Episode 84 - Setting Boundaries for Birth - With Clinical Psychologist Jenna - Transcripts

Welcome to the Ultimate Birth Partner podcast. I am Sally-Ann Beresford, a doula, author and antenatal teacher, and I'm on a mission to help educate anyone who supports pregnant women and people to achieve their dream bear. This podcast is about giving them the power back by offering knowledge and wisdom shared by me and my incredible guests. So let's get started. Hello and welcome to this week's episode of the Ultimate Birth Partner podcast. Today's topic is about boundaries, a really important subject for anyone who is pregnant and becoming a parent. So I've roped in Dr. Jenna Bruff to come back on the podcast and talk to me about this subject because she is far more experienced with boundaries than I am. And I'm excited to get into this conversation. Let's get started. Jenna, hello. It's lovely to have you back on the podcast. I'd really love to explore this topic of boundaries with you in detail.

Thanks, Sally. I'm having me back. Yeah, I'm really excited to. I think it's a big topic, isn't it? And we'll try and do as much as we can in the time that we've got. Yeah, I'm Dr. Jenna Bruff. I'm a perinatal clinical psychologist. You can find me at Tribe Psychology. I work with people who are having difficulties with their emotions and relationships and experiences across the entire perinatal period. So right from fertility in pregnancy around the birth and in the postnatal period and around adjustment to parenting for the first time or for a subsequent time. And also for people who've experienced loss at any stage of their perinatal journey. So quite not an Instagram word in each.

Such valuable work. And we're so lucky to have you and to know you because you you know, you really do support so many of the people that we all support. And I'm just grateful to to have met you. And yeah, thank you. I wanted to talk about boundaries for such a long time, because I think having written about it in my book, I do feel that it's one subject that people struggle with quite a lot and how they understand the role of boundaries and how to set better boundaries. So should we start by talking about what boundaries are?

Yeah, I think it sounds really simple, but actually what it means and how we come to have boundaries, it's much more complex, I guess. So to simplify it is basically, obviously, it's not visible, but it's a conceptual limit in terms of relationships. And that limit is between you and other people so where you end and where other people begin and that extends to around knowing what's what's yours physically and emotionally and what's your also your responsibility. So knowing that you are responsible for yourself as an adult, which is why when we talk about boundaries, we often talk about sort of childhood and emerging development in relationships, because that's partly where our boundaries come from. But when I say that it's not as simple in practise, because our boundaries aren't just influenced by our early experiences, they're influenced by context. We don't have the same boundaries in different contexts. The boundaries that we would have with a loved one or a close friend or an intimate partner would be very different to the boundaries we would have to potentially be very different to the boundaries we would have, with a colleague or a child or a different relative or a professional or someone walking down the the street who opens the door for us. We have boundaries, we don't have one type of boundary, we have boundaries depending on context. And some of us have more of a range and a repertoire of boundaries than other people. So yeah, I think that when I talk about simplification of boundaries, the thing that jumps out to me, which I think you probably know what's coming is the idea of this good girl conditioning that we hear a lot of, which is a really, really valuable and valid thing for people to have an awareness of when they're thinking about boundaries, particularly in relation to maternity care. But I do think that talking about the good girl conditioning and the good girl ideas, it obviously is really helpful in sort of highlighting the influence of gender-based parenting and also patriarchy and misogyny in our society. But it actually simplifies a much more complex situation.

lot? Is it something that you think about when you think about boundaries? Yeah, definitely. I mean, I see it all the time with clients and we can do as much preparation as we want sometimes in the antenatal period. But when someone is actually in front of a medical professional, it is very hard to be assertive in the way that they maybe think they can be in life because they're in such a vulnerable situation. And I wrote about this in my book as well, about the idea that you don't want the care provider to see you as a difficult person. And so that good girl steps up because you don't want them to treat you badly. So you therefore become more compliant, more of this

