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Our Best Labor Support Tips for Dads and Partners

The Curtis Method has a private facebook group for couples who have taken our classes, where they can ask questions, get support, read articles, share birth stories, and learn from one another. It’s a phenomenal group and it’s one of the greatest resources our expecting moms have access to as they prepare for birth.

We recently asked the following question to our group members, and we got so many fantastic responses that we just had to create a blog post for everyone to enjoy! We teach a full Daddy/Partner Doula Training as part of our Curtis Method classes, so that each couple is fully prepared to participate in a positive birth experience.

Partners, are you ready for real world advice about how to be a rockstar birth companion?

What is the most helpful thing your partner did to support you in labor? Counter pressure? Affirmations? Breathing? Massage? Just staying present and holding space? Let’s get some ideas going!

I thought my husband would ignore me the whole labor because he refused to go to classes and he was totally uninterested in my pregnancy. My good friend was pregnant at the same time as me and her hubby was so sweet with her. He would go on ice cream runs and rub her feet. I was slightly jealous. I actually remember being 9 months pregnant and bursting into tears because his brother was rubbing his,non pregnant, wife’s feet. I watched and thought my husband just didn’t care about me or my hard pregnancy. Then I made him go to the Curtis Method and it was seriously the biggest difference. He was suddenly on board with everything. He would talk about how much he liked dancing and being close to me and the baby. She literally taught him how to be there for me. I don’t think he knew how to be there until Lauralyn showed him. He was so great during the labor and I’m so glad he was the only one there for me. I think it made him feel like I trusted him to be there for me. I was also so happy when my baby finally came, because it was just our little family. Me, him, and our new baby. It brought us so much closer together. It actually bothered me that my extended family came so quickly. I just wanted him and I to bond with our baby. Anyways it’s different for everybody, but he may just not understand how to be there for you. Make him be. It’s a new experience for both of you.
Miriam

Counter pressure with our doula was obviously amazing and being there for me to just dance with and hold me up through expansions! He was going through every step with me, every single expansion and I loved it!! I needed it!
Jaquelyn

My husband was amazing at helping me get comfortable, diffusing oils. I had every nurse mention how amazing my room smelled. He was amazing at getting the music meditations set up when I was in need of focus.
Stormy

All I wanted during my whole 10 hour active labour was to hug and dance with my hubby! He was a trooper. And he used the shoulder anchor when I would get out of control and massage my jaw when I would tense up. He let me stare into his right pupil, which apparently was freaking him out, but that turned out to be my focus point so he just let me do it! Lol! Then he did counter pressure in my knees and hips while I was pushing. BEST DADDY DOULA EVER!
Heather

Listening to me. Talking with me. I was very chatty during labor with my second. With my first, I labored in bed with him breathing deeply next to me. He was present. I guess I’m relatively weird because I just want him there and to do what I say.
Cora

Being my voice at the hospital when I couldn’t for myself.He would stand up for my preferences and desires because he knew them, even though I wasn’t in a space to talk for myself.
Jenna

Oh my goodness. My hubby is the best. He always knows how to make me laugh and he kept it up all the way through transition with our second. I was happy and relaxed and we even sang along to a cute little country song that came on while I was breathing through the contractions in the tub. The midwives were all amazed by it. It was the coolest thing and he made me feel so loved. It was the perfect birth experience. Each time I started to get a little overwhelmed he did or said something he knew I would think was funny or he would give me a kiss or do light touch massage to instantly melt me back into relaxation. You taught him that in your class, Lauralyn!
Michelle

My husband knew our birth plan and preferences so well. He would speak up for me about things he knew I wanted because I was so in the zone and didn’t want to talk to anyone. On particularly difficult expansions, I would tap him on the arm which was my signal to him that I wanted him to do the shoulder anchor. He was essentially my doula since I didn’t hire one and he was absolutely essential to a successful birth I think.
Rinda

Holding space, being quiet and patient, putting a straw in my mouth and saying “drink” or making sure I took a bite of food every so often to keep up my energy, telling me how awesome I am and how proud he is, soft touch, letting me make decisions and not answering for me. Counter pressure was huge! He was sore afterwards but it made a huge difference in managing back labor.
Brianne

Holding my hand, slow dancing, staying with me constantly even to use the bathroom, and kissing me (I have the cutest picture of him kissing my lower back while doing counter pressure on my hips). The two big ones for me: counter pressure and positive comments especially chiming in if any hospital staff said something that I might take negatively (i.e. “This is going to burn/hurt.”) He and my doula would chime in right away that I could do it, that I was strong, etc. Their reassuring words gave me something positive to focus on.
Sara

I’m going to jump in with a different perspective! My hubby is so uncomfortable with birth and hospitals– the best thing he did for me (and it took 2 births for us to figure this out) was to take care of himself, identify what he wanted to do to feel involved and useful and then hire the doula I dreamed of so I could be supported in every moment when he needed to take care of HIM. Find what works for you as a couple!! You can both have a magical time and feel supported if you can make space in your expectations for your experience to fit YOUR couple dynamic.
Katie

It helped that he knew when to just leave me alone!! Everyone tried all sorts of techniques but I just did better on my own.
Chelsea

When I would start to spin out in my head or feel out of control I would look at Ben and his eyes were so proud and so sure of what I was doing that I could instantly get back to my calm space and keep going. Everything about him was strong, proud, sure and unwavering. That’s what helped me…is having someone who knew I could do it, as much if not more so than myself. I had to commit or make a new plan…and I remember feeling the panic rise…but then I looked up and it all made sense again…ben didn’t even say words…I just knew.
Terra

For me, it is him telling me I can do this, telling me I’m doing amazing, telling me to trust myself, to “ride it out”, and at the point when I thought I was a crazy woman for going unmedicated, “this is what you want” which grounded me right away. reminding me to keep my noises low was HUGE at the end, getting me water, and doing counter pressure. After this last baby he says he wished he’d been working out his forearms because he was TIRED and sore after doing so much counter pressure with me saying “harder! harder!”
Becca

Being able to make decisions and hove my voice when I am not able to. He spoke up when he knew I wanted something but couldn’t think of the words.
Leah

Counter pressure, telling the annoying nurse to shut up, telling me to ignore the temp doc who was telling one of the nurses behind me that if I didn’t give birth in 5 minutes he would have to do a C-section, rubbing my back, giving me gatorade when I asked for it.
Jana

My husband brought the laptop and played Nacho Libre to make me laugh. I loved that, it really helped me feel relaxed. Haha. He also did counter pressure and reminded me to relax when I got too tense. When I had the feeling that I wasn’t sure if I could keep going, he was there to encourage and uplift. He held my hand. He told me multiple times that I was doing a great job. He also put music on while I was at the end stages of labor to kick my energy up. I’m so glad he was as supportive as he was!
Danielle

During labor I just want him there but to mostly just let me do my thing. When it comes to the point I get to about 9cm through pushing (I’m typically hands and knees in tub) I want him right in front of me being a focus and encouraging me and just having a hand on me. It makes all the difference.
Brooke

Mine made a playlist of songs including ones I like and he doesn’t and paced them according to the different stages of labor.
Jen

Positive affirmations from your class, massages and getting me to relax. He got me so relaxed I fell asleep!
Sara T.

Sweet words, eye contact and his strength to pull against as I pushed.
Abby

Saying my affirmations as if he were me. Also talking to the baby when the baby was stressed.
Katherine

Just supporting me 100% in all of my decisions. Knowing beforehand that I’ve had his support had made me feel like I’m the one in control, that I have someone behind me supporting me no matter what. Giving me a voice in a time where I might not always have one. So I can focus on what I’m doing and not worry if someone might try to do something against my wishes.
Katelyn

Holding space 100%. He had been trying to load up the car and I got so pissed. I made him stay with me so we could smooch. Our doula took care of all the fine details like loading the car, giving my mom directions, etc. worth every single penny.
Jackie

Honestly, smiling at me! He just looked so happy, and present, and excited, and it gave me energy and courage. I knew he was with me 100%.
Stacie

Being quiet and present with me. Reminding me why I was doing it this way and reminding me I am completely capable. And counter pressure … basically a 9 hour massage.
Jessica

Definitely staying present and holding space!! I would get anxious when I could not see or touch him. Dani

For me it was him being my focal point while breathing, and just being close by, I was doing fine on my own, but when I needed an extra boost of support I knew he was close by. Knowing that he was there for me as soon as I needed him to hold me, be my support when I couldn’t stand in my own, him telling me how well I was doing and that he was proud of me.
Artell

He kept encouraging me to keep going and that I could do it. I was strong enough. He kept me strong. He was also great to be the in between person between me and Dr.s/nurses. He understands my huffs and grunts and can understand when I’m talking under my breath, unlike they can. He was also calm. That helped loads!!
Laurel

He held me and let me lean on him for a really long time. We greeted our little one early, and were not quite as prepared for our homebirth as we would have liked. He was such a great partner that I had no idea there was a ton of business around me. He took care of things so I could just labor and love. I will say though, taking on the responsibility of all that so I could labor without a care left him with some birth trauma of his own. The idea I’d like to offer birth partners is to NEVER be afraid to ask for help. Caring for the mother doesn’t mean being the one to care for everything. delegate some details in whatever capacity to alleviate your stress so you can be there for hers.
Annalaura

Two game changers: 1. Saying the word “Sloooow” 2. Counter pressure on the knees. I was totally able to ride the waves and both hubs and the midwife thought I was sleeping between the waves. I wasn’t, but that’s how relaxed I was.
Niki

Taking your class! My husband still talks about to his friends. Being present was the biggest and most helpful for me!
Alyssa

Absolutely counter pressure! He was like my epidural with that pressure on my lower back and hips. Totally saved me and helped through every contraction after I was in transition. That and just telling me I could do it. Reminding me I was strong.
Angie

Counter Pressure and Affirmations with my spouse were heaven sent. Belly lifts (which we learned in class) were also amazing.
Mikelle

He composed music for me! It was beautiful.
Shelli

The Shoulder Anchor and whispering in my ear about how strong I was etc.
Chelsea

I labored standing because the pressure of sitting even on the ball hurt so he was literally my support! I would lean on his chest/shoulder and rock/breathe through my contractions! He was quietly supportive occasionally telling me how amazing I was and that I could/was doing it! It was just what I needed!
Heather S.

