How To Support A Woman Through Childbirth
by: Kimberly Ambrose
of Open To Birth
This is not an article on how to avoid paying for a Doula. A Doula is a necessary part of a birth support team. This is a way for the Baby’s Father, the Mother’s Partner, Family Member, or Friend to know how to be a part of the labor support team and for Mamma to know how to receive help during labor. Let’s make this plain right here: a Doula does not take the place of any member of the support team, but rather can help her supporters to help her and encourage everyone’s confidence throughout the process. If it takes a village to raise a child then it takes at least a household to get a child through a woman into the world. When it comes to healthy and supported birth, all hands are on deck, so to speak.
There is a fantastic book on this subject that I highly recommend called The Birth Partner: Everything You Need To Know To Help A Woman Through Childbirth written by birth support researcher and guru Penny Simpkin, P.T. This book is a perfect guide to being a woman’s birth partner through each stage of labor and into postpartum. It can add confidence to your birth knowing that you’ve done your research, talked about your options, and have tools to use when things get intense. It’s never too early or too late to prepare for a healthy childbirth.
I’m going to cover some of the basics from my experience as a Doula. I’ve worked in hospitals with a midwife, at a home-birth with a midwife, and been employed by a hospital, working with various obstetricians and nurses. I’ve helped women through vaginal births, both medicated and non-medicated, as well as cesarean births. Women’s needs during childbirth only vary slightly when the place and method of labor or delivery has changed. For the most part birthing women need the same thing: to see, hear, feel, and know that you have faith in them, that you believe down in your bones that this is a normal, natural process and that they are going to be okay. I believe in a woman’s strength when she doesn’t believe in it herself. Whenever she gets through a contraction I tell her the truth, “that was great, you’re being very brave and you’re doing great”. A little encouragement can go a long way. Have you even been encouraged by a fellow employee when you don’t think you’ll make it to the end of your shift? Have you ever been cheered on by a coach or teammates during a rough patch in a game? Have you ever just gotten a pat on the back when you really needed it? Being a birth partner means you’re looking past the immediate discomfort she’s experiencing to see the whole picture, that contractions mean progress, she’s getting closer to becoming a Mother and this is all a part of that goal. That doesn’t mean her discomfort doesn’t matter or that the baby is the only focus, it means that when she feels overwhelmed you can have the perspective to remind her why she’s working so hard. Remind her of her goal when she gets lost in the discomfort and pain of contractions. “Your baby is coming closer to you.” “Bring your Baby down, let Baby come down.”
A very important counterbalance to positive encouragement is listening to her and acknowledging that she is being heard. If she says, “This sucks.” or “This hurts, I don’t want to do this” or “ ****!” you should acknowledge her message, you can say, “I know this is hard, I know it hurts, what can we do that will help you to feel better?” Even just saying, “I hear you” may be all she needs. Sometimes things aren’t great, sometimes things just plain suck. If she’s telling you she’s in pain or she’s afraid don’t respond with “you’re okay”. She’s not and she’s telling you that. Acknowledge what she’s communicating and ask what she would like to do. By leaving the question open you give her the power to steer the process. If she doesn’t know what she wants you can help her my making suggestions. “Would you like to change positions? Would you like to go to the bathroom? How about you lean against me so you can bear down during your next one? What if we try the birth ball for a little while?” Don’t overwhelm her with options, make suggestions that are relevant to the moment, if she’s tired, suggesting a standing position may not hit the mark. Then again, be open minded, she may surprise you. Remember, you’re not giving her directions, her body is giving the directions, you are making suggestions in order for her to decide for herself what would be best in that moment. There is a delicate balance that can put a lot of pressure on the support person but by staying in the moment, being patient, focusing, and taking the journey with her, you two can work together to make her process a positive one, no matter how it goes down.
