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The Birth Attendant’s Toolbox for Facilitating Transformative Interac

As Birth Attendants - Midwives and Doulas - we are in a unique position to facilitate not just a smooth delivery of a baby, but to use our skills and knowledge to deepen our relationships with our clients. This depth of connection will ideally help us achieve good communication, an essential component of trust, safety and emotional intimacy. By mastering a few simple tools and techniques, the birth attendant can help her client in a profoundly positive way.

Why would things such as emotional intimacy be important in our work as birth attendants? Isn’t it enough to provide quality health care during the pregnancy, birth, and postpartum period? In some cases it is enough. In some cases the client may be intentionally resistant to developing a deeper connection with her care provider. That’s perfectly acceptable, and a good care provider can work within these boundaries and still form appropriate levels of trust and communication between herself and the person she’s helping. In many instances however, nurturing depth in a care-giving relationship can yield exponential benefits for all involved.

Most of us can agree that the birth process is one of life’s major transformative experiences. In over 20 years of helping women grow and birth babies from their bodies, I have had a rare view into what this profoundly intense and powerful experience has the potential to do for the woman, and in some cases, to the woman. By strengthening the connection between care provider and client, we can help the woman integrate what she is experiencing and ideally help her to learn about herself, deepen her relationship with herself, and grow into a better and more capable version of herself. In this way, many women can come through the process feeling as though they’ve given birth to a new part of themselves. With care and intention, the birth attendant can do much to facilitate this.

The birth attendant will encounter many different kinds of women over the course of her career. Some will be more grounded than others, more confident than others, more emotionally healthy than others. We need to be flexible in our expectations and realistic in our outlook. A good rule of thumb is try not to force anything! If you feel you want anything more than the client, it’s imperative that you examine your motivations and reevaluate your approach. That being said, if we put energy into attracting a certain kind of client, we will dramatically reduce the number of times we find ourselves serving a client who would have been better off being cared for by a different care provider. Essentially, the Midwife or Doula can draw the particular type of clients best suited to her practice style and personality.

Tools for Transformative Interactions

What can the birth attendant do to help the woman achieve a profound, positive, and transformative experience?

Communication is the single most important tool I rely on in my practice. It’s dynamic, multi-faceted, and subtle. I credit my success over the years to having mastered a few simple communication tools. The basis of these techniques involves establishing a foundation of trust and rapport. While my techniques are fluid, these are the 5 basic principles I use:

Connecting, Listening, Validation, Reflection, and something I call Hold it and Return it (when the time is right).

Connecting- The client has reached out to me for help, support, advice- it’s my job to put myself out there and connect. It’s not always easy for a woman to reach out and call a doula or midwife, and I hear nervousness in the voices of quite a few who call me for the first time. I want them to feel as comfortable as possible as soon as possible. Often before speaking about their needs, I spend a couple minutes chatting and showing her I’m a real person and willing and ready to be authentic with her and that goes a long way. If I sense urgency in her voice, I reflect this and validate her needs by urging her to ask her question as soon as she feels ready. If I’m meeting the woman in person, I make eye contact, smile, and maybe give a reassuring touch on the shoulder or arm if appropriate. I keep the conversation light and friendly. I may offer water, food, the restroom, etc… I use body language and my good sense of humor to put the woman at ease.

Listening- This is the second foundational (and possibly the most important) tool we have. Listening to someone with our whole selves - with an open heart - is a true art. We get better as we practice. There is power in just listening. Avoid giving advice, critique, even limit commenting unless needed to validate and keep it comfortable. If we set our intention to just really hear what she is saying- we will hear what she is not saying as well. Listening involves being sensitive on many levels. We have the potential to be unbelievably perceptive. Try to let it all just kind of wash over you. Don’t get distracted or jump ahead thinking about what you’d like to say to her- what advice you plan to give. Just be with her for a bit. Just listen. We can observe how she speaks to her husband or partner, how she talks about him; what words she uses and also what she looks like when she speaks. Allow yourself to become attuned to her eyes and facial expressions, to her tone and body language.

Body language is an incredibly valuable tool. When we begin to read body language and tune in to the body language of others, we can sometimes tap into things that some would attribute to having certain -even psychic- powers. But alas, no magic involved. It’s just a matter of developing awareness. Each of us must work on our own powers of perception, our intuition, our ability and comfort level with being present- and with the intimacy that comes with being present.

