Investigating our Ability to be with Pain & Suffering
Written by Rose Gordon
Recommended Readings
Glassman, B. (1998). Bearing Witness. Bell Tower NY, Harmony Books
Salzberg , S. (1997). A Heart as Wide as the World. Boston: Shambhala Press
Chodron. Pema (1997) When Things Fall Apart, Heart Advice for Difficult Times. Shambhala Press
Chodron, P. (1994) Start where you are: A guide to compassionate living. Boston: Shambhala.
Zimmerman, J. and Coyle, V. (1996). The Way of Council Las Vegas, NV:Bramble Books.
Responding to Pain and Suffering
Midwives, like other health care professionals, see the full gamut of human situations.
While pregnancy and birth can be times of great joy, the emotional intensity of pregnancy and birth can also give rise to anxiety, fear, doubt and the resurgence of old and perhaps painful memories. Sometimes areas of past or present suffering surface in the mother that can affect her well being during pregnancy, with the potential to affect her health as well as her baby’s health.
Fear and aversion to the anguish of emotional suffering can cause us to avoid listening deeply to what the mother-to-be is experiencing. Her experiences may frighten us, or bring to mind our own suffering, feelings of doubt or insecurities. Or perhaps we have fixed notions of how this pregnancy and birth should go, or how this mother should feel, what we, as midwives, should be able to do.
When the pregnancy itself or the emotions of the mother unfold in ways that do not match our ideas, expectations or hopes we may withdraw from being fully present for those we are serving. When this happens the healing potential of the relationship between midwife and mother-to- be is jeopardized.
When we are able to listen deeply, healing and a state of wellness can be realized, even if external conditions themselves do not change immediately.
What is healing?
The words health and healing are derived from the Latin root, hale. Hale implies wholeness. A healing encounter is one in which all aspects of the situation are taken into account. No part of the mother’s reality is repressed, rejected or denied. In this receptive atmosphere the mother is able to hear herself and come to terms with her own experience.
What can we do to best facilitate a mother’s well being ?
It is not only our technical skill and training that contributes to the well being of the mother-to-be.
The presence we bring to our encounters with the mother-to-be and her family makes a powerful contribution to the mother’s well being. Our ability to listen, simply and openly, is an essential component of presence.
Offering unconditional acceptance is one way a midwife can help those she serves. Unconditional acceptance is the willingness to be non-judgmental and compassionate regardless of what unfolds, regardless of what the mother might feel or say. Unconditional acceptance of another’s feelings or thoughts is not the same as agreement.
Mother Teresa calls isolation the terrible disease of modern times. Certainly each of us has, at one time or an other, found it difficult to accept our own emotions and thoughts. If we respond by rejecting the “unacceptable” parts of ourselves we experience isolation, a sense of being disconnected from others and from the world around us. Isolated in our experience of suffering, fear or grief, we are vulnerable to hopelessness and despair. But our acceptance of ourselves can be influenced if we experience acceptance from another.
Midwives can offer this kind of acceptance, which is the basis of all therapeutic communication, to those she works with.
It begins with deep, receptive and spacious listening. Listening in this way brings our full presence to the moment and to what the mother is saying. It allows for the complexity and paradox of human emotions to be expressed and establishes a foundation of trust and respect.
When we listen, fully present to what we are hearing, we also gain valuable information that can guide us in offering the education, understanding, and counsel that the mother may need to restore herself to well being.
This undefended listening allows for curiosity and curiosity allows for new information and understanding to arise. Listening, without the barriers of preconceived ideas of what should be done, always comes first.
What characterizes this kind of listening?
Listening involves more than the ear. We hear with our whole body when we are relaxed and open. All the senses are alive and present, so that we are listening to a person and we are listening to the space around the person; to all the elements of the moment. We are hearing what is being said and we are hearing what is not being said. We can understand what is being said, and we can see clearly what needs clarification.We arelistening without judgement. This listening is uncolored by our pre-conceived ideas and concepts and allows us to be with the full range of this mother’s emotions. Listening quietly, with no expectation or effort, brings a calm, abiding presence to the communication.
A simple, honest and committed presence can be all that a mother needs to see her through a difficult time. Remember, our acceptance of another’s feelings and thoughts does not necessarily imply agreement. This acceptance does, however, contribute to healing by conveying respect and a willingness to allow the mother to be fully human.
This is inspired listening. Inspiration literally means to breath in. When we are engaged in inspired listening we take in the entire moment and all that is moving through it. We receive the moment and we let it go, in the same way that we inhale and exhale.
