Ideas for supporting your partner in labor

Apr16

One of my favorite handouts to give in birth classes is a “Cliff’s Notes” to labor support. It is a two page handout with a variety of reminders and ideas about supporting your partner or wife during her labor. There are small illustrations as well and a review of the stages of labor. The handout is available here from the website Transition to Parenthood. This site offers a variety of useful handouts for childbirth educators and for parents-to-be and I really appreciate the educator’s generosity in making her materials available online like this!

The handout referenced focuses primarily on physical support and comfort measures of the laboring woman. Some additional, less concrete things I like to remind fathers-to-be of are:

Follow her lead. Labor is like a dance and your partner is leading the dance! Anything I say in class or anything you’ve read about is less important than what she is actually doing and you responding to her.
The most important thing you can do is just love her. This is more important than learning “techniques.” Just love her the way you love her and she will feel your love and support.
Let it happen. I encourage women to “let birth happen” and to let it flow. As her support person, you can help her by letting her let it happen (instead of hushing her or telling her to calm down or asking her to do something different than what is working for her).
Don’t interrupt a woman who is coping well with a new technique or idea–if what she is doing is working for her, encourage THAT instead of trying to introduce new ideas or tips.
Remember that as a support person you may also experience the three “emotional signposts” of labor–these are excitement, seriousness, and self-doubt and they correspond to stages of labor. A woman in early labor shows the excitement “signpost” a woman in active labor tends to be very serious and “busy working” and during transition many women show a self-doubt signpost maybe saying they “can’t do this anymore” or “I can’t do this much longer.” It is okay to let your partner know that you are experiencing excitement and seriousness, but try to keep the “self-doubt” signpost under wraps and don’t show her that you are also experiencing that one! Be as calm and supportive and confident and trusting as you can as she journeys through the sometimes challenging time of transition in her labor.

Care in Normal Birth

Feb4

I recently discovered there is a free pdf book available from the World Health Organization called Care in Normal Birth: A Practical Guide. The booklet is very research oriented, so while it is great for finding evidence based information, it is not “light” reading for every day use! It is directed towards birth professionals.

Evidence Based Care Fact Sheet (& Mother Friendly Care)

Jan22

In Sept. 2007, Citizens for Midwifery published a useful new fact sheet summarizing the evidence basis for the 10 Steps for Mother-Friendly Care. The fact sheet is two sided and packed with information. The Coalition for Improving Maternity Services (CIMS) has a mission “to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.” To this end, they created the evidence based
Mother-Friendly Childbirth Initiative (MFCI). This Initiative “provides guidelines for identifying and designating “mother-friendly” birth sites including hospitals, birth centers and home-birth services.” There are ten steps for mother-friendly care and ample evidence supporting each step.

CIMS also has a very useful consumer handout–“Having a Baby: 10 Questions to Ask“–that helps expectant couples ask questions of their health care providers to determine if the care they are receiving is the evidence based, mother friendly care all pregnant women deserve.

The 10 Steps are:

“A mother-friendly hospital, birth center, or home birth service:

Offers all birthing mothers:
- Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
- Unrestricted access to continuous emotional and physical support from a skilled woman-for example, a doula or labor-support professional:
- Access to professional midwifery care.
Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
Provides culturally competent care — that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
Has clearly defined policies and procedures for:
- collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
- linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
- shaving;
- enemas;
- IVs (intravenous drip);
- withholding nourishment;
- early rupture of membranes;
- electronic fetal monitoring;
Other interventions are limited as follows:
- Has an induction rate of 10% or less;
- Has an episiotomy rate of 20% or less, with a goal of 5% or less;
- Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
- Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
Educates staff in non-drug methods of pain relief and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
Discourages non-religious circumcision of the newborn.
Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding…”

Pushing the issue of pushing in labor…

Jan14

Coping with the second stage (pushing) of labor can involve several different approaches. There are many benefits to pushing according to your own body’s urging and natural rhythms. Your uterus will actually push the baby out for you without any straining from you if you are in a gravity utilizing position–upright–and following your body’s spontaneous pushing urges! Some care providers and nurses instead encourage “purple pushing”–this is often the kind of pushing you see on television portrayals of birth, prolonged breath holding and bearing down, red straining face, and directed efforts (often with loud counting to 10).

The benefits of spontaneous bearing down instead of controlled, prolonged, directed pushing, and straining include:

less strain on your perineum and consequently less chance of tearing
less incontinence later
better oxygenation for your baby (less breath holding–>more breathing–>more oxygen for baby)
less wasted effort since you are working in harmony with your uterus

If you have an epidural, delaying pushing until you feel an urge or the baby’s head is visible on your perineum is preferred as well and reduces your chance of tearing and of trying to push out a malpositioned baby.

How can your labor support person “push the issue of pushing” during labor? (i.e. support you in spontaneous pushing instead of the controlled, directed pushing common on labor & delivery units). Your labor support person–husband, partner, friend, mother, sister, doula, or other person offering you their nonmedical companionship during labor–can remind provider and nurses of your birth plan (which should specify spontaneous pushing). If directed pushing is being used anyway–i.e. loud counting–your labor support can try the counting as well once or twice and then ask you in an audible voice: “does it help you when I count like that while you push?” You can then say, “no”–this is not directly offensive to nurses, but clearly states what is helping and what isn’t and getting pushing back into your “court” which is absolutely where it belongs!

Thanks to the fabulous publication International Doula for getting me thinking about this topic (and for the catchy title)!

Comfort in Labor Handout

Dec18

Childbirth Connection also has an excellent handout titled Comfort in Labor. It is by Penny Simkin and it has TONS of great line drawings and covers a lot of labor support material in 14 pages. For partners looking for ideas of how to support women in labor, this is almost like a really quick doula training!