Being there for her means you support her no matter where birth takes her. If she had planned for an unmedicated birth and ends up asking for an epidural, let her know that you support her decision and continue to work with her even after the epidural has been administered. You can remind her to keep her knees apart so the hips are open to allow baby to pass, or suggest that she sit up in bed to use gravity to bring Baby down. On the reverse, if her pain is distressing you but she wants to labor naturally you should be prepared to handle her process with her. Natural labor does not mean she is going to be suffering and you can help her to breath and focus on relaxing her muscles, rather than tightening up. You can work together so her unmedicated labor is progressive and peaceful (in whatever way peaceful labor means to you). Whether or not she wants to use pain medication, you should believe in her ability to give birth and to cope through contractions, listen to her and acknowledge what she communicates to you, encourage her to take the lead in her process, follow her lead and support any decisions she makes for herself.
In early labor she will most likely have energy and be very excited to finally be going into labor. In between contractions she will most likely be chatting, joking, watching TV, calling or texting people, or adjusting as contractions get more intense. When she’s having a contraction she will stop talking and focus, often closing her eyes and changing her breathing. When she’s focusing, you focus. When she’s quiet, you should get quiet. Match her breathing and mimic her pattern. Use this pattern when she has a hard time coping in order to get her back to her own rhythm. Guide her coping process by following her lead. If she starts to call out, or her voice sounds scared or sounds as if she’s suffering, bring her focus to you, instruct her to make and hold eye contact with you while you breathe together. Use your belief in her to get her to focus on the positive. Moving her attention to something other than the contraction helps too. Count down, pat your hand to a rhythm, use a deep, low-toned vocalization to keep things on track (think Johnny Cash making a sound like a ghost, low tones resonate in lower areas of the body, helping to soothe the pelvic region, encouraging it to relax and open), and keep rolling through the contraction. Keep it positive and give her encouragement after each contraction, especially when she’s working hard. Reward her with a cold, wet cloth on her forward or fan her in between contractions.
She may not like what you are doing and she needs to feel free to be able to communicate that. She may not want to be touched throughout the entire labor, or she may want you to push on her back or hold her up for long periods of time. She may not like anything you suggest or she may do things on her own without discussing it. All of this is okay and it’s normal. As labor progresses her needs will change. As she gets closer to Transition (fully dilated, fully effaced) her legs may shake uncontrollably, she may throw up, she may defecate, again, all normal parts of labor. Support her experience however it happens.
A very important aspect of being a birth support person that a lot of people don’t think of is being the birth room bouncer. Guarding her space and keeping it safe for her will help her to relax. A birthing Mama needs to know she’s protected. She may want to make sure the door is closed or the lights are low and people are quiet so she can focus on relaxing. Ask the staff of your chosen delivery location if you can hang a sign on the door that asks people to knock before entering the room so you both know when someone is about to be in her space. You may have to encourage this environment throughout the birth. If birthing in a hospital you can communicate your needs through a birth plan or simply by asking for certain conditions. Hospitals are usually able to accommodate many requests such as keeping the lights low or asking to bring a birth ball with you from home. Nurses will need to monitor her and the Baby throughout labor, but you can communicate that you’d like to be left alone as often as is possible, if that will make her more at ease. You can’t boss people around or create a dictatorship if you’re not in your home, and even while in your home you need to let the birth professionals do what they need to do for a healthy labor and delivery, but you can communicate your needs to your team and you can ask to have the environment altered to make her optimally comfortable.
