Doulas – Carrie Kenner: Doula Trainer. Writing Coach. Sacred Feminine Guide.

The Felt Sense of Doula Work

Carrie Kenner — Mon, 29 Apr 2024 07:00:58 +0000

I am a copywriter for a continuing education platform for psychotherapists. In my role, I meet many expert therapists who are offering courses and I learn about their work.

So far, I’ve learned about:

How I Learned About Felt Sense

A few weeks ago, I was interviewing one of the experts about a course she was creating and she kept mentioning ‘felt sense.’ She used that term in a few sentences and alongside other concepts included in her course.

But I wasn’t sure what she meant by felt sense. So I asked her to define it for me.

“Many people think ‘felt sense’ means something they feel physically, like on their skin using the sense of touch. But it’s not that at all. In the specific context I’m talking about right now, it’s the experience one feels when they are deeply listened to. They can feel in their body that they are being deeply listened to, which leads them to feel safer and therefore able to be more vulnerable and say more. There’s an actual energetic shift that happens inside of them. And that shift is felt by the person doing the listening. The listener knows the way they are listening caused that shift and opened the other person up so a shift happens inside of them as well.”

I was blown away. Not because this sounded outrageous.

Because I’d been doing it for over 20 years as a doula.

Only I didn’t have a word for it.

What is Felt Sense?

Felt sense was a term coined by Eugene Gendlin. He described it as:

A felt sense is not a mental experience but a physical one. Physical. A bodily awareness of a situation or person or event. An internal aura that encompasses everything you feel and know about the given subject at a given time—encompasses it and communicates it to you all at once rather than detail by detail.

A felt sense doesn’t come to you in the form of thoughts or words or other separate units, but as a single (though often puzzling and very complex) bodily feeling.

The vague, beyond-words experience of a felt sense is more than just a "gut feeling" or intuition. It’s not instantaneous. It forms, fuzzy at first then morphing into clarity. It is the sense of the whole of a situation.

Because doulas are typically working with clients in atypical situations — labor, postpartum, death, crises — we cannot count on luxuries like talking during someone’s labor. So doulas learn to rely on all our senses and a state of just being to feel into what is going on in any given moment.

I believe that is where our capacity for felt sense comes from.

How do doulas learn these skills without knowing what they’re doing?

This revelation about felt sense got me thinking about how I learned how to do that. Because when I did it, it felt like magic. How did all the other doulas I knew learn it? And how did I teach it to thousands of doulas without having a term or definition for it?

Here’s how I would teach it to birth doulas:

After a long session learning about and practicing communication skills for doulas — which included how to listen more deeply, how to use all of your body (not just your ears) to listen, how to ask open-ended questions, how to be an active listener, and how to ask for consent before providing information — I would tell my students:

“You will sit down with your clients for a prenatal visit and at the end of that 2-hour visit, you’ll be shocked by how deep and profound your connection will be in that short period of time. I don’t know how it happens or why, just trust me that it does. Sitting here now, you don’t believe me. But I’m telling you, if you use these skills, it will happen and I want you to remember my words today. You did that.”

Since that interview with the therapist, I’ve talked to a number of my past doula colleagues who are now therapists. I want to emphasize that all of these doulas were birth doulas, and I believe there’s a reason for that as well.

Turns out, becoming a therapist is a really common career path for birth doulas. I can think of 10 just off the top of my head and I bet there are hundreds more. I think that’s because many of the nuanced skills we use as doulas translate to the therapist role easily. In fact, I’d venture to say doulas are waaay ahead of the game when entering the field of psychotherapy.

What my doula-turned-therapist friends tell me is that doulas learn on the job many of the most important skills that therapists struggle to learn because the skills aren’t actually taught in grad school. Mainly theories and general modalities of therapy are taught.

Why Doulas Excel in Their Next Careers

In my career as a doula, I studied developmental psychology, attachment theory, pre-and perinatal psychology, the consciousness of babies in utero and newborns, embryology, endocrinology of pregnancy, birth, and lactation. None of those things are required to be a doula, those were just my particular areas of interest and I am a very curious person so I read books, attended conferences, and took classes on my areas of interest.

Other doulas dive into other areas: postpartum adjustment, neurodiversity, trauma survivors, special needs infants, sleep, infant feeding, nutrition, business and marketing for doulas...the list goes on and on.

But every doula finds an area of interest and explores it.

What this means for any doula entering a new career field is that they’ve got so much knowledge already — and now they’re learning from people who will use words to communicate it all — the rest comes much more easily.

So whether they go on to work with families in social service agencies, to affect policies and legislation in government, to provide more expansive birth support as a midwife or obstetrician, to treat individuals as a therapist, to heal the body as a massage or craniosacral therapist, chiropractor, or acupuncturist, or to become a better parent or human being, what they learned as a doula is perhaps the best training ground possible.

What else do doulas know to do without knowing what they’re doing?

Besides learning how to listen, we learn how to sit and just be. We learn the skill of patience, observing what is happening around us and not jumping to reactions.

We learn how to watch people for facial expressions, body language, posture, voice inflection, the eyes, what’s not being said as much as what is being said. And we’re not just watching our client. We’re watching their partner, kids, family members, friends, doctor, nurse, or midwife. Whoever is in the room. We call it ‘reading the energy in the room’ and it’s a crucial skill for facilitating communication in emotionally-charged situations or when conflicts are happening.

We dance in the realm of the unknown. We learn to be okay with not knowing when a baby will come, how long the labor will be, or what someone will be like during birth.

We step into our client’s space with the acknowledgement that we have little political power. We don’t want it. We want our clients to have all the external power. We have a mother-lode of internal power in our hearts.

We learn to not have answers. Sure, we have information — and we learn to ask our clients if they’d like to partake of our information, rather than shoving it down their throats — but in the realm of the unknown no one has the answer...not the doctor, not the client, not the doula.

The Art of ‘Holding Space’

Another thing we learn to do, which almost everything I’ve mentioned so far is a part of, is holding space. This is especially relevant to birth doulas.

Holding space can be defined many ways but it involves these components:

Creating an energetic container — the space — for an experience to occur
Being fully present and empathetic with healthy boundaries to protect yourself from absorbing energy that isn’t yours
Allowing whatever needs to happen in the container to happen — i.e. not trying to influence, coerce, or create a certain outcome
Creating space for vulnerability, scary or dark thoughts, ‘negative’ feelings or emotions without fear of judgment, rejection, punishment, shame, or retaliation
Witnessing and acknowledging the emotions, words, and actions that arise in the container
Being fully present and able to witness your own emotions and responses and acknowledging them as well
Being an energetic “guardian” of the space to help align others who enter the space and help them adapt to what is in the container
Being free of judgment, intentionally putting aside your own beliefs, opinions, agenda, and desires for a situation

Holding space, in essence, is a way of creating and holding the energy of a physical space and the people and experiences within it, and holding those things to the highest good.

You can watch my demonstration of holding space in my vlog post here.

How do doulas get so good at this stuff?

As I mentioned earlier, doulas often get good at doing by doing.

There aren’t many situations in life where you have to rely on instinct because all the other tools we typically use — communication, knowledge, behavioral norms — aren’t available.

But there’s something that precedes being thrown into a space where you have to just be.

And that is the thing that compels someone to be a doula in the first place.

It’s either a love of babies, birthing people, pregnancy, families, reproductive justice, empowerment, lactation, child development, or something related to the fascinating process of ushering people through emotionally challenging times in life.

No one thrives as a doula without something afire in their belly or heart. You just cannot take someone who is not interested in birth and convince them to hold space for hours beside a moaning person in a birth tub while listening to Enya.

So there’s an underlying affinity to these nuances — felt sense, sitting in the unknown, holding space, and being present — that gets refined in the process of becoming.

That is what doulas nurture in themselves and in their clients.

That is what I nurture in doulas.

Have you been sitting on the threshold of becoming a birth doula? My friend and colleague, Amty Kramer of Thresholds, and I are collaborating to bring both of our doula trainings for the price of one to aspiring doulas.

40-module online birth doula training course
Unlimited monthly Q&A calls with Carrie
4-live Zoom sessions with Amity that cover emotional intelligence and relationship skills
Community forum for 24/7/365 problem-solving, connection, networking, and resourcing
Inclusive content and approach to birthwork
Taught through a social justice and anti-racism lens

Learn More now

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A Tribute to Penny Simkin

Carrie Kenner — Wed, 17 Apr 2024 18:57:42 +0000

One of my most impactful mentors, Penny Simkin, left this realm on 4/11/24.

Penny is known as the mother of the modern doula movement.

She has star quality in the birth world.

But to know her up close and in person — to learn how to teach alongside her — was a lesson in humility, grace, and compassion.

Here's Penny

Penny taught me these things:

You never know what's going on inside another person, but they have a darn reason for doing whatever it is they're doing.
Ask for consent before touching, speaking on someone's behalf, and even for something as seemingly innocent as offering information.
Listen.
Sit on your hands and hold your tongue.
Your job isn't to fix anything; it's to just be there.

When I was a newbie childbirth educator, one of the students in my class had a stillbirth. Penny heard about it and reached out to me to see if I needed support. She didn't even know me then, she'd just heard about the new childbirth educator in town.

Years later, after we were colleagues, I'd been called on the carpet at a birth for advocating for my client (the day after my best friend's baby had died so I was an emotional wreck), I reached out to Penny for guidance. She was so sweet. "Oh my," she said, in characteristic Penny understatement, "this is not good. Here's what you could try next time."