We had a long labor (36 hours)…I stayed dilated at a 6 for 14 hours and my husband just kept telling me “She’s almost here, not much longer now” helped a ton for like 5 hours. Once we got to pushing, I’ll never forget with each push he’d say, “All the air in the room.” It felt like we were the only ones there and helped me focus and relax. Pushing only felt like 30 minutes but was about 1.5 hours. He also would make the letter T on my forehead during contractions which symbolized to me more of a cross for religious beliefs and that made me feel safe and protected (he picked this up from our doula).
Jenni

Breathing with me was way helpful and counter pressure. He did it every contraction for 22 hours I don’t know how I would have survived without it.
Rachelle

He helped with counter pressure, massage, and just always by my side. He never left my side because he wanted to stay with me, even when he was tired. With our first, I had been in labor for over 24 hours and 4 1/2 was active labor and pushing. I was so exhausted and so was he. I was on the bed by this point snoozing in between contractions and he was right there laying beside me, holding my hand the whole time and would help brace me during each contraction.
Emeigh

I cannot tell you how grateful I am for your class. Giving birth is the most vulnerable and intimate experiences. My husband being 110% present was the biggest reason I was able to do an unmedicated birth because when I was weak-he was strong and prepared with affirmations and love. Another thing that helped me is that he encouraged me to dig deep to my most primal and intuitive instincts that I was afraid to do. I wanted to birth silently. I was afraid of what the nurses and what my husband might think of me. I have a lot of shame from past experiences and listening to how people viewed birth. I was so afraid but when I was birthing and I hit a wall of panic and started to hyperventilate-my husband encouraged me make low sounds (what we learned in your class) he reminded me that if I relaxed my mouth, throat etc. that it would help and he even did it with me. Oh how it changed my feelings, sensations, and birthing.
Amber

When it comes down to it, what matters most is what *you* want and need to feel comfortable and safe and relaxed in your birth environment. Not every couple has a relationship dynamic which is conducive to lots of intimate contact and attention — and that’s OK! Nobody should feel pressured to have certain people present and engaged in their birth experience if it that dynamic causes stress or distraction. And that means not just random friends/relatives, but sometimes even the father himself! There are many, varied ways to support a birthing mother, and not all of them involve close, constant contact. You should feel safe expressing what you want (and don’t want) from those you are inviting to participate in your birth experience. The last thing you want during such a time is to feel resentful or disappointed, so maybe it’s best to allow people the roles that are best suited for them. There are *no rules* about who should be present or what they should be doing. –Israel Curtis

How To Speed Up Early Labor

“I literally thought I would never go into labor on my own. It felt like I was going to be pregnant forever! I had weeks of pre-labor waves that would come and go and stop and start. It gave me a lot of time to practice my relaxation and breathing skills, which I was actually so grateful for. When my active labor began, I already knew exactly how to breathe through my expansions. Oh… and I wasn’t pregnant forever! Babies do come out!”
— Corinne

What is Practice Labor?

This is the longest phase of labor, and can last many days or weeks. Expansions are inconsistent, sporadic and mild, generally lasting well under a minute in length. There is no need to “do” anything about it or try to hurry things along. Your body is wise and it knows exactly what it’s doing! If you have any concerns about what’s going on, discuss them with your care provider. Get plenty of rest, eat nutritiously, and stay hydrated. If expansions are continuous but inconsistent and unproductive, try The Belly Lift.

  • Cervix begins to soften and thin (dilation & effacement).
  • Cervix may or may not dilate anywhere from 0–3 cm.
  • Cervix may or may not begin to change position from posterior to anterior.
  • Uterus begins to contract intermittently to “warm-up” for the big day.
  • Cortisol (a stress hormone) levels rise towards the end of pregnancy, which helps prepare the baby’s lungs for life outside the womb, while also playing a role in beginning the hormonal process of labor.
  • As a result of this surge of cortisol, you may begin to feel some emotional stress. You may feel irritable, or impatient for labor to begin. You may feel like you’ve been pregnant forever and you can’t stand it anymore.
  • Some women feel suddenly nervous or unprepared, even if they’ve been practicing faithfully.
  • You may or may not experience frustration with your partner, difficulty concentrating at work, etc. All of these feelings are normal, and are nothing to worry about. You’re getting close to going into labor.
  • Allow the feelings to come… and then let them go. Continue to focus on practicing your relaxation skills. Anchor your feelings of frustration or irritation to a positive mental thought such as: My baby knows when to be born, and my body knows how to give birth. My baby will be born at exactly the right time.

Am I in Labor Yet?

A lot of couples worry that they won’t know when the baby is coming; that they’ll go to the hospital too early… or leave home too late. It’s useful to understand the signs of impending labor, so that you know your body is getting ready for the big day. The number one question I get asked as a doula is “How do I know if I’m in labor” and my best answer is always “It’s like being in love: When it’s the real thing, you’ll just know.” Generally speaking, if you’re still wondering, you probably aren’t in active labor yet.

While the following symptoms are signs of progress, they do not mean that you will go into labor within a few hours or days. They are simply a means of saying that your body is getting ready to give birth. You may want to note the date you experienced any of these signs, or you may take a more relaxed approach and not pay much attention, knowing that labor will begin when you and baby are good and ready!

Signs of Labor may include:

  • A sudden increase of energy, stress, impatience, irritability caused by catecholamines
  • The baby engages in the pelvis
  • An upset stomach
  • Loose stools
  • Bloody show (this may be the cervix beginning to open, or from sex or a vaginal exam)
  • Loss of your mucus plug
  • Slight increase in blood pressure
  • Increase in “practice” expansions (commonly called Braxton Hicks contractions)
  • A persistent crampy feeling, like period cramps
  • Expansions that get longer, stronger and closer together, forming a pattern for at least an hour

Some women notice most or all of these signs, but others don’t experience any; either way is perfectly normal. You shouldn’t worry if you aren’t; that just means your body is preparing in a different manner. The signs of labor may also differ from baby to baby, so what you experienced the first time may not happen the second time.

Release of Membranes (Water Breaking)

This is a definitive sign of labor! In about 2-3 out of 10 births, the membranes release before labor begins. However, most of the time the waters do not release until later in labor, often not until after transition, when mama is getting ready to push. When your water breaks it may be just a constant slow trickle, or a sudden gush. You should notify your care provider when your waters release, and in the event of the following circumstances:

  • Fluid is not clear, but green or brownish
  • Fever
  • If you can see or feel the umbilical cord in the vagina (Get into the knee-chest position and call 911 if this occurs)
  • Do not place anything inside the vagina after waters have released. Avoid intercourse and vaginal exams

Practice Labor or True Labor?

It can be hard to tell if you are experiencing practice labor or “True” labor. Here are some characteristics of each:

Practice LABOR

  • Expansions do not increase in length or intensity over a period of 1-2 hours.
  • Expansions are erratic, coming at random intervals and lasting for varying lengths of time.
  • You can walk and talk, or continue your normal activities during expansions.
  • Expansions diminish or disappear if you change your activity level or position.
  • May be caused by dehydration: Expansions diminish if you hydrate yourself and relax.

True Labor

  • Expansions are getting longer, stronger and closer together.
  • Expansions become rhythmic, forming a predictable pattern which grows.
  • You feel the need to focus and breathe through your expansions, and no longer want to walk or talk through them.
  • Expansions remain consistent regardless of activity or position.
  • Expansions intensify when you hydrate and relax.

Practice labor is a vital part of the birth process! Don’t try to force it into becoming active labor. Your body knows best. Your cervix is softening, your hormones are changing, and your baby is rotating into the best position for birth. Here are some strategies that may help you make the best of your practice labor. It’s a great way to manage early labor, as well. If you’re not sure if it’s real labor or warm-up labor, try the following sequence:

  1. Drink some water, red raspberry leaf tea or coconut water. Dehydration can cause uterine cramping. Just drink to thirst; you don’t need to over-hydrate.
  2. Empty your bladder.
  3. Take a warm, relaxing bath for about 30 minutes. A bit of Epsom Salt can help relax tense muscles. You should be comfortably warm, and not so hot that you begin to sweat a lot.
  4. Drink some more clear fluids, and empty your bladder again.
  5. Lay down on your left side (which optimizes blood flow to your uterus and baby).
  6. Turn on your affirmations or a relaxation track.
  7. Allow yourself to fall asleep and nap as long as you like.

If it’s practice labor, this sequence will probably relax your muscles enough to cause it to slow down or stop. If it’s real labor, it will relax your muscles enough to help labor progress! Either way, you’ve just gotten into a state of deep relaxation, rested your birthing muscles, and replenished your fluids and electrolytes, and that’s always good for a pregnant and birthing mama.

Early Labor

“Almost as soon as I got up I started to have this crampy feeling that I’d not yet experienced. It would start, then go away, then start again. This happened a number of times, at consistent intervals. I tried to distract myself with a movie but it wasn’t happening. The expansions (our word for contractions) were steady so I decided to time them. They were 3-4 minutes apart lasting about 30-45 seconds. I walked, bounced on my birthing ball, did some yoga stretches until I decided to wake my husband. ‘Hey baby…I think I’m in labor. — what, REALLY?’ So we go on doing the things I had procrastinated, such as: packing a hospital bag, packing a diaper bag, packing the daddy doula kit, installing the car seat… You know, just the important stuff. A little after 8 AM I contacted my Doula. We were supposed to have our last pre-natal Doula visit that evening. I guess our dress rehearsal was going to be the real thing.”  — Holly

Early labor may stop and start again over a period of several hours, up to a day or two. A very long early labor is nothing to worry about medically, however, it can be tempting to try to hurry things along. Lots of rest and quiet time is best. When your expansions begin they will be very mild and won’t last very long. You may not even know what’s going on at first, and that’s ok. Your body will tell you when you’re in active labor, and when you need to get to your birth location. Don’t time your expansions in early labor. Just get in tune with your body, relax and breathe, and listen to your relaxation recordings and music. Drink clear fluids, eat lightly, take a warm bath, and then take a nap. Don’t announce early labor to family or friends, or even post about it on social media. Go about your business and do activities that create calm, peaceful, positive feelings for you. This is the best approach to helping early labor progress most quickly and effectively into active labor. The more you worry about and focus on what’s going on, the more you’ll chase it away. The more you relax and focus on other things, the more quickly this time will pass.

