Labor support: a partner’s touch

Give your laboring partner a hand!

Dads-to-be want to give their partners the best support possible during their birthing time. Here are a few simple ways to comfort, encourage and empower your partner while taking care of yourself, too.

be near

Your partner wants to know that you’re involved. She wants to see that you’re invested. You already know not to fixate on the machines, but do you know that there is a big difference between sitting next to her and standing 3 feet away?

Physical contact with a loved one may be one of the most comforting experiences a woman can have during labor. If she enjoys being touched, slow dance with her or sit in front of her and let her lean into your chest. If she’s not a big cuddler, hold her hand or rub her feet. If she doesn’t want to be touched, stay within arm’s reach. She may change her mind from one contraction to the next and will appreciate your unwavering presence.

Where ever you are and whatever you are doing, do it with the intention of being connected to your partner. Turn the TV off. Put your cellphone in the labor bag. Use your iPod to find an ambient station on Pandora and just wallow in the presence of your life-giving partner. Even if she’s updating her Facebook, resist the urge to do the same.

Temper your attentive focus with common sense. Don’t regard her like a science project. Scrutinizing her and asking “did that really hurt as bad as you made it look?” is not offering her emotional support. Stroking her back and telling her “you are doing so well, you were made for this” is affirming her hard work and giving her strength for the next challenge.

never fear

If the medical team moves into your partner’s space, don’t move out. So often during hospital births, a laboring woman and her partner may struggle to claim the institution’s space as their own. Birth centers tend to have a less clinical feel but are still someone else’s territory. Even the most comfortable couples can feel intimidated by the medical attendant who asks to do clinical tasks.

When this happens, ask the staff member, “do you have enough room there?” as he or she gets close to the area they need to be in to carry out their task. You’re not requesting permission to stay where you are; you are making it clear that you are stuck like glue. What you are doing is setting the foundation for a mutually respectful birth environment.

For example, hold onto your partner’s hand while a nurse checks her temperature.If the caregiver needs to squeeze in, shift just enough to give that person room to do so. It’s a small gesture that goes a long way. The caregiver will see that you are confident in your role yet considerate of the entire birth team. Your partner will see that you will always put her first and not leave her feeling alone during potentially uncomfortable moments.

Even if there is a concern for Mom or baby, assume that it is okay to stay close. Reassure your partner regardless of any anxiety you may be feeling. Pack up that big ball of stress and put it away so you can discuss it with when the worry has passed. Make eye contact with your partner and help her take deep, steadying breaths.

When in doubt, don’t freak out! The staff will not hesitate to ask you to step back if Mom or baby is at risk. In the very rare case of a true emergency, you will told to move out of the medical staff’s way immediately.

tank up

Take care of you so you can take care of her. Every time you remind your partner to drink, remind yourself to sip on something too. Water is one of the basics that should always be available, but be sure to pack some drinks with some punch too. Juices, coconut milk and gatorade can boost your energy level with some much needed sugar and calories. Be sure to offer your partner some, too!

Some things are just for you, however. Coffee is almost always available (especially if you’re willing to compromises on the quality) but keep in mind that coffee breath becomes 10 times more unpleasant to your partner when she’s in labor. If you’re putting Folger’s in your cup, there better be some Altoids in your pocket.

Make sure some one-handed snacks like apples and granola bars are easily accessible. It’s not very considerate of you to be chowing down on a greasy double cheeseburger while your partner is working hard through each contraction. Just like with coffee, consider the smells certain foods might carry. Be mindful of garlic, onions, pickles, barbecue sauce and the like.

dress down

Labor is an athletic event for birthing women and their partners. You will probably sweat and stretch alongside your partner, so dress appropriately. Take a cue from the clothes your partner is choosing to wear. Most women will want something that is loose fitting, soft, stretchy and comfy. If she’s in her pajamas, you can be too! Going to the birth place is not a new parent interview; no one is assessing your fathering skills based on how well your pants are pressed. Wear something that evokes positive thoughts (like a t-shirt your partner got you on a special occasion) but not something you wouldn’t mind parting with (birth is usually messy).

