Pregnancy, Birth and Beyond

http://www.pregnancy.com.au/resources/topics-of-interest/labour-and-birth/the-ideal-birth-support-person.shtml

The ideal birth support person: everything you always wanted to know

A birth support person can make a huge difference to what happens during your labour and birth. Most people have one, sometimes it’s the father of the baby, sometimes it’s the mother of the mother, other times the relationship is unexpected, such as an ex-partner, a brother or a mother-in-law

By

Birth Support

Most people have one, sometimes it’s the father of the baby, sometimes it’s the mother of the mother, other times the relationship is unexpected, such as an ex-partner, a brother, a mother-in-law or even a friendly sperm donor! Whoever it is that you choose for your support person, know this; they can make a huge difference to what happens during your labour and birth.

Jodie’s story

Jodie is what you would call ‘experienced’ when it comes to birth. Currently pregnant for the fifth time, she has really done it all  – from caesarean, to home birth, to hospital birth. After sadly miscarrying twins ten years ago, Jodie never would have imagined she would one day be about to give birth to child number four.

Elicia

Her first baby, Elicia, was born by caesarean section. “The placenta lay across my cervix, which is a dangerous pregnancy complication called, placenta praevia, ” Jodie explains. “There really was no other option than to have a caesarean.” Despite this, Jodie says she experienced the best birth she could have had under the circumstances. She managed to have her partner Matt in the operating theatre, as well as Janine her support person and life-long friend. Jodie was also grateful she got to hold and breastfeed her little girl straight after the birth.

“Janine was not just a friend and support person, but she also had great photography skills,” Jodie explains. “She was able to come into the operating theatre and take some wonderful pictures.” Jodie says she needed the photos because she missed out on a natural birth and there was also some question as to whether she would have to be put under a general anaesthetic during the surgery, due to the placenta praevia. The photos of the birth are now treasured memories for Jodie and one of Elicia’s most precious possessions.

Jodie says Matt her husband was really reluctant to be at that first birth, and in some ways Janine was there to support both of them. “Here we were in a room surrounded by lots of masked strangers and beeping machines and there was Janine taking photos, smiling and giving me the thumbs up. It was so nice to see someone else excited that I was going to be a mother, when everyone else was just focusing on the technical aspects of a caesarean,” Jodie says. And what about Matt? “Matt coped amazingly well. Here was someone who had never been in hospital and didn’t really want to be there, and yet he was, and I am grateful he was, as it was a big sign of his support and love for me.”

Aimee

Pregnant with her next baby Jodie was determined to have a natural birth. She found an independent midwife and went on to give birth to Aimee after a very quick labour. While she had the complication of polyhydramnious (too much amniotic fluid) everything went well. “This birth helped with so much healing after the first birth, “ Jodie says. Matt, her midwife Jan and support person Amy, all worked together to add to the magical event. “This time Matt found the birth so different and so much more enjoyable,” Jodie says.  Amy, Jodie’s support person, was a great friend and a strong believer in natural birth. “This was important to me because she was the only one in my circle of family and friends that embraced home birth and was supportive.” Amy had other important attributes as well, Jodie explained. “She was a very kind and giving person as well as being assertive. She had that important balance of being gentle and calm under pressure and I knew she would be objective enough to be able to advocate for me.” This was important, Jodie says, because Matt would naturally be emotional and need to focus on her. Amy knew everything Jodie wanted by the time of the birth, because she was present at the antenatal visits, attended the antenatal classes, read books, did a reflexology course and understood all Jodie’s hopes and dreams for the birth.

Jodie describes how Amy set the birth scene at home. “When the labour started Amy lit candles, got the aromatherapy going, arrived with a bunch of roses, which was the birth flower for that particular month. Amy’s presence was so calming. I had never felt so nurtured.” Jodie feels the birth was very healing after her first experience. Her only regret is that Amee’s birth happened so fast – there were no photos, like the ones she treasured from Elicia’s birth. Jodie also had her mother there to look after Elicia while she gave birth to Aimee and she says this was difficult at times. Her mother had nearly died giving birth to Jodie, and naturally had a lot of unresolved fear surrounding childbirth. She also did not feel confident about Jodie’s birth choices, which was not a reassuring whilst giving birth. “I remember her looking into the room with a really worried expression on her face,” Jodie says, “and it made me feel worried. I was worried about her, worrying about me”.

