The gentle warrior-how to support women through a broken maternity system

During the first year I worked as a doula, I suffered massively burnout, and I had t learn to develop a new way to look after myself.

One of the things I do, is try to always have some kind of bodywork treatment after each birth I support.

I do this because supporting a woman through a pregnancy and birth takes a lot out of me, so it’s important to regenerate myself.

I have a handful of favourite therapists who really get me, work on an energetic level, and know how to reset me after a birth (and best of all, we do skills swaps together!).

I usually get some insight about what I was meant to learn from the birth during the treatment. I think the deeply relaxed state facilitates that.

Recently as I was receiving such a treatment from wonderful osteopath Teddy, I had this huge insight about how difficult it is to do what I do as a doula.

First I saw myself as a mother wolf protecting her cubs, growling fiercely.  This represents how I feel when supporting a women through birth.

Then I saw some kind of enlightened being. I saw how important it is to stay in a state of love, something I know deep down is the right way to go, and which I have written about before here.

Finally, I saw a tightrope walker. It symbolised the challenges of protecting my client whilst staying in a state of love.

This struggle is very real for most of the doulas I know.

I remember when I was a new doula, and I poured my heart out to my wonderful mentor Suzanne, after a very challenging birth, and Suzanne used this expression of being a gentle warrior.

Very early on in my doula career I had to face these kind of choices, there is a particular story that happened, which I talk about in this post, that keeps reminding me of this.

How do we stay kind, supportive and compassionate in a maternity system which lacks humanity (how on earth can birthing women form trusting relationships with people they have never met before?), and in the face of sometimes, harsh, unkind behaviour?

I can think of several examples in my doula life.

The time were an obstetrician walked into the room and proceeded to examine my client vaginally without introducing herself, treating my client like a piece of meat (I no longer let this happen, which means that I sometimes have to place myself between my client and the doctor in question, plaster a big smile on my face and say “Hello this is John and Sarah, and your name is?”).

The time when an anaesthetist walked into the room, talked to my client mid contraction, and when she didn’t get an immediate reply, said “What’s wrong with her, she doesn’t speak English?”

The time when a client who discharged herself against medical advice got told ” Well I hope you don’t get a stillbirth during the night”

The countless times when fear, coercion and unkindness were used against my client in order to make her comply. I wish this was a rare occurrence but sadly it’s not (read this).

How do we stay calm and compassionate in such a broken, dehumanised system? How do we defend our clients right to choose and feel supported in their choices? How do we hold space for all involved?

And most importantly, how do we stay in a state of love?

It is challenging because the answer is NOT to respond to the lack of humanity by behaving in the same way (however tempting it might be).

And how do we navigate the unpredictability?

Because, within our unfit for purpose, broken maternity system, I also witness incredible kindness and humanity, all within the same hospital.

A few weeks ago I supported a woman through an elective caesarean. For medical reasons, the birth had to happen much earlier than term. Whilst my client was in theatre, the nurses in recovery were just incredible. Normally I find myself sitting alone in a room whilst waiting, sometimes even outside the unit. This time the nurses chatted to me, gave me coffee and biscuits, and kept me updated of the surgery process (I normally get very worried for my client if the caesarean takes longer than usual, which was the case here). Then, when the babies had been born and had to go to the neonatal unit, they took me to get changed into scrubs so I could support my client during the rest of the surgery whilst her partner was with the babies. Later on, they wheeled her, on her bed, to the neonatal unit so she could see her babies. And they even made sure that she would go to the antenatal ward instead of the postnatal one so she wouldn’t be surrounded by crying babies whilst her own was not there. I was touched and humbled by the kindness and humanity I saw.

I can remember many other examples like this, and that this kind of behaviour mattered especially when the birth didn’t unfold as hoped, for example the anaesthetist who kneeled next to a woman who couldn’t have an epidural, to talk to her gently about what other options were available.

Or the obstetrician who took the time to talk through the options, and to read my client’s caesarean birth preferences, when she ended up needing to go to theatre after a very long labour, and then let me accompany the couple in theatre for the birth.

