by Susan Hodges

INTRODUCTION

Most Americans are convinced that all women should give birth in the hospital and that childbirth is very dangerous without all the interventions of modern techno-medicine. If we are going to ensure that the Midwives Model of Care and natural childbirth will be widely available in the next millennium, our challenge is to persuade an awful lot of people to think and believe and behave differently about birth and "maternity care."

Since most people won't read printed material that challenges their current knowledge or beliefs on any topic, effective oral communication with individuals and groups is essential. Speaking has advantages: while an article or book is static and written for a predetermined audience, oral communication can be customized for the listener as you go. Oral communication does not replace reading, of course, but persuasive speaking may be the best way to get someone to finally read one of those fliers or articles. And in the political arena, brief oral communication may be your primary means of persuading legislators about your cause.

Good communicating involves the clear and intelligent presentation of ideas, but that is rarely enough to change someone's mind. Persuasion, on the other hand, means getting the other person to change their thinking and accept your idea.

THE MOST BASIC ELEMENTS OF SUCCESSFUL PERSUASION

1. Know the outcome you want
Effective persuaders have a strong sense of purpose. They know just what they want to accomplish (which might be as simple as getting someone to read an article or go to a meeting); they state or think about the desired long-term result in positive terms (they are FOR the Midwives Model of Care, rather than anti-doctor); and they focus on goals that can be realistically accomplished. They identify specific ways in which they will know if they have been successful.

2. Refine your sensory awareness to know when you are getting the desired response
An obstacle to effective persuading is our tendency to stay inside our own heads, to make assumptions instead of using our senses to check and verify what is actually happening. As many of us have discovered in childbirth and midwifery, being in the present, in our senses, is mind-altering and empowering; we can lean that this is just as true for the art of persuasion.

If you know the response you seek, then you can analyze if what you are doing is effective. If your approach is not getting the results you want, doing the same thing harder, longer, or louder generally won't get the results you want. You analyze by using your senses to notice how the other person is behaving, what they are doing, how they sound and how they look.

3. Be flexible in your method, be able to try many behaviors or methods
Cloud says, "If you always do what you've always done, you'll always get what you've always gotten." And, "If what you are doing isn't working, change YOUR behavior!" Doesn't this sound like working with labor or working with toddlers? If labor has slowed down, you change your activity. If your two-year-old is going bonkers, it is up to you to change the activity and the energy, and you try different tactics till you find the one that works, that results in your toddler being calmer.

As an effective persuader you realize that the meaning of your communication is actually the response you get, and you generate and utilize alternatives in your conversation or presentation as soon as you see that what you were doing is not working. As Cloud points out, there are no stubborn audiences, only incompetent speakers, no closed-minded audiences, only speakers who fail to be resourceful, no resistant people, only inflexible communicators. As he puts it, "You are the variable that controls the equation in the math of life."

Don't limit yourself! Limit your options and you lose your edge. For example, you might justify your behavior or tactic because it is "right," or have a list of things you won't do based on "principles." For instance, deciding never to discuss midwifery in terms of choice because choice is associated with abortion, which you oppose, eliminates a persuasive option likely to be especially effective with some audiences. In contrast, the greater the variety of your repertoire, the more choices of action you have and the more ability you have to influence any encounter. Isn't this true of working with someone in labor, too? And for most other areas of endeavor? So, seek to have a multitude of strategies – look for them, learn them, use them. When you find one is not working, you'll have others to try.

You will meet people you can't persuade. Then ask yourself: what did I try? What else did I try? What didn't I try? What else didn't I try? This will help you develop your awareness and your repertoire.

ESSENTIAL SKILLS AND USEFUL TACTICS

Essential Skills and Useful Tactics
Accomplishing persuasion requires more than just the three key elements described above. The following points are essential skills and techniques that will help you be effective with people who are neutral or negative regarding the midwifery issue at hand.

1. Build Rapport
Rapport with your listener is very important, and good speakers do things to get in sync with their audience whether one or many. Rapport means getting into alignment or getting in step with the other person's reality, meeting them in their place instead of expecting them to meet you in yours. Most of us do some of this all the time with friends and family, but you may have to do it more consciously with someone you want to persuade:
Mirror the other person's posture and non-verbal behavior – sit how they are sitting, if they lean across the table, you lean across the table, etc. (This includes clothing!  Dress similarly to or appropriately for the people you'll be talking with.)

• Mirror facial expressions – when they smile, you smile back, etc.
  