It was always "here's what you could try," never "what you SHOULD do."

Because if Penny believed in anything, it was empowering other people by listening, witnessing, being present, and reflecting what she heard. Not telling them what to do.

"Here's what you could try..."

Penny's Legacy

When I think of the words "leave a legacy," Penny is my model. A few years ago, when I wrote what I'd like my legacy to be, Penny was who I had in mind.

Penny leaves a legacy of...

Establishing the word 'doula' in the American lexicon
Ushering in thousands of doulas who are still serving families around the world
Educating, empowering, and entertaining thousands (like over 15,000!) of expecting and new families
Inspiring a world of birth professionals
Bridging the divide between hospital birth and natural birth practices (she was magical at that)
Teaching positions and movements to support normal birth from her expertise as a physical therapist
Introducing birthing tubs, squat bars, and birth balls into hospitals
Illuminating the impact of trauma on birthing people
Being open to change and inclusivity instead of being stuck in outdated ways

For all the things she accomplished, I've never met a person more humble than Penny Simkin.

How Penny Furthered My Career

Penny and I had our differences... she was calm and certain. I was a hothead and outspoken. But our mutual respect was undeniable.

Penny taught me how to create a curriculum, working elbow to elbow at her dining room table. That simple tool catapulted my career, helping me create and offer courses and continuing education credits for thousands of doulas.

We were the two Senior Instructors at the Simkin Center for Allied Birth Vocations at Bastyr University. We debated the nice-to-know, good-to-know, and must-know topics for the doula training curriculum.

We sat in countless planning meetings, taught birth doula trainings side by side, and attended birth conferences around the country. Penny and I were invited to Astoria, OR, for a weekend of events and shared an airbnb together. I delighted my group of doula students with a guest appearance from Penny. That evening, I cooked dinner for her husband, Peter, while Penny spoke at the local hospital.

I was fascinated by the energy, dedication, and determination of this woman. Even though she is known for her humility, her steadfast devotion to promoting normal birth and supporting birthing people never wavered. She always found a way to speak her mind with compassion and conviction.

Penny's Most Profound Impact

The most profound thing Penny taught me (and many others) was to ask this simple question:

How will she/he/they remember this?

Before taking any action at a client’s birth, I would ask myself this question.

Will my action of “helping them” actually leave them feeling less empowered or weak?

Do I know for certain this is what they want in this moment or am I expressing what I want?

Am I doing something because I think it makes me look good?

What can I do to make my client’s memory of this moment better?

Trust me: the answer stopped me in my tracks many times.

Penny went so far as to print this question on t-shirts. On the back of the t-shirt so anyone else in the room (doctor, nurse, midwife, partner, relatives, staff) might also stop and ask themselves this powerful question.

I invite you to adopt this quesetion into your life when you are working with anyone in any setting, as I have.

Penny also helped thousands — if not millions — of birthing people without them even knowing. If you have ever used a birthing tub, squat bar, or birthing ball in labor, you have Penny to thank for introducing those into American hospitals. They are now standard equipment in most labor rooms.

Sharing A Loss

They say a person only truly dies when the last person who has a memory of them passes on.

I know many of the thousands of families Penny taught have told their kids about their childbirth educator, Penny Simkin.

I'm going to make sure my children and grandchildren know who Penny Simkin was and what she meant to me so she'll live on for a long long time after her passing.

I know Penny’s family is deeply grieving their mother/grandmother/sister. For the rest of us, we are missing an icon, a mentor, a huge influence in our lives.

I think of the pain and sadness I’ve gone through since my mom passed away a few months ago. I often felt alone in my grief. But I also didn’t have to “share” my mom with the world, or share my loss alongside tens of thousands of other people. I think that must be an odd feeling.

I hope Penny’s family is buoyed by the outpouring of love Penny has created around the world.

Penny At Her Best

You'd think — with all the conferences, fund-raisers, trainings, planning sessions, and meetings we attended together — I'd have a great picture of the two of us. I know there were many pictures of us taken together, I just don't have them : (

But here is one I took of Penny at her best...listening (to her dear friend, Phyllis Klaus:

Rest in Power, Penny! You deserve it.

I am grateful for your mentorship. I am grateful for our friendship. I love you and I will miss you.

Thank you!

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Growing A Business: My Journey into the Heart of Entrepreneurship

Carrie Kenner — Mon, 08 Apr 2024 15:02:33 +0000

Welcome April! A new month means it’s time for a new theme.

Leading into the year, the theme was all about the nature of human beings: families, our brains, decision-making, and where our passions and inspiration come from.

February, I explored how we want to be heard and seen, which led into March, which was about where your business is going and goal setting, creating plans to move forward.

And this month is about growth and expansion.

I’m going to talk about ways individuals and businesses can help themselves evolve, transform, move on to bigger things, and how to do that.

Today, I’m going to start with how I grew my business and the changes I’ve seen...

The Beginnings of Big Belly Services

The year was 2001.

When I started my business, Big Belly Services, there was a nascent internet. No Wix, no Squarespace, no online courses.

For bootstrap entrepreneurs on the brink of the technology boom, it was bleak. You had to DIY it or die.

If you didn’t have that start-from-scratch ability, you had to have money to pay someone to start it for you.

I didn't have money, but thankfully, I had an old-school work ethic and dug in. I took free classes from the Small Business Administration on business finances. Wrote and printed out brochures on my home printer. And learned how to create a website with a book.

I didn't know anything about marketing. That was years to come.

I also want to set some context for starting my business...

I had a newborn baby. I’d just turned 40. My father had died two months ago — while I was eight months pregnant — and a few weeks after that, I got laid off from the company I'd been with for 16 years.

A lot was going on.

You often hear people say, “Out of adversity comes opportunity.”

And that's what happened to me.

This confluence of events opened a doorway that I'd been wanting to step through for many years, which was starting my own business.

I didn't know what I was going to start a business for. I thought maybe I’d be a race director or an event organizer or a wedding planner.

But instead — because I was pregnant and I was in the world of birth — it was going to be as a doula, and eureka! I became one.

“Out of adversity comes opportunity.”

The Unfolding

Starting in April of 2001, I took a birth doula training. Everything was in person in those days and I was fortunate to live in Seattle where doula trainings were offered regularly.

Two months later, I went to a Birthing From Within childbirth educator training.

When my son was nine months old, I started offering my first childbirth classes.

When he was 11 months old, I went to my first birth as a doula.

It was a pretty rapid process of starting a business and doing the things.

Growth Through Learning and Connecting

I was especially fortunate that my midwives said, “Hey, why don't you teach childbirth classes? We'll refer our clients to you and you can teach them in our waiting room.”

I had some really key connections that helped me get started.

But this was also an area of passion.

I'd wanted to be a midwife since my first child was born 20 years ago. And I'd been a childbirth educator when I was much younger, but in a very different style of education that didn't fit where I was at this time in life.

So things were lining up very nicely for me.

Now, some other things you should know is that I am a diehard do-it-yourselfer. I spent hours and hours and hours in my basement office with my baby in a sling strapped to my chest — either napping or nursing. As he got older, he'd play at my feet while I created everything from scratch.

Registration forms, my curriculum, brochures, a website.

I remember getting my first online sale without even talking to the client and their money just showed up in my account. I thought I was the shit!

This was the greatest thing since sliced bread!

Challenges and Early Wins

Those early wins certainly helped me to grow and expand.

Plus, I'm just naturally creative, resourceful, and dedicated.

I had a lot of energy. I got shit done. I'm 63 now and I still get shit done!

I still work with the same principles of hard work and building what you need, only now there are so many more tools at our disposal.

I was teaching childbirth classes and the people in the classes asked if I would be their doula. So I started going to more births as a doula.

My business kept slowly growing. It wasn’t fast and crazy growth like some folks might see today with an online reach, there was just a nice, steady stream of people coming my way.

Various doctors and midwives heard of me from their clients who had taken my birth classes, so I started to get more birth class registrations from them.

And then those birth class students turned into more doula clients and word-of-mouth referrals.

So my business kept growing.

Now, I don't want you to think there weren't months when I had to cancel classes because nobody signed up because that definitely happened.

But I do want you to know that I attended 25 births in my first year, then 35 births the next year, and 40 or more births per year from then on.

With my birth classes, I was teaching one evening a week for six weeks or a weekend immersion. I'd alternate those every month until more people wanted in.

And there were other professionals in the community who wanted to teach Birthing From Within classes with me.

So I started to offer classes two nights a week, and every weekend a month instead of every other month.

I brought in another teacher, then a second, and a third, and stopped teaching the classes myself.

By now, I was running a childbirth class business. I hired an assistant who managed all of our registrations and communications with students.

Birth of a Doula Trainer

And then in 2004, I was approached to become a doula trainer with the Seattle Midwifery School. It doesn't get much better than training alongside Penny Simkin, the godmother of the doula world.

So I became a birth doula trainer. By 2008, I'd created my own doula training curriculum.

I was teaching it through my own business, and I was invited to travel to different places around the country to train doulas in their communities as well.

Things were continuing to grow very nicely for me.

By 2015, I was done running the childbirth education business and closed that part of my business entirely. I wanted to focus on being a doula and training doulas.

In 2017, I started to offer my doula trainings virtually so people locally could attend in person while people from around the country could attend via Zoom.