good girl and don't hurt me, don't do anything to me that could harm me or my baby. Yeah, and I think that's where it's important to distinguish between, in some ways, the gender-based parenting and actually how, as a society, we've got really mixed up between what compassion is and what submissive compassion is. So compassion is the sensitivity to suffering in ourselves and other people and that we are motivated and committed then to try and prevent or alleviate that suffering. And that's what we want. We want everyone to be, but the tendency is very much that that is the, if you like, in a gendered world, a woman's job to be compassionate and caring for everyone. And obviously the self drops off, doesn't it, in terms of we only have so much resource. But I think we get mixed up in and I think because of the fact that we see so much violence against women and girls and so much misogyny and it's quite risky to be a woman and to be a girl in this society. We know that it's much more risky than it ever was. And actually what that can lend itself to and specific authoritarian gendered parenting can lend it to us seeing compassion as something different, which is what has been termed submissive compassion. So that's caring for those that functions to either protect ourselves. It sometimes functions to self-advance ourselves, so to stay close to others, connected to others to succeed, but there's also that protective factor. So that's about either wanting to please others to be liked or to avoid rejection and hurt, which is what you just said, isn't it?

links to the good girl stuff doesn't it? Actually it's a completely different thing. Yeah and I guess that's why I use that example because for me that's what I witness. When I see women go through this experience it very much is at the end of their pregnancy when they're in this state, this hormonal state and things change for them. So if we sit together in the antenatal period and talk about vaginal examinations just as an example, I can say to them is this a hard boundary or a soft boundary for you? Do you want to absolutely say to me I do not want vaginal examinations? That is a big fat no. If on the day she is coerced into changing her mind, where do I fit with that? Do you sit there and go but this is something you said to me you didn't want, this is something that you highlighted that was very important to you that you didn't want and why is it that they then change their mind? So I can see these things happening before my eyes can have a discussion with them and say look this wasn't something you wanted, are you sure that you want to change your mind? Is this going to help you to make a well-informed decision at this point in your labour? It is really difficult to understand why some people are put in this position when you're sort of an outsider looking in and you can see their resolve diminishing.

And I think that with that I work with people who, I do work with people who would say that generally there are people pleaser or that they identify with this idea of being a good girl and that might relate to having a particular upbringing. But then I also work with people who have had a birth where they either agreed or not declined certain things that they, like you said, had decided that they were going to decline or not agree to and then they come out of that and they're like oh I'm usually so assertive, like I don't know why I didn't speak up and like this isn't a problem in the rest of my life. So actually you know it is something about the system, it is also something about the vulnerability of someone at that stage of pregnancy and in labour because whilst it's a very powerful time it's a very vulnerable time. There's a lot of hormonal shifts going on and our sense of attuning for safety and threat is heightened, of course, because we want to look after ourselves and our baby. So it is a vulnerable time and I work with people who experience quite a lot of shame because their plans were, well, they criticise themselves because I should have been able to do this. I would have no problem doing that in other areas of my life and I don't know why I didn't speak up and and all of those things so yes as children we do need to be supported. Obviously we start early, we need children who are supported to develop autonomy and to understand that they're responsible for themselves and that they learn for themselves so you know how to learn rather than what to learn and how to make choices rather than what to do, so we have that template for healthy boundaries more easily accessible but we also need to consider the context and also the life stage and also the fact that we're not in an environment where that's being positioned, we're not in an environment where someone is inviting that. We might have that template for healthy boundaries, but if we're in a context where our active participation, as we know, is not available, permitted, encouraged or welcomed, if the context doesn't offer that, it makes it much harder for us to use that template for healthy boundaries. It only gets us so far without really good assertive communication skills. We're still up in the same position where we aren't saying no while we're agreeing to things because we don't feel able to ask questions and actually that's about our ability to tolerate doing something that's for our benefit that doesn't feel good immediately because of the context of the situation and because of that fear, so it actually in a sense adds discomfort and fear to the situation and obviously people want to avoid that and it's only afterwards that they then realise that in the longer term that short-term discomfort for being assertive would have been most helpful option, but that's a hindsight thing, isn't it? Like at the time they weren't weighing up here, it was that I want to avoid risk, I want to avoid feeling uncomfortable and so I can't, like this context is not a safe one for me to be doing these things or saying these things. So yeah, I think that the self-awareness and the template and the understanding that we may develop from our childhood is one thing, like in terms of if we're not raised to be a good girl that's going to make it much easier for us but our context and our communication skills and our ability to understand that feeling uncomfortable with something doesn't mean that it's wrong and actually that, making that person feel uncomfortable might be necessary and it's not your job in terms of some, you know, caring for others or being liked to make them comfortable, like actually in that situation that context, making you comfortable

