The power of discernment

The power of discernment

I am proud to be a supporter of natural childbirth.  I am thankful for the opportunities I have had to assist families as they made decisions about birth and parenting as both a childbirth educator and a doula.  But I’m starting to realize something that bothers me.

The advice that I used to give as a doula and childbirth educator was not always helpful or even correct. Ouch!  For someone who adores research as much as I do, that is difficult to say. But I’m realizing how unfortunately true that statement is.

Why do I say that?  Because I had limited understanding of the real problems in pregnancy, and I used that understanding as the basis for all the information I gave.

As a doula and childbirth educator I was trained in natural, normal, physiological pregnancy and birth. But included in that training was an unhealthy dose of distrust of the medical establishment. I was not trained to mistrust research, I was not trained to question what was posed as “natural.” I was trained that doctors (and sometimes midwives) make terrible decisions about how to care for patients because they do not know the truth about birth.

I tried to temper this distrust by objectively educating my clients.  I never told them their doctor was an idiot, but I made sure to point them to resources that countered what their doctor had to say. I believed what I had been taught, problems in pregnancy and childbirth were rare  – so rare in fact that I encouraged all my clients to disbelieve any problem they might be having was really a problem.

Whether their problem was real or not is NOT the issue. What is the issue is that I lacked the ability to discern when a problem was real and when it was not.  In my early days as a childbirth educator I passed on that lack of discernment – all concern about blood pressure, weight gain or issues with the baby must be false because doctors are not to be trusted and real problems are so rare. As I gained experience and expanded my knowledge I slowly began to understand that sometimes problems do exist.  But I still didn’t understand how to tell the difference between something really dangerous and something just a little off.

My challenge to you is this – start developing that discernment.  Learn what blood pressure means, how it relates to problems and how to tell that it is a problem.  Learn about weight gain and loss in pregnancy and how they relate to problems.  Learn about the most common problems, what increases the risk and how they are generally treated.  Develop a knowledge about these most common problems so when clients come to you, you are able to point them to a wide variety of evidence based sources so they can learn to discern the real problems from the hype. Become familiar with recommended treatments so you can point them to resources that allow them to make treatment decisions.

Approaching potential problems in this way helps your clients become partners with their health care provider rather than fearing every suggestion is just to move them a step closer to cesarean. And if the health care provider does not practice evidence based care, it makes it very obvious for your clients to recognize it and find someone else who does.

As a bonus, it helps prepare you to move up to the midwife role.


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Jennifer Vanderlaan CNM MPH is the author of the website. She has been working with expectant families since 2000, training doulas, childbirth educators, and midwives. She has worked with midwives in Central America and Sub-Saharan Africa. Her interest in public health grew in 2010, and she is now a PhD student learning to become a producer of knowledge.

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