By 2018, I put an entire doula training online (when folks said it couldn't be done — of course it could be done!)

Around that time, I retired as a birth doula so I was solely training doulas.

I offered birth doula trainings in several different formats.

I traveled around the country training doulas, and I offered a number of advanced doula courses as well.

Watching the Trajectory

What I want you to notice from this trajectory is that there was a gradual buildup.

There were points where it wasn’t just me wanting to do more, but people in my community recognizing what I was doing and approaching me.

It was a combination of being “self-made” and also having a good reputation and getting tapped on the shoulder to say, “Hey, would you come do this with us?”

That's a good sign that your business is growing and that you're establishing yourself as an expert or leader in your field.

The other thing I want you to notice is that the format, the way that I was teaching, and the things I was teaching also evolved over time.

This was an 18-year process of building and growing, trimming away things that were no longer working, trying new things, and adopting new technology to do work differently.

It took time.

Is It Possible to Do It Faster? And If So, Is It Better?

One of the things I see now, which I think is really interesting, is that the timeline of growing, evolving, developing expertise and leadership has condensed into a really short timeframe for a lot of people who are in the online space now.

They were a doula for a few years, and now they're training hundreds of doulas online.

I'm impressed with the chutzpah that it takes to do that.

But I'm also curious about what it takes to create a thriving business in such a short amount of time.

And I wonder about the quality of the end product.

Because what I've seen in my lifetime is that expertise takes time.

Now, granted, I'm older. I wasn't raised with technology and everything being super fast like it is today.

I certainly didn't grow up having access to people from around the world doing a gazillion things instantaneously. That has changed how we think about who we're going to follow, what we will believe, and what we perceive as quality.

Reflecting on Growth and Mastery

What I've observed over the years from really masterful teachers — which I consider myself one — is that we had to understand adult education theory: How do adults learn? What are all the different ways that they learn? What's the psychology of learning?

As education moved online, I was one of the early adopters. I created the first hybrid program at Bastyr University for training childbirth educators.

I had to learn about online education and the theory and psychology behind online learning.

I put many hours of education, experience, and trial and error into creating the courses I developed.

So I wonder if folks who have always had access to online information — just by being immersed in it — have a sense of what's good and what's not good.

That's very possible.

For me — because I wasn't immersed in it — there was a steep learning curve.

Another thing that I've observed from watching experts in a field is their mastery of the content. Their knowledge.

I often say they could teach things from inside a cardboard box.

They could be in a box or online, and you’d feel their charisma, energy, wisdom, and the nuance of everything that they've embodied, transmitted out of the box or across the airwaves.

Somebody who's new at their game doesn't have that.

For example, I've done the double hip squeeze hundreds of times. I've taught it to thousands of doulas. I know how to describe it in words and pictures and demonstrations. I know the camera angles and all the different nuanced ways to describe where to find the landmarks and what the doula should feel and what the pregnant person should feel and how to ask about that.

I know all the intricate aspects of teaching one technique because of my years of teaching it in person.

What Do YOU Think?

I can’t watch everything out there; I'm just seeing all the new courses popping up.

So I'd love to hear from you...

Do you notice when somebody hasn't been in the trenches a long time to have developed their chops — the personal finesse of doing different things before they're teaching it — is a good teacher?

I don't want the public — who's overwhelmed with choices — to be confused, to not know which course they should pick, or to choose one that isn't very good.

I'd love to hear what you are seeing in the trends of online education or where education, in general, is going.

Are you getting your needs met? Is it hard to discern a quality course or not? Are you satisfied with what you are finding?

And Also, How's YOUR Business Doing?

I'd love to hear how your business started, how it's grown, and the direction you're taking it in.

I'm always ready to help people figure out the business they want to start, or help their business grow, or help market new services or products.

Supporting heart-centered business owners is what I'm all about. So leave a comment below, or send me an email if you have questions, or schedule a call if you need assistance.

And be sure to sign up for my blog below to get instant notification when a new one is posted.

Next week, I'll talk about the evolving role of websites and my formula for a winning website.

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You Can Do Better Than ‘Junkie’

Carrie Kenner — Mon, 19 Feb 2024 07:59:42 +0000

The Words We Use

When you’re passionate about birth, you want to learn about it.

You dive into books and podcasts.

You search for blogs and videos on YouTube.

You scour social media for people to follow.

What should you be called for doing that?

A birth nerd? A childbirth junkie?

That’s what I see. People referring to themselves as a birth nerd. Calling anyone who’s diving into birth information a birth junkie.

And I don’t like it, so that’s what I want to talk about today.

Why do we use words with negative connotations to describe someone who is passionate about a topic?

A Positive Alternative

Why don’t we say something positive about someone who is heartfelt, excited, and devoted to an area of interest?

If someone was pursuing a PhD in psychotherapy, we wouldn’t say they’re a therapy junkie.

We don’t call cardiac specialists heart nerds.

I don’t think this is a case of misogyny — dismissing the interests of predominantly women in a field related to predominantly women — even though I am prone to such accusations.

I do think it’s a case of downplaying the genuine and necessary interest people have of birth, a subject that our culture has relegated to the shadows. And those people are doing it to themselves!

I think of the power that words have on us and invite you to think about how you want to frame your passions.

“The limits of my language means the limits of my world.”

― Ludwig Wittgenstein

Your Passion is Real

If you are fascinated by the birth process...

If you care about how people are treated in labor...

If you believe new parents are not well-cared for in our society...

If you are passionate about the power of human milk...

Find a way to describe your commitment to those things in a way that legitimizes, rather than undermines, you.

Choose Your New Title

Advocate • Aficionada • Appreciator • Authority • Believer • Champion • Custodian • Defender • Devotee • Disciple • Enthusiast • Expert • Fan • Friend • Guardian • Keeper • Lover • Proponent • Protector • Scholar • Spokesperson • Steward • Supporter • Upholder

Each of those words has a nuanced, powerful definition that says so much more about your role than ‘nerd’ or ‘junkie.’

When you take on a more accurate, descriptive, and empowered title, your work will be infused with meaning and people will understand the true value of what you do.

Let me know which title/s you choose.

With love from a social justice advocate, earth steward, birth process aficionada and protector, baby champion, wisdom keeper, and autonomy upholder.

If you’d like to explore deeper into your interest of birth, I just launched a new 4-part series on marketing for birth professionals. Learn more about The 4 Pillars of Marketing for Birth Professionals: A 4-part series to grow your business

or check out all of my courses here.

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So You Want to Be a Doula?

Carrie Kenner — Mon, 12 Feb 2024 05:25:03 +0000

So You Want to Be a Doula?

Twenty years ago, few people knew what the word ‘doula’ meant.

Now, most people know what a doula is

But there are so many kinds of doulas...birth, postpartum, death or end of life, full spectrum, even divorce or surgery doulas.

What is the difference between all these types of doulas?

And which is the one for you?

Are all doulas the same?

I’m going to focus on birth and postpartum doulas in this blog, but what you learn here can be applied to all.

You may question the truth of that so let me share a little story...

I’d been a birth doula for 10 years and was attending a death doula training.

Those are two experiences at very opposite ends of the spectrum, right?

In the first hour, I shouted out, “That’s what we do in labor!”

By noon, I had shared, “That’s just like at birth!” “That’s just like being a birth doula!”

By the end of the day, I had repeated those phrases so many times I knew I was annoying everyone and would need to shut up.

But in my head for the next 3 days, that was my refrain: “It’s just like being a birth doula!”

The Core Essence of Being a Doula

The core essence of being a doula is to be of service to people in a significant — often emotionally charged and physically challenging — experience.

Think back to a challenging experience you had that didn’t end up so well. That’s where a lot of doulas start: wanting to help others prevent what they went through.

Imagine what that experience might have been like if you had a doula. At every turn where you felt unsure, unknowing, afraid, or pressured, someone would have been there to help you get what you needed. They couldn’t have turned back the hands of time or done anything super-human, but you would have had someone on your team. You wouldn't have been alone.

But everyone’s experience is different. How do you learn skills that can apply to everyone?

That's Not Your Job

When I train doulas, they often ask, “But isn’t my job to prevent people from making mistakes, from making the same mistakes I made? I want to save them from having a bad experience or outcome.”

And my response is always, “Your job is not to protect people from walking their own path. It’s their journey. Who are you to dictate what that journey looks like? Your job is simply to support and witness them along the way.”

Doulas don’t tell people what to do — or even how to do it — they help them find their own way.

So, how do doulas do that?

The Core Principles of Being a Doula

Doulas recognize that birth, postpartum, [fill in the blank], are rites of passage that change a person emotionally, physically, and spiritually after they emerge from the experience.

Doulas recognize the inherent autonomy and respect that all people deserve when going through a challenging experience.

Doulas acknowledge that existing systems that people must engage in do not serve all the emotional, physical, and spiritual needs of people going through the experience.

Doulas understand the intersection of racial and social oppression within systems and how those factors impact experiences and outcomes for marginalized people.

Doulas believe that people are innately capable of navigating challenging situations and know that compassion, preparation, support, and being seen make challenges more doable.

Doulas see themselves as a bridge or stop-gap measure to provide holistic support to their clients on their individual journey, while making efforts to improve the systems that are not meeting people’s needs.

Doulas understand significant experiences are a transformative journey that can have lifelong impacts and knowing how to guide a person through that transformation and the integration period afterward.