is a parody. It's funny because when I was a child, I'm 52 at the moment, so when I was a child in the 70s when uncle so-and-so came round you were made to kiss them, you know, you were made to give everybody hugs and show affection to people you didn't want to show affection to or you didn't like and we've got a lot better at not making our children do something physically with their bodies with hugs and love and showing things to people that they don't feel comfortable. I think that I don't know whether that is true of everyone else but I feel that as a society we got more respectful of boundaries regarding our children and how we raised them and then masks came in with Covid and people were told you had to do this and you you know you started crossing a boundary in my in my mind. A boundary was very much crossed with regards to body autonomy and it is difficult because what you were just describing there to me is about coming across as rude and so we got better at communicating what we did like and what we didn't like. We were more respectful until Covid and I feel like we've taken a massive step backwards and that's not gender specific obviously but our old subconscious mind thoughts and things that we've seen from the past kind of rise up in those circumstances and we comply all over again. We do what we're told and you know this to me is a real shame about Covid. I mean there's been some good things there's been a lot of bad things but some of the things that have come out of it for me is this tendency to be compliant and then also trying not to be rude you know not being allowed into the maternity ward unless you had a vagina examination that showed you were a certain level of dilation and then your partner could join you and not until you'd complied to do that. So if you didn't have that VE your partner would still be sat in the car for the next six hours that's because you needed to be that good girl you needed to comply and you didn't have the level of communication that said no actually I don't have to have that my partner is coming in and you know I'm going to have my baby and so it is really difficult isn't it to there's sort of like a bit of pre Covid and a bit of post Covid work going on as well. I don't know if you see that.

Yeah I think the thing is with Covid everything for whatever reason was termed as you know for the greater good and you know people that weren't complying were deemed with various you know elements of what we were told that we shouldn't be doing. We were being selfish and we were it was getting to the point where people who decided not to do some things were really ostracized. And there was talk of like, real bullying behavior, you know, there was lots of pressure tactics that are not particularly ethical, from my perspective as a psychologist, but other psychologists would see that that had a function and a purpose. But actually, we're social creatures, and we do not want to be rejected by our social group. And, you know, depending on the context, how wide you see that social group as, it, you know, depends very much. Well, actually, it's not just a social group, the this sort of inherent power dynamics between a hospital and staff and doctors and a person, especially when we have the narrative of the dominant narrative of birth as we do, that actually you need to give birth in a hospital, which isn't true. And birth is risky. And birth is a medical event, which are not true on the whole. It's the idea that actually I need to be in this place to be safest. just in case. A lot of the time it's that just-in-case niggle isn't it? And you know some people do make a very informed decision to get both in hospital for various reasons but it's that well I need to be in here so I am actually, there's no choice about the matter is there?

not. It still had the result. Yeah, for sure. What about digging your heels in and being too boundaried? Because this is something I talk about as being backed into a corner when a care provider is putting a person in a situation that has done their research, that has done a lot of work on identifying what their hard boundaries are. Being backed into a corner can often mean that you become so boundaried and you dig your heels in that actually it could be unsafe because then you're not tuning into your instincts, then your heckles are up and you're so alert and in

that fight or flight if you like. What's your view on that? Yeah, I don't know whether it's about boundaries or whether it's just about people having such a specific idea and maybe like one birth plan or all of their boundaries are hard, hard boundaries, just to manage their anxiety. Again, to try and control and predict something that for the most part will unfold beautifully without intervention or any other person needing to do anything, but actually there is variation. We can't predict everything that's going to be needed or what the person's going to even want, but if you're going in with, well, I'm not going to pay attention to what I want in the moment, I'm just going with this because I can't possibly entertain the idea of it being different. So whether that's because someone's had a previous traumatic birth, that's what I tend to see that someone will want to control everything and they'll be like, this is my birth plan and then you do hear on the internet, if you entertain, I think we get into the general consensus that we should be paying attention to the fact that there can be variations where we need to listen to ourselves and sometimes the care providers to change paths, but there can be that, you know, I've had a traumatic birth, so I don't want to hear any of that. I want to do the exact opposite. And also the toxic positivity around birth that I don't want to hear anything about, anything other than my dream birth. And for some people that's okay, but actually for most people, if they're particularly anxious, that comes, like you say, back them into a corner and they're not even engaged in thinking at it because they're like, I'm just going to rely on this piece of paper and the work that I previously did. And I'm just gonna like follow that. And actually, how good is that? Like it's like having them.

