Medical studies have shown that women with supportive labor companions have better outcomes, shorter labors and need less pain medication than women who labor alone. In recent years, birth doulas, who are trained to provide
physcial and emotional comfort to women during childbirth, are quickly
becoming a popular labor support option. Pam England, Certified Nurse
Midwife, birth doula and author of Birthing From Within, shares her beliefs about the most essential qualities a doula should possess.
The knitting midwife
There once was a hospital midwife in Albuquerque who earned a
favorable reputation for her unusual form of labor support:
sitting in the corner of the room and knitting. At first I was
troubled when I heard mothers describing their
"knitting-midwife" and wondered what they thought of it.
I anticipated they would complain she was not really present,
but in fact, every mother was comforted by it. They described
her presence like this, "I would finish a contraction, open my
eyes, and look to see her knitting in the corner. That let me
know everything was fine, I was fine, and I could do it. In fact,
it was when she got up to do medical checks, I began to
wonder a little bit if something could be wrong -- so long as she
was knitting, I knew nature and I were still on course."
I now view this kind of labor support as a continuation of what
traditional healers and wise women have always done, and I like
to call it "holding the space."
Traditional values in childbirth
Something stirs in me when I see old Native American women sit
motionless against their adobe dwellings gazing at the boundless
desert out of dark eyes set in brown faces wrinkled by a million
creases. I believe in their stillness they are "holding the space"
for all of us. When I was pregnant the second time, the image
of those old wise women became a living metaphor for me. That
was what I wanted from my doula. I asked my doula to do three
things:
- To wear boots to "kick ass," if that was what was needed,
- To make me a chocolate birthday cake; and
- To "hold the space, the feminine knowing and trusting space."
Power of presence
In labor, my doula arrived wearing her cowboy boots, made the
chocolate cake, and "held the space." She didn't do or say that
much, it was her presence that told me she believed in birth
and she believed in me. From her I learned the power of a
doula's presence. And this is the gift I try to give other laboring
mothers -- and the mindset I want to pass on to new doulas.
When doulas go to a hospital birth, there is little that can be
done to stop the anxiety and distress of parents and staff, or
the steady trickle of routines and interventions. Parents, staff,
and doulas are destined to participate in birth rituals not
necessarily of our "choosing." In every birth culture, people
engage in birth rituals out of years of social and religious
conditioning, in response to fears, a vague feeling of
not-knowing what else to do, and out of a sincere belief and
intention to do the right thing.
One thing I know doulas can do is to "hold the space" of quiet,
trusting mind in the labor room. Especially in the midst of frenzy
and fear, doulas should try to generate a quiet, trusting
presence, like the old Native American women. When doulas
practice breath awareness or non-focused awareness
themselves, their ability to completely relax into whatever is
happening brings the mother into harmony with herself and the
doula. We can look for ways to renew the mother's confidence
in herself, acknowledge her for finding her own way through
labor, and embrace whatever medicine she believes in.
Empty cup
A favorite practice in Zen is to "be an empty cup." I'm striving
towards being an "empty-cup" doula. Before I open the door to
a mother's hospital labor room, I close my eyes, open my heart,
and pour out all my ideas and fears. I enter, and fill my "cup"
with whatever is unfolding and focus on "doing what needs to
be done next."
I strive to drop my ideas about what I think should be done. I
look to see how whatever is happening is "working," and help
the parents and staff see that too, so they can go with it. To
the degree I am able to be a "nurturing" doula, I may help the
mother express herself as a protective, knowing, self-confident
mother.
I notice that most of the ideas about birth any of us hold fast
to protect us from our own fears, and rarely honor or serve the
mother we are attending. Righteousness and knowledge buffer
us from feeling our helplessness in the midst of this fast-moving
event. The fewer fixed ideas and judgements we bring to labor,
the more deeply we might immerse ourselves in the birth that is
happening, and draw from a flow of creative solutions and
support.
Choosing
One of my favorite books is Grace and Grit by Ken Wilber and Treya Killam Weber (1993, Shambhala). It's a moving compilation of Ken and Treya's journals during Treya's treatment and dying of breast cancer. In Treya's
chapter, "What Kind of Help Really Helps?," she writes about the complex
process of making difficult decisions about her treatments, and how she
experienced "support" from others. I love this quote summing up supporting
people who have made difficult choices:
"A dear friend of mine, who made me feel beautiful even when my hair felt
out, recently said, 'You didn't choose what I would have chosen, but that
didn't matter. Then I said, 'But you can't know what you would have
chosen; I didn't choose what you think you would have chosen. I didn't
choose what I thought I would have chosen either."
Making decisions in labor is complex for both parents and professionals.
Even when couples ask for information, I sometimes sense that their
"decision" is already made, or that the "decision" they make will be based
more on unknown, unconscious factors and beliefs than on what I, or the
experts, say. As often as possible, rather than debate the decision, doulas
can show genuine support of the mother and her birth by throwing themselves
into doing what seems to need to be done next.
From maidenhood to motherhood
As a teacher of doulas, I am searching for words to describe what genuine
labor support means. Sometimes it is silent, it may be expressed in a firm
voice, a smile, through teaching, or a skillful, timely intervention.
Whatever its form, genuine support comes from a positive-intention to "hold
the space for the mother" in the belief that she is, moment-by-moment
discovering how to birth.
As a doula, I am witness to the unspeakable power of birth, maidens turning
into mothers, and various dances of madness in the face of unchecked fears.
I am all too aware, when a doula is prideful or too busy doing and knowing
in birth, she forfeits being touched by the great mystery of birth. And, if
no one in the labor room is in touch with that great mystery, and no one is
"holding the space" by being truly present, there is the greatest risk of
all -- that the mother, even though she gives birth to the child, might not
realize she is also being born -- as a mother -- during her rite of
passage. "Holding" the laboring mother in a safe, secure, heart-space is
the best gift a doula can give.
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