Birth Supportbirth support

ON THIS PAGE
What Support Means
How Support Helps
Research
Support from Fathers
Should Fathers be Present?
Doulas
Helen Swan's Comments
Support: Practical Nuts and Bolts Ideas
References

What Support Means
Supporting a mother during childbirth is a crucial part of childbirth though not a medical one. Birth support is provided by midwives of course, and also by partners,and professional birth supporters (doulas). Birth support covers four main areas:


Emotional support
Encouragement – reassurance – continuous presence – keep saying well done!
Physical support
Comfort – massage – cool compresses – hot water bottles – food & drink – cuddles
Opening windows – taking her to the toilet – helping her change position - making the midwife a cup of tea
Informational support
Explanations – suggestions – finding out what you need in order to relax
Advocacy
Interpreting the mother’s wishes to staff – acting on her behalf – knowing the birth preferences

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How Support Helps
There is considerable research about the benefits of continuous support for a woman during childbirth, and this is now recognised by the UK government. Sadly, the UK midwifery service is not always able to provide the recommended continuous support.

Support in labour can improve childbirth outcomes:
It is less likely the mother will -
Need an epidural or other pain medication
Need augmentation of labour with drugs
Need caesarean birth
Need forceps or ventouse assistance
Tear or need an episiotomy
First stage of labour is likely to be shorter
5-minute APGAR scores are improved
(The Apgar test is a checklist of five aspects of the newborn baby’s immediate health.)
Mothers more likely to find labour better than they expected

Having a companion during labour also helps postnatally:

Mothers are less likely to be depressed after the birth
Breast feeding likely to be more successful
The experience of mothering is likely to be easier
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The Research
Most research has looked at the effect of having female supporters during labour, with or without the baby's father being present. Female supporters include midwives, childbirth educators, specially trained lay people (such as doulas), or friends, family members, or even strangers with no special training in labour support, but who had given birth themselves. (Most of this evidence comes from the first reference listed below.)

In general, the greatest benefits are found when the supporter is not a member of the hospital staff (and is therefore not fulfilling a dual role), when epidural anaesthesia is not routinely used, and when support begins early in labour.
Further research has suggested that if a chosen supporter has had previous negative childbirth experience, this may affect their ability to support the woman. This could apply equally to both men and women.
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Support from Fathers
Men now attend more than 90% of UK births. There has been very little research on birth support by men. A loving male partner can give emotional support, and can be an advocate for the woman. Some doubts have been expressed about handing over the supportive role entirely to the father, partly because he may not have the necessary experience, and partly because the father is actually sharing the amazing birth experience, and may need to be supported himself. (The same would apply to a male partner who is not the father, or to a same-sex partner.)

MIDIRS (Midwives Information and Resource Service) suggests the following:
• Even if a woman in labour is accompanied by her partner, she will benefit from the continuous presence of a second support person of her choice.
• Where midwives provide continuous one-to-one care, they fulfil the function of the second support person. Unfortunately, in many areas, midwives are unable to provide continuous support.
• The father of the baby is often the woman's first choice of labour companion, but it should not be taken for granted that he is the right person, or the only person, who can help her.
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Should Fathers be Present?

Michel Odent, world renowned obstetrician and proponent of natural and straightforward birth, is also famous for asserting that fathers have no place in the birth room. He expresses concern that if a mother senses a father’s anxiety, this adversely affects her labour by reducing the labour hormone Oxytocin. "The ideal birth environment involves no men in general….The best environment I know for an easy birth is when there is nobody around the woman in labour, apart from a silent, low-profile and experienced midwife”.

Grantly Dick-Read, childbirth pioneer, stated in his 1959 classic Childbirth without Fear: “The question that has now occupied so much attention in so many hospital and maternity organisations - ’should the husband be present?’ - depends entirely upon the husband.” He emphasised that before fathers can take a useful place in childbirth, they need to be informed and involved.
He too understood the role of fear in damaging the birth process, but he knew it wasn’t only men who contributed negatively: “Mothers, husbands and friends must be recognised as agencies for the production of fear in the minds of the vast majority of young married women.”


See video of Michel Odent at
www.youtube.com/watch?v=zBjZ5rMoHkU
Read more of this debate at
www.dad.info/
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Doulas
‘Doula’ (pronounced "doola") is a Greek word meaning a woman servant or caregiver. It now refers to an experienced woman who offers emotional and practical support to a woman (or couple) before and during childbirth, and sometimes afterwards.

A doula provides nurturing, continuous support and reassurance. She can make it easier for a father to be involved at a level he is comfortable with.

Read more at www.doula.org.uk/ or http://www.britishdoulas.co.uk/. There are other sites too.

Doulas are trained, insured, and backed by professional organisations. Most doulas negotiate a fee which provides support for around a month. But some doulas are volunteers: a recent project in Hull is training volunteers to give free doula assistance to women in difficult personal, social or economic situations. The project has produced fantastic results, with lower than average rates of epidural anaesthesia and caesarean birth, and much higher than average breastfeeding success.
Get inspired at http://goodwindoulas.org/

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Helen Swan's Comments
My experience in running antenatal classes suggests that most fathers (= partners etc) want to be involved in childbirth, and offer support. My experience also shows me that most fathers feel their presence is expected.