in ourselves. That's so important. I wrote the journals because I wanted people to recognise how they relate to boundaries, to be able to really work on looking at what is buried in their subconscious mind and to understand how to put boundaries in place that are necessary. And then the soft boundaries, the ones that you know they can be more flexible on, they can have in the background sort of somewhere if they need them. And so it's important really isn't it to identify what you're like as a person so that you don't find yourself in a position where you are backing down unnecessarily in any given moment, that you're consistent with your message and that you are able to work out in advance how to share with your birth partner where their advocacy role comes in. Because if you have got a very clear no on some things, working that out in advance and being really well prepared for that I think is important. I just want to take a moment to tell you about the range of fantastic resources I have available for you all in preparation for your birth. Labour of Love, the ultimate guide to being a birth partner, is not only a best seller but an award-winning book that has without doubt changed the birth experiences of thousands of couples across the world. Fondly described as the bible for birth partners, it offers both the pregnant woman and her partner a depth of knowledge that is simply not taught in standard antenatal education. This book is an essential read for not only birth partners but also pregnant women and people, midwives, doulas, family members, friends, sisters, brothers, anyone who is involved in your pregnancy that might be interested in offering you support. This is an important read for everybody and it will make a huge difference to your birth experience because as I always say the birth partner can literally make or break the birth experience. If they don't get birth they won't be able to understand what they need to do in order to support you and you also need to know what you can do to help them be the best birth partner possible.

So in terms of I think the journals are an amazing idea and I think that like I said earlier lots of people do have a template for healthy boundaries but the first step would be to understand if that is you. So you know this the self-awareness and understanding you know what you know yes thinking about the good girl concept like what was our childhood like? What was what were we responsible for as we were growing up? How much freedom did we have to make our own decisions? What were the expectations of us in our education system and in our family? And then obviously we need to factor in context and yes good communication skills in some contexts might come quite easily to us but in this context do they? Like in previous interactions with healthcare professionals or people in authority, how have we been able to assert our wishes? And how is that felt when we have done that? Because we may have done it but felt quite uncomfortable with it and if we feel quite uncomfortable with that in a situation where we're not particularly vulnerable like hormonally, when we're in labour we are more hormonally and emotionally vulnerable and so would that feel more uncomfortable? And would that hold us back from that? So it's about sort of plotting out your experiences. And the thing about developing a self-awareness and understanding, that's of what our templates are, and sort of if we need to do any of that work, that's like quite reflective and exploratory.

early on. I couldn't agree more with you about the boundaries in terms of it's not enough to know them, you have to be able to communicate them clearly. And I love that you've recommended that you start earlier in the pregnancy with other people around you. So in my book I talk about, I mean, the art of giving birth is all about physiological birth. It is very sort of specific in its role. But let's say, for example, you were choosing to give birth at home, and there were people around you that you knew were going to be negative about that decision. You could either choose not to tell them, or you could put a very clear boundary in place and say, look, I'm not prepared to discuss this with you. This is a preference of mine that I've researched thoroughly. And it's not your birth, it's mine. So just say no, because the more you are able to communicate to others around your preferences, the easier it gets as you keep going throughout to be able to put those boundaries in place. Because this is about your preferences, your desires, your limits, and then figuring out where your non-negotiables are. And once you understand that, it does get easier and easier and easier.

people that want to sabotage your happiness. That's a really interesting comparison, because before you mentioned the term dementors, I was thinking about, the fact is, people with the whole no-negative-energy-in-pregnancy type thing, I think people don't assert boundaries when they just avoid. And that's their strategy and, actually, then they don't practice putting in the boundaries which they're entitled to. If you are given both in hospital or you have Middlewell boyfriend presence at home or whatever, you can't avoid those people, because they're there. They're in your space. And actually, I think this is right, When you think about Dementors, they're sort of, in a way, a little bit mindless. They'll keep coming back with their negative energy. They'll keep coming back until you literally stand up to them, if that's how it works for anyone else. If people listen in, understand, watch Harry Potter. That's what happens, isn't it? They keep coming back to try until you stand up to them, and you sort of banish them. And actually, when you see that, it's a very confident, assertive communication, isn't it?

