mommy whisperer
How watching a cowboy train a horse helps nurses give women the childbirth experience they want.
By Jan Morrison

AT A FARM outside of Waynesboro, Va, animal behaviorist Jeff Spooner trains his horse, while Lisa Roberts’ class observes his use of non-verbal communication and trust-building techniques.

Some experiences require a coach — a seasoned expert, with solid suggestions and experiences who can help navigate unknown terrain. Lisa Roberts, R.N., a nurse at the University of Virginia Health System, trains professionals to be coaches through the life experience that may require the most support — labor and delivery. She teaches nurses, childbirth educators, nurse-midwives and physicians to empathize with women in labor, and navigate the unpredictable path of natural, unmedicated childbirth by watching a different type of expert — a horse trainer.

“[By attending the class] I was looking for different perspectives on how to help laboring women, and I was interested in how the day with the horse trainer related to labor,” said Diane Sampson, childbirth educator and class participant. “I drove home after watching the trainer and the wild horse, trying to make the connection between what I saw and what I know about supporting a woman in labor. The next day in our discussion, I started to make the connections. I think the classroom discussion would not be as valuable without the day observing and learning from both the trainer and the horse.”

Sampson educates women about those future moments when they will need the guidance of an experienced coach and tries to combat the preconceived notions of birth brought on by viewing too many episodes of The Baby Story, which can make labor look easier than it is, she said.

“I tell my students that birth is beautiful, but it is not pretty,” Sampson said.

AS JEFF SPOONER progresses in the training of his horse, he moves it from the closed pen to an open corral, while participants of Lisa Roberts’ birthing class observe.

She sees that as a parallel to watching the wild horse training — in the end, a beautiful relationship is formed between trainer and horse, but the process can be painful to watch as the wild horse fights to escape and avoid the training process entirely.

Class participants observe Jeff Spooner, an animal behaviorist and trainer, train a wild horse on a farm near Waynesboro. Spooner designed a version of his instruction as a leadership course in 2001, “Cowboy Logic: Lessons in Relationships,” and Roberts now applies it to her birthing class.

Sampson and her fellow students learned several key lessons through Spooner’s instruction that they take to the second day of the course, which is specific instruction and discussion in a classroom. They dissect Spooner’s ability to observe non-verbal cues and develop a trusting relationship with his horse, then apply that to their goal of developing a trusting relationship with their patients.

Through her class “Caring for the Woman/Family who is Planning an Unmedicated Labor and Birth Experience” taught at U.Va., Roberts teaches her students first that natural birth is an option, and that the hardest part is not the patient’s pain, but providing her with enough emotional support so that she feels safe and confi dent in this new experience. She illustrates this concept and others by drawing parallels between labor and the horse training.

They learn that an experienced, educated professional makes all the difference in the participant’s ability to adapt in such a situation. They also learn that the experienced professional must be fl exible and learn to take challenges in stride. As long as the professional stays present, is open to changes, and has an arsenal of ideas and tactics, a trusting relationship will develop. With his horse, Spooner observed carefully and read its signs. When the wild horse was not progressing during training, Spooner removed the horse he was riding to eliminate that possible distraction. Soon, the wild horse began to respond to Spooner’s training more directly. Sampson drew the parallel to students or family members present in the labor room. Some birthing women may not mind their presence, but others fi nd it distracting.

Class participant Becki Lawhorne, an RN at U.Va, also noticed the similarity between horse and patient when removing distractions. She makes it a point to rid her laboring patients of all distractions, to support their comfort and progress.

“I like how [Spooner] got his horse out of the ring when he noticed the wild horse’s training wasn’t progressing,” said Lawhorne. “I’ll be the bad guy and kick people out of the birthing room. I don’t care, even if it’s the father. If he is impeding the process of my patient, I’ll be the bad guy.”

Roberts uses the comparison as a perfect example of reading a patient’s nonverbal cues, just as Spooner attended his horse’s physical cues. Spooner also makes it a point to remain in the corral with the horse-in-training even when he is not engaged with the animal. His presence is a continued reminder that the process is not complete, and he is still committed to the training. Likewise, Roberts says that being in the room with a patient is an essential part of the work.

“I had a patient that wasn’t progressing for two hours,” Roberts said. “For her, all I had to do was be in the room, and talk to her, and remind her of my support. Then, she was comfortable enough to relax and continued to progress.”

When Spooner’s horse seemed to have a problem grasping a new instruction, Spooner backed up and reviewed knowledge that the horse had learned earlier, guiding it back into the learning mode. Roberts says that reminding her patient how far she has progressed and done and how much work she has done accomplishes the same goal. It serves as encouragement, and motivation to continue through the process.

After comparing nonverbal communication and trust-building techniques between horse training and labor, Roberts then provides new approaches and concrete suggestions for laboring unmedicated women. She addresses possible changes in environment, stimuli, touch, moral support and speech that can assist a laboring woman. Students leave the class with new approaches and ideas for laboring the unmedicated woman, from different birthing positions to accessories such as birthing balls and stools.

“I left the class wondering, ‘How am I going to empower this woman to go through this process with confi dence?” Lawhorne said.

After Roberts’s inaugural class in the fall, she noticed a difference in the confi dence level of the nurses on her unit, in their approach to unmedicated birthing women.

“I have seen huge benefits on the unit. The new knowledge empowers them. Not only do they learn new techniques, but they gain the confidence to work with a different type of patient after the class,” Roberts said.

Lawhorne admitted that she had touched more feet than ever before after the class taught her the power of foot massage. She also found herself accommodating her patient’s comfort level instead of being interested in the doctor’s or her own comfort.

Roberts’ nurses may not have had the confidence to labor an unmedicated patient before the class because many of them did not have experience with the process. As epidurals became widely available in the 1980s, many laboring women chose this method of pain relief, leading new nurses to learn only about the birthing process with medicated patients. Roberts estimates the American rate of epidural use in vaginal births may be as high as 90 percent. Now, as older nurses retire and are replaced by nurses learning only to care for medicated women, birthing an unmedicated woman is becoming a lost art. Nurses are relearning what they were taught in nursing school. Her goal is not to persuade patients to choose one birthing method over another. She is an advocate for women giving birth the way they choose.

“I want to give my patient as close an experience to her dream birth as possible,” Roberts said. “And educating more nurses how to do that is my dream project.