Midwife as Coach

Jan 18th, 2015 Working With Clients

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I want to share a wonderful line I heard recently.

“I am going to remind her of the goals she set for herself.  As her coach, that is my job.”

This resonates so well with my philosophy of care.  As a midwife, it is not my job to set the goals.  It is my job to give  information and education, to lay out the options and the most likely outcomes.  It is the woman’s job to decide the goal.


Because she will never be committed to a goal she doesn’t set.

But if I can get her to share her goal, to tell me what she would like to accomplish, we can work on it together. She does still have to do the ‘work’, I cannot do that for her.  But I can giver her information and encouragement.

When she is discouraged and wants to give up, I can remind her of the goals she set for herself.  As her midwife, that is my job.


What I learn from hosting a web directory – five things you should change

Jan 10th, 2015 Marketing

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If you have never looked at the Natural Childbirth Directory, you should.  This portion of the website is truly a labor of love.  While the rest of the pages need little work but annual review, these pages get updated often because the links change and people submit new websites.  It takes a lot of work and is part of the reason I regularly ask myself if all the work I put into the website is worth my time.

Keeping the directory gives me a chance to look at many childbirth professional websites.  I get to see what people are doing that is good, and what people are doing that they should probably change.  I thought I would take a minute to give you my top five things you should change about your website. They are all variations of the same theme — websites that give useful information build trust in the reader.

1. You don’t list your location

This is probably the most common problem I see with websites, and potentially the biggest.  Potential clients will be searching for childbirth professionals on the internet using the location in their search.  If your website doesn’t list that location, you won’t show up in search results.  This means your website isn’t working to bring you people who are actively searching for your services in your area.  Worse, families that search on the internet know links go bad.  If they are directed to your link from another website, but don’t find the service area listed, they may not be willing to contact you to verify you provide services in their area.  Websites that can tell the reader where they work build trust in the reader.

2. You don’t list your services

Just because you are a doula doesn’t mean I know what you do.  It doesn’t mean I know what I am purchasing if I hire you. If you teach childbirth education classes, can I tell from your website what your classes are like?  Does your website let me know I can participate in your classes without hiring you also as a midwife? This is especially a problem in areas where families have multiple choices for service providers because the other providers probably give me this information.  Providing this information builds trust in your business and prevents potential clients from walking away just because it was easier to get information from another provider.  Websites that can tell the reader what they do build trust in the reader.

3. You don’t list your availability

Your website should in some way let readers know if you are able to provide the services they need when they need them.  Why?  The first question your potential client has is if you are available when they are due. Midwives and doulas may want to add a blanket statement such as “Now Accepting New Families.” Or you may want to provide a more specific information such as, “Openings for families due in January and beyond.” This saves you time responding no to people, but also increases the likelihood someone who fits your time frame will contact you. One caveat, make sure you keep your availability updated or it will work against you (people will think you no longer work in that capacity). Websites that answer the most common question build trust in readers.

4. You don’t list a calendar of events

This is especially important for businesses that provide education.  A reader should be able to tell when your next class or series of classes begins and what will be covered in that class.  If you do drop-in information nights, be sure these are listed. This information needs to be easy for readers to find and understand, so give full date, time and location — remember, only the most invested will call or email to get more information. Websites that provide current information build trust in the reader.

5. You don’t give good contact information

Having a contact form may prevent your email from being spammed, and you may think it protects your phone number, but it doesn’t give a good impression of your business. It increases the chances you won’t get good contact information from the potential client (even in the submissions for the Natural Childbirth Directory people mis-type their URL and email address — and these submissions are for people trying to advertise a business which means a high investment in establishing contact). Readers expect legitimate businesses to have a legitimate email and a legitimate phone number to ask questions.  Websites that portray services as a legitimate business build trust in the reader.


OK, now go make any necessary changes to your website.