I think the other thing I would say to clients is about consistency, because if you are really, really clear and consistent with your message, let's say you are planning a home birth, and you're deemed to be high risk. And let's say you had a previous caesarean section, or perhaps you've got gestational diabetes, or something that you've kind of ticked this box, and you've done your research, and you're 100% sure that this is a decision that you're making for all the right reasons for yourself. If you're consistent and calm about the message that you give, and you say, I am having a home birth, and they say, And they go off on a bit of a tangent, and you look at them afterwards, and you smile, who say, thank you for sharing that. I am having a home bear. If you're really, really clear and consistent in your message, they actually very soon realise they can't win you over and they back down. And I've seen this so many times. And it's the clients that I have that are wound up by the conversation and get a little bit aerated and they're like, ooh, and they can't see the wood for the trees. It's like the red mist, isn't it? Once you're in that flooded mode, you're so flooded with emotion that you can't really see how you're going to get your message across. The beauty of a boundary that you're putting in place that is practised and you're confident in your decision up to this point, because of course we can all change our mind at any stage. Nothing is ever set in stone. Even the firmest, most rigid boundaries can be let go of in any circumstance that you decide to let go of them.

That repetitiveness, it reminds me a little bit of, obviously this is not, well, I say it's not the same experience, but it is actually potentially experience as the same. So there's a term called grey rocking in the way that you should respond to manipulative or abusive people who are trying to push your buttons or trying to get you to do something or say something different. Actually, grey rocking is just being consistently boring in your response to them because there's no way in, there's no gaps. In your head, like you say, you may be flexible and willing and listening to what they're saying to be able to change your decision if you so want to, but actually that is the, this is my stall and this is what I say and it's the same every time. So thank you for the information and my decision is still the same. I'll let you know if I change my mind. You just become consistent and it can happen because people can be asked in different ways in one consultation, what about this? What about that? What about that in this situation? And it's that beating you into submission verbally in some cases, not necessarily intentionally on the part of the provider, but that's how it can be experienced. And that's why people who have been in those relationships elsewhere, those interrelationships of domestic violence may find this period of time more triggering, more difficult. But yeah, it's being consistent and boring and you understanding that that is not necessarily you not listening to them, but you're giving the appearance that you're impenetrable to their fear, because a lot of the time it is their fear, isn't it?

that I would usually compare systems to other types of abuse today. I liken it to parenting because you know what? We need to develop these skills for parenting. They're exactly the same when you're putting boundaries in place for your children and when you put boundaries in place, as a parent, you're doing it to be kind, you're doing it to ensure that they feel loved and safe.

And it shows them more respect when you put these boundaries in. And produces their anxiety. And actually, that's really an interesting comparison when we think about providers because lots of what providers are doing is out of their fear and anxiety of something that maybe they don't understand or that the policy doesn't necessarily support even though it's completely safe. So they're acting from that place of fear and actually the more consistent and boring you are and you know consistent with your boundaries and your communication actually I do find and I actually this was the approach that I tended to take in my interactions with healthcare professionals when I had an out of guidelines how at home before I mean most people have an out of guidelines home birth, right, but um yeah I was just, thank you for the information, I'm still on home birth list, that is still the plan um and that was you know if I was ever and I didn't face a lot of resistance but um that was my tact it was just very very

consistent and boring. And it's okay to say to them, I can see this is really uncomfortable for you because it's okay that they're feeling uncomfortable but this isn't their journey