Wow, That's a Lot

When you look at the doula role from that perspective, you may be thinking, “Wow, that’s a lot. That’s heavy.”

Yes, it is. And that’s what makes doulas so necessary in the world today. I often say:

“The doula role is the most profound and nuanced profession you’ve never heard of.”

The Exquisitely Unique Skills of the Doula

Doulas are able to uphold those core principles with a unique set of skills that, when combined together, form the exquisitely nuanced role of the doula. Here they are:

Emptying their cup of their own ideas of how the experience should go
Developing communication skills, especially how to ask open-ended questions, listen deeply, and observe with curiosity
Getting familiar with their client, what’s important to them, and their specific desires and concerns
Using interpersonal skills to support the relationships between your client, their chosen support people, the professional staff, and the doula
Translating their client’s past experiences into what could be helpful for the new journey ahead (for example, taking what they learned from being in grad school to how to prepare for birth)
Being emotionally and physically open and present for their clients
Accessing intuitive skills, specifically how to “read” a room, notice shifting energy, and watch what is unfolding around them
Knowing about the birth process*
Knowing about the perinatal care system*
Knowing of comfort measures and strategies for coping with labor*
Knowing about medical conditions of labor and birth, and options for addressing them*
Keeping their personal stories and opinions to themselves
Sharing allegorical stories as a means to educate and offer options
Advocating for people in a way that doesn’t take away their power
Asking for consent before offering ideas or an intervention
Networking and accessing resources for information, family support, and community services
Being trauma-informed
Being diplomatic while changing the world

*These skills will vary based on the field you work in; the rest of the skills say the same

Pursuing Doula Training

As you can see, the above list doesn’t include much about double-hip squeezes, nursing positions, or baby-wearing techniques, All that stuff is the cherry on top after you provide the skills above..

I am 100% certain that if you are interested in birth, you’re already learning about the stages of labor and labor support techniques. You’re watching a copious number of birth videos on YouTube or have a library of birth-related podcasts or are reading every birth book you can get your hands on.

And if postpartum is your jam, you’re learning about postpartum depression, perineal healing, and how babies sleep.

You’ll learn more (and more evidence-based) information in your formal doula training, but what really makes you a doula are the core principles above.

Pursuing Doula Training

So now we can look at the bigger picture of being a doula for any other challenging experience: miscarriage, INFERTILITY, abortion, ADOPTION, death, marriage or wedding planning, DIVORCE, surgery, cancer care, psychedelic journeys, the list goes on and on.

With those core principles and specific skills, you can be a doula for anything!

Do I Have to Be an Expert?

I’m often asked if you have to be an expert in the field you practice in. No.

You just need all those magic doula skills and to learn the specific ‘knowing’ skills asterisked above for your chosen field.

And you don’t need to know it all...just a little bit more than your client about the systems they’ll interact with, the emotional process most people experience, the physical processes they can expect, and the spiritual impact this experience may have. If you’ve already gone through the experience yourself, you’re probably there.

Being a doula is one of the most rewarding jobs in the world, but it’s more than a job… it’s an identity, a calling, an act of service. It’s also an entirely unique role because so few people really know what is a doula, much less what they do.

Are you thinking about becoming a birth doula? I have the most affordable, comprehensive, and accessible online birth doula training around. For only $197 you can learn to be a birth doula starting today.

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Decision-Making Part 3: Skills for Doulas

Carrie Kenner — Mon, 01 Jan 2024 04:44:22 +0000

Decision-Making in Real Life: Role Plays and Reality

This is the last of a 3-part series on decision-making. In this post, I outline the process I used with my clients when working as a doula.

The Decision-Making Role Play

This process is done in a prenatal visit — a meeting done with clients at the end of their pregnancy — where we talk about their vision, preferences, and concerns for the upcoming birth.

One of the things I want clients to understand is that there may be times during their birth when they might have to make some hard decisions.

They might be tired and in duress, in the throes of labor, and they might be asked to decide about a procedure they weren't planning to have as a part of their birth.

Here’s how the process goes:

Step-by-Step

Explain there are times when they may need to make a decision.
Teach them about the BRAIN process.
Walk through an example scenario to explain the Benefits, Risks, Alternatives, Intuition, and Nothing or Not Now steps of the process.
Explain that these are questions they would need to ask if a procedure or treatment was recommended.
Then ask: “Who's going to be asking these questions when you're in labor?"

Making It Real

My pregnant client would often say, “I'll be the asking questions!”

“Ah,” but I’d counter, “you're having contractions every three or four or five minutes. Are you sure you’re going to be able to ask all these questions?”

The lightbulb would go on and they’d look toward their partner.

“Yes," I'd nod, "your partner would need to lead this discussion.”

I’d turn to the partner. “So how do you feel about that? Does this feel like something you're going to be comfortable doing?"

And they would usually say, “Oh, yeah, I've got no problem asking these questions.”

Making it Even More Real

“Great! So now I want you to imagine that you're asking these questions, the care provider is giving you answers, and now your partner is having a contraction. What do you want to do?”

“Well, I’d keep listening and asking the rest of the questions.”

Sounds reasonable. Except, turning to my pregnant client, I’d ask, “Do you think you’d want to hear the questions and answers?”

“Yeah, this has to do with my body.”

“Okay, Partner. Now, what are you going to do?”

“I guess I’d have to tell the doctor to hold on.”

“Okay. You can ask them to wait, but they might be busy, they might have other patients they need to attend to, they may not have time for what’s looking like a lengthy 20-30 minute process. What will you do?”

“I don't know.”

Controlling the Process

“You might need to take control of the process to advocate for yourselves. You may need to tell the care provider ‘Oh, hold on. My partner is having a contraction,’ and then turn your body way from the care provider and toward your partner. Support them through the contraction, and then turn back to the care provider and say, ‘Okay, we can continue now.’”

Now, care providers might not like this. Care providers might be in a hurry. They are used to recommending a treatment and people complying. So this process might not be well-received.

I want my clients to have a good idea that, while this process is not rocket science, it's also not easy to lead and there are things they may have to do to control it.

Because it Could Get Even Harder...

Then I would remind my clients that they might be really tired, stressed, and concerned in this situation. How might that affect their ability or confidence leading this process?

They might have been laboring for 24 hours and have to make these decisions. They might be tempted to just say, “Okay, Doc, you’re recommending this so I guess we’ll do it.”

If my clients were to give consent without going through an informed consent process, I would ask them, “Are there any questions that you have about this procedure?”

That question isn’t so much a literal question as it is a cue.

I taught my clients that if they ever hear me ask, “Are there any questions that you have?” that means they should be asking questions right now.

By this point in our meetings, they had a good idea of what leading the process might be like, and my cue if they needed to be reminded of it.

From Decision to Action

Next, I would ask them questions from the Groopman spectrum, to help them recognize if they're risk-averse or risk-tolerant, if they're a naturalist or a technologist, a minimalist or maximalist, or if they are a doubter or a believer.

(If you missed last week's blog, it explains the BRAIN process and the Groopman Spectrums in detail.).

Once we had gone through the BRAIN process, determined who would lead the process, and assessed their decision-making preferences with the Groopman Spectrums, I would show them how to advocate for themselves after they'd made a decision.

Making a decision is one thing. The next step is communicating it.

Have HEART

The HEART model is an easy way for people to learn self-advocacy skills.

H Hear “I hear your recommendation, care provider,...”

E Empathize “and I appreciate your care and concern for me and my baby.”

A Assert “I have chosen to do XYZ for now...”

R Reassure “but I will let you know if I change my mind.”

T Thanks “Thank you for your support.”

The HEART model gives people an opportunity to articulate the process and their plans clearly.

***

So how did going through this process with clients play out?

As you’ll see, there are some additional tricky things that can come into play...

Harassment

Client A was pregnant with twins. In many parts of the country, a twin pregnancy meant an automatic cesarean birth. But where my client was giving birth, that wasn't the case. Her first baby — the one closest to the cervix — was head down, but her second baby was breech. In most parts of the country, a breech baby meant an automatic cesarean as well. But since her first baby was head down, and her second baby was smaller than the first baby, her doctor said her first baby would probably 'pave the way,' so she was a candidate for a vaginal birth.

But when she got to the hospital, her doctor wasn't on call. The doctor who was attending said, “Oh no, we need to do a cesarean. You've got twins. One of them is breech. A cesarean is absolutely the safest way to birth.”

Now this client kicked into gear. She said, “I know the statistics. I've talked about this with my physician. I know there's a possibility that I could give birth vaginally to the first baby and the second baby would need to be born by cesarean. But that is a chance that I'm willing to take.”

She was very well-informed, and articulated what she knew and what level of risk she was comfortable with.

Within the next hour, seven different physicians came in to tell her about the risks of having a vaginal birth. Seven. This is not an exaggeration. (Okay, some of them did come into pairs, so it wasn’t seven separate visits — it was 4 — but still...within one hour, seven different physicians came in to tell her how she was endangering her babies.)

Later that day, she had a vaginal birth of both her babies.

Isolation & Coersion

Client B was planning to have her baby at the hospital, even though she came from a family of home birth advocates, because that's the place she was most comfortable. She was a physician herself and she spent most of her adult life in hospitals. Her family thought she was crazy to have her baby in the hospital.