End of the Year and Waterbirth

Dec 30th, 2014 Uncategorized

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When I wrapped up the last series I thought I could make weekly posts…I was ambitious.  I was correct in my suspicion that my workload would increase near the end of the semester. I am now in the midst of a working break between semesters and I don’t see an end to the heavy workload for a few months.  The trick is figuring out how to balance the blog with my “real” job.

I do have some things to show for my hard work. Continue reading


Wrap up for Fear of Childbirth

Oct 30th, 2014 Working With Clients

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childbirthFearThank you for exploring the concept of fear of childbirth with me.  My personal understanding of childbirth fear has changed in the 15 years I have been working with expectant women.  Fear of childbirth is a more complex experience than natural childbirth theories I learned so long ago seem to accept.Even so, I have been challenged by the research readings this past month, and I hope you have too.  Here are the top three lessons I learned this month:

Continue reading


Fear of childbirth and Guilt

Oct 28th, 2014 Working With Clients

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childbirthFearAs I researched for this series, I was struck by Fisher’s (2006) paper on the social context of fear.  The thesis of this study was the social context of childbirth influences how women understand childbirth, and this impacts how they experience it on an individual level. In the discussion of prospective fear, Fisher discusses prior research on first time mothers and their fear of the unknown.  Without prior experience, these mothers do not know what to ask.

But at the same time they are told their bodies were designed to give birth, that they ‘should’ be able to do this.  While this provides courage for some mothers, others are left feeling that they somehow missed something important — that they are different because they fear. This leaves them feeling inadequate and actually increases the fear. Continue reading


“Ignoring” fear of childbirth

Oct 24th, 2014 Working With Clients

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childbirthFearThis week we’ve been looking at ways childbirth educators think about managing women’s fear of childbirth.  We talked about education and relaxation, but today I want to talk about ignoring the fear. If you can’t think of any natural childbirth theories that support the use of ignoring fear, it is because there are not any.  But that doesn’t prevent this method from being used.  Continue reading


“Relaxing” the fear of childbirth away

Oct 22nd, 2014 Working With Clients

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childbirthFearEarlier this week we looked at research that both supported and refuted the idea that you could teach away the fear of childbirth. Today I want to focus on another tactic for managing fear of childbirth, relaxation.  This discussion is a little more theoretical, a little more about defining what things mean than the last few posts which focused on research.

Just like education, the first place I learned of the value of relaxation for childbirth was in Dick-Read’s Fear-Tension-Pain cycle.  The basic concept was that fear caused tension, and the tension caused pain.  So if I learned to relax during labor, I could stop the effects of the fear. Dick-Read is not alone in this assertion, Penny Simkin wrote a fabulous piece on the physiological effects of stress on labor. This is often used to support the importance of physical relaxation to promote comfort during labor. So the question is, what does relaxing do to the fear? Continue reading


“Teaching” away fear of childbirth

Oct 20th, 2014 Working With Clients

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childbirthFearWe’ve been talking about fear of childbirth, and last week we spent some time in the research looking at sources of fear.  Today I’d like to change gears and begin looking at ways childbirth professionals think about dealing with women’s fears. First method to review — education.

The concept that you can teach away childbirth fear first appeared in the philosophies of Grantley Dick-Read.  His philosophy, dubbed the Fear-Tension-Pain Cycle, claims that through education about birth the fear of birth is removed and therefore the tension and pain are reduced.  Is he correct?

Continue reading


  • Fisher C1, Hauck Y, Fenwick J. How social context impacts on women’s fears of childbirth: a Western Australian example. Soc Sci Med. 2006 Jul;63(1):64-75. PMID: 16476516.

  • Fenwick J1, Staff L, Gamble J, Creedy DK, Bayes S. Why do women request caesarean section in a normal, healthy first pregnancy? Midwifery. 2010 Aug;26(4):394-400. PMID: 19117644.

  • Stoll K1, Hall W2, Janssen P3, Carty E4. Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian University students. Midwifery. 2014 Feb;30(2):220-6. PMID: 23968778.