What is a doula?

A doula is a labor support professional trained to support birthing women physically and emotionally. She is a non-medical care provider who offers continuous one-on-one care during labor and birth.

Care Practices that Support Normal Birth

Dec5

The Lamaze Institute for Normal Birth has a powerful series of research based care practice papers describing the six care practices that support normal birth. The papers were updated recently and are available on their website in both HTML and printer-friendly PDF formats. These care practices are of vital importance to the normal birth process. The papers are extensively researched and include many citations and are an excellent resource to share with your doctor or with curious (or doubtful) family members or friends. These care practices form an underlying basis for much of the information I present during classes and are practices that should underlie good care in any birth setting (though, sadly, all too often what women receive from their care providers is NOT evidence based and does not follow these care practices. I will write more about this later). Lamaze’s Care Practices are:

Care Practice #1: Labor Begins on Its Own

“Labor is a set of complex, interacting components. Alteration of the natural process can expose a woman and her baby to unneeded risks.”

Care Practice #2: Freedom of Movement Throughout Labor

“Free movement during labor allows a woman to manage contractions and assist the baby’s rotation and movement through the pelvis.”

Care Practice #3: Continuous Labor Support

“Current research supports the benefits of continuous emotional and physical support during labor.”

Care Practice #4: No Routine Interventions

“Supporting the natural, normal, physiologic process of birth requires clear medical indications prior to any medical intervention.”

Care Practice #5: Spontaneous Pushing in Upright or Gravity-Neutral Positions

“Allowing a woman to find positions of comfort and encouraging her to push in response to what she feels is beneficial to the birth process.”

Care Practice #6: No Separation of Mother and Baby, with Unlimited Opportunities to Breastfeed

“When a baby is kept with the mother, there are physiological benefits to both, including the facilitation of breastfeeding.”

My own short description of the care practices using more direct language would be:

1. Avoid induction.

2. Stay out of bed. Move around a lot!

3. Hire a doula.

4. Demand individualized care–no interventions that are “just because” or “hospital policy.”

5. Squat, kneel, or get on all fours to push.

6. Breastfeed your baby early and often! Keep your baby with you and do not let hospital staff separate you from your baby because of routines or policies.

Finding Your Question

Dec4

Another concept I like from Birthing from Within is that of, “finding your question.” Really, it is your question in response to the question, “what is it I need to know to give birth?” This question was personally meaningful to me during each of my pregnancies. During my first pregnancy, my question was simply, “Can I do this?” I felt like birth was a “test” that I had to pass and that I needed to make sure to study for so I could “pass” it well! After giving birth, I realized that it hadn’t really been a test, but was instead really a rite of passage.

With my second pregnancy, I revisited the concept of finding my question and it was, “Can I mother another?” I finally answered this question for myself late one evening (while not in labor and resigned to being “pregnant forever”) and less than four hours after that I was holding my baby in my arms! 🙂

My personal experiences have led me to believe that finding your question can have important implications for your birth and it is an interesting concept to consider.

Worry is the Work of Pregnancy

Dec3

This is a concept I like to introduce in childbirth classes. I first came across the phrase “worry is the work of pregnancy” in my most favorite of birthing books, Birthing from Within by Pam England. I’ve noticed that women often feel like they shouldn’t have worries during pregnancy and that talking about their fears is somehow “dangerous” (like it will make the fear come true). Bringing fear out into the open and “looking at it” instead of keeping it tucked away and bothering you is actually one of the best ways to work with it. Another common concern is that your worries are “silly” or unfounded. It is okay to have worries, even “silly” ones! The strategy Pam suggest for exploring your worries is as follows:

Explore each worry with questions:

° What would you do if this worry /fear actually came true?

° What do you imagine your partner and/or birth attendant would do/say?

° What would it mean about you as a mother if this happened?

° How have you faced crises in the past?

° What, if anything, can you do to prepare for, or even prevent, what you are worrying about? What is keeping you from doing it?

° If there is nothing you can do to prevent it, how would you like to handle the situation?

The Three R’s of Childbirth

Nov26

A concept I find useful to share in birth classes is that of Rhythm, Relaxation, and Ritual–the Three R’s of Childbirth. This is a concept developed by Penny Simkin and is illustrated in her labor support video by the same name. Ritual refers to a repetitive coping mechanism that spontaneously arises during labor–it usually is rhythmic and may be something like humming, singing, repeating a favorite phrase, tapping, vocalizing, rocking, swaying. You can think about and plan for possible labor rituals in advance, but the ritual that is most useful to you is often one that just arises on its own during your own individual labor and birth.

These are three R’s that enhance a woman’s experience of birth and help her cope with her sensations. When thinking about them today, I also came up with three R’s that detract from a woman’s birth experience: Routine, Restriction, and Risk (perception of).

I also considered other supporting R’s: Rest, Relationships, Rapport, and Respect.

Birthing Affirmations

Nov22

One tool I like to offer during birth classes is the use of birthing affirmations. I have a list of favorites that I hand out and I also encourage couples to create their own affirmations that hold personal meaning for them. An affirmation is a positive phrase that you repeat to yourself. Some women like to cut these phrases out and post them around the house to read during pregnancy (such as on the mirror in the bathroom or on the wall in the bedroom). The affirmations can then “sink in” and when labor comes, they are part of your mental vocabulary of birth. Also, some women in labor find the use of rhythm to be a useful tool (humming, singing, swaying, rocking, etc.) and repeating a soothing phrase can be part of this rhythm.

Another use of affirmation is to have your labor support partner read your favorites aloud to you as you labor.

Some favorites from my list are: