The childbirth experience lives in the new mother’s spirit and effects her mood, emotions, sense of pride and self-determination. She integrates her prior expectations with all the rewarding, challenging, painful, frightening, exhausting, and demanding aspects of it. She needs to make sense of her childbirth experience by bringing all the pieces together, deconstructing it and putting into words what occurred and how she felt. Your training as a doula can help her process this experience in the early postpartum period just days following the birth.

Of course, if the new mother feels triumphant, powerful, and fulfilled by her child’s birth, having a chance to recall the details and relive the joy will reinforce the positive aspects, enhance her self-esteem, and deepen her satisfaction. Negative impact, trauma or upset does not heal or go away if it remains unresolved; in fact, they tend to fester and grow and effect other areas of her life.

If the birth was traumatic for her or her baby, early processing and reframing may even prevent later Post-Traumatic Stress Disorder or Postpartum Depression. If she is angry at or disappointed in herself, in people who were there, or over the events that occurred, she will benefit from a caring, empathic listener who acknowledges and validates her feelings. When the time is right, the person can help her to a more comfortable or positive perspective.

Suggestions for the Doula

• Before the birth, indicate that you will be interested in her feelings after the birth
• Before you get together for a postpartum visit, tell her you would like to go over it with her in detail
• Allow enough time for a thorough discussion

At the postpartum visit, introduce the subject in an open-ended way

• “Even though I was there, I’m interested in knowing what this experience was like for you. What are some of the things that stand out most?”
• “Would you like to review your labor from the beginning?”

Goals of getting together to review the birth experience

• For both the mother and the doula to have an accurate picture of what happened and why
• A positive impression of the mother’s participation
• For the mother, a feeling that she is heard, understood, respected, and cared for
• For the doula, greater understanding of what the experience was for the woman

Feedback for the doula from the mother regarding his/her role

• A degree of closure to the relationship, if appropriate
• Purpose of getting together to review the labor and birth
• To assist the mother in reconstructing the experience
• To acknowledge and validate her feelings
• To clarify or correct misconceptions or misunderstandings
•  To fill in any “missing pieces” and answer questions
• To help her deal with disappointment, guilt, or anger, even if the doula is the target of some of those emotions

Methods to use to achieve the goals

• Explanations/clarification of events – Questions and answers
• Active listening
• Constructive feedback (“I-messages”)
• Acknowledgment and validation of her feelings
• Appropriate allocation/acceptance of responsibility
• Planting “seeds of accomplishment” – compliments in reference to specific events from the labor
• Good timing when shifting from listening to giving feedback to planting seeds to concluding the session

Processing can take a long time, especially when the experience was frightening or traumatic. Repression of recall protects the new mother as she takes on the tasks of new parenthood; she may not deal with her feelings about the birth at all, or for months or until a subsequent pregnancy. Even if she is not ready, the doula can plant seeds of accomplishment that the mother will recall when she begins to process the birth.

Sometimes the doula is the target of some anger or disappointment, it requires you to be patient and practice non-defensiveness, and good communication skills to respond calmly and appropriately.

Some women have birth experiences that require more than one session or some intensive counseling to come to terms with a negative experience or a poor outcome. Be sure that your client has access to a clinical mental health provider for extra support.

Some women are traumatized by birth experiences that might not be troubling to others; it is important to accept her perceptions as her reality because prior life events can make some women more vulnerable than others. And its not our place as birth workers to judge, but to be a presence of support.

Early intervention, in the form of unhurried, open-minded and open-hearted processing of the birth experience, can enhance the positive aspects of the birth, help the mother anchor in reality and prevent psychological trauma. Delay or avoidance of this discussion misses an opportunity to positively influence a woman’s long-term self-esteem and mental health.

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