Cole

With the next pregnancy, Jodie once again planned a home birth with her midwife Jan, but late in the pregnancy she developed pre-eclampsia – a pregnancy complication where blood pressure rises dangerously. This meant Jodie needed to go to hospital to have the baby. Amy, her support person for the previous birth, planned to be there again, but Jodie went over her due date and Amy had to return to Tasmania, where she now lived. “That was really hard,” says Jodie. “I felt quite sad when she left.” But things turned out well, because Jodie, determined to capture this birth on film, had contacted a well-known, childbirth filmmaker, Nic Edmondstone to be present at the birth. While Amy had to go back, Nic stayed, and Jodie says, “she turned out to be a fantastic support person, even though that was not actually what she was there for. Nic has been at lots of births and knew what to say, and more importantly, when not to say anything! I guess when you sit behind the camera watching so many births; you pick up a thing or two. She would put the camera down and come over and massage me and comfort me when she saw I needed it and then continue filming.” Jodie says, “it was perfect really, because this time I was more frightened than with Aimee’s birth – being in hospital again and hooked up to machines – so I needed the reassurance.” Cole was born naturally and his birth is recorded in a beautiful film that moves everyone who sees it to tears.

To be announced!

Jodie will be giving birth to another baby in October and this time the story will come full circle, as her support person will be Elicia, her first-born – now eight and a half and very experienced after the births of her siblings. Amy, who was support person for Aimee’s birth, now lives in Tasmania and is expecting her second baby, so can’t make it. Nic is coming back to film this birth and will no doubt carry on being supportive as well. Jodie once again has an independent midwife and is hoping for another home birth. “ I don’t think there are any more problems beginning with ‘P’ that I can have,” she jokes – referring to her first pregnancy where she had placenta praevia, her second with polyhydramnious and her third where she had pre-eclampsia. “This time I hope it will be all straightforward, but birth is a journey with unknown adventures along the way. What is important is having the right people with you on the journey, because then both the good and the not-so-good can be made considerably better.”

Choosing the best support person

Characteristics of a CALMING support person

Calm in a crisis
Always positive
Loves you
Makes you feel safe and comfortable
Intuitive to your feelings and needs
Nurturing
Good attitude to birth, with no personal baggage

Giving birth is one of life’s most emotional, intimate and instinctive experiences. The people you choose to experience this with need to be respectful of this fact and be able to enhance, not detract from the experience. Birth should not be treated as if it were a family reunion or an office Christmas party, and yet this is exactly how some people seem to view it. Loud raucous-laughter punctuated by yee-haas, is generally not conducive to a good birth. Women often instinctively know who would be the best support person for them. Like Jodie said, when describing Amy, her support person, a calming person is ideal (see break out box 1.). Where a woman cannot find this sort of person in her circle of family and friends a Doula can be invaluable (see break out box 2.).

Can having a support person be helpful?

Doulas

Doulas are women trained in giving women professional birth support. They meet a woman and her partner during pregnancy and support her during the birth and sometimes also in the early postnatal period. This service can be of value to women who do not have adequate support and/or can’t access a midwifery programme where they get to know one midwife or a couple of midwives. Doulas provide emotional and physical support for the woman and her partner during birth. They provide massage and other comfort measures during labour. They can also help with communication between yourself and the hospital staff. Doulas are not midwives and therefore not trained to provide any clinical advice or examinations.

Having the right support person can help make the birth a better experience. Research indicates women who receive close support and care throughout labour are less likely to need pian relief, or have major interventions, such as caesarean sections, forceps or vacuum. They are also more likely to be satisfied with their birth experience.

Can having a support person be harmful?

If a woman does not feel comfortable with the support person, it can adversely affect her labour. Women need to feel safe in order to labour. There is nothing worse than a support person’s own anxiety affecting your labour. A mother, who breaks down crying and begging for pain relief for her daughter, because she can’t stand watching them in pain, is not helpful. Likewise, a best friend who had a caesarean and keeps telling you that you are doing it the hard way is not ideal. Your support people need to be strong and help you out, not make you feel like you need to help them out. If you become frightened and feel unsupported you begin to secret adrenaline. This is known as the fight-or-flight response and it prepares your body to escape, or to fight when under threat. During labour this has a negative effect, as it inhibits the production of the most important hormone in labour – oxytocin.  When this is inhibited, labour slows down, leading to interventions in birth and what we commonly call the ‘cascade of intervention,’ where one intervention leads to another.