Fear, Pain, and Childbirth

Oct 17th, 2014 Working With Clients

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childbirthFearLast week I introduced you to the idea of the value of perfect health.  If you remember, a physician places a higher value on perfect health than the general public; the general public puts a higher value on avoiding a condition than the people who live with that condition.  This comes from economic research into what is generally termed as “utility.”  These studies measure how much people are willing to do to avoid certain conditions, or for the chance for complete recovery of a condition.

The fact that the value of not having the condition is reduced when reported by someone who has the condition is an interesting phenomenon. I suppose once you have a condition, like diabetes or hypertension, you learn how to live with it.  It becomes your new normal.  I began to wonder how this might be reflected in childbirth. Continue reading


  • Stoll K1, Hall W2, Janssen P3, Carty E4. Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian University students. Midwifery. 2014 Feb;30(2):220-6. PMID: 23968778.

  • Elvander C1, Cnattingius S, Kjerulff KH. Birth experience in women with low, intermediate or high levels of fear: findings from the first baby study. Birth. 2013 Dec;40(4):289-96. PMID: 24344710.


Childbirth Fear: Family or Media?

Oct 15th, 2014 Working With Clients

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childbirthFearWhen I began working in the birth world I was told women were afraid of childbirth because of the media portrayal of birth. Television, movies, and magazines were teaching women to be afraid by their unrealistic labors and horror stories.

So, is this true?  Maybe, but maybe not.

Stoll’s (2014) survey of college students found an association between media as a source of birth information and higher fear scores.  But two things stand out to me in this sample of college students.  First, the mean fear score between those who got information from media and those who didn’t was less than two points different on a 36 point scale — basically one was just below 18 and the other just above. The difference between those who used only the media and only family was less than three points.  Second, less than half the students reported using media as a source of information about childbirth.

Another problem to consider is that this is only an association.  We don’t know the order of events and so we cannot say it was the media that caused the fear of birth.  What if the media use is in response to the fear of childbirth — young men and women trying to find out if their fears are founded? In this scenario those without a fear might not bother using media because there is no perceived need for information.

I have two other studies to share with you on this topic.

Let us begin with  Fenwick, 2010.  This was a study of women who requested a cesarean  in a normal, healthy, first pregnancy.  These women reported concern that vaginal birth would result in physical injury to themselves or their baby. Two things stood out to the researchers as unique for these women.  First, they couldn’t conceptualize how a baby could be expelled safely from the body — as if the vaginal canal couldn’t accommodate the baby’s head. Second, the women did not seem to derive any personal meaning from birth, it was just a process to get the baby or a means to an end.  The women used language that said they were “getting” a baby not “having” a baby.

A similar study is Faisal, 2014.  This was a study of Iranian women who also requested a cesarean surgery for a normal pregnancy. These women also reported fear of vaginal birth being too difficult.  It was not only the pain, but concerns about pelvic floor disorders and other physical damage to themselves and the baby. They reported believing a cesarean was safer and less traumatic for the baby.

What was similar between these two studies, besides the fear?  It was the influence of family on their decision to request a cesarean. It seems the experiences of close friends and family played a major role for these women in conceptualizing what childbirth would be like.  These women reported a bad birth experience for a close friend or loved one which served as their “prototype” birth — what they expect all births to be like.

All this to say I’m not quite sold on the theory that media drives fear of childbirth anymore.  What do you think?




  • Faisal I1, Matinnia N2, Hejar AR1, Khodakarami Z3. Why do primigravidae request caesarean section in a normal pregnancy? A qualitative study in Iran. Midwifery. 2014 Feb;30(2):227-33. PMID: 24055288.

  • Stoll K1, Hall W2, Janssen P3, Carty E4. Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian University students. Midwifery. 2014 Feb;30(2):220-6. PMID: 23968778.

  • Fenwick J1, Hauck Y, Downie J, Butt J. The childbirth expectations of a self-selected cohort of Western Australian women. Midwifery. 2005 Mar;21(1):23-35. PMID: 15740814.


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