  • Cervix further softens and thins. You may dilate anywhere from 0 – 5 or 6 cm.
  • Expansions get longer, stronger and closer together, but are mild enough to talk and walk through.
  • An increase in prostaglandins may cause a warm, heavy feeling low in your uterus.
  • Most women feel excited and happy in early labor. You may feel a surge of adrenaline and energy.
  • You’ll probably feel energetic and positive. Your expansions are easy to work through.
  • If you feel any nervousness, concentrate on taking deep, slow breaths and you’ll find that it settles quickly.

How to help early labor progress more quickly:

You’ve been practicing for weeks for this moment! You’ll know exactly what to do if you breathe, relax your muscles, and follow your instincts.

  • Don’t time expansions or make a big deal of early labor: a watched pot never boils. Nothing inhibits oxytocin and slows labor more than being “on the clock”.
  • If you can still carry on a conversation during your expansions, it’s still early labor. Early labor is shy, and it shuts down easily when you feel observed or pressured.
  • Take a break from social media. Social media is, by nature, a form of social exposure and pressure, and social pressure can greatly slow or even stop labor.
  • Mute your phone. Don’t accept calls or texts for a while. Constant queries of “have you had that baby yet?” will keep you from having that baby.
  • When you begin to have expansions, do your best to ignore them as long as you possibly can. Go about your daily activities, but stay close to home and get lots of rest.
  • Dim the lights, or find a nice dark space to relax. Dim lighting increases your sensitivity to the birth hormones.
  • Have some private time. Your birthing hormones will kick in more effectively if you go within and allow it to happen on its own. Keep to yourself for a few hours and have “quiet time” with your unborn baby.
  • When you do have expansions, try the Belly Lift (from unit 4) to help increase pressure on the cervix and speed dilation.

Judging Birth

Birthing Behaviour

Women’s behaviour has been judged and controlled throughout history. We are supposed to be ‘good girls’ – do as we are told and not create any problems for others. However, the act of giving birth is primal and ‘wild’. Our birthing behaviour originates in the limbic system, the area of the brain shared by all mammals. To labour well we need to shut down our neo-cortex – the thinking human part of the brain. The result is instinctive ‘animalistic’ birthing behaviour. Because we are individuals, our birthing behaviour is also individual. Some women become quiet, withdrawn and ‘in control’. Others become loud, wild and ‘out of control’. For many it is somewhere in-between, or both, at different times during labour. Just like behaviour during sex (also controlled by the limbic system) there are similarities between humans, but we all behave slightly differently.

The idea that there is a ‘right’ way to behave or worse, a ‘wrong’ way to behave is unhelpful and judgemental. It seems that being quiet and ‘controlled’ is considered to be the best way to birth. How many times have you heard a woman’s labour described in a positive way because she was ‘so in control and quietly breathed her baby out’? In contrast, the loud woman is encouraged to breath (ie. stop screaming/shouting) and focus. This happens often in the hospital setting where midwives attempt to keep a woman quiet so as not to ‘frighten the other women’. These women are often described as ‘not coping’ – when in fact they are coping just fine… but loudly. It is those around them who are not coping. Michel Odent suggests that the intense fear and sense of ‘losing it’ often experienced near the end of labour facilitates the fetal ejection reflex. Not many women experience this because midwives (or others) intervene to calm the woman and help her gain control of herself.

It’s not just midwives, but also mothers who judge themselves for ‘losing control’ and making noise. I find it sad to hear a birthing woman apologise for her instinctive behaviour – but they do. Indeed there are childbirth preparation programs aimed at learning how to be quiet and in control during birth. Unfortunately, some women who have undergone this training feel like failures when their instincts take over and they become vocal. Perhaps we (society/culture) are afraid of the primal power expressed during birth – here is a woman connected to, and expressing the immense power and strength of woman. The response is to shut her up and encourage her to act like a ‘good girl’ so as not to upset anyone (including herself).

Here is a beautiful example of a mother birthing instinctively and loudly:

So, lets honour our birthing behaviour whatever it may be. Whether you are a quiet, breathing birther, or a loud and wild birther – you are equally, but differently amazing. Midwives need to learn to distinguish between a woman who is expressing her wild birthing instincts, from a woman who genuinely needs reassurance and calming. Talking with her before birth about what she will say if she really does need ‘help’ can be useful. In addition make sure she knows that you will not judge anything she says or does during labour. It is also important that women hear and see birth stories that show a range of birthing behaviours – not just the quiet and in control types.

Birthing Choices and Experiences

Women are also judged (and judge themselves) on their birth choices. Here, you really can’t win. If you choose an elective c-section for no medical reason – you will be judged. If you choose to freebirth your baby – you will be judged. And for every birth choice in-between others will have an opinion and judgement about what you do, or don’t do. There is no right way to birth. For healthy women and babies a physiological, undisturbed birth is probably the safest option in terms of outcomes. However, some women don’t want this – or are unable to have this. Any birth choice a woman makes based on an assessment of the benefits/risks and her own situation/needs should be respected. The focus should be on ensuring women have access to adequate information on which to base their choice – not on the choice itself.

How the birth looks on paper may be very different to how it was perceived by the mother. I learned quickly as a community midwife doing postnatal visits that the ‘birth report’ had no connection to the woman’s perceptions of her birth. Women who had experiences such as ‘failed forceps’ and then a c-section could emerge feeling empowered and more than happy with their experience. On the other hand, women who had experienced ‘normal’ vaginal births without intervention could be traumatised. I find it is best to ask a woman how she feels about her birth rather than making assumptions based on the events. Often feelings centre around the care and respect, or lack of that was given during the birth journey rather than what happened.

Every birth experience is valuable – even those that don’t go as expected or planned. Hindsight is a wonderful thing, and we often look back and wish we’d known X because we wouldn’t have made the choice Y and ended up with Z. Many women choose homebirth based on a previous birth experience that with hindsight could have been very different. It is only because of that previous experience that they have explored and learned about birth and themselves. That previously disappointing (and in some cases traumatic) experience has provided the foundation for self-growth.

Sometimes birth does not go as planned because if left to unfold as nature intended the result would be a poor outcome. Appropriate intervention can, and does save women and babies. However, women are often left doubting their body and can then judge themselves and their birth experience as a ‘failure’. I have recently been discussing this issue lots with my lovely Doula friend Pernille. Her insights into this matter are interesting and I would like to share them (please let me know P if I’ve mis-interpreted you). For these women, the choice of intervention can represent the ultimate expression of motherhood. For example, allowing your own body to be cut open to save your baby is surely the epitome of mothering.

Summary

There is no correct way to birth, or to behave during birth. As women and mothers we are subjected to more than enough judgement from others and ourselves. Perhaps it is time to start nurturing and supporting ourselves and others instead.

This post is also available in Spanish at Placentera.

The Win-Win Birth Plan

A Win-Win birth plan states the parents’ personal preferences but does not compromise quality of care. Its tone is respectful and flexible.

Components of the Birth Plan

Your birth plan should contain an introduction, your most important issues, fears, or concerns; a general description of the approach to birth you prefer; and sections on normal labor and birth, care of the newborn, and unexpected events (a prolonged labor, cesarean birth, a premature or sick baby, even death of the baby).

Your caregiver, your guide on the hospital tour, childbirth educator and your doula may be helpful resources as you prepare your birth plan, especially if they are familiar with the options available in your community. Use your childbirth educator or doula as a consultant on local practices, choices available, wording to use, or any aspect of the birth plan with which you need help. Your birth plan, however, should reflect your preferences and your partner’s, and not those of your friends or advisors.

The Introduction

The introduction is a paragraph that tells the staff a little about your partner and yourself, why you chose your caregiver and place for birth, and explains why your birth plan is important to you. For example, you might want to tell the staff such things as: if your pregnancy has been pleasant and healthy; if you have had difficulties, such as infertility, previous miscarriage, emotional or physical problems during this or a previous pregnancy; if you have a fear of childbirth, hospitals, or medical procedures; if you have cultural or religious preferences or special needs; or if a natural or a medicated birth is extremely important to you. Also, provide helpful information about your partner or others who will be present. Who will accompany you? Do they have any physical or emotional problems that may influence their participation in your care? Will there be a unique combination of family members present (for example, adoptive parents, lesbian co-parents, children present), or stressful family dynamics? Are there people whom you do not want at the birth? Will you be accompanied by a doula? The nurses can help you more effectively if they have this kind of information. You might also state that you will appreciate the expertise, help, and support of the staff in carrying out your birth plan.

Important Issues, Fears and Concerns

This paragraph is optional; you may have no particular fears or concerns, but if you do, this is your opportunity to disclose these to the staff and, if possible, why you have these concerns.

For example, you may fear for your baby’s well-being; you may fear the hospital or its policies; you may be uncomfortable or distrustful of people whom you do not know who are in authority, such as nurses and doctors or midwives; you may worry about the pain of labor and how you may behave or cope; you may have issues with modesty; you may fear losing control; you may find vaginal exams, blood draws, or other procedures very stressful. Sometimes negative previous experiences play a role in these fears. Previous pregnancy losses or traumatic births, negative experiences with doctors or hospitals, growing up in a dysfunctional, abusive, or neglectful family—all these experiences and more may influence your feelings as you anticipate birth.