• Pace yourself to the other person's tempo – walk at their speed, talk at their rhythm, etc.
  
• Match the volume at which they are speaking.

All of this mirroring and matching lets you present yourself non-verbally as a person that resembles your listener; it validates them and helps to establish trust and credibility. Mirroring non-verbal behavior leads to synchrony and often lets you experience the world a little like the other person does. Once you are "in sync" you can lead the other person where you want to them to go. Mirror, pace, match, etc., then lead, and if they don't follow, go back to more mirroring.

2. Ask Questions and Use Reflective Listening
Another way to build rapport is to sincerely ask questions to elicit the listener's point of view on the subject. Use reflective listening techniques (such as "If I understand you correctly, you are saying that...."), clarifying questions (such as, "Can you explain a little more what you mean by..." or "I'm wondering how you arrived at that conclusion, could you tell me more about what happened?"), and informational questions (such as "I'd like to understand more about your concerns on this issue" or "You mentioned ..., can you tell me some more?"). Everyone likes to be heard and taken seriously. Your listener will feel important, validated and respected and some of that will rub off – the listener in turn will see you as a good person (because you listened to them). The trick is to listen and draw the other person out, without stating your disagreements, opposing position or counter-arguments! You will at the very least learn valuable information about what is important to this individual which you can use in your persuasive efforts, you will have control of the conversation because you are asking the questions, and in the end, the listener usually feels so good about you that they will be willing to hear a little about your point of view on the issue.

3. Get to the real issue
In debates, issues are brought up and responded to, one after another, but no one changes their views. This can happen in individual conversations, too, often because the issue that is truly of concern to the listener is not being addressed (the listener may not even be quite aware of what is really important to them....). Both the content of your remarks and how you are addressing the issues may be the problem. Don't assume you know how your listener thinks! In addition to establishing rapport, here are some steps you can take:

** Isolate the issue
State your familiarity (or lack of it) with the situation your listener brings up, such as, that they oppose out-of-hospital birth because it is too dangerous. You can ask your listener something like, "If we looked at the evidence and found the situation was actually NOT as you described , that is, the statistics showed that home birth is NOT dangerous, etc., would you be convinced to change your position on this?" If they answer no, then you can say, "It seems there is something else more important that is of concern to you – can you tell me about that?" and prompt the person to explain (perhaps stemming from a personal experience etc.). After addressing that real issue, you can go on and ask, "In addition to that is there anything else that concerns you?" and then deal with that. This is much more effective than going round and round on "obvious" issues, which aren't really important to that person and won't change their thinking.

** Identify the criteria for acceptable evidence – the "onus of criteria" principle
You can ask your listener what they would accept as convincing evidence that your hypothesis or position is valid, and you can ask "what if" questions with hypothetical ideas to help them recognize their criteria. For example, ask "What if you saw..... would that convince you?" or "What if you became convinced that ...?" In other words, generate hypothetical criteria for people to help them realize what their criteria are. Sometimes you will be asking a person to spell this out for the first time, and it can be very enlightening and useful for the listener. Obviously, if there is no criteria for acceptable evidence, the listener is operating on belief, not rational thought about the issue.

** Use the "falsifiability principle"
This is similar to the criteria principle above. Ask what demonstration, facts, etc. would convince the listener that their hypothesis (for example, hospitals are the safest place to have a baby) is false or wrong? If a theory cannot be falsified, it cannot be verified either. In that case, it is not a theory but a belief. Since people generally do not know what would convince them, you can ask "what if" and "suppose" questions. For example, "Suppose evidence showed that all women in childbirth did better with a midwife rather than with an OB? Would that convince you that not all women need an OB for childbirth?"

** Use "Mind-Altering" questions
For effective persuasion, you will benefit from spending time looking at HOW people think – the processes, patterns they use. Do not presume that you know how your listener thinks! You can ask questions! However, avoid asking "why" questions; as these lead to justifications, rationalizations, generalizations and denials and do not help you accomplish your purpose. The best questions begin with how, what, when and where. Here are some examples of the kinds of questions you can ask:

• Specifically, how do you know when an idea is worth considering?
  
• What information would allow you to know that you had made an error?
  
• What would get you interested in a new idea?
  
• Specifically, what are you unsure of in this discussion?
  
• When would you know if my evidence were valid?
  
• What would motivate you to get more information?
  
• How do you know when you are open-minded on an issue?
  
• Was there ever a time when you did not have this belief?
  
