When to Reign In Your Birth Team

As most of you know, I teach a 10-week course on natural childbirth.  The first night of class, the number one question is, "When do we go to the hospital?"  Line-upon-line here.  We don't hit that until Class 5!

Over the years, I've learned that this question is really asking, "When can the professionals take over?"  It usually is asked by a dad-to-be.  It's interesting to watch these expectant parents learn and grow.  Education and information is unbelievably empowering!  Several years ago, I was teaching "emergency" (ie. unattended) childbirth.  By the time we get to that point, we've spent countless hours together, watched more than a dozen birth videos, and everyone has a very good idea of what normal childbirth involves and what to do -- or not do!  I asked this particular father-to-be how he felt about the possibility of this happening.  I should preface his answer with the fact that he didn't speak to me until Class 5 and was totally depending on his mother-in-law to help his wife at the birth.  He despised that he was forced into attending this class.  So, when asked this question, I was amazed at his cool reply:  "On the one hand, totally terrified, but on the other -- bring it on!"  I should also mention that the mother-in-law didn't make it to the birth and they were only at the hospital for 22 minutes before the baby was born!

The answer to the question "When do we go to the hospital?" often changes as you get more information.  Let's back up for a minute.  You know how I feel about hiring a doula.  Do it.  Who are the people you are inviting to your birth?  A sister?  Mom?  Mother-in-law?  Other children?  Your best friend?  Do you call them all the minute you have your first "real" contraction?  Of course not.

There is nothing like being pregnant with your first baby.  Not that the other pregnancies and labors aren't exciting, but they are undeniably different.  You've done it before.  You have distractions now that you didn't have the first time around.  Regardless of what baby number this is, enjoy early labor with your spouse.  I love early labor!  Get into a rhythm together.  Figure out what works, what doesn't.  Practice different positions.  Nap.  Eat.  See a movie.  Enjoy this time together.

Everyone's labor is different.  You may have several hours of early labor -- this week I had a mom that did this for several days! -- or it may not exist at all.  You may jump right into active labor and need your doula right away.  There is no way to know beforehand. 

But let's assume that you do have early labor -- you are contracting regularly but are able to talk, walk, or sleep during and/or between contractions.  If your husband is sleeping, and it's 2:00 a.m., let him keep sleeping.  A lot of moms don't like it when I say that.  Here's the thing -- yes, labor is exhausting, but it's also exhausting for your birth team.  This often doesn't get a lot of sympathy from moms, but if your labor is on the longer side, you are going to need your birth team to be able to step it up, and they may not be able to if they are utterly exhausted.  If you don't need his help, let him keep sleeping.  You'll both be glad later.  You may find yourself enjoying those early contractions, just you and the baby.

As things progressively get harder -- and you feel like you need some extra help -- think about who you want to reign in.  Maybe it's your sister or mom or maybe it is your doula.  Whoever it is, be sure that you are ready for the help.  And perhaps even more importantly, be sure they will be a positive influence on your labor.  For example, the mom who is freaking out that you didn't go to the hospital with the first contraction or the minute your water broke may not be the best person to be with you and your husband.  She may not be someone you want at your birth at all!  In the end, if you don't need help yet, you may feel like a watched pot, which won't be good for your labor.

There's not a set time that is right for all couples.  I hate it when couples are told to head to the hospital when contractions are 5 minutes apart lasting 60 seconds.  You could do that for hours!  It's really hard to explain, but there will come a time in your labor that you will know who you need.  With my 2nd baby, I had no early labor and wanted my friend there immediately.  It was a very fast labor.  But with my 3rd and 4th babies, no one was there until about an hour before the birth, including our midwives.  But I knew when I needed them.

Again, it's hard to explain, but there will be an urgency felt to be with your birth team as labor progresses, whether you are in the hospital or at home.  This will be different for each woman.  Some women feel this urgency earlier than others.  This is their emotional relaxation -- how they feel about where they are giving birth, who is there, are their wishes being honored?  I remember with my first homebirth -- 3rd baby -- the minute the midwife walked through the door, I felt like crying.  I felt such a release.  She wasn't there more than an hour and my baby was born.  My body held back until my birth team was in place.

I often think of it as involving people according to their skill set:  my mom was needed because I needed help with the other kids (1st called).  She cleaned up, made food, changed sheets -- a good one to have around!  Anyone else helping out with the kids was next.  They'd usually help my mom too.  One of these people was usually on video duty.   As labor progressed, if I had a doula or doula-friend, they'd be called in to help me and David.  Your chiropractor is also a great person to call in for a period of time.  Eventually, you'll want someone to catch the baby, so either calling your midwife or heading to the hospital will be necessary!  You'll know when this time is.  You'll be very serious, eyes closed, not talking or smiling.  Some women will be sounding out contractions and others won't make a peep.  Either is fine.  One is not better than the other.