By disclosing such feelings and some of the reasons, you can help the staff provide sensitive care and take your special needs into account.

Normal Labor and Birth

When labor and birth proceed normally, few interventions are necessary for medical safety. Some interventions may be used, however, for other reasons. Sometimes, for example, caregivers induce labor or start giving intravenous fluids even when there is no problem, in the belief that it is better to use them before rather than after a problem arises. Other routine interventions, such as the back-lying position for birth, the use of stirrups, taking the baby from the mother for testing and observation, and changes of shifts of nurses and other staff, exist for the convenience of the staff or caregiver. Still others, such as antibiotics for the baby’s eyes, newborn screening for PKU, hypothyroidism, and other conditions, are preventive and required by state or provincial governments. Some practices, such as enemas, shaving the perineum, and draping the mother’s body and legs during birth are less common today, but continue in some areas of North America. They became routine at a time when they were believed to be beneficial, but now are known to be of little or no benefit or even harmful. Some routines, such as anesthesia and circumcision, may present an element of risk to mother or baby that may not be worth taking, depending on the beliefs of the parents and the benefits to be gained.

Others, such as feeding sugar water or formula to the baby, began at a time when breastfeeding was discouraged and were believed essential to the baby’s well-being. Some procedures, such as epidural, cesarean, and circumcision, require your informed consent — that is, only after your caregiver explains the procedure, its benefits and risks, and the risks and benefits of any alternatives (including not doing it) is your consent recorded in your chart.

Part of your preparation will be to find out which routines you are likely to encounter, along with the reasoning behind them. Childbirth classes, the hospital tour, and your caregiver can help you find out which routines are used. As you prepare this part of your birth plan, mention only the preferences that matter to you. You do not have to hold an opinion on everything. Or, better yet, you might summarize your preferences with a blanket statement, such as, “I prefer to avoid routine interventions and procedures, and want to discuss any that are being considered.” Or, “I am comfortable relying on my caregiver to make decisions about interventions and procedures, and do not wish to be consulted.”

Care of Your Newborn

This section describes how you want your baby cared for during the first few days. There are as many differences in the way healthy newborns are cared for as there are differences in every other aspect of maternity care. Generally, the healthy newborn needs little more than a warm environment, diapers, clothing, and access to her mother’s breast and parents’ arms. Particular observations, tests, and procedures are done routinely to discover serious congenital disorders or prevent potentially serious illnesses. In considering your options, balance concerns for your baby’s comfort and well- being with the potential benefits and risks of each procedure.

Unexpected Events

The section on the unexpected will be most helpful if something unforeseen arises. A birth plan for a cesarean birth can help you retain some of the priorities of your original birth plan. Though an unexpected cesarean can be a disappointment, you will feel better about the experience if you have thought about this possibility, learn about your options, and express your preferences.

Although almost all babies are born healthy, there is a slim possibility that something could go wrong or that your baby might have a problem. This possibility worries most expectant parents to some degree. You know that prematurity, illness, birth defects, or even death sometimes happens. It is helpful to consider in advance how you would want such misfortunes handled, because if they occur, many decisions have to be made when you are upset and unable to think clearly. Your birth plan can include such possibilities, so that the staff can care for you and your baby with knowledge of your preferences.

Once you have made your birth plan for the unexpected, put it aside and concentrate on a normal birth and a healthy baby. You will probably not need the plan for the unexpected, but if you do, you will have your own plans to follow at this extremely difficult time. This will mean a lot to you later.

Conclusion

As you can see, preparing a birth plan requires time, thought, and information gathering. You should get input from your caregiver before you prepare the final version. By the time you have finished, you should have a fairly complete picture of what you can expect in terms of your care during childbirth and immediately afterwards. Not only have you and your caregivers formed a trusting relationship and made a general plan for managing your uncomplicated, normal labor and birth, you will also know how unexpected variations and complications are likely to be handled. This Win-Win Birth Plan helps lay the groundwork for a satisfying birth experience.

Ideas for the Best Planned Cesarean Possible

You may feel disappointed that you must plan a cesarean for your safety or your baby’s. Here are some ideas for making the cesarean birth of your baby very special and personally satisfying for you, your partner, and your baby.

Before the surgery

  • Be sure you understand and agree with the reasons for the cesarean (i.e., malpresentation of the baby, or a medical problem for you or the baby).
  • Learn about the procedure. Read about it in Pregnancy, Childbirth and the Newborn or the Birth Partner and discuss it with your caregiver.
  • Learn about your anesthesia choices and how each is administered. General information is available in the books mentioned above. If possible, however, meet and discuss medications with an anesthesiologist along with any concerns you have. A spinal is the most common type of anesthesia when a cesarean is planned in advance, but there are other possibilities. (See “Anesthesia and other medication issues” below).
  • Learn the layout of the operating room, particularly where the baby will be taken for initial care. Will she be in the same room or an adjacent room? Will you be able to see or hold her? Can your partner move back and forth between you and your baby?
  • Discuss the possibility of waiting until you go into labor and then going to the hospital to have the cesarean. The advantage is that the timing for birth is more likely to be optimal for the baby. The disadvantages are that you might not know the doctor on call who will do the surgery, and that you cannot plan ahead (which is the same as with most vaginal births).
  • If you do not await the onset of labor, you will make your appointment for the surgery. Consider being the first on the day’s schedule for two reasons: there is less likely to be a delay (from earlier surgeries taking longer than expected); and you will not be as hungry if you do not have to wait all day. You will probably have to avoid eating from the night before.
  • There is a new practice, “seeding the baby” with mother’s microbes which you may want to discuss with your doctor in advance. The procedure allows the baby to pick up some of the mother’s important microbes (ie: beneficial bacteria that help protect the baby from harmful bacteria) which vaginally born babies get as they pass through the birth canal. While it may at first eem bizarre, you may want to read this and discuss it with your doctor. Here is how it is done:
    • As long as you do not have Group B strep or other disease causing microbes (ask your doctor), one to two hours before you go to the operating room, a sterile pad is unfolded and inserted in your vagina, where it will remain for at least an hour before surgery
    • Then, just before the surgery begins, the gauze should be removed and placed in a sterile container
    • As soon as possible after the birth, the gauze is wiped over the baby – mouth, face, and body. In this way, your baby can get some important protective bacteria that a cesarean-born baby would otherwise miss. This link has an excellent discussion of this topic.

During the surgery and repair

For your personal comfort, consider these ideas:

  • Ask if at least one arm can be left unrestrained.
  • Have your partner put some pleasant-scented (lavender and bergamot are popular) lotion, massage oil, or cologne on your cheeks. He can also put it on his wrist for you to sniff. This is soothing and may counteract the “hospital smells.” Because some staff members may be allergic to some scents, you should ask if this is okay.
  • Bring your own music to listen to during the surgery. Music that is familiar and that you love is most soothing. Many operating rooms have CD players, or check whether you may use your own ear buds and music player.
  • Plan to use relaxation techniques and rhythmic slow breathing (like sighing) during the surgery. Hold your partner’s hand.
  • Ask them to lower the screen when the baby is lifted from your body so that you can see the birth.
  • Ask if they will delay clamping your baby’s umbilical cord for 30 seconds to three minutes after birth, or “milk” the cord, to allow the baby’s blood that is in the placenta to return to the baby. There are many advantages for mother and baby to delayed cord clamping. (see Pregnancy, Childbirth and the Newborn)
  • During the repair procedure, some doctors lift your uterus out of your abdomen to inspect it and then replace it, while others believe this is unnecessary and possibly problematic. This procedure may cause greater nausea, and more severe gas pains than if the uterus is not lifted out. You might wish to discuss this with your doctor beforehand. Ask about the advantages and the disadvantages.
  • Ask about picture taking during the surgery or afterwards. There sometimes are policies restricting picture taking. With a digital camera you can see pictures or videos of your baby within seconds.
  • Once your baby is born, it may be possible to have him or her placed on your chest, skin to skin. This practice is becoming more popular for healthy babies, and the skin to skin contact helps warm your baby, and allows him to feel your touch and smell your skin.
  • If you don’t get the baby right away, your partner may be able to bring the wrapped baby back to you for your first contact. You can nuzzle, kiss and talk to your baby. Ask if you will be able to hold her or breastfeed until you leave the operating room.
  • You and your partner might talk or sing to your baby. A familiar voice often calms the baby at this time, and seeing the baby’s response is a poignant moment for you both. If you sing the same song (i.e., “You Are My Sunshine”) aloud to the baby daily for a few weeks before birth, it soothes the baby at birth and long afterwards when hearing your voices and the familiar song.

Anesthesia and other medication issues

The spinal block has many advantages for a planned cesarean, which make it the usual choice. It is quick to administer and to take effect. It usually involves only a single injection, and does not require a catheter in your back as does an epidural. It causes numbness that lasts a few hours. You remain awake and aware. It hardly affects your baby. The injection may also contain some long-acting narcotic such as morphine that provides good postpartum pain relief without grogginess for up to 24 hours after the surgery. If you have been in labor and already have an epidural, they will likely add medicine to the epidural for a cesarean to increase the numbing effect. There are some concerns about spinal and epidural blocks that might be disturbing or frightening:

  • What to do: Say that you cannot breathe. The anesthesiologist, who is at your head, will check and reassure you. Your partner should coach you with every breath, watching closely and saying, “Take a long breath in — yes you are doing it, and now breathe out. Good.” Your partner might also hold your hand in front of your mouth so you can feel your breath, and reassure you, “You are breathing, even though it doesn’t feel like it.” This feeling does not last for the entire surgery.
  • On very rare occasions, the level of anesthesia rises high enough to involve the muscles of breathing, so that you really are not breathing. You cannot talk either. The anesthesiologist, who is watching the monitors closely, discovers this and takes measures to assist your breathing. You and your partner should also have a signal. If you can’t breathe and can’t talk, blink your eyes many times. That means, “I can’t breathe!” Your partner should be watching you, and if you blink in that way, says, “I think she can’t breathe!” This may alert the anesthesiologist a few seconds before he would pick up the problem.
  • On other rare occasions, the anesthesia is not adequate, and you feel the surgery. This is very scary. The doctors will probably want to make sure your reaction is not an anxiety reaction to the surgery, and may seem not to believe you at first. If you are feeling the surgery, tell them to stop. Your partner must help you with this. Make them give you better anesthesia before proceeding. This might mean they would repeat your block or give you a general anesthetic so that you are totally unaware of what is going on.

