BFW Dictionary: Outcome

There are so many words that are special to Birthing From Within, words that we use in very specific ways that are important and meaningful — but not always entirely self-explanatory. The purpose of the BFW Dictionary posts is to shine a clarifying light on the language used by BFW and its practitioners and to explain how some of these words are so central to our unique approach to the childbearing years.

OUTCOME

noun.  the result or effect of an action or event.

— Oxford Dictionaries online

Birthing From Within mentors frequently emphasize the point that our work is not “outcome-focused.” While this might at first sound like a relatively straightforward idea, there’s a lot of complexity underneath it. So let’s take a closer look: What does it mean to be outcome-focused in a birthing context, what problems might such a focus create, and what are alternative approaches?

To be outcome-focused means to conduct your birth work (birth classes, doula support, fitness classes, body work, counseling, etc.) with a specific goal in mind in terms of the outcomes of your clients’ birthing experiences. Some outcomes that birth professionals frequently focus on are vaginal birth, unmedicated birth, calm birth, painless birth, etc. A childbirth class taught with the specific slant of “how to have a natural birth,” or doula support with the central purpose of “avoiding a cesarean” (especially common in VBAC contexts) are examples of outcome-focused stances.

There are a couple of obvious potential problems with such approaches. Let’s take the example of a birth professional focused on the outcome of birth without pain medication: a childbirth educator whose class is geared towards convincing parents that epidurals are unhealthy, a doula whose support is explicitly geared towards the avoidance of the epidural, etc. The first problem occurs if the professional encounters a client who actually wants to birth with an epidural, or feels equivocal about it; there will be an immediate break in the relationship when they realize that the professional disapproves of their stance. But even if the client agrees wholeheartedly with the no-epidural goal, there is a second problem: if they go on to have an epidural after all, then they have “failed by the terms of that goal, which was introduced or reinforced by the professional. In other words, the professional has effectively created a “failure,” or collaborated with the client in doing so.

This is not to say that a client should not have preferences, or that a birth professional should not help them explore ways to increase the likelihood that those preferences might come to pass. The dysfunction occurs when the professional focuses on specific outcomes as the measure of a birthing experience.

To help us understand how this works, let’s look at the goal of “evidence-based” care. It might seem to be universally unobjectionable to teach a client to pursue the outcome that all of their care proceed according to “evidence-based” practices. However, what can happen if we encourage a client to make the concept of “evidence-based” into the ruler with which they measure their experience? If, over the course of their birth, they make medical decisions or experience medical practices that are not strictly “evidence-based,” then their birthing experience becomes a bottom-line “failure,” no matter what complications occurred, and no matter how they may actually feel about things themselves.

Even if a client “succeeds” in achieving the wished-for outcome, conceptualizing birth as a success-failure model is deeply problematic.

The framing of the psychological/physical/relational transitions of birth in terms of “success” and “failure” is unhealthily narrow, and does not support birthing people in developing the complex understandings necessary for navigating the challenges of parenthood, particularly the maze-like marathon of the early parenting period. If, for instance, a childbirth educator or doula encourages a client in focusing on the outcome of unmedicated birth, and the client does achieve this outcome, has the client actually learned anything about coping with the complexity and uncontrollability inherent in the process of becoming a parent? How prepared is that client for the potential that other goals (to exclusively breastfeed, to have a consistent sleep schedule, to return to their pre-baby norms, etc) may not be met, despite their best efforts? 

To encourage parents to see these processes in terms of achieving or not achieving a goal, rather than in terms of a series of experiences to be navigated by drawing on internal and external resources, is a long-term disservice that can have profound, lasting effects on their emotional health and their sense of self-worth.

(It’s worth noting that many birth professionals — even postpartum doulas — do not have long-term postpartum relationships with their clients beyond an occasional call or message, and thus may never become aware of such effects. In other words, “they were doing well when I did the postpartum visit/followed up a few weeks later” may not be a particularly meaningful measure of a client’s long-term mental health vis-a-vis the perinatal experience.)

Additionally, by encouraging clients to focus their prenatal preparation on how to “get” a certain outcome, a birth professional is drawing a direct line from achieving that outcome to feeling happy or satisfied with the experience. In other words, they are effectively promising that if the client’s birth has the wished-for outcome, the client will then feel happy or satisfied. However, any experienced birth professional knows that it’s not that simple: some clients who “get” everything they had thought they wanted from the events of the birth are still profoundly traumatized.

The outcome-focused approach doesn’t allow for the possibility that the psychological experience of a birth may be only tangentially related to whether its external shape fits into a previously-determined mold.

The question is, if we don’t focus on outcomes in childbirth preparation, what DO we focus on? The answer is simple, if not easy: we focus on the process, and we focus on solutions. This means thinking about ordeals and transformations and what they demand from us, and coming up with flexible plans and practices for coping with those demands, whether or not they meet our previous expectations and goals. All of the most powerful Birthing from Within instructional modules – Labyrinth, Inanna, Heart’s Question, Pain Coping Practices – do this work of simultaneously illuminating the unpredictability and challenges of the path ahead and offering powerful modes of coping and psychological self-care. (Note to parents: You can experience these preparatory activities in a session with a local BFW practitioner, or by reading about them in Ancient Map for Modern Birth and walking yourself through the processes.)

All clients, whether they admit it or not, have hopes, wishes, and dreams for the outcomes of their birthing and parenting experiences. It is not our place as childbirth mentors to approve or disapprove of these hopes, wishes, and dreams, no matter how healthy or unhealthy they may seem to us. Rather, it is our job to give our clients the gift of seeing beyond matters of like-and-dislike, want-and-don’t-want; to help them see themselves as capable of traveling into unknown territory and then finding their way back home again.

About Koyuki Smith

Koyuki Smith is a BFW mentor and facilitator, and she edits the BFW blog, Through the Labyrinth. She loves thinking, teaching, and writing about the universal experiences of initiation and transformation - especially how art and literature can illuminate, interrogate, and even guide those experiences. She lives in Harlem with her husband, her two sons, and a little dog, too. Learn more about her work at www.BirthingFromWithinNewYork.com

2 Comments

  1. Donna Moore on January 10, 2019 at 5:46 pm

    Well( and beautifully) said.

  2. Shannon on April 24, 2019 at 1:52 pm

    I love this post!

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