My client’s obstetrician knew that her family was pro-homebirth and I guess the doctor assumed that I was a home birth advocate, too (a common misconception of doulas). But I'm actually an advocate for people having their baby where they want and how they want. That's what I'm there to support.

But this doctor didn't trust me. And when my client’s birth wasn't going well and her doctor started to bring up the idea of having a cesarean, there was a point where the doctor said, “Okay, everybody out. I need to talk to my patient about her options and I need all of you to leave the room.”

I don't argue with medical staff unless my client asks otherwise. I asked if she was okay with that, and she said, “Yes” so I left.

Normally, a conversation like that would take 10-15 minutes. Thirty minutes later, we were still standing in the hallway wondering what was going on inside. What is the doctor saying? What are my clients needing? They're still having contractions. Are they getting the support they need? It’s an awful feeling to be banished from providing the support you were hired to give.

And to make it worse, I was really hungry but my purse was inside the room.

So I knocked on the door and stuck my head inside. The doctor said, “We don't want you in here. We don't need you..” and I interrupted, saying, “I'm just coming in to get my purse so I can get some food.”

As I passed my clients, I asked them, “Are you guys doing okay? Do you need anything?”

“Yeah,” they replied weakly. They didn't look super happy, and their faces showed the stress they were under. But they dind't ask me to join the conversation. So I left again, and waited outside in the hall eating my package of crackers.

Another 15 minutes later, the doctor opened the door and said we could come back in. “We're getting ready for a cesarean.”

My worst fear is that clients go into the O.R. without being prepared. There are many ways I can help them get ready so they have the best cesarean possible. I did what I could with what little time I had.

My clients had a cesarean and technically it went fine, but they did not have positive memories of that experience.

Disrespect

Client C was having a great birth; everything was going the way she wanted it to. She was having an unmedicated birth. It was going quite fast, a little too fast because when it came time to push, she was overwhelmed. She couldn't quite get into her groove, and there was a lot of hustle and bustle in the room to get ready for the birth that was happening faster than anyone expected.

A new doctor she hadn't met came in to be the one to catch her baby. The nurse was trying to get the equipment tray set up while coaching her on pushing. Then another nurse came into the room to talk to the doctor about another patient.

There was a lot of talking going on so my client turned to me “There's too many voices!I don’t know who to listen to. Can you please tell them to be quiet?”

I turned to the room and said, “Shhh! My client is trying to focus.”

Everyone stopped talking, and then her nurse resumed telling her what to do and my client was still very disorganized. I tried to help her focus and find her groove and within 10 minutes her baby was born.

My client was thrilled that everything went well as far as she was concerned. But a little bit later, the second nurse that had come in to talk to the doctor entered, pointed to me, and said, “Come with me.”

That nurse took me out in the hall and berated me, literally wagging her finger in my face: “You do not shush me”

“I’m sorry,” I replied, “my client was having a really hard time, there were a lot of voices, and she asked everyone to be quiet. I just simply did what my client asked for.”

The nurse wasn’t having it. “Well, we had a medical event going on and you can't shush the medical staff.”

And I had to accept that the medical staff just didn't respect my client. They came into her birth space. She asked for something specific, easy to do, and was ignored.

So even people who know how to ask for what they want may not get their needs met.

But When It Works...

The final story I want to share with you is about Client D, who was prepared for decision-making, so when a medical situation came up in her labor, she asked the BRAIN questions. She got all the information she needed and opted for the ‘N’ part of the model.

“I'd like to wait an hour. I'm going to try walking, and then we'll reassess.”

She walked the halls for an hour, had her cervix re-examined, and when she found out it hadn’t changed at all, she said “Okay, now I'm ready to do that intervention you suggested.”

Her ability to choose an alternative, control the timeframe, and revisit the recommendation was very empowering to her.

The Take-Aways

What’s important about each of these stories is that how people are treated during labor has a big impact on how they experience their birth.

They will remember their care and it will impact how they think about themselves. Empowered and respected, or isolated and ignored?

When people aren't able to integrate a negative experience, they will find different coping strategies such as blaming.

They might blame a doctor, saying, “Why was that doctor so lenient? They should have intervened sooner,” or “Why was that midwife so conservative? They should have let me do XY and Z!”

They might blame their childbirth educator, “Why didn't they teach me about cesareans so I would have been prepared?” or their doula, “You didn't come when I called and therefore XYZ happened.”

And often, they blame themselves: “I should have known better. I should have known these things. I should have made a different choice.”

The thing is, when people are blaming, they’re looking for something to pin the responsibility on because it was taken from them and they can’t quite accept that yet. Blame may find new targets and morph over time until they are able to integrate their experience, understand the meaning it made for them, and learn the lesson of the heroic journey that comes out of challenging experiences.

If somebody is blaming others, it's usually a sign that they need help integrating their experience.

If you're frustrated with the decisions that others make, remember the things that I've talked about in this 3-part series on decision making. Decision making is not clear and scientific. It’s messy. It's complex. It's very human. Please have compassion.

People do the best that they can in the moment, but they might need help cleaning up afterwards.

If you or someone you know is struggling with birth trauma, a story that doesn't make sense, or a negative experience, I encourage you to look at some resources I have.

Find somebody who does birth story listening. It's a really beautiful process that helps people make sense of their birth story and develop new meanings, so that what was a challenging experience can become a heroic journey.

And if you or somebody you know struggles with memories from traumatic situations, you might find a therapist who specializes in Memory Reconsolidation. This is a technique that takes old memories from traumatic experiences that are still driving aspects of your life and overlays them with other things that you know to be as true or more true, so you can have more freedom to respond to things that are happening in the here and now and not be controlled by past traumas.

I'm all for people having powerful experiences, having agency and autonomy in their lives, and developing good coping skills and resilience so that they can make the most out of this crazy challenging life we have. Thanks for reading!

Birth Story Listening:

https://thresholds.info/birth-story-healing/

https://diveintobirth.com/birth-story-listening/

https://birthstorymedicine.com/

https://www.jamiemossay.com/birth-story-healing

Memory Reconsolidation:

https://www.psychologytoday.com/us/therapists

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Decision-Making Part 2: Tools

Carrie Kenner — Wed, 27 Dec 2023 04:18:48 +0000

Part 2 In a 3-Part Series

In last week’s blog, I shared about decision-making and how it's not what we think it is. We tend to think it's very logical, analytical, and reasoned, when in fact it's a very emotion-based process.

Check out Decision-Making: Faking You Out Big Time! to learn about the parts of the brain — almost all involved with emotion — that we use in the decision-making process, t the power of implicit memory (the deep, old memories that we're not even necessarily conscious of) in the decisions we make, and why decision-making skills should be taught to people starting at a young age.

What's a Decision-Making Model?

Decision-making models are tools that are helpful to people faced with making an important choice. The ones I share here are useful in the context of healthcare, and especially in the context of birth in the healthcare setting.

There are several decision-making models used by both patients and providers.

Use Your BRAIN

The BRAIN model is an acronym representing questions patients or clients can ask when a procedure or treatment is recommended.

B Benefits of the procedure or treatment

R Risks of the procedure or treatment

A Alternatives to the procedure or treatment

I Intuition

N Nothing, or Not Now

You've probably heard about the importance of weighing the benefits and risks of many things in life. It’s important to remember that all procedures or interventions have a potential benefit and a potential risk. In healthcare, we're weighing the benefits against the risks in the context of the medical condition.

100% Risk-Free!

There's no intervention that is risk-free. Even breathing air can come with a risk if there's pollution in the air. Yet, certainly, stopping breathing would carry a bigger risk. So we need to look at alternatives.

What are the alternatives to what’s being recommended? There could be one thing, three things…15 things! And for each one, you have to go through the benefits and risks.

If you’re paying attention, you’re probably starting to realize that this isn't just a simple five-question process. It can be lengthy if it involves a lot of alternatives.

'I' Is For Intuition

The letter ‘I’ in the BRAIN acronym stands for intuition. Intuition is a different kind of information that we can access. But it's not highly valued. In fact, it’s often not considered at all in healthcare situations.

Intuition hasn't been researched, it’s hard to measure, and there's very little data on the efficacy of intuition. But in my opinion, it's extremely important.

During pregnancy, people's intuition is heightened; in labor, it’s even more acute.

So we can ask a client: What does your intuition, your gut, your sixth sense, say about this intervention?

We can help them get into a state where they can access their intuition, instead of being influenced by their thoughts or by the voices of others.

When people are supported in this way, they often have a strong sense if this is something they want to do now or not.

Not Now!

Which leads us to ‘N.’ What if we do Nothing, or Not Now? This is just another alternative, but it's an important one.

What would happen if we didn't do this thing at all? Or if we waited an hour, a day, a month?

Answering the 5 questions is how the BRAIN model gathers information for decision-making.

But something is missing: the context.

It's All About the Context

What is the medical situation that's occurring, and how important, urgent, or dangerous is that situation? If the situation is dangerous or urgent, the risks may not seem as bad. But if the situation is normal — something that happens to everyone or is just a symptom of the process — then the risks are not worth it.

Without knowing the situation’s severity, you can't accurately weigh the benefits and risks.

Consider this: If someone is sitting in their living room writing up their birth plan and they are choosing the intervention they want or don’t want, ALL the risks don’t seem worth it because nothing dangerous is happening in their living room. It’s impossible to say what you might want or not want later in labor.

That’s why it’s so important to have a model like this one to use in labor when someone might need to be making decisions in the moment.