Recently, I was denied access to the local NICU whilst trying to support a client in tears, because it wasn’t visitor time. I had a difficult time holding it together not bursting into tears myself. I left the hospital feeling bereft and powerless, not knowing what to do with myself, and feeling sad and angry at a system which applies inflexible rules in the name of “safety” and leave no place for humanity.

I am walking on my own tightrope because I feel angry at a maternity system that applies rules blindly and leave no space for women’s unique circumstances.

I am listening to what’s happening inside myself and it’s not pretty.

Yet I know, deep down, that anger isn’t the answer, that staying in these angry feelings doesn’t make change happen and only hurts me.

I feel frustrated, and I feel like I’m failing to protect the women I support and I feel like I’m failing to change the system.

I’ve been in the birth field for ten years now, and when I started, I thought in the time I would work I would see the system improve.

It’s been the opposite. Lack of staff, lack of funding, means that women rarely see the same midwife more than once throughout their pregnancy and therefore fail to build trust with their caregivers. It’s not satisfying for midwives either.

Women no longer have a named midwife they can call when they are worried, and I’ve seen a really worrying trend towards medical questions being directed at me instead.

I’ve seen a general tightening of rules and women’s choices. Less access to homebirths, more inductions, more caesareans, and generally more interventions, increases which aren’t backed up by any solid evidence.

Famous obstetrician Michel Odent one said “I used to say we’re at a crossroad, but now I believe we’re at the bottom of the abyss”

I believe we have reached the bottom of the abyss and started to dig.

As well as worrying that I’m failing my clients, I also feel somewhat responsible for my powerlessness to change the system for the better.

I feel like I’m going at it the wrong way, and that I ought to do more, to fight more, and to do more campaigning or stuff like that.

Only this is not what I am about (and this isn’t how change happens either-I take solace in this model about how ideas spread-through small groups of innovators and early adopters, not through the majority of the population, see here)

And deep down, I know that the negative changes in the system aren’t my doing (or lack of doing).

Coming back to the analogies I made at the beginning of this post, I believe the challenge of the gentle warrior is to harness the fierce energy of the mother wolf protecting her cubs, whilst staying in a state of gentleness, benevolence, and love. Yes, even towards those unkind, coercive professionals.

In her book, “eat, pray doula“, midwife Robin Lim reminds us that some health care professionals have built a cage of ice around their hearts to protect themselves, and that our job is to try and gently melt it.  You can’t go at it with a pickaxe.

It sounds corny, but it really is a case what Gandhi said: of “be the change you want to be in the world”

Wayne Dyer compares us to an orange: what do we have inside, and what comes out when someone squeezes us? (you can read the whole story here )

 “Let’s assume that this orange isn’t an orange, but it’s you. And someone squeezes you, puts pressure on you, says something you don’t like, offends you. And out of you comes anger, hatred, bitterness, fear. Why? The answer, as our young friend has told us, is because that’s what’s inside.

It’s one of the great lessons of life. What comes out when life squeezes you? When someone hurts or offends you? If anger, pain and fear come out of you, it’s because that’s what’s inside. It doesn’t matter who does the squeezing—your mother, your brother, your children, your boss, the government. If someone says something about you that you don’t like, what comes out of you is what’s inside. And what’s inside is up to you, it’s your choice.”

So it starts with me, how I treat others, and how I treat myself. How I look after myself, and my immediate circle of family and friends.

It’s about what I move towards, and not what I move away from.

The reason it is a tightrope act is because it’s always a challenge not to fall off the rope and also to manage fierce protection whilst remaining kind at all times.

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1 Comment

  1. francoise freedman on March 30, 2018 at 7:28 pm

    Thank you Sophie for expressing your feelings about your Doula role so vividly and from the heart. I have come to the conclusion that maternity care does not really worsen or improve over time, the balance remains roughly the same between being atrociously bad and admirable. Different protocols, procedures, drugs, in principle better, but a system not making space for quality care and individually-tailored allowances. Doulas are there to stay, please do not get discouraged or bunt out!

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