You may have already packed your swim trunks if your partner has expressed an interest in hydrotherapy. Just a casual change of clothes wouldn’t be a bad idea either. If Mom wants you near her but not in the water while she is in the tub or shower, you may end up soaked anyway. Everything from you wrist to shoulder may get wet while leaning in to apply counter-pressure to her back or squeezing her hips. Changing out of a wet shirt will be more comfortable for you and your partner. Plus, your new baby will want to snuggle on your nice warm (not chilly and wet) chest.

Also plan your foot wear with care. Be prepared to be on your feet. A lot. For a long time. Pretty frequently, your partner will need you to be standing, kneeling or squatting in order to offer her emotional or physical support. If you normally work in or like to wear heavy duty or inflexible shoes (think steel-toed boots, birkenstocks, etc) stash a pair of comfy sneakers in a strategic place ahead of time. Think about putting your birth shoes in the car you plan on taking to the birth place or in the labor bag. Think twice about flip flops or Vans. They may look like a good idea, but after a few hours of active birth support, your feet will not agree with you.

find your voice

Laborland is a wonderous place, infused with the same creative intuitive magic as deeply satisfying sex. Labor and birth work best when Mom and her partner feel free to do and say what feels right. So speak up! Even if you start out feeling as awkward as a high school freshman, you’ll get the hang of it pretty quick.

Look for her nonverbal cues first. When you say, “RELAX!” and grip her shoulder, what happens? If she tenses at your voice and touch, it may be time to soften your approach. Try again, saying “let your shoulders go completely limp and loose, just rela-a-a-a-a-x” while lightly squeezing her shoulder. Watch in amazement as her upper body sags forward and she lets out a long, deep breath.

If she is resistant, be gentle but insistent. Being able to relax the body when it is being gripped by one of the most intense sensations on the planet—a contraction—is a learned-on-the-job skill. Top notch encouragement will help her be patient with herself as she learns to work with her body. Keep trying different strategies until you find one that works.

There are some very obvious things that probably should not be said to a woman in labor. Unless your partner enjoys fart jokes, any joking references to her bodily functions or fluids are pretty much off limits (commenting on her vagina, vaginal discharge, vomiting, peeing or passing stool just to name a few). Birth is involves a lot of physical changes. Trust me, she is already super aware of that.

Don’t misunderstand—laughter is a powerful analgesic. Just use your powers for good instead of evil. Regale her with a funny story from when you were dating or talk about a movie you both loved to laugh about. Enjoy any poop or puke observations privately.

If you’ve got no idea what to say to her in the moment, try some of these out:

 

She says…

“It hurts.”

 You could say…

“Does it help if I rub/push here?”

“Let’s try something different with the next contraction.”

“All you have to do is breathe. Blow the pain away.”

“Relax your entire body. Let your belly and our baby do all the work.”

“The more we focus on something else, the less you’re going to think about it hurting.”

She says…

“This is hard.”

 You could say…

“Yes, it is. But you are doing so well!”

“Do you want to try that position we talked about before?”

“Remember how much better it felt when you were ____” (standing) (leaning) (swaying) (in the tub) (on the birth ball)

“I can turn off the lights and tell your (mom) (sister) (best friend) that we need some quiet time.”

She says…

“I can’t do this.”

You could say…

“You ARE doing it! You’ve BEEN doing it! You WILL do it!”

“Every contraction is helping you and our baby make lots of change and progress.”

“Maybe it’s time to try something new! What’s one thing we could change that would make it doable?”

“Let’s get back into your _____” (rhythm) (focal point) (favorite position)

She says…

“My back hurts.”

You could say…

“Let’s try a different position.”

“Do you want something warm on your back? I can heat up this rice sock.”

“Does it feel good when we do counter-pressure? Or the hip squeeze?”

“Why don’t we get in the tub/shower for a while.”

She says…

“I can’t believe I’m only ___ (3 cms) (0 station).”

You could say…

“Let the medical attendants worry about that. You’re doing so well. Let’s get back into that rhythm you liked.”

“Your body and our baby know just what to do.”

“Dilation ain’t nothing but a number!”

“Focus on what we’re doing now. We’re going to take these contraction one at a time.”

“Each contraction is bringing our baby closer to us.”