SHAREing is Caring

The next model I want to tell you about is a model that care providers use to develop a collaborative decision-making relationship with a patient. It’s called the SHARE model.

S Seek the patient’s participation

H Help them explore the options

A Assess the patient’s values and preferences

R Reach a decision

E Evaluate the decision

In this process, the care provider is inviting their patient to join them in decision-making. It’s not only the care provider’s expertise, or the patient’s preferences, that are being considered.

Any good decision-making model looks at options; that is the core of informed consent. The care provider can explain what they are recommending, provide alternatives to their recommendation, and describe how each option works along with their benefits and risks.

The next step is finding out what is important to the patient. What are their values and preferences when it comes to their healthcare? These might include religious or spiritual practices, mental/emotional preferences, and personal values.

From here, together they can reach a decision on the course of action. Then, the care provider can evaluate the decision to make sure it is relevant to the situation and assess its effectiveness over time.

There you have it! Two common tools used to help in making a decision.

By the Numbers

But now I want to dive a little bit deeper. I want to look at some of the factors that influence what decisions are made.

One of them has to do with research information, data, and how numbers are presented. Remember, we are conditioned to try to make rational, logical decisions. We tend to pay attention to the numbers.

But the numbers can be manipulated to try to influence people.

If someone is told they have a 5 in 100 chance of a complication, they probably think that number is pretty low. They’d have to try hard to imagine 100 people in a room and pick out the 5 that have the complication.

But if someone is told they have a 1 in 20 chance of developing a complication… ooh! They can imagine 20 people in a room and see the 1 unlucky person.

Five in one hundred or one in twenty are the same odds. But unless someone is quick at math, they are likely to hear those numbers differently and that can influence their decision.

Another way data is manipulated is when someone is told, “You are twice as likely to have this complication if you do A versus B.” For example, if intervention A has a complication that happens to 1 out of 1,000 people and intervention B has a complication that happens to 2 out of 1,000 people, intervention B is twice as likely to cause a complication. That is true.

But the real risk is .1% vs .2%. We’re talking very small numbers here. If someone is very risk-averse, those numbers might mean a lot to them. But to the average person, 1 to 2 out of 1,000 people are very small odds.

You can see that how statistics are communicated can influence people's sense of risk or safety. That’s why people must see actual numbers and be given guidance on how to interpret those numbers.

The Groopman Spectrums

And that brings me to the Groopman spectrums. Jerome Groopman is a physician who wrote the book, Your Medical Mind, published in 2011. It explored how medical decisions are made, and was used by a lot of physicians and lay people to understand how to factor in information for decision-making.

Groopman identified different spectrums that people might place themselves on that influence how they make decisions.

One is called the Naturalist-Technologist scale. On this scale, people are asked to consider if they favor natural remedies — herbs, acupuncture, diet, meditation, exercise — to treat medical conditions. Or if they prefer technology — machines, medications, devices — for their medical care.

The next one is the Minimalist-Maximalist scale. Do they want to try all the things available or do they like as little intervention as possible? Do they prefer to rely on the natural course of events or do everything in their power to change the trajectory of their health?

The next scale is the Doubter-Believer. Is the person suspicious of doctors, distrustful of the medical system, dubious that any medications work? Or do they do anything their doctor tells them, believe wholeheartedly in the Western medical system, and trust the ads for pharmaceuticals they see on TV?

And finally, there’s the simple Risk Averse-Risk Tolerant scale. Risk-averse folks are not willing to take chances. The numbers scare them and they want as little risk as possible. Risk-tolerant folks see life as a series of probabilities, and they are more interested in trying things aligned with their values even if they don’t provide the best odds.

But here’s where it gets interesting: The spectrums intersect. Someone could be a naturalist and a maximalist. So they want to do all.the.things as long as they fall in the natural-remedy category. Or they could be a risk-taking minimalist. They only want to try the one thing that appeals to them, even if it’s less likely to work. Or they could be someone who wants lots of technology, but only the kind that comes with low risks.

Oh, but there’s more...

First Birth Story

A few weeks ago I wrote a blog about How We Learn and how families are our first teachers. The deep-seated rules and agreements we made as small children affect the decisions we make as adults.

I like to use the process of The First Birth Story to help clients see this phenomenon at work…

What’s the first memory someone has about birth? It usually happens when they are elementary school age, as old as 10 or as young as 3. They might recall hearing a birth story of a relative, or remember when a sibling was born.

If they lived in a hippie commune and all the babies were born at home, they might say, “When the baby comes, the midwife comes over and everyone brings food and is really happy.” They would form a rule or agreement about birth like, Birth is exciting and a celebration and everyone is there.

If they remember when their little brother was born, and "Mom was really loud, and then she was whisked out the door and gone for 3 days, and Aunt Martha stayed with me but she wasn’t very nice and wouldn’t let me go see mom, and then when mom finally did come home she had this baby with her and everyone paid attention to the baby…" their rule and agreement about birth might be, Birth is scary and people go away somewhere and then you lose love.

Now keep in mind, these rules and agreements come from the mind — and with the language — of a child. Over time, other experiences overlay (but don’t replace) the original rules and agreements. Those new experiences might confirm what the child thought, only now with more adult language. Birth is intense, needs to happen in a closed environment, is an ordeal.

When we help clients understand their First Birth Story, they can see how it may be influencing the decisions they're making as adults.

The Aftermath

What happens after a decision is made and then things don't go as hoped for?

A lot has to do with one's stress-coping and resilience skills.

If someone sees their birth plan slowly evaporating — each thing on the list being removed by the hands of fate — they may try to salvage anything that’s left.

They want to feel like they have some control in all of this, that they are a good person/parent/birther who did something right. If they aren’t able to have the home birth / unmedicated birth / vaginal birth they hoped for, maybe they can at least have their baby on their chest right after birth, or keep their placenta, or play a special song. They are looking for the one thing they can still have.

Then there are the “Oh fuck it!” people.

These are the folks who, when their birth plan starts to derail, throw up their hands and say, “Forget it, do whatever you want.”

They're not just throwing up their hands to their birth plan. They're giving up all their agency and power for the rest of their birth.

This is often a stress response, a way they've learned to protect themselves when things get really hard and they don't know what else to do.

How Doulas Can Help

As you can see, there's a lot to the aftermath. And that's why doulas can be so crucial to positive experiences of birth, even if they don’t go as planned.

Doulas help people process and integrate the experience they had at their birth. They do that by giving clients time to first adjust to new parenthood. Then, after they've had a chance to let some of their thoughts and ideas about their birth percolate, we can explore what that experience was like for them.

We often start by just asking clients to tell us what happened from their perspective. It's important to let them tell their story without interruption. Then we ask:

What was that like for you?

Depending on how they tell their story, we might ask some follow-up questions. For some people, it might be helpful for them to verbalize what they wished happened differently, and we can validate that.

We can ask what they learned about themselves from that experience. If you’re familiar with the Heroic Journey, you know that the hero has to face the unknown and go to the underworld, where hard things happen and they have to do things they didn't want to do. But they learn important lessons which they bring back to the upper world in their new version of self.

Someone might have learned that they're tougher than they thought, or that birth is humbling. or that their partner now recognizes their strength and endurance.

Doulas help bring those learnings to the forefront. And that's how we help them to integrate their experience and make sense of it.

I hope you can use some of the nuggets from these decision-making tools to help your clients, family, or friends if they call and say, “I have this thing that I have to make a decision about and I don't know what to do.”

Join me next week because I'm going to share the process I used with my doula clients when I was preparing them for birth. I'm also going to share some stories of decision-making from the trenches in my career as a doula. Thanks for reading!

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Decision-Making Part 1: Faking You Out Big Time!

Carrie Kenner — Mon, 18 Dec 2023 01:23:51 +0000

A new series of blogs on how we make decisions

I read a newsletter article this week by Anne-Laure Le Cunff of Ness Labs. It was called “Why Smart People Make Dumb Decisions.”

Her article reminded me that I wanted to blog about decision-making, so here we are.

Decision-making is the process we use to identify, sort through, and select an option, produce a final choice, and maybe take action on it. For the most part, this is a rational process...at least it appears to be, and we like to believe it is.

The decisions we make in a day can range from what to eat for breakfast, should I click on this link or not, or what to invest our money in.

We Do It In a Nanosecond

We make thousands of these choices every day — most automatically — using mental models that integrate past experience, consequences, memory, values, beliefs, and desires so we know how to behave next. We don’t have the luxury of full seconds to decide which way to move when a ball is speeding our way, or how to respond when we see brake lights in front of us, so most of this happens in a nanosecond.

If you asked the average person, they’d tell you they make mindful, well-thought-out decisions. If you told them the left brain is rational and the right brain is emotional, and asked them which side of their brain makes decisions, the resounding chorus would be, “Left brain!”

And they’d be wrong.

Left Brain, Right Brain, Front Brain, Back Brain

The decision-making process is actually a front-to-back-of-the-brain process that relies dominantly on emotional centers. We like to think we use reason and logic (and data!) to arrive at a smart decision. That’s because we don’t notice the emotional, historical, and subversive memories operating in the netherregions of our brain.

Our bias towards our decisions being logical is further emphasized when we use words to justify them — words that come from the left region of the brain, where our verbal centers reside.

Wrong Again

A lot of research on decision-making has been done in the realm of dieting. But my interest has always been on why people choose certain things for their births... and why they don’t follow through or change their minds when the rubber hits the road.