This is your journey. This is your job to make them feel comfortable. It's their job to make

you feel comfortable. Exactly and this is your birth and you are going home or staying home with that child. The experience is yours to own and you're really only going to be putting boundaries in place if something is particularly important to you. If you're the kind of person that's really like I'm just going to go with the flow, I don't really mind, then of course this isn't even a conversation that you need to have. Boundaries are important for people who do have preferences that they want to be respected and when you've got as far as doing your research, learning more about your options, your choices and you've made really well-informed decisions, that's the time when boundaries are put in for good reasons and those reasons are yours. They're personal to you, no one else needs to go into any more detail than to understand that you are putting those boundaries in for good reasons and that's why your partner also needs to respect you and you know that that's really important that anyone in your support team, anyone involved in your care needs to respect your decisions. And they also need to remember, and I think this is one of the most key points that I share with everybody, is that you will never put yourself or your baby in danger, as long as you're not backed into a corner. And no one has a greater investment in the health and wellbeing of your baby than you do. No care provider that you sit opposite is more invested in their life than you are. So trust yourself and trust the process of working out in the pregnancy what your personality style is like. Do you have these good girl tendencies? Are you likely to cave or buckle under coercive techniques?

away at and that's not really where you want to be. Yeah, it's that process isn't it? It's a three-step thing. It's like understand, do the historical stuff, think about your experiences, your self-awareness, reflection and exploration, and then practice in a range of contexts and understand how this context might affect you and also tolerate the discomfort. Because like I said, even for the most assertive people, even if it's not immediately, like even me walking away from consult, and I'm not saying even me like I'm the most assertive person on the planet, but I am pretty assertive, walking and pretty confident that, you know, I had 100% trust in myself, 100% faith that I would make the right decisions for me and my baby. Even walking out of the appointment, you still get that a little bit of the brain, it's like oh yeah but and but I was like okay, I know that that's my brain trying to keep me safe and I know that that's because I'm conditioned to think that doctors know more than me but I actually know in the situation a lot of what that doctor said is not true and so I could rationalise with myself and have that conversation. Because I am well versed in being assertive and because I know that those feelings of discomfort come up and then my brain tries to make sense of those feelings of discomfort. Actually that's a product of the society that I've been raised in and the society that I function in, it defers to the white coat and the fact that I'm a woman... and you know, also the fact that I want to protect my baby and I've been conditioned to think that that is the way to do it but actually no I know differently and I can ignore that part of my brain and that needle and have full trust in myself that is yeah that is the thing that people need to know that will happen and that that doesn't mean that, what part of yourself are you listening to, what part of yourself are you tuning into, because we have all these two different paths that have been influenced by different things.

What an amazing conversation, and I've really enjoyed it. Thank you so much, Jenna. Do you have any top tips that you can finish with? I know you've just given us some tips, but yeah, do you have any top tips that you can share with us?

Another one would be, so this is one that lots of women in business use but I think it's very applicable when you think about healthcare and gender differences. So what would a man do in this situation or how would a man's answer be received? Maybe imagining yourself as a man, but actually, how would this be different? Would I be asked this if I was a man? How would it feel to embody a male presence in this situation? Because gender does come into it a lot, because that's a whole other podcast topic. So when we're thinking about assertiveness and how it is punished and frowned upon and seen as unattractive in women, but actually one of the most revered traits in men, just think about that. Why is that? Why is that? And hold that in mind. And we find it, don't we see it, don't we? The doctors will ask the typically husband in the room, if the woman is being difficult or says no, or for whatever reason doesn't answer the question, the doctor will ask the husband.

and the understanding the discomfort and where that comes from afterwards. Amazing. Thank you so much.

Where can people find you? Thank you for having me. And so I'm Tribe Psychology on Instagram and Facebook and my website is also Tribe Psychology.

So really quite simple. You can find me there across all of those platforms. Amazing. Thank you so much, Jenna. I've loved chatting to you. Thank you. Thank you so much for joining me and listening to this episode. I love having thoughtful discussions about all things Labour and birth. If you enjoyed it, please leave a rating and review and share it with your friends. If you want to receive a notification of the next episode, then don't forget to hit subscribe. If you would like to purchase either of the books that accompany this podcast, then head over to your online bookseller and search for Labour of Love, The Ultimate Guide to Being a Birth Partner, or The Art of Giving Birth, Five Key Physiological Principles. Follow me on Instagram at The Ultimate Birth Partner.