Who provides support during labor and birth?
Doctors and midwives Physicians are typically only in attendance at the delivery itself and for about one hour after the baby is born. Prior to that, they are available for phone consultation. They may come in briefly a few times during labor to check on you, answer questions or provide recommendations about your care. In one study, 70 percent of moms reported their baby was delivered by the same caregiver who had provided most of their prenatal care. However, 10 percent said it was someone they had only met briefly prior to the delivery, and 19 percent said they had not met their primary birth attendant before the delivery. Midwives may remain with you through a much larger portion of your labor and are more likely to offer the kinds of supportive care described in this article.
Nurses Hospital staff members can meet your concrete needs and will attend to the safety and well-being of your baby. Many nurses are excellent at providing hands-on labor support and also offering emotional support and encouragement. However, they also have other duties and responsibilities, which may prevent them from attending you continuously through labor and birth. Also, usually your nurse is a stranger to you, and you may have multiple nurses attending you, depending on the length of your labor.
Husbands/partners If you and your partner are both comfortable with the idea of his attending your labor and birth, he or she can be your most valuable source of emotional support and comfort. Loving partners are one of the strongest tranquilizers and most effective pain relievers available. Their nurturing presence may also encourage the flow of oxytocin, a hormone which helps labor to progress more quickly. For many fathers, the involvement in birth gives them a chance to nurture and care for their partner like never before, which is great practice for nurturing their new babies.
The dubious support person
If your partner is worried about his ability to be helpful during birth (such as being worried about fainting), education about what to expect can be very helpful, especially attending childbirth education classes and watching videos of births. Talking with friends who’ve attended a loved one’s birth can also be helpful. Some couples may also want to have an additional support person (see below) to take some of the burden of responsibility off the partner’s shoulders, reduce anxiety and make him more available to support mom.
After the birth, partners may worry that they were not useful. Nurturing and supporting can feel passive, and they may feel as if they didn’t do enough. Learning about birth ahead of time may help them realize how vital relaxation and reassurance can be to labor progress and pain relief.
Some fathers feel overwhelmed by their laboring partner’s discomfort and the feelings of helplessness it causes. Again, knowing ahead of time what to expect and how to help is useful. Also, birth education may help to normalize that the pain of labor is productive and isn’t something to be fought against, just something to be soothed with loving attention.
The dubious mother-to-be
If you’re worried about your partner’s ability to be helpful during birth, especially if there are problems in your relationship, you might be nervous about your partner’s presence at your birth. You can involve additional support people, if that would be helpful. You may want to seriously consider seeking out counseling to resolve some of your issues before the baby’s birth, as the stresses of parenting can strain even the healthiest relationship.
Friends and family
Familiar faces can be comforting, helping you to stay calm and relaxed. Friends and family can provide support for both you and your partner. The more educated and experienced they are with labor and birth, the more effectively they can support you with concrete ideas for comfort and for helping labor to progress.
However, sometimes friends and family members have a difficult time seeing a loved one in pain. Rather than being able to reassure you that you’re doing well, they may convey their anxiety to you in messages like “Wouldn’t it be better to use pain medications?” The more you can talk to them in advance about your desires for your labor and birth, the more aware they will be of what would be helpful for them to do and what would not be helpful.
Doulas
A doula (also known as a monitrice or labor support professional) is a professionally trained labor support companion. Doulas have completed education about the normal labor and birth process, medical interventions, techniques to minimize pain and aid labor progress and emotional needs during labor. They provide information, advocacy, emotional support, physical comfort and suggestions to laboring women and their partners.
A doula does not replace your partner; instead, she helps your partner to be as supportive as possible by reducing his anxiety, giving ideas for how he could be more supportive and giving positive feedback to him for the support he is giving.
A doula provides a continuous presence throughout labor. Typically, you inform your doula when labor begins, and she will join you at whatever point in labor you and your partner decide that extra support is needed. The doula stays throughout the labor until one or two hours after your baby is born.
The fee for a doula’s services varies depending on her skills, experience and the degree to which she relies on her doula work to support herself versus serving as a supplement to her income. A typical fee ranges from $300 to $550, including a prenatal visit, labor support and postpartum followup visit. Sliding scale fees are often available for low-income mothers.
Your concerns during labor
Some pregnant women are nervous about having people at their birth for various reasons. Here are some responses, based on my conversations with women who have given birth and friends and family who’ve been in attendance.
Concern: modesty “I’m not comfortable with my friends seeing me naked.” During labor, most mothers forget about this concern; they are so focused on the labor and birth that modesty seems less important to them. Support people who are truly being supportive will also be focused on the birth process and generally don’t put much thought into your clothing -- or lack thereof -- or exactly what your body looks like.