One explanation is that labor is just harder than what they expected, what they could imagine, or what they’re prepared to navigate. The birth process really is outside any other life experience. It's like trying to plan how to jump a car across the Grand Canyon when you’ve never operated a vehicle before.

For decades, I watched childbirth educators and doulas make a fundamental mistake when it came to preparing people for labor and how to make decisions when they’re in it.

The most popular school of thought relies on the belief that if people have good information — current, evidence-based, rational data — they will make good decisions for their care in labor.

But that’s not how it works at all.

All the Emotional Players

Here’s what scientists have discovered about how we make decisions:

The hippocampus is involved in memory, learning, and emotion. Its main job is transferring short-term memories to long-term storage, but it also plays a role in emotional processing, including anxiety and avoidance behaviors.

The prefrontal cortex regulates our thoughts, actions, and emotions by connecting with other brain regions. The prefrontal cortex is in close contact with the structures and circuits of the emotional brain that seek gratification and alert us to danger. It also evaluates risks and rewards and applies them to the future.

The anterior cingulate cortex is involved in several complex cognitive functions, such as empathy, impulse control, and emotion.

The orbitofrontal cortex — primarily known for its role in identity and reward values for taste and smells — seems to determine the relative reward value of choice options as well, and provides biasing signals in more complex decision-making situations.

And then there’s the ventromedial prefrontal cortex (I know you were wondering when I’d bring it up!), which binds together the networks that support emotional processing, decision-making, memory, self-perception, and social cognition — all factors that influence our decisions.

You see, it’s not about data at all!

Why Don't We All Know This?

I used a completely different model of birth preparation, taught to me by Pam England from her book Birthing From Within, that focused on excavating one’s first beliefs about birth, exploring their current values, and guiding them through a process to initiate and prepare them for the journey of birth however it unfolds. Sure, we talked about facts and data, and I shared a decision-making model for labor, but now they had a heads up that their emotions were the real driver of decisions they’d be making.

“Because we have to make decisions every day — at work and in our personal lives — it’s surprising that smart decision-making is not taught in school. It’s the kind of skill everyone should have in their mental toolkit.” — Anne-Laure Le Cunff, Ness Labs

It sure would make navigating birth a lot easier.

(P.S. It’s also important to note that the frontal lobes of the brain don’t fully mature until after puberty. So kids and teens are literally unable to make good decisions. I know that’s not a surprise to any of the parents here. But it also stresses why decision-making skills should be taught in schools.)

Changing Our Tune

In last week’s vlog, I spoke about neuroplasticity and how our nervous system, brain, patterns, and beliefs — all the things that drive our thoughts and behaviors — are not rigid. So it goes without saying (but I’m going to say it anyway) that if we make decisions based on past experiences and observed consequences, but we change the meaning or value of those things via neuroplasticity, our decisions will change as well.

Which is why some folks start making very different choices after a period of transition, reflection, or personal development.

If you do end-of-the-year goal-setting, you might be interested in how the concepts of neuroplasticity and decision-making can be factored in.

The New Year goals that many people create are often a narrow-visioned prospect: pick the things you want to happen, write them down, and post them on the bathroom mirror. Maybe say a few mantras or self-affirmations to make them come true.

I take a different approach, and I love sharing it with folks. It’s a process of deep reflection, forward-visioning (to your funeral, to be specific...about as far forward as you can go in your own life's events), and using your decision-making style to set 1-, 5-, and 10-year goals. I use this process in my JumpStart program because it's also a great process for business owners.

Next week, I’ll talk about two models for decision-making, the factors that influence our decision-making style, and how our best-laid plans can get derailed via the “Oh, fuck it!” phenomenon. See you then.

I’m thinking about offering a goal-setting workshop using my 3-part approach around the new year. Let me know if you’re interested.

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Inductions: Why Are They So Damn Hard?

Carrie Kenner — Mon, 27 Nov 2023 10:55:17 +0000

Labor inductions are a topic that so many doulas struggle with.

Why are they so challenging? And is there anything doulas can do to make them more manageable?

First, let’s start with the basics:

What Is an Induction?

A labor induction is when labor is started artificially. Normally, labor starts on its own due to a shift in hormones that start circulating in a pregnant person's body. Those hormones trigger several different physiological actions that cause the uterus to start contracting and eventually lead to the baby’s birth.

But sometimes, labor doesn't seem to want to start on its own. Or sometimes, there are reasons that labor starting soon might be necessary.

The medical process to start labor is quite complex, and I won’t go into those details in this blog. For now, you just need to know that a combination of medications, medical devices, or procedures are used to get the uterus to start contracting, or to cause the cervix to start opening. All of which are designed to kickstart the birth process.

Now, that sounds easy enough (or not). But here's the thing: If the body wasn't going into labor on its own, chances are it’s because it's not ready, and there's a reason why it's not going into labor on its own.

And for that reason, inductions aren't always successful.

Have you ever tried to force an avocado to ripen? I think we've all been there... Gathering up the bowl of chips and a dish of salsa... Mmm, some guacamole would be excellent!

And then you spy the rock-hard avocado on the counter.

If you're like me, you Google ‘How do you get an avocado to ripen fast?’ and learn to put it in the oven. You end up with an awful, warm, funky tasting avocado that is ruined.

If the avocado was close to being ripe and just needed a little nudge, it might have worked.

Kind of like labor... If someone is close to going into labor and just needs a little nudge, inductions tend to work okay.

But otherwise, you might end up with a funky labor that doesn't work very well.

So why does anyone bother inducing labor?

Why Is Labor Induced?

Hopefully, labors are only induced for medical reasons. The pregnant person may develop a medical complication, and it’s safer or healthier for them not to be pregnant anymore. Preeclampsia is the most common example of a medical condition that necessitates forcing labor to start. Gestational diabetes and cholestasis are other conditions.

The baby may also need to be born sooner rather than later for medical reasons. As the pregnancy continues, the placenta may start aging and not functioning fully. If the baby is not growing well, or shows signs of distress, or its amniotic fluid is decreasing, being born a bit early might be safer than staying.

Those are the primary reasons labor should be induced.

However, the most common reason that labor is induced has to do with one's due date. If someone is 40 weeks pregnant — in other words, their due date — and they haven't had their baby yet, many people are encouraged to have their labor induced. Why?

Well, there's some research that says that, as babies go past the 40-week mark, they may get too large to be born easily, they may not tolerate labor as well if the placenta is aging, and in the worst case, the risk of stillbirth increases. (The incidence is really small: 14.9 out of 10,000 births, or .00149%).

Despite that tiny number, people understandably get a bit nervous if their care provider suggests an induction. Even if they didn't want induction, they often go along with it.

But it's not just 40 weeks. Sometimes, people are advised to get induced at 39 weeks, 38 weeks, or sometimes even 37 weeks. There might be a medical condition contributing to that recommendation. But often, it's really more about personal preference.

“You're getting towards the end of your pregnancy; your baby should be fine. Let's induce labor and get this going.”

You may have heard about situations where an induction is done for convenience: the doctor will be out of town so they schedule for the week before they leave. Or the pregnant person wants to be induced because they're really tired of being pregnant. Or a family member is coming to help for a limited period, and the parent doesn’t want the baby to come late and minimize the support window.

All those reasons are valid. As long as everyone can balance the risks and benefits.

What the Research Says About Inductions

Several studies have been done on the potential complications or benefits of induction.

Complications include additional medical procedures that increase rates of infection, parental distress, and fetal distress. Many studies have found inductions lead to a higher risk of cesarean birth, which is a major surgical procedure that carries significant risks.

One of the most recent studies was done in 2019, called the ARRIVE study. This study compared the outcomes of births between two groups of people: one group who had their labors induced at 39 weeks, and another group who waited until labor started on its own. The researchers looked at rates of cesarean birth, stillbirth, and medical complications between the two groups.

They found no difference in rates of stillbirth. However, there was a slight decrease in the rate of cesareans in the induction group. (The study did not exclude parents who developed medical conditions that led to cesarean births from the control group; excluding them may have lessened the rate of cesarean in the control group lower than the rate in the induction group.)

There has been a lot of research on inductions. For the most part, it shows that there's an increase in medical intervention and a rise in the Cesarean rate. There may also be significant dissatisfaction for people who've had inductions because they didn't know what to expect. And that's what I want to talk about next.

Preparing Clients for Induction

When I was practicing as a doula, clients would come to me either with questions about induction or because their care provider had suggested an induction. There are many things a doula must consider when an induction is recommended.

The first thing to find out is if the client knows what an induction is. I don’t expect they’ve looked at the studies. But do they even know what's involved in having their labor induced?

Do they know the potential risks? Has their care provider explained any of the possible complications to them?

I would compare their information with what I knew my clients wanted for their birth. What kind of birth were they hoping for? What were their biggest desires and most significant fears?

For every individual client, their ideas about induction would be unique.

Then, I hoped there was an actual medical condition for advising an induction. Not that I wanted there to be a medical complication; I just didn’t want there to be an unnecessary induction.

When a medical condition is present, it’s easier to talk about the benefits of induction that outweigh the risks. If there aren’t any benefits, the risks are all just risks — nothing to balance them out.

Clients need both so they can give fully informed consent and know what will happen to them and their baby before they start the process.

But What About Me, the Doula?

