Medical studies have shown that women with supportive labor companions have better outcomes, shorter labors and need less pain medication than women who labor alone. In recent years, birth doulas, who are trained to prov
Pam England, CNM, MA

Medical studies have shown that women with supportive labor companions have better outcomes, shorter labors and need less pain medication than women who labor alone. In recent years, birth doulas, who are trained to provide physcial and emotional comfort to women during childbirth, are quickly becoming a popular labor support option. Pam England, Certified Nurse Midwife, birth doula and author of Birthing From Within, shares her beliefs about the most essential qualities a doula should possess.The knitting midwife
There once was a hospital midwife in Albuquerque who earned a favorable reputation for her unusual form of labor support: sitting in the corner of the room and knitting. At first I was troubled when I heard mothers describing their "knitting-midwife" and wondered what they thought of it.

I anticipated they would complain she was not really present, but in fact, every mother was comforted by it. They described her presence like this, "I would finish a contraction, open my eyes, and look to see her knitting in the corner. That let me know everything was fine, I was fine, and I could do it. In fact, it was when she got up to do medical checks, I began to wonder a little bit if something could be wrong -- so long as she was knitting, I knew nature and I were still on course."

I now view this kind of labor support as a continuation of what traditional healers and wise women have always done, and I like to call it "holding the space."

Traditional values in childbirth
Something stirs in me when I see old Native American women sit motionless against their adobe dwellings gazing at the boundless desert out of dark eyes set in brown faces wrinkled by a million creases. I believe in their stillness they are "holding the space" for all of us. When I was pregnant the second time, the image of those old wise women became a living metaphor for me. That was what I wanted from my doula. I asked my doula to do three things:

  • To wear boots to "kick ass," if that was what was needed,
  • To make me a chocolate birthday cake; and
  • To "hold the space, the feminine knowing and trusting space."

Power of presence
In labor, my doula arrived wearing her cowboy boots, made the chocolate cake, and "held the space." She didn't do or say that much, it was her presence that told me she believed in birth and she believed in me. From her I learned the power of a doula's presence. And this is the gift I try to give other laboring mothers -- and the mindset I want to pass on to new doulas.

When doulas go to a hospital birth, there is little that can be done to stop the anxiety and distress of parents and staff, or the steady trickle of routines and interventions. Parents, staff, and doulas are destined to participate in birth rituals not necessarily of our "choosing." In every birth culture, people engage in birth rituals out of years of social and religious conditioning, in response to fears, a vague feeling of not-knowing what else to do, and out of a sincere belief and intention to do the right thing.

One thing I know doulas can do is to "hold the space" of quiet, trusting mind in the labor room. Especially in the midst of frenzy and fear, doulas should try to generate a quiet, trusting presence, like the old Native American women. When doulas practice breath awareness or non-focused awareness themselves, their ability to completely relax into whatever is happening brings the mother into harmony with herself and the doula. We can look for ways to renew the mother's confidence in herself, acknowledge her for finding her own way through labor, and embrace whatever medicine she believes in.

Empty cup
A favorite practice in Zen is to "be an empty cup." I'm striving towards being an "empty-cup" doula. Before I open the door to a mother's hospital labor room, I close my eyes, open my heart, and pour out all my ideas and fears. I enter, and fill my "cup" with whatever is unfolding and focus on "doing what needs to be done next."

I strive to drop my ideas about what I think should be done. I look to see how whatever is happening is "working," and help the parents and staff see that too, so they can go with it. To the degree I am able to be a "nurturing" doula, I may help the mother express herself as a protective, knowing, self-confident mother.

I notice that most of the ideas about birth any of us hold fast to protect us from our own fears, and rarely honor or serve the mother we are attending. Righteousness and knowledge buffer us from feeling our helplessness in the midst of this fast-moving event. The fewer fixed ideas and judgements we bring to labor, the more deeply we might immerse ourselves in the birth that is happening, and draw from a flow of creative solutions and support.

One of my favorite books is Grace and Grit by Ken Wilber and Treya Killam Weber (1993, Shambhala). It's a moving compilation of Ken and Treya's journals during Treya's treatment and dying of breast cancer. In Treya's chapter, "What Kind of Help Really Helps?," she writes about the complex process of making difficult decisions about her treatments, and how she experienced "support" from others. I love this quote summing up supporting people who have made difficult choices:

"A dear friend of mine, who made me feel beautiful even when my hair felt out, recently said, 'You didn't choose what I would have chosen, but that didn't matter. Then I said, 'But you can't know what you would have chosen; I didn't choose what you think you would have chosen. I didn't choose what I thought I would have chosen either."

Making decisions in labor is complex for both parents and professionals. Even when couples ask for information, I sometimes sense that their "decision" is already made, or that the "decision" they make will be based more on unknown, unconscious factors and beliefs than on what I, or the experts, say. As often as possible, rather than debate the decision, doulas can show genuine support of the mother and her birth by throwing themselves into doing what seems to need to be done next.

From maidenhood to motherhood
As a teacher of doulas, I am searching for words to describe what genuine labor support means. Sometimes it is silent, it may be expressed in a firm voice, a smile, through teaching, or a skillful, timely intervention. Whatever its form, genuine support comes from a positive-intention to "hold the space for the mother" in the belief that she is, moment-by-moment discovering how to birth.

As a doula, I am witness to the unspeakable power of birth, maidens turning into mothers, and various dances of madness in the face of unchecked fears. I am all too aware, when a doula is prideful or too busy doing and knowing in birth, she forfeits being touched by the great mystery of birth. And, if no one in the labor room is in touch with that great mystery, and no one is "holding the space" by being truly present, there is the greatest risk of all -- that the mother, even though she gives birth to the child, might not realize she is also being born -- as a mother -- during her rite of passage. "Holding" the laboring mother in a safe, secure, heart-space is the best gift a doula can

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