My ultimate answer to the question "When do we go to the hospital?"  Alright, here it is.  There will come a point when she (talking to dad because mom won't remember this or be thinking logically) will not want to walk anymore.  She will still get up and go to the bathroom when you encourage it, but she doesn't want to.  She has to wait till the end of a contraction to get up and she will move quickly so she doesn't get caught standing up during a contraction.  Contractions are stronger and longer when she stands up.  Still willing to move, but not wanting to.  This is usually a good time to mosey on down to your birth place or call in your midwife.  Labor is very well established at this point.

Most of all, enjoy your labor.  Choose your birth team carefully and reign them in as you need them.  So many women wish for a fast labor, not understanding how hard a fast labor is -- just to get it over with.  A longer labor is not a bad thing.  Like I always say, labor and birth serve as a bridge between pregnancy and becoming this baby's mother and father.  Enjoy it.  These hours are unlike any in your whole life.

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MY List of Things You Can Do to Avoid a C-Section

I've seen a couple of lists lately about the top 5 things a woman can do to avoid a c-section. While I think these lists are good, they differ from my personal list. I thought I'd take the time to write out my list. I guess I'll keep it to a top 5 as well, so as to not overwhelm anyone.

Education for both husband and wife: Some women are able to advocate for themselves in labor, but most are not. Preparation on the front-end is huge. Dad needs to know what is going on and how he can help. He needs to know what's normal and what's not. He needs to know the questions to ask. Having a doula will help with a lot of this. The doula cannot speak for mom, but dad can. I love The Bradley Method for this reason. Both individuals take responsibility for their role in the birth.

Careful Choosing of a Care Provider: Also huge. All the education and preparation in the world won't matter a bit if you have chosen a care provider and/or hospital who is determined that you need to be rescued from your pregnancy, labor and/or birth. This is the step where, if you ignore the red flags popping up during the education/preparation phase, it will bite you in the end. If you are getting information and statistics about your doctor or hospital that make you second-guess their philosophies, don't ignore them. It's never too late to switch care providers. I've had people change in the middle of labor! Typically, care providers like to see you for the last month of your pregnancy. I changed care providers at 33 weeks with my third pregnancy. A bit nerve-racking, but worth it for a great outcome. You will only give birth to this baby one time. Don't take on the "maybe for the next baby" attitude. Do it this time! Do it for this baby! If you don't know where to start, ask your out-of-hospital educator or doula for referrals.

Keep Moving - Don't Lay Down and Take It: Remaining in a hospital bed is one of the worst things you can do. They can/will strap a monitor on you and "watch" you from the nurses station. Health care at its finest! Laying around for your labor leaves it all up to your baby to make its way out. Baby needs movement. He is moving around, changing position, trying to find the easiest, most comfortable way out. If mom is moving -- walking, sitting on birth ball, pelvic rocking, rotating hips, even standing -- she's using gravity and movement of the pelvis to help her baby descend and get into a good position. Mom will have less vaginal exams (which often lead to Failure to Progress diagnosis), less time on a monitor (which often leads to a false-positive signaling fetal distress), and usually a more comfortable and faster labor. What's good for mom is usually what's best for baby.

Drug-Free Birth: I'm not just talking epidurals here. I'm talking inductions as well. Pitocin is a drug. Prostaglandins (cervical ripeners) are drugs. Baby may react "fine" to induction drugs, and he may not. There's no way to know how your baby will react. So trust in your body to start labor on its own. Don't be induced. Stadol, Nubain, Demerol -- they are all drugs that go to the baby. There will be physical results to the baby when they are born if they received these drugs -- more sleepiness, "laziness" at the breast, depressed breathing. If mom had educated and prepared herself during the pregnancy, she probably skipped this step. It's a tough thing to hear a mom's birth story and realize that her c-section was a direct result of her own actions -- induction, pain-relieving drugs, trusting her doctor, and not educating themselves on the normal process and what to do and what not to do. A woman is 50% more likely to have a c-section if she is induced, and four times as likely to have a c-section if she has an epidural. These are numbers that we simply cannot ignore.