During the repair, you may feel nauseated and shaky for a period of time. These are normal reactions to major surgery and vary from feelings of queasiness to vomiting, and from trembling to shaking and teeth chattering. There are medications to ease these symptoms. They are often put into your IV without you knowing, which may be okay with you. They may, however, cause amnesia (e.g., Versed), or make you very sleepy. They can keep you from being able to nurse your baby (or to remember that you did), and to remember the first hours of your baby’s life. If you want to stay awake for this time, discuss this with your anesthesiologist ahead of time. You might ask the anesthesiologist not to give you anything for nausea or trembling unless you ask. You may very well be able to tolerate these temporary symptoms, but if you cannot, then you can ask for the medication.

Post-operative pain medications are available to help you during the days and weeks after the birth. Some women try to avoid using them due to worries about possible effects on the baby. However, since very small amounts reach the baby, the effects seem to be minimal. The baby nurses and remains awake and alert for periods of time. The downside of avoiding pain medications is extreme pain, which greatly reduces your ability to move about and to care for, nurse, and enjoy your baby. With adequate pain relief, you can have more normal interactions with your baby.

It is not uncommon to have a period after the block is given when you feel breathless or as if you cannot breathe. It can be scary. This sometimes happens because the anesthetic may numb the nerves that let you feel your breathing, while the nerves to the muscles that make you breathe are probably not blocked. In other words, you are breathing, but cannot feel it.

The first few days

Most hospitals have a bed available for the partner so he or she can remain in the hospital with you. This is lovely for many reasons. You are together as a family. Your partner can share in baby care. If your partner stays, your baby can probably room in with you the entire time. If he or she is not there, you will need help from the nurse to change the baby’s diapers, move him from one breast to the other, and carrying him, even for short distances. In some hospitals, the baby spends more time in the nursery if the partner is not there.

Breastfeeding is definitely possible! There can be some challenges after a cesarean, however. Nursing positions such as sidelying, and the “football” or clutch hold avoid painful pressure on your incision. Using a pillow over the incision also reduces pain while holding your baby on your lap. Ask for help from the hospital’s breastfeeding consultant in getting started with nursing.

Rolling over in bed can be very painful, if you don’t know how to do it. The least painful way uses “bridging.” To roll from back to side, first draw up your legs, one at a time so that your feet are flat on the bed. Then “bridge,” that is, lift your hips off the bed, by pressing your feet into the bed. While your hips are raised, turn hips, legs, and shoulders over to one side. This avoids strain on your incision.

Help at home is essential to a rapid recovery. If possible, someone (relative, friend, or postpartum doula) in addition to your partner should help keep the household running smoothly. If that person knows about newborn care and feeding, all the better. All three (or more) of you need nurturing and help during the first days and weeks to ease and speed your recovery and help you establish yourselves as a happy family.

As you can see, there are many possible options for a cesarean birth. Some are personal touches and personal self-care measures that will improve your satisfaction and self-confidence. Others are measures that involve the support of the hospital staff and your doctors. After thinking about your own preferences, prepare a birth plan, review it with your caregiver, and bring it to the hospital for the nurses to read.

The Birth Doula’s Role in Maternity Care

Introduction

The birth of each baby has a long lasting impact on the physical and mental health of mother, baby and family. In the twentieth century, we have witnessed vast improvements in the safety of childbirth, and now efforts to improve psychosocial outcomes are receiving greater attention.

The importance of fostering relationships between parents and infants cannot be overemphasized, since these early relationships largely determine the future of each family, and also of society as a whole. The quality of emotional care received by the mother during labor, birth and immediately afterwards is one vital factor that can strengthen or weaken the emotional ties between mother and child. (1, 2) Furthermore, when women receive continuous emotional support and physical comfort throughout childbirth, their obstetric outcomes may improve. (3-7)

Women have complex needs during childbirth. In addition to the safety of modern obstetrical care, and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences. The role of the birth doula encompasses the nonclinical aspects of care during childbirth.

This paper presents the position of DONA International on the desirability of the presence of a birth doula at childbirth, with references to the medical and social sciences literature. It also explains the role of the doula in relation to the woman’s partner, the nurse and medical care providers. This paper does not discuss the postpartum doula, who provides practical help, advice and support to families in the weeks following childbirth. The postpartum doula is the subject of another DONA International Position Paper. (8)

Role of the Doula

In nearly every culture throughout history, women have been surrounded and cared for by other women during childbirth. Artistic representations of birth throughout the world usually include at least two other women surrounding and supporting the birthing woman. One of these women is the midwife, who is responsible for the safe passage of the mother and baby; the other woman or women are behind or beside the mother, holding and comforting her. (9) The modern birth doula is a manifestation of the woman beside the mother.

Birth doulas are trained and experienced in childbirth, although they may or may not have given birth themselves.

Doulas provide continuous physical and emotional support and assistance in gathering information for women and their partners during labor and birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement and positioning, and comforts the woman with touch, hot or cold packs, beverages, warm baths and showers, and other comforting gestures. She also assists the woman and her partner to become informed about the course of their labor and their options. Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort for the entire labor. (4)

Doulas are well-versed in non-medical skills and do not perform clinical tasks, such as vaginal exams or fetal heart rate or blood pressure monitoring. Doulas do not diagnose medical conditions, offer second opinions or give medical advice. Most importantly, doulas do not make decisions for their clients; they do not project their own values and goals onto the laboring woman. (10, 11)

The doula’s goal is to help the woman have a safe and satisfying childbirth as the woman defines it. When a doula is present, some women have less need for pain medications, or may postpone them until later in labor; however, many women choose or need pharmacological pain relief. It is not the role of the doula to discourage the mother from her choices. The doula helps her to become informed about various options, including the risks, benefits and accompanying precautions or interventions for safety. Doulas can help maximize the benefits of pain medications while minimizing their undesirable side effects. The comfort and reassurance offered by the doula are beneficial regardless of the use of pain medications.

The Doula and the Partner Work Together

The woman’s partner (the baby’s father or another loved one) is essential in providing support for the woman. A doula cannot make some of the unique contributions that the partner makes, such as a long- term commitment, intimate knowledge of the woman and love for her and her child. The doula is there in addition to, not instead of, the partner. Ideally, the doula and the partner make the perfect support team for the woman, complementing each other’s strengths.

In the 1960s, the earliest days of fathers’ involvement in childbirth, the expectation was that they would be intimately involved as advisors, coaches and decision-makers for women. This turned out to be an unrealistic expectation for most men because they had little prior knowledge of birth or medical procedures and little confidence or desire to ask questions of medical staff. In addition, some men felt helpless and distressed over the women’s pain and were not able to provide the constant reassurance and nurturing that women needed.

With a doula present, the pressure on the partner is decreased and he or she can participate at his or her own comfort level. Partners often feel relieved when they can rely on a doula for help; they enjoy the experience more. For those partners who want to play an active support role, the doula assists and guides them in effective ways to help their loved ones in labor. Partners other than fathers (lovers, friends, family members) also appreciate the doula’s support, reassurance and assistance.

Doulas as Members of the Maternity Care Team

Each person involved in the care of the laboring woman contributes to her emotional wellbeing. However, doctors, nurses and midwives are primarily responsible for the health and wellbeing of the mother and baby. Medical care providers must assess the condition of the mother and fetus, diagnose and treat complications as they arise, and focus on a safe delivery of the baby. These priorities rightly take precedence over the non-medical psychosocial needs of laboring women. The doula helps ensure that these non-medical needs are met while enhancing communication and understanding between the woman or couple and the staff. Many doctors, midwives and nurses appreciate the extra attention given to their patients and the greater satisfaction expressed by women who were assisted by a doula. (12, 13, 14)

Terms for labor support providers

The terms describing labor support providers are sometimes confusing. When a person uses any of the terms below to describe herself, she may need to clarify what she means by the term.

Doula – a Greek word meaning a woman who serves. In labor support terminology, doula refers to a specially trained birth companion (not a friend or loved one) who provides labor support. She performs no clinical tasks. Doula also refers to lay women who are trained and experienced in supporting families through postpartum adjustment.

They are well-versed in emotional adjustment and physical recovery, newborn development, care, and feeding. They also offer practical assistance with newborn care, household tasks and meal preparation. They promote parent confidence and parent-infant bonding through education, nonjudgmental support, and companionship. To distinguish between the two types of doulas, the terms birth doula and postpartum doula are used. See DONA International’s Position Paper, “The Postpartum Doula’s Role in Maternity Care.” (8)

Labor Support Professional, Labor Support Specialist, Labor Companion – synonyms for birth doula.
Birth Assistant, Midwife’s Assistant, Labor Assistant, Monitrice – sometimes these terms are used as synonyms for doula, but usually refer to lay women who are trained in limited clinical skills to assist a midwife (vaginal exams, blood pressure checks, set up for birth, fetal heart rate assessment, etc.) and who also provide some labor support.

Research Findings

In the late 1970s, when Drs. John Kennell and Marshall Klaus investigated ways to enhance maternal-infant bonding they found, almost accidentally, that introducing a doula into the labor room not only improved the bond between mother and infant, but also seemed to decrease the incidence of complications.(3, 4) Since their original studies, published in 1980 and 1986, numerous scientific trials have been conducted in many countries comparing usual care with usual care plus continuous labor support.