When we are pre-occupied with our own thoughts, fantasies, judgements and self-concerns we cannot listen in this way.
What can we do to develop and strengthen our capacity for this kind of listening?
The following exercises can help us develop and strengthen our capacity for listening deeply.
Each of these exercises explores a dimension of therapeutic relationship.
These dimensions and the exercises we will use to investigate being with suffering include:
- Identifying qualities in a midwife that contribute to healing (Healing Qualities)
- Knowing how you define or view a “successful’ pregnancy or “successful birthing experience” (a writing exercise)
- Compassion and equanimity. (An exercise in healing communication, called Seeing Purely)
- Knowing our limitations and extending our care for one another. (Loving kindness practices towards ourselves and those we serve)
- Resource: creating a container of objects that call to mind our intellectual, spiritual, emotional and community tools and resources.
Summary of the descriptions for these exercises are as follows:
- Identifying how we view ourselves as midwives. Brainstorming with others or creating a list of qualities based on our encounters with healing/ examples of midwifery we have witnessed or heard about and the creation of a drawing or Lifescape that uses objects or images to display these qualities.
- Writing on two topics. Worst-case scenario of the unfolding of a pregnancy. (5 min 5 min, unedited, don’t stop writing!.)Read it back to yourself. How do you feel as you read this? Where in your body is this feeling located?
Best-case scenario of the unfolding of a pregnancy (5 min, unedited, don’t stop writing!) Read this back to yourself. How do you feel as you read this?
Worst-case scenario of a birth/ same directions. Best-case scenario of a birth. Read it back to yourself. How do you feel as you read this? Share these writings with your mentor/coach who will listen without comment.
- Compassion and equanimity will be defined. This exercise involves belly
breathing to stabilize the communication and requires 2 people. (40 min. guided meditation followed by sharing a personal story of suffering with mentor, who does not speak, console or make physical contact. Then mentor shares a story of their suffering. Demonstrates the worth and influence of deep listening.
- Loving kindness exercises that help balance our good wishes for one another
with our human limitations. Involves forgiving self and other. (Recommended 20 minutes a day for one week)
5. Resource Kit : creating a container of objects that call to mind our intellectual, spiritual, emotional and community tools and resources.
Exercises for Investigating our Ability to be with Pain & Suffering
Exercise # 1: What qualities create a healing encounter? What qualities do we wish to develop further?
Mentor’s instructions:
This exercise is most useful when a variety of input is gathered. It is best to recall an actual situation, rather than reciting a list of qualities the student believes creates a healing encounter. If there is only one student involved the exercise will be enhanced if both mentor and student participate in the exercise and contribute to creating the list. If there is only one student, consider doing this exercise in the company of nurses or other care-giving professionals or volunteers. Remind everyone that sharing is done without comment by others or questions. Invite the student(s) to listen without judging or comparing the story told to other stories that are told. The emphasis is on listening and developing a broad insight into what is experienced as healing and what qualities create a healing encounter.
Stage 1: Ask the student to recall an encounter they participated in or witnessed that they define as a healing (not necessarily curing) encounter.
- In a group, each student briefly shares the description of this encounter with the others. Set a time limit for this part of the exercise and have the student (s) monitor their own participation. 2- 3 min. per person is adequate. If there are several participants they should be reminded to simply and attentively listen to each other without comment. If the mentor is working with one student, they each can share a healing encounter. The time limit can remain the same.
3. Next, have student (s) name the qualities of a healer and write these on a large piece of paper. IE: humor, lack of self-consciousness, humility, fearlessness, wisdom, compassion, ability to listen, ability to be non judgmental, empathy etc.
4. When the list seems complete, read it back aloud. The student can choose 2-3 qualities that they would like to develop further in themselves and write these in a journal. The exercise can end at this point.
Stage 2: Homework: Participants are instructed to select 2-3 objects from home that remind them of the qualities of a healing encounter. These objects can later be included in the “tool kit” they will create in exercise # 5. Participants bring these objects to another session and discuss them and why they choose them. They can either include the object in their tool kit or describe the object they choose on a piece of paper and include that in the tool kit.
Exercise #2. Writing Exercise. Best and worst case scenarios of the unfolding of a pregnancy.