Remain Low-Risk: If you do not take care of yourself and become high-risk, you give up a lot of power. You need to physically prepare your body to give birth by regularly doing pregnancy exercises. You need to eat the required nutrition to grow a healthy baby. A well-balanced diet with plenty of protein will benefit both mom and baby. The old saying "eating for two" does not mean eating for two adults! Be wise and mindful in your life choices. Practice relaxation every day. This will help with all aspects of your life, even after the baby comes. Keep stress out of your life as much as possible. Choose pre-natal tests wisely. There are so many that are done these days. Find out why it's being done and what they expect to do with the results. You can opt NOT to do them. Some may unnecessarily put you in the high-risk category if you test positive.

Of course, I must mention that every now and then I do have couples that do everything right and still have a c-section. I recently had one of these and it broke my heart. This mom worked so hard. I truly do not know what she could have done differently. You can't feel bad about a c-section that comes out of a situation like that. I feel sad for her. She really wanted a natural, unmedicated birth, and was so prepared. ICAN will be an important part of her healing.

My c-section rate of people who take my class is 14%. Some of those were necessary and some were not. Most that were not necessary can be traced back to one of these steps. One other way that can often help prevent a c-section is not rushing off to the hospital the minute your water breaks or you realize you are in labor. The longer you are there, the more excited everyone is to intervene.

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Can Your Husband Be Your Doula?

It seems like a very long time ago that I posed this question! In fact, I think it was two weeks ago. I bet y'all had about given up on me to ever write the post. You would not believe how much I have gotten done around my house over the last two weeks, in preparation for summer vacation. So, while those things have gotten done, the blog has suffered. I apologize.

I also knew that I have so much information on this topic, so much to say, that I was probably a bit overwhelmed to sit down at the computer to write it. I'd like to post some of the email from a former student/Bradley-teacher-in-the-making that started it all:

"There are a few things I think Bradley has a little off, and I think the whole idea of the husband being "the" labor help person is one of them. It probably sounds preposterous, especially since I am looking into becoming a Bradley instructor. But I agree with Martha Sears in The Birth Book where she says that it is better for the husband to be freed up to be "just" a husband to his laboring wife by a doula being there to help. I think you may agree with me slightly, since I remember you encouraging our classes to hire doulas if we could (and at the time thinking, "Why would we hire a doula? We're taking this class. This--husband--is my doula.").

Now, I am not saying that Bradley should not teach about husbands' involvement. I think it is one of the biggest reasons Bradley is one of the best preparations for natural birth. However, I believe that one of its greatest strengths (educating the husband about the physiological components, benefits and risks of different choices, as well as ways he can be a help in labor) is also a great weakness (raising the woman's expectations that he will be all these things she's been taught in class, even if that person doesn't remotely resemble who he has been throughout the pregnancy). In my experience, it did not happen that way, and I felt let down by my husband that he wasn't there for me the way that I needed him in Ruby's labor. I don't think I would have felt as let down if my expectations not been raised with the Bradley books and classes. What I eventually came to grips with is that I just can't have those kinds of expectations for my hubby (suggesting things, being observant, thinking of things on his own--like food, drinks, frequent bathroom breaks, how to make me more comfortable, verbal encouragement, the works!) and it does not say that he is a terrible husband because he didn't remember to do those things. When it comes to things like this, he is happy to do them, he just DOESN'T think of them himself. Especially on birth day. He needs coaching, and I am not the kind of person to do that while in labor. I just want him to KNOW."


Our results from the poll a couple of weeks ago were:

Can Your Husband Serve as Your Doula?

Even better! 30%

Are you kidding? 13%

He did alright. 56%

Hurray for the dads that did "even better" than a doula could have! I was surprised that the "Are you kidding?" category had so few votes! The majority, as I expected, fell into the "He did alright" category. This is where I would place my husband.

Thank you, also to those who contributed their experiences with their husbands and/or doulas. Some great comments. There was no right or wrong answer, obviously.

Quick history of "doulas" in America: Before birth moved into the hospital, approximately 100 years ago, men were not a part of birth. Birthing women had their mothers, sisters, aunts, best friends, and midwives attend their births. When birth no longer took place on their own turf, they could not take all these women with them. They were alone. Male doctors administered drugs that wiped women out entirely. The nurses, having several women to tend to, were all the female companionship a woman would have as she gave birth. Needless to say, her needs, emotionally and physically, were not met.

In the 1960s and early 1970s, the doctors and hospitals began to be pressured to allow husbands in the delivery room. Dr. Robert Bradley, with the publication of his book, "Husband-Coached Childbirth" advocated for women to birth without intervention or medication with their husbands "coaching" them through the experience. This was an exciting time for women and their husbands. A funny side-note to this time period: They wanted to give the husbands something to do, so the job of cutting the umbilical cord became his. They figured that he couldn't mess this up and he would feel like he had done something significant. It's really rather demeaning to think this is all the husband can do when it comes to birth.

