September 16, 2010

How to Recruit and Prepare Labor Support

Ina May Gaskin, the renowned midwife, coined the phrase The Sphincter Law in her book, Ina May’s Guide to Childbirth. Her theory is based on the idea that the body has sphincters, and these sphincters can be shy and can NOT be forcefully opened. Think back to a time when your bladder was shy. For example, if there was a long line behind you for the bathroom and you when it was your turn, you suddenly couldn’t go. At some point or another we have all encountered this law. Mine was in India with a foot tread toilet – the experience still haunts me.

Anyway- I digress. The cervix is a sphincter and can refuse to open under pressure or seize up when feeling uncomfortable or embarrassed. This is why it is important to choose who YOU want supporting you during your labor and delivery. Labor is a primal and private affair. It’s not too different from the act of getting pregnant, and would you really want onlookers present for that event? In all seriousness, when recruiting your labor support team, think about who you can feel most open with. Who are you comfortable being vulnerable in front of? Those are the special people that should be invited into this private ceremony. Nobody you invite in should be there because you feel obligated to have them there, including hospital staff (You can request not to have student doctors and nurses present and limit the amount of extraneous people coming in and out of your room). Distractions will only prohibit you from opening up and doing the job you need to do.

Once you have chosen your team, it is important to discuss your wishes regarding you foresee your birth. I also recommend having an honest conversation with them about any fears and concerns you may have surrounding your birth. This way, your support circle will be armed with support and comfort should these issues appear.

Here are a few ideas to discuss with your posse.

When do you want to get to the hospital or birth center?
Many of the doctors and midwives I work with instruct the mother to labor at home for a period of time. If the mother is planning on not taking pain medication, most care providers suggest staying home until active labor.

What are your desires for pain medication?
Are you planning on foregoing it? Are you waiting to reach a certain dilation before receiving it? Do you want it immediately upon arriving at the hospital?

What pain coping techniques do you want to try?
Massage and counterpressure, visualizations, movement, shower or tub, hot or cold pack, aromatherapy?

Do you have a code word for letting your support team know that you have REALLY changed your plans for your birth and you are ready to take a different direction?

What interventions are you comfortable accepting and which ones would you like to avoid?
If you are low risk and it is not hospital protocol, you may want to have intermittent fetal monitoring instead of full time. Perhaps you can have just a hep lock (a portal for an IV drip) instead of continuous intravenous fluids. Are you going to try natural methods for augmenting labor if necessary or do you prefer pitocin?

Would you like their support for immediate skin to skin contact or help with breastfeeding?

I also think it is beneficial those that are planning to be present attend a childbirth education class or read about the birth experience. Labor and delivery rarely unfolds the way it does in the movies and on TV, and a more realistic understanding will leave less room for surprises. (For those that want to read up on the subject, I really like The Birth Partner by Penny Simkins.)

The team should know that birth happens on its own schedule- which for many first-time mothers is on average 16 – 20 hours. After the initial excitement that labor is underway, the longevity of the situation can test some people’s patience. Be prepared to camp out for a while and do not pressure the mother to move things along faster than she desires. (I personally estimate that once I am called into a birth, that I will be gone for at least a 24 hour period.)

Know what birth looks like. Or specifically, unmedicated birth. As I mentioned before, birth is primal and the daily demeanor of the person that you are used to seeing is quite different than an unmedicated laboring woman. This is particularly helpful in deciding when to head to the hospital or birth center. I often get a call from the expectant father that labor has progressed and they are heading into the hospital immediately. I then ask to speak to the mother to listen to her during her contraction. Most of the time, the mother is just starting to turn the corner into active labor, and her behavior begins to change. This shift can be scary and overwhelming for those that are not expecting such a dramatic change.

It can also be hard for someone to see a loved one in pain. Remember, in terms of labor- the pain has a purpose! Contraction pains help to open the cervix and expel the baby from the mom’s body. It is just as nature intended, but that does not mean it is easy to watch.

Now that you have some guidelines for how to pick your support group, and how they can assist your labor and delivery, you can move forward knowing you are in good and caring hands. This confidence will allow you to focus on you and your baby, rather than on hospital staff and their protocols.



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