Question 1

Your client is in her 9th month of pregnancy, and says, "I think I want to change doctors." Your BEST response is:

Accepted Answer

Asking an open-ended question to elicit more information from the speaker, along with the addition of feeling words, is an essential component of active listening. This allows the speaker to clarify and problem-solve. It is never too late to change providers when a woman feels unheard by her current doctor or midwife, even if she is only days away from her due date. Judgments and bias ("rash" and "surprised") should be left out of the doula's response.

Question 2

While discussing writing a birth plan, your client says, "I think I'll probably just end up having an epidural." Your BEST response is:

Accepted Answer

Asking an open-ended question to elicit more information from the speaker is the core of active listening. This allows the speaker to clarify and problem-solve. Judgments and bias ("crazy") should be left out of the doula's response. While the doula may feel disheartened by such a comment, and may know the local hospital's epidural rate, the conversation should stay focused on the client's needs in order to improve understanding and communication.

Question 3

While half of communication is active listening, the other half is speaking and expressing thoughts, ideas, facts, and feelings. In order to be an effective speaker, the doula should do all of the following EXCEPT:

Accepted Answer

When a doula judges, moralizes or preaches in response to what she hears, she is creating a barrier to effective communication. Using "I" statements when expressing opinions allows the speaker to share thoughts and feelings without the listener feeling attacked or blamed. For example, saying "I don't feel heard" rather than "You're not listening to me" allows for continued civil conversation and deepened understanding between the speaker and the listener. The language a doula uses affects the "reality" she presents to clients. The doula needs to be conscious of body language, word choice, and cultural biases (her own and others) in order to avoid miscommunication.

Question 4

In order to best support clients as they move through pregnancy and birth, the doula needs to make the distinction between offering information and giving advice. Which communication strategy empowers the mother to make decisions that are best for her own family?

Accepted Answer

Providing information lets the mother know what her options are and allows her to make the decision for herself. When offering information, the doula uses phrases such as, "Research shows..." or "Many women have found...", and does not criticize the mother's ultimate decision. Identifying emotions as part of an active listening style should be used before giving information so that the most appropriate facts are shared and miscommunication is avoided. Advice, on the other hand, is telling another person what they should do, and implies a value judgment. It may send an unspoken message that the listener is not capable of making her own decisions, but needs to be told what to do. A doula should avoid advice-giving phrases like "you should...", "you ought to...", "you need to...", or "if I were you...".

Question 5

You are supporting a mother in early labor. She has been having mild contractions throughout the evening, and is saying how much they hurt. Your response includes all of the following EXCEPT:

Accepted Answer

Telling a client labor is only going to get worse makes a judgment about the client's coping skills, and blocks meaningful communication. Recognizing the emotion behind the statement allows for explanation from the client. Offering solutions can add to discussing the client's feelings. Asking an open-ended question empowers the speaker to find a solution that works for her.

Question 6

In order to foster effective communication with clients, the doula needs to examine her own values and biases. By doing so, the doula can do all of the following EXCEPT:

Accepted Answer

When a doula examines her own belief system, she makes it possible to accept others even if their beliefs are different based on upbringing, religion, politics, etc. The doula is better able to communicate effectively with everyone, not just those who share her same views. Through this process of self-discovery a doula can define her own moral set and explore the ethics of her profession. This strong sense of self will help her to identify personal biases that may act as roadblocks to understanding and communication. The doula will be ready to deal with clients from many different backgrounds.

Question 7

During a prenatal consultation, your client says, "My doctor has said he will use episiotomy at his discretion, but I don't want him to cut me." Your BEST response is:

Accepted Answer

Asking an open-ended question to elicit more information from the speaker in addition to labeling the emotion "heard" is the core of active listening. This allows the speaker to clarify and problem-solve. Only a physician can decide if episiotomy is necessary, but the client should open dialogue about her fears at a prenatal appointment. Discussing the pros and cons of a procedure with a client is part of a doula's scope of practice, but should be done after identifying the underlying emotions behind a statement. Advising compliance does not help in finding a solution that meets the client's needs as an individual, nor does it recognize her feelings.

