Hakomi & Healing: An Interview with Hakomi Practitioner Rachael Koeson

Hakomi Blog Photo

Hakomi can provide healing through mindfulness.

— by Beth Singleton, Birth Quest doula and photographer

In May of 2016, I attended a postpartum mood disorder class in Grand Rapids. As someone who supports moms – and as someone who struggles with bouts of anxiety and depression – I was eager to learn as much as I could.

Navigating my way through the parking lot, looking for the entrance, I noticed a woman who I figured was probably doing the same thing I was. But there was something about her that stood out to me, and I gravitated towards her without any real thought. Her energy was warm and kind. We met in the parking lot and found our way in together.

There had to be at least a hundred people there for the class, probably more as they couldn’t all fit in the main room. We (Rachael and I) sat together and got acquainted. I was one among a handful of doulas in the room. Rachael, however, was one of a kind.

In the short time we spent there that day, I did my best to take in and understand what Hakomi was. We’ve even kept in touch since then; but to this day, I’ve wanted to know more. Thankfully, Rachael, who practices through her business, Making Space Hakomi, was kind enough to oblige my request for an interview.

I hope you’ll all enjoy what she has to share. As she is just getting started on this path, I also hope you’ll all welcome her and encourage her on in her calling to serve women and their families.

Beth: First of all, what is Hakomi? I know when I met you, it wasn’t something I’d ever heard of and I haven’t really met anyone else who has.

Rachael: Hakomi is a mindfulness-based, body-centered form of assisted self-discovery. It is also experiential. What this means is that we work to stay mindful and in the present moment to explore our underlying unconscious beliefs about ourselves and the world. Often we learn a lot when we pay close and respectful attention to the wisdom of our bodies. It is an extremely gentle, respectful and sensitive method that understands the client to be the expert of themselves; the job of the Practitioner is to assist the client to maintain mindfulness and help guide them toward a more complete awareness of themselves.

Beth: What was it about Hakomi that appealed to you?

Rachael: I knew from my experience as a client that it really works and it felt so much more elegant and respectful than anything else I had tried. I love the founding principles of non-violence, organicity, unity, mindfulness and body-mind holism.

Beth: What inspired you to become a practitioner?

Rachael: My own experience as a client. It was a truly transformative experience for me through which I realized so many things about myself that I hadn’t consciously been aware of before and I felt like I gave (with the help of my Practitioner) those wounded places within myself the healing they needed; that resulted in really knowing I could choose to inhabit my life differently than I had been before. The result is that I generally feel more resourced, more connected to myself and able to connect with others, more aware of my unconscious beliefs and more able to make more life-affirming and nourishing choices in my daily life. Of course, I have hard days and I forget all these things sometimes, but generally feel much more whole, aware and vibrant than I did before going through my Hakomi process. I continue to learn and struggle but am so grateful for what I continue to learn through this lovely method.

Beth: What kind of training did you have to complete in order to become a practitioner?

Rachael: I completed an 18 month comprehensive training program through the Hakomi Institute. I then completed the certification process, which is based on competence rather than hours, about 16 months after I graduated from the program.

Beth: How would you say Hakomi is helpful for women before, during, or after pregnancy?

Rachael: The transition into motherhood or transitioning from mothering one to two or two to three children, etc. is significant in all women’s lives. So much happens to women as we go through that process. It is a time when we can be particularly vulnerable and particularly in need of extra support to find our footing in who we are and how we want to embody our life as a person who is also a mother. The way that process unfolds is different for everyone, but across the board it is a unique time of life that lends itself to mindful self-discovery as we come face to face with a lot of our own wounding, fears, desires and the impacts of our personal history. Hakomi is such a lovely way of learning to be with and learn from those parts of ourselves that can arise during times of transition.

Beth: What are some of the reasons women might seek out the assistance of a Hakomi practitioner?

Rachael: I often see clients who are having trouble transitioning into motherhood, feeling stuck in behavior patterns that don’t serve them or interacting with their children in ways that feel triggered but not grounded or based on their truest desire for how to be in relationship with their child(ren).

Beth: Is Hakomi something that can help new parents adjust to the changes they’ll face as well? If so, how?