Childbirth is a magical and significant event for all parents, and can bring couples closer together. I am proud to be a member of the National Childbirth Trust, the charity largely responsible for the changes allowing fathers to be present at births. However, this is not the same as saying that fathers must be present. We are all different, and for some couples, other arrangements may work better.

Let us be open minded about involving other supporters. Remember, too, that the primary birth professional, the midwife, is willing and able to provide assistance such as massage, helping mum to the toilet, breathing, offering food, wiping her forehead and so on, and used to do all these things before fathers were allowed in!

As Dick-Read says above, fathers are by no means the only source of negativity. I would add TV, papers, magazines and other media. Too often, childbirth is represented as unnatural, shocking, unbearably painful, and dangerous. Both men and women today grow up seeing only this misrepresentation, and often have no experience of the beauty, transformation and achievement of birth. Keeping dads out of the labour room isn’t the answer to that.

Fear and anxiety may accompany any new experience, and childbirth is no exception. An anxious mother may have trouble labouring easily, and an anxious father will complicate the birth further. But we can change that! With the right support, practical advice, and information, anxiety can be reduced to manageable levels.

I cannot express how wonderful the fathers are that I have met on antenatal courses. I would hate to see them excluded from childbirth. I just don’t want them to feel they must carry the whole burden of supporting the mother.
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Support: Practical Nuts and Bolts

Before the birth:
Educate yourselves about birth and parenting, but don’t overdo it. One good book, read and understood, is worth more than 20 books unfinished, and avoid those digital TV birth channels like the plague.
An antenatal course such as NCT, Parentcraft classes, or pregnancy yoga, offers the chance to meet people in a similar situation – a lifeline.
Practise different positions, breathing, simple massage and relaxation. Practise at home before the birth! Familiarity is the key, and the reassurance of familiarity will actually make your birth hormones flow better. Most women spend a good part of labour at home, even if the baby is born in hospital.
Invite postnatal visits from people who will be genuinely useful! Ask for particular help such as cooking cleaning or shopping. You aren’t imposing - people often appreciate knowing exactly what they can do.
Fill the freezer with ready meals. If you don’t have a freezer, buy one if you can afford it, or ask a neighbour if you can borrow some space in theirs. There may be local sources of second hand or free freezers.
Prepare food for the birth day, such as snacks and sandwiches, and freeze them.
Get your teeth checked while treatment is free.
Don’t work right up to the last minute; make sure you get a break before the birth. Due dates can be misleading!
If finances allow, investigate paid help with housework.
Set up accounts for online shopping or deliveries of milk, vegetables and groceries.
Get the car serviced.
I know I’m wasting my time saying this, but try to avoid major changes like moving house or job, just before or after you have your baby. It’s an awful lot to adjust to, all at once, and extra stress may increase your chances of post natal depression.
Remember, baby won’t care what colour the nursery is, or even if there is one! Baby would rather have happy, relaxed parents.

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During birth:
Consider a second birth companion for mum, either friend, family or a professional doula. This allows the father to relax a bit and take a break.
Consider a particular friend to support the father, during and after the birth. Though this friend may not be present during the birth, he/she can offer invaluable support by making tea, food, or phone calls, helping with transport, and being a shoulder to lean on and a listening ear specially for the man.

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After baby arrives:
Family. Many people now live far from their relatives. Relatives may be very keen to visit – consider the timing carefully. Avoid agreeing to long visits from the family unless you are sure you get on well.
Friends, neighbours and colleagues. Don’t be open for visits all the time, you will get too tired. And if visitors have outstayed their welcome, don’t be shy to tell them you are tired, busy, or must sleep or feed your baby. Be sure to ask visitors for help. Unwelcome visitors could be asked to help with something unpleasant!
Network: members of any antenatal classes you attended; internet chat such as mumsnet or facebook.
NCT services are open to all, not just members. You may find coffee mornings, nearly new sales or postnatal support groups in your area.
If you breastfeed, breastfeeding support increases your chance of success. Use NCT BF counsellors, NCT BF helpline, La Leche League, breastfeeding peer supporters, and local BF groups in community centres or clinics.

Midwives can often visit for up to a month after the birth.
Health visitors and doctors offer additional community support.

Ruthlessly prioritise your time and any housework you do. Most housework can wait a few weeks, or can be done by someone else. Prioritise food, sleep, hygiene of key areas.

Be willing to work shifts with baby so that you both get vital sleep in the early weeks. It’s worth it, though it may mean you don’t spend much time together.

Check out specialist support groups for single parents, postnatal depression (can affect men too), illness or disability of parent or child, miscarriage, stillbirth.

Financial support eg. maternity benefits, tax credits.

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References:
Continuous support for women during childbirth.
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Cochrane Database Syst Rev. 2007 Update of 2003 research, University of Toronto, Ontario, Canada.

The obstetrical and postpartum benefits of continuous support during childbirth.

Scott KD, Klaus PH, Klaus MH. J Women’s Health Gend Based Med 1999 Dec;8(10):1257-64 Division of Public Health, County of Sonoma Department of Health Services, Santa Rosa, California, USA.

MIDIRS www.choicesforbirth.org/booklets.php?id=1

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