In fact, the largest systematic review of continuous labor support, published in 2011, reported the combined findings from 21 randomized controlled trials, including over 15,000 women. (7) The trials compared “usual care” in the hospital with various types of providers of continuous labor support: a member of the hospital staff (i.e., a nurse); a family member or friend; and a doula (not a hospital employee, family member or friend) whose sole responsibility was to provide one-to-one supportive care. While overall, the supported women had better outcomes than the usual care groups, obstetric outcomes were most improved and intervention rates most dramatically lowered by doulas. According to a summary of the findings of this review (15), the doula-supported women were:

  • 28% less likely to have a cesarean section
  • 31% less likely to use synthetic oxytocin to speed up labor
  • 9% less likely to use any pain medication
  • 34% less likely to rate their childbirth experience negatively

Obstetric outcomes were most improved and intervention rates most dramatically lowered by doulas in settings where:

  • the women were not allowed to have loved ones present
  • epidural analgesia was not routine (when compared to settings where epidurals are routine)
  • intermittent auscultation (listening to fetal heart rate) or intermittent (versus continuous) electronic fetal monitoring was allowed

Services and costs

There are two basic types of doula services: independent doula practices and hospital/agency doula programs. Independent doulas are employed directly by the parents. They meet prenatally one or more times and maintain contact by email or telephone. The doula becomes familiar with the woman’s and her partner’s preferences, concerns, and individual needs. Once labor begins, the doula arrives when the woman or her partner asks her to come, and stays with them until after the birth. One or more postpartum meetings are included in the doula’s service. Most doulas charge a flat fee, and some base their fees on a sliding scale.

Another type of doula service is the doula program associated with or administered by a hospital or
community service agency. The doulas may be volunteers or paid employees of the hospital or agency. These programs vary widely in their design. In some, the hospital or agency contracts with an independent community-based doula group to provide the doulas. Others train and employ their own staff of doulas. Payment of the doula may come from the institution, the client or it may be shared by the two. Some hospital/agency services are set up as on-call doula services. A rotating call schedule ensures that there are doulas available at all times. They meet the client for the first time during labor and quickly establish a relationship.

Other hospital or agency doula programs match a doula with each expectant mother, along with a backup doula. They work together in much the same way that private doulas and clients work together.

Questions to Ask a Doula

In selecting a doula, the following questions should help expectant parents make a good decision. These same questions might also be asked by maternity care professionals who wish to know more:

  • What training have you had? (If a doula is certified, you might consider checking with the organization.)
  • Tell me about your experience with birth, personally and as a doula.
  • What is your philosophy about birth and supporting women and their partners through labor?
  • May we meet to discuss our birth plans and the role you will play in supporting me through birth?
  • May we call you with questions or concerns before and after the birth?
  • When do you try to join women in labor? Do you come to our home or meet us at the hospital?
  • Do you meet with us after the birth to review the labor and answer questions?
  • Do you work with one or more back up doulas for times when you are not available?
  • May we meet them?
  • What are your fees and your refund policies?

Third-party reimbursement of doula services

Insurance companies in some countries are increasingly offering coverage for doula services, either as a listed service, through the clients’ flexible spending accounts, or as part of their universal health care coverage. Grant funding for doula services is also sometimes available, and, in the USA, some Medicaid– funded health agencies have contracts with doula organizations to support women in poverty and women with special needs. Although some health insurance and flex pay plans pay for doulas, at present, private doula care is usually paid for directly by the client.

Training and Certification of Doulas

Doula training focuses on the “art of labor support,” that is, the emotional needs of women in labor, and nonmedical physical and emotional comfort measures. The program requires that participants have some prior knowledge, training, and experience relating to childbirth, and consists of an intensive two to four day seminar, including communication skills, understanding of the psycho-emotional experience of childbearing, hands-on mastery of comfort and labor enhancing measures, such as relaxation, breathing, positioning and movements to reduce pain and enhance labor progress, touch, and many others.

To become certified by DONA International, the doula meets the following requirements:

  • either a background of work and education in the maternity field, or observation of a series of childbirth classes
  • either a background of work and education in the lactation field, or attendance at a professional level breastfeeding course lasting a minimum of three hours
  • agreement to adhere to DONA International’s Standards of Practice and Code of Ethics
  • attendance at a doula skills workshop offered by a DONA Approved Birth Doula Trainer
  • completion of extensive background reading from a list of recommended books and published articles
  • submission of an essay that demonstrates understanding of the integral concepts of labor support
  • receipt of positive evaluations from clients, doctors or midwives, and nurses
  • submission of detailed records, observations and essays from a minimum of three births
  • development of a client resource list with a minimum number of entries in specific categories
  • continuing membership in DONA International

Summary and Conclusion

In summary, doulas provide unique positive contributions to the care of women in labor. By attending to women’s emotional needs, some obstetric outcomes are improved. Just as importantly, early mother– infant relationships and breastfeeding are enhanced. Women’s satisfaction with their birth experiences and even their self-esteem appears to improve when a doula has assisted them through childbirth.

Analysis of the numerous scientific trials of labor support led the prestigious scientific group, The Cochrane Collaboration’s Pregnancy and Childbirth Group in Oxford, England to state: “Continuous support during labor has clinically meaningful benefits for women and infants and no known harm.” (7)

References

1. Klaus MH, Kennell JH, Klaus PH. “Longer-term benefits of doula support.” Chapter 6, in The Doula Book, 3rd Edition. Da Capo Press, A Division of Perseus Books Group, Boston, Mass. 2012.
2. Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol 186 (5Supplement): S160172, 2002
3. Sosa R, Kennell JH, Klaus MH, Robertson S, Urrutia J. “The effect of a supportive companion on perinatal problems, length of labor, and motherinfant interaction,” N Engl J Med, 303:597600, 1980.
4. Klaus MH, Kennell JH, Robertson SS, Sosa R. “Effects of social support during parturition on maternal and infant morbidity,” Br Med J, 293:585587, 1986.
5. Kennell JH, Klaus MH, McGrath SK, Robertson S, Hinkley C. “Continuous emotional support during labor in a US hospital: a randomized controlled trial,” JAMA 265:21972201, 1991.
6. McGrath SK, Kennell JH. A randomized controlled trial of continuous labor support for middleclass couples: effect on cesarean delivery rates. Birth. 2008 Jun;35(2):927
7. Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J . “Continuous support for women during childbirth.” Cochrane Database Syst Rev. 2011 Feb 16; (2):CD003766.
8. Kelleher J. Position Paper: The Postpartum Doula’s Role in Maternity Care. DONA Internationals, Denver. 2008
9. Ashford JI. George Engelmann and Primitive Birth. Janet Isaacs Ashford, Solana Beach, CA, 1988.
10. DONA International. Standards of Practice. DONA International, Aurora, CO, 2008.
11. DONA International. Code of Ethics. DONA International, Aurora, CO, 2008
12. Ballen LE, Fulcher AJ. “Nurses and doulas: Complementary roles to provide optimal maternity care”. JOGNN 35: 304311, 2006
13. Gilliland AL. “After praise and encouragement: Emotional support strategies used by birth doulas in the USA and Canada.” Midwifery 27: 525531, 2011.
14. Hodnett E, Lowe N, Hannah M, Willan A, Stevens B, Weston J et al. Effectiveness of nurses as providers of labor support in North American hospitals: a randomized controlled trial. JAMA 288:147481, 2002.
15. Childbirth Connection. “Best Evidence: Labor Support.” 2011. Retrieved on 3/17/2012 from http://www.childbirthconnection.org/article.asp?ck=10174

This paper was written by Penny Simkin and approved by the 2012 DONA International Board of Directors.

For more information about doulas, contact: DONA International
(888) 788-DONA (3662)
info@DONA.org
www.DONA.org
© DONA 1998, 2005, 2006, 2012.

Permission granted to freely reproduce in whole or in part with complete attribution.

How do I choose the right birth care provider?

Five steps to hiring the right care provider for your birth

1. Decide how and where you want to give birth

If you don’t know, start doing some serious research. You have lots of options: Natural or medicated? Hospital or home? Water or dry land? OB or midwife? Do you want to be actively involved in all decisions and choices or will you allow your care provider to take control? If you’ve had a previous cesarean, are you interested in a VBAC (vaginal birth after cesarean)? Will you have a doula? What interventions / medications / procedures will you accept or refuse? A good, comprehensive childbirth education course will help you navigate these decisions confidently, without imposing a dogmatic bias about what type of birth is best. The best birth is the one that is safe, healthy and joyful for you and your baby. Don’t necessarily allow yourself to be swayed by what your best friend or your mom or your college roommate thinks is right.

Here is a simple meditation and journaling exercise you can practice with your partner or a friend to help you decide what you want. Sit down in a quiet space, turn off all technology and close your eyes. Have your partner read the following questions to you, giving you lots of time to think through each one. If you like, you can have a journal and pen on hand to record your responses:

  • Take a few deep breaths and begin to visualize yourself giving birth, safely and joyfully. What does that look like and feel like to you? Your joyful birth story is completely unique to you.
  • Imagine how you would like to feel on your birthing day, emotionally and physically.
  • What is the lighting like in the room?
  • Is there music playing, or some other sounds in the background?
  • How would you describe the atmosphere in the room? Calm? Celebratory? Social? Intimate?
  • What level of routine medical intervention do you prefer? Some women feel safer with more intervention, others prefer less. (If you don’t know, find a comprehensive childbirth education class which will help you explore all of your birth options.)
  • Who is with you? How involved is your partner? Is there another support person or doula there?
  • What is the energy and personality of your ideal care provider? Are they upbeat or mellow? Calming or energizing? Quiet or assertive?

2. Get recommendations from local Doulas, and talk to other moms in your area who had the type of birth you are hoping for

If you are planning an unmedicated VBAC, find moms who have had unmedicated VBACs. If you know you want an epidural, find moms who had great epidural births. I have found Facebook birth-related groups to be most helpful in this task. When bringing up this topic with friends, you can say something like “I am looking for a care provider who will support my ________ [natural/hospital/home/birth center/VBAC/surgical/medicated/water] birth. Any suggestions?”