• What would let you know that you are convinced?
  
• How do you know when an argument persuades you?
  
• Have you ever changed your mind on an important issue?
  
• How did you go about it?
  
• What would you need to change your mind on this issue?
  
• Etc.

One of our biggest errors is to assume that the listener thinks the same way we do. Ask questions to find out. Then you can know exactly what you need to do to change this person's mind.

4. Use language to your advantage
If the law of the jungle is kill or be killed, Cloud says the law of politics is "define or be defined." Words are both weapons and tools.

History includes many examples of the power of names and words, and currently enormous sums are spent on developing product names and advertising slogans, because word choices greatly influence peoples' perceptions of products (and people, causes, etc.) and their actions. Words can have powerful connotations, so it is important to be aware and choose names and words that generate positive responses to your cause. The Coalition for Improving Maternity Services, and the Mother Friendly Childbirth Initiative are inspired phrases. Who can be against these? If you are against either one, you must be in favor of making maternity services worse or supporting mother-hostile childbirth! No one would want to be associated with those positions. Use names or words that make it awkward or ridiculous for someone to be in opposition.

** Find out what your terms really MEAN to others
What are connotations that go with "lay midwife," "traditional midwife," "birth attendant," "certified professional midwife," "licensed midwife??" What about "home birth" vs. "out-of-hospital birth?" You'll probably want to choose your terms carefully depending on the background, point of view, and the connotations those terms are likely to have for your listener or audience, rather than the term you like the best for yourself. Let's look at "Midwives Model of Care." Because it has similar words and structure to "medical model of care," the kind of terminology familiar to health care professionals and officials, the term gives midwifery care equal stature and suggests that midwifery is good care in its own right, NOT the absence of medical care, while avoiding words with negative connotations. The key is to find out what the terms you use actually mean to your listeners and audiences.

** Avoid terms with negative connotations.
You want to avoid having words or phrases with negative connotations applied to your cause. Here is a strategy to use when someone else uses biased or negative language to describe your position.

• "Unpack" the connotations of the unflattering term used; in other words, describe the negative meanings the term usually implies (but don't agree that yes, maybe you could think of your cause in that way because of the history or less common definitions of the word – its negative connotations will still stick to you, and that is what you want to avoid.).
  
• Critique these connotations (briefly explain how they don't apply to you).
  
• Define your position with more accurate terms.
  
• Identify and point out two or three positive implications for outcomes of your position.

For example, someone says that your position supporting midwifery and home birth is just too radical. You could say something like, "Radical usually means extreme or off the wall, even irresponsible, radical at all costs, and that does not describe us. We don't support extreme or irresponsible practices. We support using proven, evidence-based practices that have been shown to be effective for having healthy mothers and babies. Midwifery care leads to shorter labors with fewer drugs and interventions – safe and healthy for Mom and for Baby!"

5. Use "political cross dressing" to reach groups with different perspectives
We all know that midwives and midwifery advocates include people from the entire political and demographic spectra and many special interest groups. We can use the "political cross dressing" technique to reach many different kinds of people. For midwifery, this really means recognizing the important concerns of each political/philosophical group, and showing how midwifery meets their concerns. For example, for the environmentalists' midwifery care, especially at home, is "green" – it is "natural," saves resources and is gentle to life and the earth. For the religious person the midwifery model is family centered, respects birth and the Creator's plan, and may be compatible with specific religious laws or teachings. For the feminist, the midwifery model is about choice and empowerment. For the capitalist, this approach supports free enterprise. For medical and public health professionals (and many others) the Midwives Model of Care is about proven, evidence-based care for healthy mothers and babies. Etc.

If you want to persuade people with different political and philosophical outlooks, you need to gather some information first:

• "Know their "language" – the key words and phrases used by that group or philosophy, as well as their emotional key words and the basic evidence, arguments and beliefs that support their positions.
  
• Know the concerns (hopes, fears, wants and needs) that motivate the group and individuals who join it, and what they want to accomplish.
  
• Show how the Midwives Model of Care addresses their concerns and is part of the solution.

Michael Cloud's tapes also include some more advanced techniques, which require practice and quick thinking, and are not applicable to all situations. These involve being able to use opposing arguments to make your own points persuasively – the martial arts of persuasion.
Think through these points. Try them out and practice with a friend. Use some of them and analyze the results – you'll become effective at persuasion!

Reprinted from Citizens for Midwifery News, July 1999. Permission to reprint with attribution.