Concern: body image “Will my friend like me less if she realizes I’m fat?” “What if I’m out of control, or a wimp or whatever… Will he think less of me?” Birth is an intense and intimate experience. Your friends and family will see more of you (in many senses) than they see in normal interaction. They will see some of your weaknesses, but they will also see your strengths. Sharing this life-changing experience will change your relationship -- but typically, it’s a change for the better: a deeper, stronger, and richer relationship.
Concern: privacy “I want this to be an intimate experience, with just my partner and me.” If you are giving birth in a hospital, the experience will not be private, as staff may come in and out of the room on a regular basis. Having a trusted and supportive friend there with you can actually help serve as a buffer between the birthing couple and the support staff, sometimes in the abstract sense of being a familiar face in a room full of strangers. Sometimes, if the couple needs some time alone, the extra support person can stand outside the hospital room and let others know that.
Concern: politeness/etiquette “I’m afraid I’ll say something offensive.” Sometimes during labor, social inhibitions slip about what is “acceptable” to say out loud and what is not. If you are concerned about this with a particular support person, just apologize in advance: “If I say something offensive during labor, I apologize, but it’s an intense experience and I’m not sure how it will be until we get there.”
Concern: non-helpful helpers “What if he flips out and I end up feeling like I need to take care of him?” Prior to the birth, if friends or family who you do not think would be helpful to you ask to attend your birth, it is ok to tell them they can’t come. Try to think of other things they can do to be helpful.
Prior to the birth, let support people know what you think will be helpful to you during labor. Also, let them know that you are not certain what your needs will be and that there is a chance you will ask them to leave. Reassure them that this won’t be out of anger but simply out of trying to figure out what your needs are during this unique experience.
During the birth, if someone is doing things that bother you or if you feel like you can’t focus on the birth because you need to take care of this other person, then you can first ask them to change what they are doing. If that doesn’t help, then you may ask them to leave. If you don’t feel comfortable asking your friend or family member to leave, quietly ask a nurse or caregiver for help: they will find a gentle way to send them away.
Advice for labor support people
Throughout labor and birth, you should help a continuous presence, reassuring, supporting, encouraging, normalizing and loving. Sometimes this is very active, giving ideas and taking actions. Sometimes all a mother needs is the presence of someone who cares about her, who is calm, who helps her feel safe and is confident of her ability to give birth in the way she wants to.
Remind the mother to take care of basic self-care needs: eating, drinking, resting, going to the bathroom at least once an hour. (Remember to do these things for yourself, too!)
Support people remain sensitive to mom’s emotional needs and try to match activities and behavior to mom’s mood.
During early labor, keep mom calm, relaxed and distracted. Encourage mom to alternate rest and relaxation with activities to promote labor progress. Reassure mom that everything is fine.
At the hospital, serve as mom and baby’s advocate or help mom to advocate for herself. Ask questions of the staff to make sure that you have all the information you need to make decisions, ask questions of you to clarify that you understand the risks and benefits involved and clarify any places where your choices may differ from the birth plan you developed in advance.
During active labor, remind mothers about breathing techniques, remind her to change positions often, suggest different positions, massage and offer distractions such as reading and music. Reassure and encourage. It’s important to offer specific suggestions and options from which she can choose.
During birth, assist with positions, help the caregiver guide pushing efforts and remind mom to breathe.
What should support people not do during labor and birth?
Don’t criticize and complain. The mother needs support in laboring her own way and suggestions for things to try. She doesn’t need to be told that she is doing things wrong. During labor, women are very receptive to the things that are said to them. If you say to a laboring mom “You look exhausted,” then she will feel even more exhausted! Instead, notice for yourself what mom’s state is and try to adapt suggestions to that: “Maybe it’s time to try a resting position,” or maybe it’s time for a little extra emotional support.
Try not to ask open-ended questions such as “What would you like to try next?” Especially late in labor, mothers may not be able to think up any ideas and will only find the questions stressful. It’s better if you can say, “Here are three suggestions; which one of these things sounds best to you?”
Don’t encourage the mom to do things that don’t fit in with her hopes for the birth. The most common situation is that in which the mother-to-be hopes for a non-medicated birth, but then a support person finds it difficult to see her in pain and makes comments like “This is too much, honey, why don’t we find out about pain medication?” or “How much longer until you can have pain medication?”
Support people should try to keep their own issues out of the way and focus on the birthing mother. Labor and birth is not a good time for the husband to vent at his mother-in-law about how he “hates it when she does that!”
At the most basic level, laboring moms need to feel respected, loved, nurtured and reassured.
Breathing techniques, massage and all sorts of other comfort techniques for labor help with pain.
© Janelle Durham
Janelle Durham is a doula, childbirth educator and owner of Transition to Parenthood.