She says…

“This is taking forever.”

 You could say…

“We could cover up the clocks.”

“Let’s ___” (go for a walk) (change positions) (have a snack) (get some rest)

She says…

“I’m so tired.”

 You could say…

“You can lean on me. I’ve got you. You just work through the next contraction.”

“Let’s find a position that works for you to rest in between contractions.”

“I can turn the lights off and close the curtains.”

“We can put a cool cloth on your eyes while you rest in between contractions.”

Mother the mother like no other

Mother the mother, or tend and befriend?

There has always been one caveat of doula-ing that I have resisted: mothering the mother (MTM).

Oh yes, the big one.

The big one that almost completely defines the spirit of a doula.

The biggest one (arguably) in both the formal and informal worlds of doula trainings and apprenticeships.

THAT one.

I heard the phrase while researching the original Klaus and Kennel childbirth-educator-turned-labor-support paper. Upon reading it, I think I literally cocked my head to one side and said “…huh?” My initial reaction was—why would any woman want that?

First off, the words literally bothered me. It might have something to do with the fact that I was forbidden to call my mom “mother”. She hated the word almost as much as she hated the phrase “that was a hoot” and the smacking of chewing gum. She’s not a tyrant. She is one of the most wonderful people on the planet. She just has a few pet peeves that we learned to respect at an early age.

So there’s strike one. The word “mother” has always had a negative connotation for me. Repeating it twice in the same sentence makes me grimace.

The next facet of my resistance to MTM was the perspective with which I was personally approaching motherhood. Being a 20-year-old-first-time-mama disrupted my transition from being my mother’s daughter to being my own daughter’s mother. My view on mothering had been sucked into a vortex; I was fixated on my most recent experiences with my mom rather than the earliest. Unfortunately, I was stuck in the tumultuous high school and college years when my mom was more of a manager on duty than anything else. There was a lot of directing and facilitating, but not a lot of hands-on or heart to heart. I had so little time to adjust to the idea of being a mom myself that I completely forgot to consider the experience of being on the receiving end of mothering as a child.

There’s strike two. In my frenzied attempt at merging my identities as “the mothered” and “the motherer”, I had bypassed the early years of baby and toddlerhood and preserved the most recent memories instead. Treating my clients like unruly teenagers was not an appealing thought.

Finally, at the age of 22, I could not fathom “mothering” women who were, more often than not, older than myself. Of the handful of clients I started with, the majority of them were older than I was. It was uncomfortable for me to even imagine mothering these mothers. I envisioned myself puffing up like a brood hen and drawing these women beneath my feathers. It was absurd. It didn’t fit who I was. What did fit was more of a casual, instant-friend-who-knows-and-trusts-birth position that set me up as a friend/confidant/educator/therapist. As I stepped into this role I had built for myself, I felt comfortable and confident. I felt like I was the doula I wanted to be. Mother the mother? No. Tend and befriend the mother? Yes.

That’s strike three (if you’re still keeping score). Being young and deeply convinced that mothering was a brood-hen-ing/hyper active management syndrome did not make MTM a good fit. At the time, MTM meant putting on a persona that I felt was poorly fashioned for my disposition.

There I was, a doula who didn’t believe in MTM, a doula who had struck out with one of the basic tenants of doula-ing. Then an epiphany came that changed the whole game.

One sunny day I took my daughters (4 years old and 2 years old) to a family farm. As we wandered from one end of the small establishment to the other, my littlest one tripped and went sprawling into the gravel. She cried over her scratched hands and knees. I scooped her up, murmured incoherent words to her, set her on her feet and marveled as she instantly went back to running down the lane as if nothing had happened.

Later, as we were lavishing worshipful love upon a farm dog named Cricket, my oldest daughter took a crack on the nose from the top of the dog’s head. I gathered my child in my arms, showing her how to rub where it hurts to help the pain go away. Then I distracted her by imploring her to hop on one foot and taking her on a butterfly hunt.

And then, just as we were leaving, my kids took on the most confrontational duck I have ever seen. They must’ve gotten a little too close to the flock, for I heard my girls scream just as I saw the big male duck lower his head, hiss, and charge at them. As ridiculous as I found the sight (it’s a DUCK not a raging BULL), my children were terrified. I stood up from the crouch I had been in, towering over the duck, and with a stomped foot and forceful “shoo!” sent the animal hurrying back towards the pond.