Doulas are really your secret weapon when it comes to finding the right maternity care provider. An experienced doula has seen many different care providers in action, and they can tell you who’s great and who isn’t. Look up local doulas and pick their brains. Most of them will be happy to talk to you and point you in the right direction on your search. Even better? Hire a doula as your own personal birth-guide.

You wouldn’t ascend Everest without a Sherpa who knows the way and has been to the summit many times: Doulas are Birth Sherpas! Experienced Doulas have worked with care providers to support a great variety of birth scenarios, and they are really good at facilitating cooperation and communication between mom and her provider.

3. Create a birth plan

Now that you know what kind of birth you want, you can begin putting those preferences down on paper. Again, a good childbirth class will be a great resource for you. Our class session #5 is Birth Choices night, and will give you all the tools you need to begin creating your birth plan. Read books, ask questions, talk to your doula and listen to your intuition. Two books I recommend that couples read as they create their birth plans:

  • Gentle Birth, Gentle Mothering — Sarah J. Buckley, MD
  • The Birth Partner — Penny Simpkin

Two downloadable resources that will help make this whole process much easier:

4. Interview the recommended care providers

Once you’ve got your list of recommendations, contact each care provider and set up an interview. Just to be clear: YOU are interviewing THEM. You are the CEO and your job is to hire the employee you like best. Bring your birth preferences sheet with you to the interview, and go through it point by point. If the care provider is a good fit, this process will be so smooth and easy. You’re gut will tell you if it’s a good fit or a big mistake. Throughout the interview, you should feel listened to, understood and supported. If you feel like you have to defend or “fight for” your choices during the interview, can you imagine how you’ll feel on your birthing day? You, as CEO of this birth, have the right to find an employee who will provide you with the level of service and performance you require. Keep interviewing until you find that employee.

5. Know that you can switch care providers at any time, even late in your pregnancy.

You can change your mind and “fire” your care provider if you feel you need to. The latest I’ve ever heard of a mom firing her doctor was (believe it or not) at six centimeters dilation! She was tired of how she was being treated during labor, so she signed herself out of the hospital, contacted a local midwife, drove to a birth center, and had a victorious VBAC in the water, no tearing, not trauma, no complications. AND her baby weighed 11 and a half pounds…

It’s best to choose your ideal care provider much earlier than that, of course. It’s incredibly beneficial for an expecting mom to have a relationship of trust with her doctor or midwife that she can call upon whenever she needs support or reassurance. So don’t put this off, get it done! Do your childbirth classes, read your books, ask your questions, hire your doula, get some recommendations, and start your search for the best provider for your birth journey.

How to induce labor naturally: Learn the ROPEs

There are many hormones that govern the process of labor and birth. In this article we are going to focus on four of the main hormones:

Relaxin, Oxytocin, Prostaglandins, and Endorphins.

We want to encourage mom’s body to produce these hormones in order to help labor begin naturally, making birth as easy and safe as possible.

Relaxin

  • During pregnancy, relaxin is released from the placenta, the membranes which surround the baby, and the lining of the uterus.
  • Softens the ligaments and cartilages of the pelvis so that it can expand and “open up” during labor, facilitating the descent of the baby into the birth path.
  • Helps the cervix become looser and softer so that it can thin and open.
  • Smooths and softens vaginal tissues and perineum, making them more flexible and “stretchy.”
  • Makes the baby’s whole body more flexible and “squishy”, and allows the head to mold.

Maximizing relaxin

  • Relaxin levels increase during the last few weeks of pregnancy, making your pelvis more flexible, and the baby’s head and body squishier and easier to birth.
  • Practicing prenatal yoga and gentle stretches can help maximize the effects of relaxin in helping the pelvic area open and expand for birth.
  • Try squatting. Make sure your care provider approves this exercise.
  • In men, relaxin is secreted from the prostate gland and can be detected in the semen. Intercourse during pregnancy can be helpful in softening the cervix, due to relaxin and prostaglandins in the semen.

Oxytocin

  • Stimulates uterine contractions during orgasm and childbirth.
  • Large amounts of oxytocin are released when the cervix is fully opened, triggering the fetal ejection reflex.
  • The Love Hormone: initiates feelings of bonding and closeness in both mom and baby.
  • Works in synergy with your body’s endorphins, creating a state of euphoria.
  • Suppresses the production of stress hormones, which are responsible for the Fear-Tension-Pain cycle.
  • Contracts the uterus strongly after birth in order to deliver the placenta and stop bleeding.
  • During breastfeeding, produces the “Let-Down” reflex.

Maximizing oxytocin

  • When the baby’s brain is finished developing, it signals the mother’s body to release oxytocin.
  • Lovemaking: skin-to-skin contact, kissing, intercourse, and particularly, orgasm.
  • Light Touch Massage, and any other form of massage, or pleasurable physical contact.
  • Nipple Stimulation! This can be done during lovemaking or light touch massage.
  • Prenatal bonding exercises, visualizations and guided meditation.
  • Fear release: Stress hormones can slow the production of oxytocin.
  • Dark Chocolate is known to produce an increase in oxytocin.
  • Keep the lights in your birthing room dim! Melatonin is produced in dim lighting, and melatonin helps make your body more sensitive and responsive to oxytocin.

Prostaglandins

  • Ripens the cervix and causes it to begin the process of thinning and opening.
  • Stimulates uterine contractions.

Maximizing prostaglandins

  • Semen is a rich source of prostaglandins. Allow the semen to stay in the vagina after intercourse for as long as possible.
  • Fresh pineapple and spicy food may help stimulate prostaglandin release by irritating the digestive tract slightly, triggering prostaglandin release.
  • Walking helps to create pressure on the cervix, which may further increase prostaglandin production and help thin the cervix.

Endorphins

  • Your body’s own natural morphine: much stronger and more effective than any other pain killer.
  • In large amounts, it creates an amnesiac state where you become unaware of the outside world or the passage of time.

Encouraging endorphins

  • Sex. (Are you noticing a pattern here?) Orgasm produces a huge rush of endorphins.
  • Light touch massage: Getting “the chills” means that the endorphins are at work.
  • Laughter and humor.
  • Exercise: all muscle contractions and stretching of the muscles or tissues of the body create endorphins.
  • Hypnosis, guided meditation, warm baths.
  • Acupuncture and acupressure release endorphins and may relax you enough so that labor can kick in on its own.

Active Birth Manifesto

1. In every uninhibited labour there is a marked restlessness: the woman walks, stands, squats, kneels, lies down and moves her body freely to find the most comfortable and appropriate positions. There can be no fixed position for a natural healthy labour and birth when a woman follows her own instincts – for birth is active, involving a succession of changing positions and is not a passive confinement.

2. Throughout the world, and for thousands of years, women have spontaneously laboured and given birth in some form of upright or crouching positions – often supported. Whatever the race or culture: African, American, Asian, European and so on, the same upright positions predominate. History confirms the evidence of ethnologists showing the prevalent use of vertical positions throughout the ages.

3. Most women in post industrialised countries today are confined in a recumbent or semirecumbent position, usually in hospital. This practice is illogical, making birth needlessly complicated and expensive, turning a natural process into a medical event and the labouring woman into a passive patient. No other species adopts such a disadvantageous position at such a crucial time.

4. Research reveals serious disadvantages to the use of the recumbent position:

  • Lying on the back causes compression of the major abdominal blood vessels along the spinal column. Compression of the large artery of the heart (descending aorta) hinders circulation to the uterus and placenta and can result in foetal distress. Compression of the large veins leading to the heart (inferior vena cava) restricts the returning blood flow and can contribute to hypotension and other circulatory problems, increasing the risk of heavy bleeding after birth.
  • The recumbent position reduces the potential mobility of the pelvic joints, in particular the advantages of flexing the knees and hips in an upright posture, i.e. the acute angle made by bringing the knees towards the chest (as in squatting) which opens and widens the pelvis to its maximum. In the reclining position the body weight rests directly on the sacrum and prevents the pivotal movement of the posterior wall of the pelvis to accommodate the baby’s descending head. This significantly reduces the diameter of the pelvic outlet between the symphysis pubis and the coccyx, losing up to 30 percent of the potential opening, compared with squatting or leaning forward.
  • It is easier for an object to fall towards the earth’s surface than to slide parallel to it (Newton’s law of gravity). In reclining positions the uterus has to work in opposition to gravity. This wastes energy, causes unnecessary effort and pain while increasing the duration of labour and birth. The descent, rotation and birth of the baby are made easier when the maternal position directs the baby towards the earth rather than along the horizon.
  • Malpresentations are more likely when the spontaneous movements of the mother which guide the baby’s rotation through the birth canal are restricted.
  • When lying down for the birth, the perineal tissues stretch unevenly at the expense of the posterior part, this causes stress and pain and increases the risk of tearing or the need for episiotomy.

5. Movement and position change is more important than a single optimal or best position during labour. Spontaneous labour positions include standing, walking, sitting upright, kneeling, crouching or resting on one side.

A labour position is is physiologically effective when:

  • there is no compression on the blood vessels
  • movement is unrestricted
  • the pelvis is fully mobilised
  • the body works in harmony with gravity

For birth, squatting and its variants are the positions closest to nature’s laws and are known as physiological birth positions. These include full or semi squats, standing squats or various kneeling positions.

The use of such upright positions produce the following additional benefits in the second stage:

  • more powerful contractions resulting in an effective expulsive reflex
  • optimal foetal oxygenation
  • minimal strain and muscular effort
  • an optimal angle of descent
  • maximum space for descent, rotation and emergence of the presenting parts through the pelvic outlet
  • optimal relaxation of the perineum

It has been demonstrated that where the use of upright positions during labour and birth is actively encouraged, the number of spontaneous physiological births increases.

6. In an active birth the physiological process unfolds spontaneously due to the uninhibited release of birth hormones. Oxytocin secretion is optimal, resulting in efficient contractions in labour, an effective expulsive reflex during birth, expedient delivery of the placenta and good retraction of the uterus thereafter. High endorphine levels increase the mother’s ability to cope with pain without intervention. The altruistic effects of the high hormone levels in both mother and baby promote normal attachment and bonding in the critical first hour after birth.