Suggesting different positions is a great way for both of you to play an active role in the progress and give her something to focus on. There are a few labor positions you two can do together. Since this article does not contain pictures I’ll encourage you to download the Open To Birth Childbirth Basics App to see the suggested partner positions in the How Childbirth Works section, as well as to read the book The Birth Partner. I’ll describe for you a very popular and commonly used hip hold that a lot of women absolutely love. This is called the low-back squeeze and requires that Mom is sitting or standing and is stable, without the risk of falling forward, as this requires a good deal of pressure from her partner. It also requires that it not be painful for her to experience what is essentially deep compression on the hip bones: When the baby’s head is engaged in the pelvis and pressing against the front of the pubic bone, you can apply pressure to the back of her hips, on either side of the sacrum. By pressing into the hip bones, interlocking the fingers and either squeezing into the scrum (at the bottom of the spine) or pressing directly into the middle of each hip-bone with your palms – you can slightly open the front of the pelvis, taking pressure off of the baby’s head on the pubic symphasis. The low-back squeeze is a must in the Birth-Partner tool kit, as well as massage tools like a ball to roll across her back and shoulders, or a rice sock (a thick sock full of dry rice) that can be microwaved, for applying heat where needed. Reverse of that, Mom may enjoy a cool cloth placed on her forehead. It’s little things like that that can go a long way for a woman in labor. Additionally, encouraging her to stand and use gravity to bring the baby down can decrease labor time. A good partner position that not only uses gravity, but also uses the widening effects of squatting: if you sit on a bed or stool (as long as the stool is stable) or a chair with your legs spread apart and feet planted on the ground. Mom can squat between your legs with her arms on your thighs, holding her up. This position encourages the pelvis to be optimally open. This is also good for giving her a neck/shoulder/scalp/face massage in between contractions. Lastly, one more partner position to try: while you both are standing you can have her wrap her arms around your neck and dropping down a bit, either standing with legs spread to her comfort or doing some light swaying. Swaying back and forth while standing not only uses gravity, but moves the hip bones around the baby’s head as baby descends. Being in contact with her partner will help keep her calm and give her something to focus on while using positions that encourage progress.
What if she plans to birth naturally, she wants me to encourage her not to have an epidural, and then in labor she asks for an epidural? This is where listening to her and supporting her come into play. Remind her that when she planned to give birth she was very adamant about not getting the epidural. Remind her that you support her no matter what. This is important for two reasons: 1. Giving her the power to make the choice for herself does just that, it gives her the power. 2. It takes the pressure off of you of disappointing her for not supporting her one way or the other. If you don’t think she should get an epidural and she gets it, she could face dealing with guilt for a long time, but if she wants the epidural but doesn’t get it because of outside pressure she may feel resentful towards the sensations she had to endure. Tell her she can do it without it, she’s strong and she was built for this, but if she wants an epidural you completely support her decision. Tell her you’re proud of her for taking care of herself, no matter what she chooses. It’s not your job to save her from the pain of birth. Childbirth is a natural process that includes pain, but she doesn’t have to suffer. She can have a pleasant experience with or without pain-relief and medical intervention. It’s your job to help her stay on path with whatever kind of birth she is trying to have while working hard to cope through contractions. It’s not your job to make decisions for her or even encourage her one way or another. As the birth partner it’s your job to be open-minded about the birth process so you can support her no matter how long it takes and no matter what you go through together or what decisions she has to make.
Last but certainly not least, you have to take care of yourself to take care of others. Pack a birth bag for yourself that includes a change of clothes, a toothbrush, a water bottle, snacks, reading/entertainment, a blanket, a pillow. Go to the bathroom when you need to, snack when you need to, take a nap when you can. You may have to leave to get a hot meal or just to take a breather. A Doula can help by giving you breaks without leaving the Mother unattended. You and the Doula can take turns taking care of yourselves so you can both take care of her.
Being a birth partner is a dedicated, and intense job that is very exhausting. If you are the Baby’s Father or Mother’s Partner and you are going to help Mamma through both labor and postpartum, you may want to arrange to have someone come to the house to help you both adjust to your new life with a newborn. The birth itself is exhausting for the Mother and anyone who helped her through it, but a baby has needs that need to be met. Make sure you have someone to help take care of you both as you take care of each other and your new family member. This is a team effort. You can work together, you can get professional help, and you can prepare for a healthy, supported childbirth.