On the drive home, it finally struck me: I had doula’d my children while mothering them. With the scraped knees, I had offered nothing but a warm embrace, unconditional affection and acceptance of how she coped with her pain. With the busted nose, I showed her how to use her body’s very real (and still startlingly magical) abilities to soothe it’s own hurts and the power of distraction. As the duck charged, I showed my children how to face their fears—whether they be big or small—with the help of a confident ally.

I mothered my children. I have been doing it since they were in utero. I’ve been telling myself, however, that I was “nurturing” instead of “mothering”. Both these the labels fit, but until now, I failed to realize how powerful and important the key components of mothering are when it comes to labor support. Mothering means:

• Emotional and physical affection & unconditional acceptance
• Awe of women’s bodies & their innate capabilities and power
• Support, advocacy & faith in how birth unfolds

I have made my peace with “mothering the mother”. Regardless of what I have chosen to call it over the years, I know it’s there. I see it working every time a woman I am with during labor literally looks at me for comfort, burrows her head into the crook of my arm as we embrace, or asks me to tell her “it’s okay”. I have mothered these mothers in my own way, but now I understand the words as they were intended.

To “mother” is to completely surrender yourself to the needs of another, to subjugate your ambitions to the desires of those you care for. To “mother” is to come when you’re needed, to stay until the job is done, and to be connected forever after by the tender threads of compassion. We “mother” our clients as we ourselves were (or should have been) mothered. We honor our clients by mothering them.

Seduction of the Deployment Induction

Is a deployment induction an act of altruism or an obligation?

The #1 reason a military wife may ask for an induction & the 5 things she may not have considered

Deployments are no respecters of persons, be they pregnant women or their husbands. As an added irony, the majority of the DOD families are in their childbearing prime, adding a new baby to their brood every couple of years.

Even the most well-timed conceptions, planned around workups or battalion schedules so that both parents can take part in the birth of their baby, can be usurped by Uncle Sam. After all, the only predictable aspect of the military is that work and deployment schedules are completely unpredictable. So is the timing of spontaneous labor and birth. This truth often makes for an anxious, stressful end of pregnancy for many military Moms.

The March Of Dimes is one of the loudest voices urging mothers and care providers to do away with inductions that are not medically indicated. But when an expectant mother is just a few days or weeks shy of her due date with a deployment on the horizon, an elective induction is incredibly tempting. Some may even argue that to choose NOT to induce would be selfish; if the pregnancy is in the “safe zone” of 36 weeks or more, Mom owes it to Dad to give birth while he’s still around. It can quickly become less of an option and more of an obligation.

Who would say no to a woman who wanted to have her husband with her during labor? What could possibly be more important than a parent holding their child for the first time? Why would a woman choose to stay pregnant knowing that her husband would not hold his child for the first time until the baby was nearly crawling?

There is no one-size-fits-all answer. Choosing an induction because of an impending deployment is a personal decision. But the risks of starting labor artificially before a woman’s body and baby has decided they are both ready are not always factored into such an emotional decision. There are many reasons to consider when weighing the pros and cons of elective inductions. Here are just 5 factors to consider.

1 – Marathon of Labor

What seems like a straight-forward process (and can be under specific circumstances) is different for every woman. A Mom beginning her labor with an unfavorable cervix may be agreeing to a much more invasive and lengthy process than she had first anticipated. Inductions, especially for first-time Moms, can mean many hours or possibly a few days before the baby is born.

If Mom’s cervix is long, thick and closed a cervical ripening prostaglandin gel may be her care provider’s first suggestion. If the cervical ripener was enough to help Mom’s body begin labor, she can progress to the birth of her baby on her own. If not, as is more likely when Mom’s body is not naturally ready for labor, Mom’s provider may suggest more interventions to speed the process. These procedures are typically tied together in a cluster known as the “cascade of interventions”.

