confusing. Let's consider a client who asks us whether or not we vaccinated our own children. We could simply tell them what we did.

"I vaccinated the first two Anna, but then decided not to vaccinate the last one as I had discovered more about the pros and cons of vaccination."

Think about how this information may or may not help a client. Have you taught her any skills, or given her any further knowledge that enables her to make the choice that is right for her? Now consider how you could instead share the decision making process, without any mention of the actual decision itself.

"That's a great question. I found the whole issue of vaccination to be such a confusing one. What I did was to consider all the different vaccines being recommended by our pediatrician and then looked at each one individually. I read the leaflets the doctor had given us so I had the medical view. I then also read a book that was all about the issues related to vaccines. I also searched online and found the product inserts for each of the vaccines and read about what was in them and what the risks and possible reactions were. Finally, I read about the diseases themselves and tried to decide which ones I thought were higher risk and which ones were not a problem. Then I took all the information and we came up with a list of pros and cons, then decided on what we were personally comfortable with."

In this example you have explained to her that there is a host of information available, giving different arguments for and against vaccines. You have described the process of noting down pros and cons, assessing what you are personally comfortable with. The actual decision you made is irrelevant, except to you personally and your family.

So what is the big deal about telling a client what choices you made? We would ask you to examine why you feel it is beneficial. If you tell a client you did not vaccinate at all, what are you hoping she might or might not do? Are you simply letting her know that it is not a foregone conclusion that all parents vaccinate? Or are you hoping that she might make the same choice? Be honest with yourself about your motivation.

Knowing there are lots of options, including rejecting medical advice or treatment, can be enormously beneficial to a client. It may not be beneficial to know specifically what her doula or childbirth educator would do. For example, if you share with a client that you chose not to have epidurals during your own births, this may have the benefit of her feeling you have personal experience of a drug free birth. But as a doula or educator, we do not need to have experience of every single type of birth in order to support someone else through it. A doula may never have had a cesarean but they are perfectly competent in empathizing with someone who has, or supporting a mother who is experiencing breastfeeding difficulties after a cesarean. What if the client plans a drug free birth and then goes on to decide during labor that she wants an epidural? Does she now feel a sense of disconnection with her doula? That she has somehow not met the mark or let the doula down? How did the information about the doulas own births truly benefit her?

CBI would argue that there is NEVER a place in a client relationship where our own experiences are relevant to the client. There is NEVER a situation where sharing our own personal choices benefits the clients more than simply sharing how we made choices (the decision making process). Whether a client is trying to decide whether or not to have a prenatal test, an induction, or vaccinate their baby, the decision making process is what is really important. And it is pretty much the same in all choices. Teaching a client how to examine their choices, how to determine the right answer for them, is an invaluable skill for expectant parents. It will continue to benefit them throughout their child’s life, whether they are trying to decide when to wean onto solid foods, which school to choose or whether to let their teenage daughter go out on her first date.

There are many tools that you can share with parents that are helpful in decision making. One commonly used one is BRAIN. What are the benefits, the risks, the alternatives? What does your intuition tell you? What if you do nothing? This is a simple tool, and easy to remember. It can quickly be worked through during labor if a decision needs to be made about an unexpected situation.

Another tool is MPOWER. Developed by Childbirth International, MPOWER enables families to consider the options available to them.

Minute – have we got one?

Some decisions are more urgent than others. Many times parents mistakenly think that a decision needs to be immediate or the life of their baby will be threatened. Asking this question first enables parents to understand whether or not the problem is life threatening, or if there is time to consider the options.

Plans – what were they?

It is always beneficial to consider what they originally had planned. This helps to see if they are still on that same path or if they are branching off.

Options – what are they now?

Consider each of the options available. The caregiver, doula and childbirth educator can all provide information on what the options are.

Wait – for how long?

How long would parents be comfortable waiting before making a decision? How long would the caregiver be comfortable waiting? For example, if the parents are considering an induction, it may be that the caregiver is comfortable waiting for several days with closer monitoring of the baby's wellbeing, rather than having an immediate induction. Simply asking this question can present options the parents were unaware of.

Evaluate – pros and cons

This is where the parents do the work. Consider the pros and cons of each option, determining what they are comfortable with.

Reach a decision!

Another way that parents can evaluate options and reach decisions is to consider possible scenarios. Imagine a client shares with you that her caregiver wants her to have a cesarean for her breech baby, without trying to turn the baby first using external cephalic version. You can work through the options with her, considering how she might feel depending on which choice she made. The possible outcomes might be:

1. Have a planned cesarean with no external version

2. Try the external version and it does not work, so you have a planned cesarean

3. Try the external version and it does work, and you go on to have a normal vaginal birth

4. Try the external version and it does work to turn the baby but you have an unplanned cesarean after labor starts

How does she think she might feel several weeks after the birth for each of these possible outcomes? Which one feels most comfortable for her.

In teaching parents these tools and helping them to develop their decision making skills, you are teaching them skills they can use for life. They will come up with the choices that are right for them, without any influence from the choices their doula or educator made. This situation becomes solely about them and not about the doula or educator, or what is a "right" or "wrong" solution.

Think about times where clients, friends and family have asked you for advice. How many times have you held back and how often have you passed on advice, or told them what you have done, or would do in their situation? How could you have approached this differently and focused on skills for decision making? Why are we so eager to give advice and are there any circumstances where it really is beneficial?

Much of this is about effective communication - being an active, reflective listener rather than a competitive listener. Consider whether or not you truly are supporting your clients in whatever choices they make if you are sharing with them the choices that you made. When choosing a training program look at how much focus they have on communication and decision making skills. While we all like to think we are excellent communicators being truly effective at communicating is usually something we continually need to work on. If you want your clients to be skilled at communicating with their caregivers, you will need to be skilled at communicating with your clients! If you have already completed your training and certification, could you work on these skills through an advanced training program, or additional reading?
 

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