Rachael: Absolutely. Hakomi is based on the idea that when we are mindful and we have a skilled assistant on our side we can uncover our unconscious beliefs that often drive our behaviors and ways we live in the world. Hakomi allows us to gently make space for the wounded parts of ourselves that can become particularly activated upon becoming a parent as so many of our developmental wounds
are revealed as our children grow. Hakomi also provides amazing and individualized resources and skills that people can take home with them and practice using in their daily lives.

Beth: I see you have a Mindful Mothering Support Group coming up in November. Is this a little different than other support groups for moms and if so, how?

Rachael: Yes. This is a unique support group because it is founded in mindfulness. Mindfulness is slowing down, being aware and also cultivating a sense of non-judgement or curiosity. So we will engage in some guided meditation time and be able to study what arises during those times of mindfulness. It will be a highly facilitated group where participants will be encouraged to speak from their present experience rather than retell the “story” of their struggles. In doing that we can more easily access the issues UNDER the story and hopefully offer some healing to those places that need it.

Beth: Do you offer any other classes or provide private consultations?

Rachael: Yes. I provide one-on-one sessions as well as an eco-grief mindful support group which is designed to support people who deeply feel the pain of the earth and the damage we have done to it in this moment in time. The goal is to provide a safe space to share grief and pain and also allow those feelings to flow and move and see what else can arise through that process. This is inspired by the work of Joanna Macy and her book, “Active Hope.”

Beth: Is there anything else you’d like to share?

Rachael: Thank you for the opportunity to share about Hakomi. I am grateful. I have myself worked at a college for midwives, trained as a birth and postpartum doula, volunteered as a postpartum doula and experienced postpartum mood disorders. So I have a deep well of empathy, compassion, and resonance with the struggles that come with the transition into mothering and learning how to be who you truly are in the new and overwhelming role of parent.

Beth: Thank you so much, Rachael, for your time and help with this. I can honestly see how this is something everyone could benefit from, and I hope that services like yours continue to grow and help people heal.

Preterm Labor: Understanding Treatment Protocols

Birth Quest doula attends lecture with Obstetric residents about preterm labor.

On August 22nd, 2017, Sandy Parker from On the Path Yoga and I drove to the New Holland Brewery in Grand Rapids to hear Dr. June Murphy, DO, Maternal Fetal Medicine Fellowship Director at St. Joseph Mercy Oakland Hospital, talk about “Advances in Management of Preterm Labor: Achieving Optimal Practice.” The lecture was at an event that combined the journal clubs of obstetric residents at Mercy Health Hackley in Muskegon and Metro Health (University of Michigan) in Grand Rapids. The event was sponsored by Hologic, the makers of the fetal fibronectin test.

Understanding the ever-changing standard of care involving preterm labor is important for maternal and infant health advocates, like doulas and childbirth educators. People who experience preterm labor are often confused about why treatment varies so much between patients. Not understanding the standard of care can lead to anger when it appears that patients have not been treated equally. While unequal care can occur, protocols can prevent bias and reassure patients that everything possible is being done to protect them and their infant.

While preterm labor is the leading cause of infant mortality in the US, it is very common and often harmless. In fact, I learned that as many as 1 in 4 women will experience four contractions per hour prior to 32 weeks! However, 30% of preterm labor resolves spontaneously, without treatment. Only 1 in 10 women who are diagnosed with preterm labor will give birth within 7 days. In other words, uterine contractions poorly predict whose baby will be born too soon!

To complicate matters, steroids given to mothers with preterm labor improve newborn outcomes when given as late as 34 – 36 weeks, but can be harmful when given unnecessarily.

So, what are providers supposed to do? Fortunately, the March of Dimes created the Preterm Labor Assessment Tool (PLAT), an algorithm, or decision tree, based on the Rose et al study (2010), to assist healthcare providers in deciding whether to admit someone in preterm labor. Dr. Murphy explained how the cut-offs for cervical length combined with the fetal fibronectin results best predicted who would deliver early. Unfortunately, the protocol does not prevent preterm birth, but does save money, time and stress from unnecessary hospitalizations.

In addition to the lecture, residents reviewed two articles, one comparing the efficacy of vaginal progesterone to an injection. Studies in the last decade have shown that progesterone treatment to prevent preterm birth is effective. Barriers to this treatment include problems with insurance reimbursement and compliance with office visits to receive injections. Vaginal progesterone has the advantage of being cheaper and easier to administer. Although the study was small, it showed promise for an alternative, but effective, treatment to prevent preterm delivery and save lives.