Question 8

In labor, your client is experiencing self-doubt and says, "Why did I ever think I could have a natural birth?" Your BEST response is:

Accepted Answer

Recognizing a client's feelings, even in the midst of labor, is essential to communicate effectively. Doing so will build trust and respect, and will allow the laboring mother to do the work of birth. The additive and open-ended "let's see if" invites both participants in the conversation to work together. Personal feelings, judgments, and bias should be left out of a doula's response.

Question 9

When you visit a client in the hospital after the birth, she says, "My partner didn't want me to have a natural birth. But today, he can't stop raving about how strong I was." Your BEST response is:

Accepted Answer

Identifying emotions doesn't always mean finding the negative emotion in a statement. Active listening is important at building trust and respect even in a positive conversation. An additive response helps to avoid miscommunication, and increases the connection between those in conversation. Judgments and personal feelings are not helpful, even in positive conversations.

Question 10

In a postpartum visit, your client says, "This baby never sleeps. I'm already ready to tear my hair out!" Your best response is:

Accepted Answer

An additive response identifies the client's feelings and prompts further conversation allowing for improved understanding and less miscommunication between a doula and her client. Allowing others to care for the baby may be the last thing a mother wants, and the phrasing does not allow for meaningful conversation on the topic. "You should..." implies giving advice, rather than providing information. Facts and emotions alone are less effective than an additive, reflective response.

Question 11

Your client says, "I'm worried about what kind of mother I will be. My mother was very young when I was born, and it always seemed like I was a burden to her." Your BEST response is:

Accepted Answer

By identifying the sadness the client is feeling, as well as adding a guess at how the client perceives herself, the doula facilitates the process of communication. The client then has the opportunity to agree or to clarify her emotions, and to find a solution that works best for her. Platitudes do not allow for further communication. Labeling emotions is good, but not enough by itself to truly improve communication. Judgments and personal bias should be left out of the doula's response.

Question 12

When working on a birth plan with your client, she says, "My partner just doesn't want to listen to any of my suggestions about this birth. He doesn't think I need a birth plan." Your BEST response is:

Accepted Answer

By identifying the client's feelings, as well as adding a guess at how the client perceives the situation, the doula improves communication. The client then has the opportunity to agree or to clarify her emotions, and to find a solution that works best for her. Judgmental sentences close the conversation to additional communication and understanding. Identifying the feeling is a good start, but adding more to it allows for greater introspection and conversation.

Question 13

During the active part of labor, your client says, "I hate that nurse. Don't let her come in here again." Your BEST response is:

Accepted Answer

Part of a doula's work may be facilitating conversation between others. But the tenets of active listening are still important. By identifying the client's feelings and adding an open-ended statement or question, the doula improves communication. The client then has the opportunity to agree or to clarify her emotions, and to find a solution that works best for her. Judgmental sentences close the conversation to additional communication and understanding, and in this instance may set up a confrontational scenario that is best avoided.

Question 14

You are visiting a client the day after the birth, and she says, "I've started breastfeeding, but I just don't enjoy it." Your BEST response is:

Accepted Answer

The additive, reflective response is the strongest form of communication when using active listening techniques. Judgments, like questioning the speaker's opinion, break down trust between the client and doula. Identifying a feeling, while a reasonable strategy, doesn't go far enough to improve true communication. A lactation consultant may be a good addition to the care team, but asking about her should not be the first response to the mother's statement.

Question 15

Your client's baby has just been born, and she says, "This is the most wonderful day of my life. This baby is absolutely worth the pain of labor." Your BEST response is:

Accepted Answer

Reflective listening with an additive response is just as effective a communication tool in a positive interaction as it is in a problem-focused one. Empathy is a good tool for connection with another, but is not as effective as a more thoughtful reply. Suggesting the mother and baby be separated or that the mother's emotions are unimportant are not appropriate responses.

Question 16

Your client says, "My doctor never listens to me." Your BEST response is:

Accepted Answer

Identifying the speaker's feelings and adding an open-ended question allows for more thoughtful conversation to take place. The speaker then has the opportunity to clarify her emotions and find solutions that will work for her. Judgments and personal bias will not improve respect or trust in the client/doula relationship. While the mother does have the right to informed consent, the doula can improve the client/provider relationship by helping the client find ways to communicate with her provider.

Quiz 2: Communication