In the 1990s, we started hearing the word "doula" or labor assistant. My first baby was born in 1996. My sister-in-law, who happened to be a doula, was present at our birth, and without her, I am certain that I would have had a C-section. And while I never paid an actual doula money to attend my subsequent births, I was always surrounded by my friends and family. And, of course, I had my Bradley-trained husband! (He was fantastic on the 4th birth!)

Many of the women who commented on their experiences, said that their husbands were a better doula with later births. There are many things that play into this: First of all, he has been through it before! But perhaps even more importantly, he has listened to his wife talk about what she likes and doesn't like in labor, probably many times over the years! He has attended other births and that gave him knowledge and experience. He knew what to expect. Imagine hiring someone who has attended dozens or hundreds of births -- the experience she brings is beyond helpful -- not just for the laboring mother but for the father-to-be.

There is a page in the Bradley workbook that is titled "Whose Job Is It?" Fortunately it appears in Class 11 instead of Class 1 because if I was a husband, looking at this list, I'd have to insist that she have an epidural because I didn't sign up for this! It is a list of 50 things that Dad should be doing. So if the mom has a C-section or an epidural, does that mean Dad failed at his list? He didn't do his job? It's just too much to put on a new dad.

With that being said, I do feel like my Bradley class prepares Dads extremely well for labor and birth. He comes away with good general knowledge of pregnancy, labor, how to help his wife in labor and birth, interventions, avoiding a C-section, consumerism, questions to ask, adjusting to life with a new baby, and breastfeeding. But the fact remains, when his wife is dilated to a nine, but the cervix has a lip, will he remember what positions are good to help with that? Maybe, maybe not. But a doula, who sees this very often, will know how to help. It's like the comment in the beginning: a lot of husbands want to help, but often need to be told how to help. Even with 12 weeks of class, a lot of husbands will not think of helpful laboring positions depending on what "symptom" mom is having. The more one reads about and attends births, the more experience and expertise they will have. In my expereince as a Childbirth Educator, the dads are not the ones reading about birth!

Dads must be advocates for their wives. It is important, even crucial, that he understand the birthing process, and that they do everything they can, as a couple, to prepare for this life-changing day. Doulas cannot speak for their clients, but husbands can speak for their wives in the delivery room. She will not be able to be her own advocate when she is in labor. A doula is familiar with the birth setting and terms, equipment used, etc., and it is easy for many dads to be overwhelmed by it all, especially the first time through. A doula, as Hannah said, is not so emotionally involved and can often help navigate the way through to a great birth.

Here are the simple facts:

Women have better obstetrical outcomes when they are accompanied throughout labor by a doula. She will provide emotional, physical, and informational support to a couple in labor. The presence of a doula reduces the C-section rate by 50% (!), the length of labor by 25%, the use of pitocin by 40%, the need for forceps by 40%, the request for pain medication by 30%, and the use of epidural anesthesia by 60%. If you are planning a VBAC (Vaginal Birth After Cesarean), statistically you are more likely to achieve a VBAC with a doula by your side.

Women who have a doula are more likely to report feelings of having coped well with labor and a greater satisfaction with their birth. They report having less anxiety after the birth and even an improved relationship with their partners after the birth. (Perhaps, in part, because the pressure was off of dad and he could lovingly support his wife without the "coach" role.) In addition, women who have a doula report higher self-esteem and lower postpartum depression and anxiety 6 weeks after the birth.

Babies also benefit from a doula being present for their labor and birth. They have fewer neonatal complications, fewer workups for sepsis, and fewer health problems at 6 weeks of age.

If you decide to have a labor assistant at your birth, ask around. Interview. Some cities have "Doula Teas" where you can go and meet lots of doulas and find one you like. Find out their personal statistics. I once heard of a doula that had a 90% epidural rate! That tells you that she isn't sure how to help you! You also might consider having a friend or two with you. Be sure they are supportive of natural birth and/or have given birth naturally.

Congratulations for making it to the end of this insanely long post. I hope you can appreciate why it took me so long to sit down and type it out.

I want to leave you with a single thought: Many times over the years, I have heard couples say how glad they are they hired a doula, but I have never heard anyone say, "That was the biggest waste of money."

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Can A Husband Be a Doula?

I throw out this question because I want your opinions and experiences before I continue from here. I had a former-student-turning-Bradley-Instructor pose this question to me a few weeks ago, and I've been thinking about it ever since. Remember, the Bradley Method of Natural Childbirth is based on the book by Dr. Robert Bradley, "Husband-Coached Childbirth."

Let's hear what you have to say before I throw out statistical data, etc. Looking forward to hearing from you.

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