As she shares, she may repeat themes – her life struggles with relationships, self-love, communication, fears, hopes, insecurities, hang-ups, weaknesses and strengths. Many times there is fear. Sometimes her fear will be overwhelming. There isn’t anything to do at this moment, isn’t anything to fix- we just listen.

We show her we are listening by our body language, eye contact, facial expressions, and maybe giving brief verbal responses as well. If she takes a pause, don’t feel the need to fill the empty space the silence seems to leave, just be patient as she may be searching for the right words, or trying to find courage to share- don’t interrupt! Stay focused on her. I use my breathing to show her I am relaxed and at ease with her taking her time.

Mirroring- When we find we are subtly and subconsciously adopting the body language of the person we’re speaking with or vice versa, this is called mirroring. It’s a very effective and natural technique that humans do in the process of building a rapport, which puts the person at ease. - an essential part of communication. When you’re mimicking another’s body language and posture, you actually begin to understand more about them- Mirroring one another is a silent signal that you’re positively relating to her, and she you.

*It’s also important to mention that because we are real people with our own lives and issues, we may find we become triggered at some point. In this work we need to maintain our balance. There are times when we’ll feel too raw, to tender, too vulnerable to hold a space for our clients. Notice this as early on as possible and seek out self-care immediately before it clouds your ability to function in a professional manner.

Validation- We now acknowledge what the client has shared with us- confirming that her experiences, thoughts, sensations, emotions- are understandable, valid, acceptable, normal etc. It does not necessarily mean agreeing or approving. It means being present, focused, and accepting. This will flow into the next principle of reflection, which is actually a part of validation.

Reflection- We reflect accurately and authentically what we have heard and seen in a non-judgmental and accepting way. We use reflection in the communication process as it is usually very validating for the person. When we show the client that she has been heard, and what she has shared is valid, we can go a step further and show we understand why they are feeling the way they are. The client needs to feel safe and we must do everything in our power to guard that feeling of safety. I may commend the woman on being honest, on giving me her trust, or on the courage it took to share- to be open with me.

Hold it and Return it (when the time is right) – We have ideally established communication and trust between ourselves and our client. We “hold” what she has shared for her. Her history, her triumphs, her disappointments, her pain, her joy, her fears, her wounds, her unique and special self. We are now keepers of what she has given us.

Now it is time to integrate what we know into how we care for her. This is the part that may take the most skill. It too comes with practice. We allow ourselves to love her unconditionally. (Ideally we also like our client, but that is not a prerequisite for loving her.) Every client deserves to have a loving (appropriately so) care provider. I credit this approach with the ability to give individualized care.

At some point, it may be important to reflect back to her what you know about her, this time in your own words. We show her she is loved because we listened, received, accepted, and integrated what she gave us. Now, we know her better and we can “Return It” at an opportune time. Not necessarily at the first meeting and maybe not for a while- if ever. Sometimes I “hold it” for years before “returning it”. At some point however, we may find ourselves in the position to help connect the dots for her and it is so, so powerful. Returning it takes time, energy, and patience. I view it as “behind the scenes” midwifery.

Holding it and Returning it is an extension of reflection, where the Midwife or Doula helps the woman integrate her new self by supporting and validating growth through experience. It becomes even more profound if the woman becomes a repeat client. Then, the birth attendant and woman are already on a certain level of relationship and the potential is there for going even deeper.

Often what I “return to her” is a combination of what I know about her from what she’s shared, working with her, and what she experienced during the pregnancy and birth. I show her love and compassion by reflecting what I see – how she’s grown, what she may have learned, how she is strong, competent, confident, triumphant, willing to be vulnerable, flexible, forgiving, and anything else I feel it’s important to share. As midwives and doulas, what we share, or return to her, often holds more weight than the reflections of others in her life. We have seen her innermost qualities, witnessed her essence as she birthed her child.

Simply put, our clients are trusting us to see them and accept them for who they truly are. For many women, we are the only ones with whom she has ever been this vulnerable. This can be truly terrifying, or truly exhilarating. Nurturing this trust has the potential to affect deep, emotional, physical, spiritual, and psychological growth for our clients, for ourselves as care providers, and as human beings.

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