Mentors instructions:
This is a timed writing exercise. Invite students to write without editing, without stopping, not lifting the pen or pencil from the paper. If they become stuck they can repeat the question, i.e.: the worst case scenario would be, or the best unfolding of a pregnancy would be, or I do not know what to say, I do not know what to say, until more words come. Students begin to write and do not stop until the time is up. Mentors will keep time and let students know when there is only 1 minute left. There is no right or wrong response to this question. Please be sure that the atmosphere is silent and conducive to writing uninterrupted. NO CELL PHONES. Mentors also remain silent and in the room, demonstrating patience and presence.
Mentors “script”:
- This is an unedited, timed writing exercise. The first writing is to imagine the worst-case scenario for a pregnancyor birth. Please be descriptive in your writing. Where does this happen? What is the environment? Who is present? Please write for 5 minutes. I will let you know when you have one minute left.
Read what you have written. How do you feel as you read this? Where in the body is there feeling? Please write about these feelings for one minute.
2. Now, please describe the best-case scenario for a pregnancyor birth.
Please write without editing or stopping for 5 min. I will let you know when I minute is left. If you see students stopping, remind them gently to write the question again, to keep writing.
Please silently read what you have written. How do you feel as you read this?
Where in the body is this feeling? Please write for 1 minute.
If a group, mentor asks, “How many people felt the best case scenario took place in a hospital? How many at home? How many have witnessed the worst-case scenario they described? How many have experienced the worst-case scenario they? How many have experienced their best case scenario?”
This helps participants loosen up before the vulnerable activity of sharing their story. (OPTIONAL for a group: If time and situation allows: Please form small groups and read your worst-case scenario. Writing is to be read without comment from anyone. When everyone has read, please read your best-case scenario to one another)
3.What is most striking to you about the qualities of your worst-case scenario? Your best- case scenario? Please write notes for yourself on each of these, for 1 minute.
4.POPCORN style sharing: Those who would like to are invited to share insights with the group for 3 minutes or so. Mentor and student are invited to share general insights into best and worst case if they like.
Exercise # 3. Compassion and Equanimity in the relationship of midwife and mother.
Mentors instructions:
This exercise involves belly breathing. Breath is used to stabilize the communication. Please practice sitting in a comfortable posture, both feet on the floor and breathing deeply and gently before hand. Breath deeply into the belly, inhaling and exhaling in a comfortable and natural rhythm. You can place your hands on your diaphragm and/or belly to feel the inhalations and exhalations. Feet are flat on the ground. Back is relaxed and upright. Breath is gentle and unstrained.
It is important that you read this script many times and make the language your own. Your confidence in this experience is important to the effectiveness of this exercise, which is deeply instructive and worth the effort!!
Remind the student that this is NOT THE STYLE of communication to use with the mothers. THIS IS A PRACTICE EXPERCISE, designed to demonstrate the importance and effectiveness of simple presence and deep listening. The importance of listening first, without comment or effort to console. With mothers one would demonstrate more physical signs of empathy, but still not comment initially.
The following is to be practiced and then “delivered” to the students. Please make this language your own.
The essential points are: to be a nonjudgmental presence, to recognize the inherent strength of a person who is suffering or in pain, to balance caring with equanimity, to experience the power of presence as a healing force in the experience of someone who is suffering, to realize ones own impulses to fix, change, control the experience of another and to use the breath, deep in the belly, as a stabilizing force that can allow one to remain present and caring, without manipulating the situation.
Seeing Purely
Please move yourself so you are in groups of two. Make yourself comfortable and be sure you can easily see the person across from you, without twisting or turning.
Find a place of ease as you sit up straight, by not rigid, with your feet flat on the floor. Feel the firmness of the floor and earth beneath your feet. Your whole body is supported. Your spine is long and flexible. The breath is deep in the belly, filling you with everything you need as you inhale. Breathe naturally, let the body exhale fully.
This posture of relaxed strength supports our lives and our work as midwives. The belly is soft and open, the chest and heart area is relaxed and open -- all supported by our strong and flexible spine.
Now, please close your eyes and bring to mind someone who has extended warmth and kindness to you. Someone who has cared for you. If there was no person like this in your life bring to mind an animal from whom you received affection, or bring to mind a saint or holy being. Recall their face, their hands, their voice. Just like you, they too knew both joy and suffering in their lives. Imagine a world where everyone received affection, kindness and care. Vow to extend your kindness and caring into the world as an expression of gratitude for the care and kindness you have received.
Now recall yourself as a child, at a time in your life when you were happy and carefree. If you cannot remember a time like this, bring forward the image of a child who