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Communication Problems

Communication happens all day every day, and yet somehow most of us struggle with this and it is a foundational skill for birth. That's why we are taking a deep dive into this topic -  because I want to help you learn techniques to improve your ability to communicate  so you can use it to improve your birth experience.

Improving communication in birth begins by improving YOUR communication, but before we talk about you, I want to back up and say a word about the bigger struggle with communication, because it's not just a patient problem, struggling with communication goes two ways. As patients it's hard to know the right questions to ask because the background information is missing. Very few of us grow up in cultures where we are exposed to a real birth until we experience our own. This means our expectations and preconceptions are formed by the media, movies, and stories from women in our lives who have gone through it before us. Sometimes these stories are full of joy and powerfully build us up, but today, more often than not, we hear stories of all the things that required an intervention or a disruption that interfered in the birth process.

At the other end of the spectrum, providers can have what we call a cognitive bias, in which they are so educated and experienced, they don't remember what it's like to not know about what to expect in birth. Therefore, it can be hard for them to anticipate your needs and prepare you for what to expect. Even the best, most attentive of providers can fall prey to their cognitive bias, if fact, we all have done this in one way or another, anything that we become expert in is likely to lead to a cognitive bias.

Have you ever had to teach someone something that you became proficient in years ago? Training a new hire at your job, or maybe tutoring someone in a subject that's easy for you, or teaching someone a craft that you have been doing so long, it comes so naturally that you don't even have to think about, like knitting. When you try to teach someone who is new to the information or skill, it can be hard to remember the challenges they will face because it's so second nature to you.

So, now we have a couple of things going on - as the patient, we don't have the full scope of knowledge, and your provider probably has some level of cognitive bias and forgets that we as patients don't know what they know.

 Communication Styles

Now I am going to complicate things a little further, because communication is complicated, it's complicated throughout our life, not just in birth. That's because, we all have different communication styles with different strengths and challenges. Some people are good at open communication, some are good at listening but not as good at conversing, others are better at holding the conversation, but not at making space for the other people in the conversation, and some prefer to limit communication altogether. Your communication chemistry influences conversations we have with everyone in your life, including your care providers, your birth team and even your birth partner.

I think the biggest problem with this whole communication breakdown is that it often isn't clear that there is a communication gap until things get messy. Sometimes it's when there is a problem with your pregnancy, but usually it's when you are in labor that it becomes a big problem, and these are the worst times to make this discovery.

So how do we bridge this communication gap between you, your birth partner and your birth team?

In my experience, it's all in the preparation and there are two primary ways I know of to prepare so you can avoid major communication stress in labor.

1. Understanding your own communication style, your strengths and challenges when it comes to communication. When you understand your own communication style, you can improve the effectiveness of your conversations. This is true for the pregnant mom, the birth partner, and ideally everyone on the birth team.
2. Remaining aware that communication styles of other people will vary from yours, and it's always helpful to be conscientious of cognitive biases so you can be empowered to ask questions that remind the experts you are talking to that you might need them to go back a few steps in the conversation to give you the full picture.

This kind of preparation is really, prevention, which I am sure you have heard is the best medicine. It's prevention from small issues turning into major complications, it's prevention from giving up control of your birth because of fear or confusion by empowering yourself to be able to get the information you need to make decisions.

The Communication Solution

Understanding your communication style is one of the 4 steps we include in the Natural Birth Compass program that helps our students write a birth plan that they and their birth team love to use and I want to give you a rough break down of how it works.

First, you start off by identifying your dominant communication trait out of 4 core types:

• The straight to the point & organized type
• The social & outgoing type
• The nurturing, caregiving type
• The quiet & sensitive type

The next step, once you have identified your type, is to explore your strengths and challenges associated with your type, especially in regard to communication. Are you an easy going communicator, or a conservative communicator? Do you shut down easily and hold things inside? There are many ways that we block our communication, so starting to observe yourself in your everyday life, as you communicate in your regular environment, with your household, your co-workers, or even at places like the grocery store and restaurants. By doing this, you will become aware of your communication strengths and challenges, how you can leverage your strengths and how you need to prepare for your challenging areas before your labor is here. 

With this exploration and prevention work done, you will have a powerful tool in your labor toolbox and one that is genuinely needed because, once your labor is here, your ability to functionally and vocally communicate is likely to change in the different stages of labor. In early labor, it's usually easy enough to be clear about your needs as long as you are prepared to do so, but as things intensify in later stages of labor, you may not have the full capacity to communicate vocally or calmly.

Being prepared with how you might respond is the key to prevention. So after you have identified your core type, you can then prepare for the different stages based on other life experiences you have been in and how you communicated in those times. For instance, when recovering from a cold or flu, some people will want to be taken care of, while others prefer to be alone - this speaks to how you might react in early labor as well. But as it picks up and becomes more intense, you might find that you need a support person to be right there with you, whether that's your birth partner, your doula, midwife or a nurse, and you will want to be comfortable getting that person to be there, even if asking for support isn't normally your strength.

Knowing these things about yourself means you will be able to prepare your birth partner and your birth team so they know how to approach you and support you in birth. This will take so much pressure out of your birth room because your lines of communication are open and more likely to be understood rather than misinterpreted. You can prepare them for how you want them to be there for you - for example, if you know you are not good at asking for help and support, you might want to have discussed this with your birth partner ahead of the birth and have a plan for your team to offer support without you having to ask, so you don't have to worry about whether they will be there for you and they don't have to worry about guessing whether or not you need help.

The other benefit is that by going on your own journey of discovery, you will also learn about the communication styles of other people and have some insight into the communication strengths and challenges of members of your birth team, and though this technically shouldn't be your job, in today's birth culture, you may not know your birth team before your labor, and sometimes the birth team changes during labor, or in the case you need to transfer from an out of hospital to a hospital setting, having these skills can help you maintain your ability to communicate effectively and that can be all the difference in your birth room.