2 – Caught in the Cascade of Interventions

With each intervention comes new risks; higher incidences of fetal distress and increased odds of maternal and fetal fever are just a few of the side effects associated with interventions. The short explanation of the cascade looks like this:

• Prostaglandin gel doesn’t start labor
• Pitocin is administered through IV
• Constant electronic fetal monitors are needed
• Immobility and strong contractions increases Mom’s pain
• Mom asks for narcotics or an epidural for the increased pain
• Narcotics slow labor, so more Pitocin is needed or Mom’s water is broken
• Baby’s descent into pelvis is slowed or stopped by Mom’s immobility
• Mom cannot feel urge to push or has a long pushing stage
• Forceps or vacuum are used to increase progress during Mom’s pushes
• Mom is offered or given an episiotomy to speed the baby’s birth
• Mom is exhausted, baby is in distress or baby is in a difficult position for vaginal birth and a cesarean birth is recommended

The cascade is a very simplistic way of explaining a complex process. How one intervention during labor can necessitate or predispose a Mom to needing another is going to be different for every woman. The pattern, however, is widely accepted as how events intertwine during birth.

Not every induction involves an epidural or an episiotomy, but the risks are still very real. For Mom’s having their first babies, the odds of having a cesarean birth are doubled when labor is induced.

3 – Cesarean: Short term

When a baby must be born surgically, Mom is exposed to greater risk of infection both at the time of surgery and during her postpartum recovery. She will probably lose a greater volume of blood than she would during a vaginal birth. Mom is at greater risk for accidental injury to her bladder, bowels and other internal organs that may be grazed by a surgeon’s knife during the procedure.

Babies who are born surgically have a harder time transitioning to life outside the womb. They tend to have lower scores on immediate newborn assessments that measure reflexes like breathing, muscle tone and blood oxygenation. Babies born surgically also have greater difficulty breastfeeding and depressed breast seeking instincts.

Mom and baby will have a longer hospital stay while Mom recovers from surgery. Mom will not be able to lift anything heavier than her baby for 6 weeks and may need a full 4 to 6 weeks to return to her everyday activities. The difficulty of physically and emotionally recovering from a surgical birth may be increased if her husband deploys immediately after the baby’s birth.

4 – Cesarean: Long term

After the uterus is cut for a surgical birth, it will knit itself back together into a strong, thick scar. The scar tissue can cause fertility issues for Mom as she becomes more vulnerable to miscarriages and may experience a delay in future conception. The scar tissue can later become the site of a future baby’s placenta, creating a condition that can be life threatening for Mom. If the placenta imbeds itself deeply into the scar tissue inside the uterus, it can be difficult to remove and cause major blood loss. In some cases the placenta may be impossible to remove, making a hysterectomy necessary.

Scar tissue can form at many different sites inside the pelvic cavity after a surgical birth, causing pain for Mom and complications for future births. A cesarean birth also impacts Mom’s ability to have a vaginal birth with her future babies (called a VBAC). She may have difficulty finding a care provider who will support her as she VBACs. In some areas, she may have no choice but to agree to a repeat cesarean if she wants to give birth in a hospital.

5 –  Baby is not ready for birth

If full-term means giving birth to a baby who is ready to be born, full-term becomes a very broad term. Significant brain growth and lung maturation happen in the last weeks of pregnancy. A baby who is born after labor starts spontaneously is more likely to be able to breathe and breastfeed well on his or her own.

Due dates are an approximation that can be off by two (or more weeks) in either direction. A woman who chooses an elective induction at 38 weeks of pregnancy may be giving birth to a baby who only has 36 weeks worth of development. Although 36 weeks is considered “safe” for a baby, newborns with a 36-week gestational age may need a lot of help transitioning to breathing, eating and keeping warm on their own. A baby who is not adjusting well will be admitted to a Level II or NICU nursery, prolonging the hospital stay and adding obstacles to breastfeeding and family bonding.

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Just like many of the events we experience in military life, the time frames in which labor begins and birth ultimately happens are unforeseeable. What makes an elective induction the best choice for a woman and her family is extremely personal. Perhaps that it is a discussion that is best kept private. But here in the public sphere information is freely shared. Protecting your body and your baby begins before birth, and the decisions we make have life-long effects on the entire family. A healthy birth is worth the debate.