Dr. Murphy said that if a woman presents to a hospital in preterm labor and there was a thought bubble above her fetus, if would say, “Follow the protocol!” The causes of prematurity are complex and interrelated. Clinical providers have a limited role in addressing the underlying causes of prematurity and the infant mortality that results. Standardized care based on the latest research can reduce treatment influenced by bias and help achieve equity.

Can CNMs attend VBAC deliveries in West Michigan hospitals? The answer is: it depends!

As a birth advocate, supporting the rights of women who plan a vaginal birth after cesarean (VBAC) will likely keep me busy for the duration of my career.  My heart goes out to women who have to navigate their healthcare options for childbirth after a cesarean one facility, practice and provider at a time. At the end of their inquiries, many find that their options are limited by their individual histories, provider decisions, hospital policies, insurance reimbursement and even politics.

Since October, I’ve been working through the West Michigan Better Birth Network, the local chapter of the non-profit, Birth Network National, to address the official VBAC ban at Spectrum Health Gerber Memorial. We have collected stories of women who have had VBACs there in order to stress to administrators that, despite being counseled that the main hospital campus, Spectrum Health Butterworth in Grand Rapids, is the safest place to labor and deliver, they have legitimate reasons for choosing a community hospital setting. [Link to a sample letter from Rebekah Thompson of New Life Doula Services. Link to my own letter from the perspective of a Substance Abuse Prevention Specialist.]

I was recently attending an event at Amanda Holbert’s yoga studio, Renew Mama. While discussing the work of the WMBBN, Amanda brought up the “ban” on CNMs attending VBACs in West Michigan hospitals. Amanda inspired me to look into this restriction further. Why could CNMs attend VBACs in some hospitals, like Borgess in Kalamazoo, but not at Spectrum Health Butterworth (the only hospital in West Michigan that both allows VBACs and has CNMs who deliver there)?

I called Spectrum Health to ask about their policy on CNMs attending VBAC deliveries and was referred to Charmaine Kyle, Clinical Nurse Specialist in Women and Infant Services. Right away, she informed me that the hospital does not have an explicit policy banning CNMs from attending VBAC deliveries. I checked in with Jen Kamel of VBACfacts, an advocate for greater access to VBACs nationwide, who suspected internal politics to be the culprit.

Before hearing back from Charmaine with a definitive answer, I attended the American College of Nurse Midwives (ACNM) Michigan Affiliate conference in Kalamazoo.  There, I met midwives from across the state, most of whom are supported in attending VBACs at the hospitals where they work. Meeting these midwives made me even more determined to find out what is causing the restriction and advocate for overcoming it – West Michigan women deserve all possible options!

This past Wednesday, I received a reply: “a midwife is available through the residency clinic and would be able to establish care with a patient antepartum.  When it comes time for delivery the midwife would partner with an obstetrician and co-manage the care during labor.  The only problem right now is we don’t have enough midwives to provide 24/7 coverage.  Our hospitalist (core faculty) obstetricians would manage the care during the night and on weekends.” In other words, a woman could see a midwife for prenatal care, but could only have one in attendance at her birth if she happens to deliver during normal business hours.

After speaking with a CNM in private practice who delivers at Spectrum Health Butterworth, I learned they are in a similar situation. The hospital’s laborist (salaried staff Ob/Gyn) will not cover them in the event a cesarean becomes necessary, so an obstetrician from their practice has to both be available and willing to stay at the hospital until the mom delivers without being paid to do so. Since they cannot guarantee that this requirement will be met, the midwives who practice at the hospital cannot advertise their ability to take on pregnant women planning VBACs.

Several changes could move West Michigan toward increased access to CNM-attended VBAC births in hospitals. First, Spectrum Health Butterworth could hire more midwives so that those working in their residency clinic could be paid to cover births occurring 24-hours a day. Secondly, the hospital could further find creative solutions to overcome the liability fears of the laborist which lead to the unwillingness to cover the midwives working in private practice. Thirdly, other hospitals that allow VBACs could hire midwives.  Finally, smaller community hospitals who already have midwives delivering there could remove their VBAC bans.

Are CNMs able to attend VBACs in hospitals in your area? What worked to increase access in your community? Do you wish you had this option?  I want to hear from you!