That’s what I wanted for my clients. But what was this going to be like for me?

Inductions are really challenging for doulas. Inductions are usually very long, at least 24 hours. Often, the first 24 hours are spent just getting things started. Various medications or devices are applied to the cervix to prepare it for labor. Followed by another 24 hours to get contractions going, regular, and effective.

People could be in the hospital for two days before having their baby. That is different from what they were expecting. I asked my clients, ‘What do you think an induction is like?’ And they’d respond, “Well, the hospital told us to show up at 7am. We expect we’ll have a baby by 7pm... It's going to be awesome!”

It was usually me breaking the news to them. There was so much they didn't know and so much that they hadn't been told. It was quite awkward to be the one to inform them they could be in the hospital for days. And that it's an emotional and mental marathon as much as a physical one.

I also had to break the news that their birth would look a lot different from what they planned. There would be more restrictions on what they'd be able to do because of the medication and the medical equipment in use. And I would be limited in what I could do to support them.

The reality is that if labor is two days long, I can't be there for two days. I would let them know I wouldn't be there for the beginning part, or I may have to have a backup doula come in to give me a break. The emotional relationship my clients and I had developed was now being tested.

Show Time! Getting Ready for an Induction

Over the years, I developed ways to help make the conversation with clients less awkward, and make inductions more successful for all of us.

Prevention. No, doulas cannot prevent inductions. But we can prevent inductions from being such an unknown.

In prenatal visits, ask clients if they’ve heard about inductions. Has their care provider ever mentioned in induction? What information would be helpful for them? Most clients will have no questions, no interest, and no idea that this could happen to them. So don’t force the information on them. But do plant a seed by saying, 'Hey, there's this thing called induction that could happen to you. Do you want to know about it?' Planting the seed is the most important part.

Information. It’s much more likely you’ll provide information when it is suddenly necessary. I’d often get a call: “Hey, I saw my midwife today, and they're recommending an induction.”

Now, there are a series of questions to ask: Why is the induction recommended? How do you feel about it? Find out where they are. They might be thrilled, “Hallelujah, this is great news!” And then I’d know, Okay, we're going to plan for the best induction possible.

But often, they’d say, “I wasn't expecting this. I'm scared. I've heard these terrible things.” And then you can respond with, "Okay, let's talk."

My conversations like this were pretty long. I'd find everything they knew about induction and determine if it was remotely realistic. I would ask them if they wanted me to share what I knew about inductions. This is an important part of being a doula: whenever we're offering information — especially potentially a lot of information, especially around something that might feel emotionally charged — we want to ask for their consent.

Ask, "Would you like me to share what I know? Are there specific things you want to know?" and then let them steer the conversation.

I feel a few things are essential for clients to know about inductions: They take a long time. And your birth may look different than what you expected.

Even if they don't want a lot of information, I would let them know these two things in terms of my role, and what they can expect from me. So even if they didn't want to know anything about an induction, even if they say, "My doctor told me to show up in the hospital at 7am, so I'm just going to be there,” I would say, "Okay, here's what my role is going to look like for your induction...” And by explaining my role, I could tell them a little bit about the induction process and what to expect.

For example, I might say, “Okay, they want you to be at the hospital at seven. Now, normally, you'd go to the hospital when you're in labor. And I would join you at that time. But because you're going to the hospital when you're not in labor, I won't be joining you until your contractions are coming regularly, just like when I would have joined you at home. I understand you might feel pretty nervous when you're going in. And there might be a lot of questions and uncertainty. So I can show up for the first hour or two in the morning, to be there for emotional support. I can help you get settled in and be there while the process gets started. If that sounds useful, then I can come in the morning. But I’ll leave after an hour or two until you're having contractions and you need my labor support.”

This is how I set realistic expectations for my clients. I didn't ask for their permission. I didn't ask what they thought about it. I only asked whether they wanted me to be there for those first few hours, and if they did, I let them know then it was only for an hour or two. I would offer to call and check in throughout the day. But I set a very clear expectation that This is how it works. This is how it's going to go. I would do it in a very loving but firm way because I was setting boundaries that would allow me to provide good labor support when they're actually having contractions.

After I explained those things and answered any questions or concerns, I’d ask if there was anything that they particularly wanted me to do. When we finished the call, I would hang up and let it go.

I often felt frustrated that clients didn't want information I thought would be helpful; I was often frustrated because I knew they were stepping into a birth they really hadn't planned on. I might be frustrated if they wanted me to come and stay for a long time and I had to tell them no. A lot of emotions might come up for me. But to protect myself, I had to get off that call and say, “I did the best that I could,” and let it go.

Because there's still so much of the story left to unfold.

Being At an Induction

Here are a couple of tips to create the best induction experience possible.

The birth space. When you arrive at the birth space, check out the ambiance. What's going on in the room? Would they be laboring like this if their labor had started on its own? Or is it not a good, conducive atmosphere for labor?

Labor is reliant on a number of hormones. And those hormones do really well in certain situations. And they don't do well in other situations. There are a lot of medical interventions during an induction, and if people resign themselves to a lot of medical staff coming and going, bright lights, wires and tubes everywhere, they don’t even try to get in the mood for labor.

And — hint hint — the mood for labor is very similar to the mood for lovemaking. A medical environment is not where most people want to make a baby. You can redirect the atmosphere, turn down the lights, put on some music, and get people chilled out to create a more soothing, relaxing, loving environment with less of a medical vibe.

Pace yourself. When an induction is looming, do your best to be rested, well-fed, and get some exercise so that when you’re called to the birth, you’re the best you can be. Also, call your backup doula and let them know you’ve got an induction happening. Make sure they know you’re going to an induction soon, and they may be called in to give you a break.

That break — depending on all the factors that go into a birth — might consist of coming in for a few hours so you can nap after you’ve been there for a long time, or it might be coming to take over for you after you’ve been at the birth for 12 or 18 or 24 hours. All of this depends on what time of day or night you were called to the birth, and what kind of condition you were in going into the labor.

When you know that you have a backup doula who’s ready to give you a break, it can keep you going a little bit longer. And if you're a backup doula for somebody who's doing an induction, knowing that if you get called in, it's going to be for a limited time, can make it much easier to get called in because you know you're not going to be there for days.

It’s also essential to be open to whatever needs to happen at the birth. Your clients may have wanted fewer interventions than they're experiencing, and you may feel bad that you aren’t helping them attain that. But when an induction happens, you must embrace as many things as needed to keep that labor going. We call this active management.

Inductions are the most successful when the labor progresses steadily. And that might mean choosing things that were otherwise on people's “I want to avoid” list. The best way to prevent a cesarean in a labor induction is to keep the labor progressing and moving as smoothly as possible.

And finally — remember — this is the birth of a baby, the birth of a family. Babies come into the world in all different ways. And this is just one of the many ways.

Inductions can be hard, they can be long, and they can be frustrating. They can be awkward, and they can be tiring. But knowing how they happen and how we can set our clients and ourselves up for success, can make inductions much less daunting for the doula.

If you want real in-depth instruction for navigating inductions, check out my online birth doula training or learn advanced skills in my doula business and marketing coaching program.

Doulas – Carrie Kenner: Doula Trainer. Writing Coach. Sacred Feminine Guide.

The Felt Sense of Doula Work

How I Learned About Felt Sense

What is Felt Sense?

How do doulas learn these skills without knowing what they’re doing?

Why Doulas Excel in Their Next Careers

What else do doulas know to do without knowing what they’re doing?

The Art of ‘Holding Space’

How do doulas get so good at this stuff?

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A Tribute to Penny Simkin

Here's Penny

Penny's Legacy

How Penny Furthered My Career

Penny's Most Profound Impact

Sharing A Loss

Penny At Her Best

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Growing A Business: My Journey into the Heart of Entrepreneurship

The Beginnings of Big Belly Services

The Unfolding

Growth Through Learning and Connecting

Challenges and Early Wins

Birth of a Doula Trainer

Watching the Trajectory

Is It Possible to Do It Faster? And If So, Is It Better?

Reflecting on Growth and Mastery

What Do YOU Think?

And Also, How's YOUR Business Doing?

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You Can Do Better Than ‘Junkie’

The Words We Use

A birth nerd? A childbirth junkie?

A Positive Alternative

“The limits of my language means the limits of my world.”

Your Passion is Real

Choose Your New Title

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So You Want to Be a Doula?

So You Want to Be a Doula?

Are all doulas the same?

The Core Essence of Being a Doula

That's Not Your Job

The Core Principles of Being a Doula

Wow, That's a Lot

The Exquisitely Unique Skills of the Doula

Pursuing Doula Training

Pursuing Doula Training

Do I Have to Be an Expert?

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Decision-Making Part 3: Skills for Doulas

Decision-Making in Real Life: Role Plays and Reality

The Decision-Making Role Play

Step-by-Step

Making It Real

Making it Even More Real

Controlling the Process

Because it Could Get Even Harder...

From Decision to Action

Have HEART

Harassment

Isolation & Coersion

Disrespect

But When It Works...

The Take-Aways

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Decision-Making Part 2: Tools

Part 2 In a 3-Part Series

What's a Decision-Making Model?

Use Your BRAIN

100% Risk-Free!

'I' Is For Intuition

Not Now!

It's All About the Context

SHAREing is Caring

By the Numbers

The Groopman Spectrums

First Birth Story

The Aftermath

How Doulas Can Help