7. The importance of a conducive environment for labour and birth, where the mother feels safe and secure and where her privacy is protected, is of paramount importance. Such conditions are essential to ensure spontaneous movement in upright positions and also for optimal hormone secretion – the key features of an active birth.

8. Immersion in warm water at approximately body temperature in the active stage of labour (5-6 cms dilation) has been shown to enhance an active birth. Contractions may intensify and the buoyancy increases relaxation, comfort and mobility. Studies have shown that pain modification is significant. While primarily intended to ease labour, a birthing pool can also provide a suitable environment for the birth, when conditions are optimal.

9. Numerous studies in the last 50 years indicate that when birth is active the advantages are:

  • the natural rhythm and continuity of birth are not disrupted.
  • uterine contractions are stronger, more regular and more frequent.
  • dilation is enhanced.
  • more complete relaxation is possible between contractions.
  • intrauterine pressure is consistently higher.
  • first and second stages of labour are shorter – some studies show over 40 percent shorter in the upright group.
  • there is greater comfort, less stress and pain, so decreased need for analgesia.
  • the condition of the newborn is generally optimal.
  • women feel that they are fully participating, in control and more often experience giving birth as a wonderful and joyous experience.

10. There is no doubt to anyone who has experienced or witnessed both active and passive birth, that an active labour and birth is usually easier, safer and more rewarding for both mother and child. After an active birth, the mother feels that she has given birth, rather than having had her baby extracted from her. She and her baby have been full participants together and both are alert, undrugged and healthy when they meet face to face. This inevitably results in the best possible conditions for maternal/infant attachment and the foundation of healthy loving relationships in the family.

11. Active birth is more than a matter of positions. While the freedom to move spontaneously and to use upright positions is fundamental, the essential definition of an active birth is one in which the birthing mother is in charge of her choices and decisions. This enables her to enjoy a productive and mutually respectful partnership with her birth attendants. When interventions are necessary, the principles of an active birth may still be useful in combination with obstetric procedures, and help to minimise risks or side effects. When this is the case, every birth, whether natural or assisted, may be called an active birth.

12. The long term consequences of unnecessary intervention around the time of birth to health and well being is an area of increasing concern. Based on research findings, modern experience and ancestral instinct, fundamental changes in attitude and provision of maternity services, in the education of midwives and in the preparation of women for birth are inevitable, in order to increase the potential for physiological birth.

13. Childbirth, in any woman’s life, is an exceptional act, a tour de force, partly instinctive and partly a learned skill. There is a knack to doing most things and birth is no exception. A prospective mother needs more than knowledge and information about pregnancy, labour and birth. She also needs physical, mental and emotional preparation throughout pregnancy, to develop comfort and ease in upright positions and confidence in her innate ability to give birth. Preparation for an active birth needs to offer her a means of profound and deep relaxation of body and mind, to enable her to access and trust her instinctual potential.

14. As well as a celebration in the family, the birth of a child is a critical, uncertain event involving suspense as to the final outcome. The skill of birth giving and of birth attendance is prized in every society. In the modern and western world, the application of technology to birth has introduced unprecedented safety and lifesaving procedures. However, the widespread and routine application of such technologies to the majority of women is inappropriate and has been demonstrated to increase the number of complicated and surgical births all over the world. This leads to the loss of valuable and essential midwifery skills and increasing reliance on technology, eroding the satisfaction and confidence of both mothers and midwives. Medical attendants have become the birth experts. Moreover, the balance of power is such that the skill of the birthing woman has been so undermined, that most women have lost touch with the age-old knowledge and wisdom of birthing that was previously handed down the generations, mother to mother. This balance of skill and power must be restored by reclaiming the instinctive potential, freedom and power of the giver of birth, the mother. The Active Birth Movement is committed to the empowerment of birthing women and the global rediscovery of birth.


Bibliography

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Arms, S. Immaculate Deception II – Myth, Magic and Birth. Celestial Arts. 1994 Balaskas, J. Active Birth. Thorsons UK, Harvard Common Press. US 1992
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Copyright Janet Balaskas, 2013. No part of this text may be reproduced in any form whatsoever without prior permission from Janet Balaskas.

Selfish Women and their Silly Birth Experiences

When I was preparing to give birth, I saw it as a once­-in-­a-­lifetime event and something I wanted, more than anything, to do “right.” By doing it “right,” I meant that I wanted the safest and most positive outcome possible; to me, it was perfectly obvious that safety and a good experience were inextricably linked. And, as the person playing the most active role in the event, I felt it was my responsibility to shape those things.

It was a little alarming to me that so many of my friends and acquaintances who had given birth did not particularly want to talk about it, and didn’t necessarily think it was a good idea that I learned as much as I could about it before doing it.

Before and after giving birth, I got the sense from some people that in seeking a “positive” experience, I was being high-­maintenance and was somehow less concerned with my baby’s well­being than someone who didn’t ask questions or want to actively participate. I rolled my eyes at the speculation and barreled right through it, but, on reflection, it struck me as odd. How could it be “selfish” to do what I could to facilitate a less traumatic birth? Didn’t less traumatic mean “safer”? ​My body — a body I’d come to know and like for the last 30-­some years — was being subjected to a major, life-­altering process. Why did it suddenly have such reduced value? Why was I suddenly not supposed to have any say over what happened to it?

And… why did people assume that my baby’s safety must be lower on my priority list, because I wanted his birth to be a positive experience? That’s a doozy of an assumption.

Prior to giving birth, my primary motivations for attempting a normal, unmedicated, physiologic birth were so that my baby wouldn’t be born with drugs in his system; so that we could benefit from the dance of hormones science hasn’t come close to replicating; and so we could avoid the dreaded “cascade of interventions” that ends in 1 in 3 American babies being born by surgery. All of these things meant healthier bodies, better bonding, and a higher chance of successful breastfeeding. That was selfish?

When I first began researching birth and options, I went in completely biased against unmedicated birth (why would anyone choose pain?), but what I found didn’t support my bias. I found, to my complete surprise, that it was possible to give birth with dignity and humanity, and that, on the whole, ​those births seemed to be the least medically risky.​Over and over again, I saw that the births where women were supported in the process rather than managed like children–where mom was treated by her skilled, attentive providers as the most important person in the room–the smoother the birth and the safer the baby. Bingo.

Choices in birth are very personal. I do not believe that every woman should, must, or can have a physiologic birth. That fact does not change a word that I write here.

It was only after I gave birth that I grasped the real value of what I instinctively wanted. I’m not sure I knew it then, but my tendency toward a physiologic birth was me protecting myself and my baby. But the bigger picture is that if birth were merely a day or two out of our lives, I wouldn’t have gone on to devote my time to this cause. Birth carries a much bigger impact than a one­time mere medical event.

Birth is valuable because it is the beginning of the mother­-baby relationship.

Once you have been a mother, you will never not be a mother again. The minute you go into labor, you are on a rollercoaster that doesn’t stop.

The way you meet your baby can very much set the tone for the postpartum period. It is a tough time. You’re unsure of yourself, on no sleep, hoping you don’t accidentally harm or starve this helpless, completely dependent little thing. The stress of a baby crying for no discernable reason is indescribable. I don’t recall ever feeling so frustrated in my life. We all laugh about those moments of irrationality, when you have to place your baby in her crib and walk away in order to keep your sanity.

I have seen first­hand how the birth experience impacts this time. I came off my baby’s birth strengthened and confident — in complete awe of what my body had done. And it was still the most difficult time I’ve ever had. I’ve seen what happens when women come off a traumatic birth, too, and I’ve seen the lack of spirit and the helplessness they sometimes exhibit. I’ve talked to the women who spent hours crying in the basement or listless in bed, unable to get it together, or just dragging through the day with no joy. Even the women who rally and carry on are carrying wounds they must wrestle with at some point or another.

When I say “traumatic birth,” I’m not talking about medical complications. I’m talking largely about healthy women with realistic expectations who were treated disrespectfully or without compassion at that most vulnerable time: women who weren’t treated like the most important person in the room, as they gave birth to the most important thing in the world.

Feelings of desperation, low spirits, and worse plague a new mother and affect how she nurtures her baby. We’ve only begun to explore the connection between birth experiences and incidences of postpartum depression or post­-traumatic stress disorder in new moms. Coming off birth strengthened and supported is invaluable to mom and baby.

Something we forget is that you are already a mother during birth. Birth and postpartum are your relationship with your baby as a new mom. The quality of that time is something you will remember all your life. Saying that what happens with you and your baby during and after birth doesn’t matter is the same as saying it doesn’t matter whether you bond with your toddler or that it doesn’t matter whether your teenager hates you. Birth is part of your life as a mother. This is your life.

Birth is valuable because women matter.

It’s a dangerous assumption I alluded to above: that only a woman who doesn’t care about her baby would care about her body and her birth. It’s damaging and wrong to communicate to women that we must make a choice between ourselves and our babies, because we can’t both matter.

Acting as if a baby’s safety is compromised by treating his mother well in birth is ludicrous, and I’d like to call for an end to that. If I could go back in time, I’d ask those people who questioned me to please explain how I was the most important factor in pregnancy and the least important in birth. How my value as a person deserving of positive experiences plummeted so dramatically when I crossed the threshold from pregnant woman to woman in labor. And how on earth treating my body well in pregnancy was intuitive, but treating my body well in birth was not.

I’d say to those people, “Explain to me again how it’s selfish to take my responsibility as a mother seriously?”

Simply by virtue of being human beings, women matter. We deserve respect, compassion, and kindness in birth, because we are human beings. But let’s not forget that greatest of responsibilities given to us as mothers: we are guardians of our babies. In pregnancy and birth, what happens to us happens to our babies. And because the ways in which our children come into the world are some of our first acts as mothers, our babies deserve for us to be treated as if we matter.

I encourage you to embrace that truth, and act as if you mean it.