Tips for the support person

  1. Be interested, by finding out what is important to the woman and by being aware of her birth plan, if she has one. Come along to some preparation for parenting classes, read books and watch a birth video. Remember, you need to be on call for several weeks to before and sometimes after the due date.
  2. Be a comforter, by massaging backs, renewing hot packs, getting ice for her to chew on, wiping brows (sometimes noses) and assisting her into different birth positions. Always check with the midwife first.
  3. Be a communicator, by taking phone calls and passing messages on to inquiring friends and family, so her partner doesn’t have to leave. Check before hand who is allowed to know what, at which time!
  4. Be a supporter, by not taking over from the partner, but by supporting them to support the woman. Don’t be loud and crack lots of jokes. She does not need cheering up; she needs cheering on (quietly). This is not a party, it’s a labour so be quiet and calm and don’t intrude too much. Don’t talk during contractions and don’t talk about the woman or over the woman as if she is not there.  After the birth, leave the couple together so they can spend some intimate moments alone.
  5. Be an advocate if there is conflict between the woman, her partner and her caregiver – but try to stay calm and appeal to reason. Refer to the birth plan if needed, but also recognise not all births go to plan. Remember, at all times this is her birth not yours so follow her lead and what you know she would want. Leave your own baggage at the door!
  6. Be a trusted friend and remember the woman you are supporting may become uninhibited and even aggressive. If she swears like a drunken sailor, remember its normal in labour. Don’t humiliate her by telling stories to others about how she acted in labour. It’s her birth and her birth story.

Partners as support people

In almost all cases women want their partner present. This does not mean that their partners always want to be present – as Jodie described in her story. Herein lies the dilemma. Not so long ago men got to pace outside the door and light a cigar at the sound of that newborn cry. Yet, in many ways I think this was far harder than being in the room with their partners. The hardest thing for any partner to cope with, whether they are male or female, is the feeling that they are so helpless. Women will say however, that their presence and touch in most instances is of great comfort. Partners who really don’t want to be at the birth can be traumatised and also potentially detract from the whole birth experience. In these cases it is better to consider a really good friend or relative as a stand-in, just in case your partner can’t cope. It is very rare partners don’t cope and they usually surprise everyone with how great they are and what an important role they play.

A support person for children at the birth

If you are having a child or children at the birth, you will need to choose a support person to specifically look after them. It needs to be someone you would want at the birth but also someone who gets on well with your child. The last thing you need when in labour is to be worrying about your child or have your partner unable to focus on you. Make sure the support person understands their role will be caring for the child and this may mean missing the birth if the child needs to be taken out of the room at any time. Also, they need to be prepared to be on call for you in the last few weeks of pregnancy.

How do you say ‘no’ to ‘birth crashers?’

Like wedding and party crashers, some women have a problem with ‘birth crashers’. These are usually family and/or friends who assume they have a right to be at the birth. In some cultures, for example, it is common for the mother and mother-in-law to be present at the birth. This is perfectly fine if it is what the woman wants and feels comfortable with. If someone has made this assumption, however, it can be very difficult to say “no,” as you may fear the ramifications. Women may find out that their mother or mother-in-law has invited herself to the birth, for example, when they hear her telling friends she will be there, or when she simply announces she has booked holidays in order to be there!

There are several ways to deal with ‘birth crashers’. One very effective way is not to tell them when you go into labour! You can also simply inform them kindly, but firmly, that you have decided it will just be you and your partner. If that is too difficult for you, then get your partner or a trusted friend to set them straight. This is also where a birth plan can come in handy, helping to make clear to those who look after you in labour, who you want at the birth and who you do not (see story on birth plans- page**). Enlisting your midwife’s help is a good idea. I have acted as ‘birth bouncer’ to ‘birth crashers’ many times, and it can be done diplomatically. Midwives can easily tell ‘birth crashers’ that now is not a good time and to come back later, or wait to be called. A sign can also be put on the door of the birth-room that says “strictly no visitors,” in order to remind everyone of your wishes.

Giving birth is about a lot more than having a baby – it’s about making mothers and growing families. The right support people can help enormously in making sure that all the ingredients are there for a wonderful start to life.