Congratulations. Be you husband, partner, friend, parent, sibling, doula, or some combination of these, you have been invited to participate in one of the most special events of mom's life. Make no mistake, if you have been asked to be present for a labor and delivery, you have attained a very exclusive level of trust. This post is to help mom be glad that she chose you to participate in her delivery. Here we go.
1. Get really familiar with non-medical pain relief (and well-versed in medical pain relief).
Whether mom is planning a medicated or unmedicated delivery, you need to know all the options. Plans can change and often do. In events like this, knowledge is your friend. Do yourself a favor and spend some time on youtube or, if you have one, calling your massage therapist friend and asking for some pointers. Learn about basic massage strokes and pressure points. Some favorites to look up right away are the hip squeeze, temple pressure, the Achilles pressure point, and different ways to hold some of mommy's weight when she is tired.
- Read up on the merits of water during labor. Baths, showers, and hot towel massages are all excellent, relaxing, and refreshing options for labor.
- Labor is not like what you see on TV. Lithotomy position (mom on her back with her legs in stirrups) is one position, but it's neither the best nor the most comfortable for mom. Some mothers deliver in a semi-sitting position, squatting, standing up, on their sides, or on their hands and knees. If one position is not working out, it's good to know about different options for position changes.
- On top of these items, bring a kit of a few ambiance items like quality essential oils and calm, meditative music. More on that later.
- When it comes to medical intervention, you won't be making any calls. But it helps if you know what is available and how it works. Different hospitals do different things, and I can't go into much detail here because this post would get crazy long, but it's okay to ask your doctor, midwife, or facility what pain relief options are available and how they work. Things to know about include: epidurals (also look up walking epidurals), spinal blocks, fentanyl or other narcotic pain relief, pudendal blocks and sterile water injections.
2. Watch mom get stressed.
It is important for you to know how mommy gets stressed. Does she carry it in her shoulders? Does she knit her eyebrows together and wrinkle her forehead? Is she a fist-clencher? It may be more subtle than that, but every woman has one or more of these stress-tells. When labor comes, it's going to hurt. All of our lives we have learned that pain is bad. Our hands recoil from a hot stove because it hurts. Our brain tells our hand, "Ow, you loser, don't do that again!" Going into labor can be similar. Contractions hurt and our bodies' natural response is to tense up and go into "fight or flight" mode (or, activation of the sympathetic nervous system). In order for labor to progress, mom's body is going to have to relax enough to let that baby out. I mean, it's going to progress eventually, but trust me, it's going to be easier if mom relaxes. When things start to get painful, help mom enter a state of "rest and digest" (or activate her parasympathetic nervous system) by asking her to focus on the part of her body that shows stress. If her eyes squeeze shut in pain, ask her to take a deep breath and focus on relaxing her eyes. If her shoulders tighten, ask her to have a deep breath and focus on releasing the muscles of her shoulders.
Our brains, when stressed, send messages to various parts of our body to demonstrate that stress. Our various body parts, however, can send a message back to our brains that we are doing just fine. Systematically relaxing various body parts sends a message to the brain that we are doing well, and can help the brain to, in turn, calm the body.
Keep with it. Be gentle and kind. She may start noticing tension in herself and self-adjust as necessary. If she does this, great, you are doing your job well. If she doesn't, just keep with her. Note that her stress sign may change from one thing to another. Encourage her not to hold her breath during contractions. Breathing deeply will help much more.
3. Know how to be assertive.
Even a type-A, organized, go-getter of a mother may have moments of doubt when in labor. Again, she has invited you to be present because she trusts that you know her mind well enough to remind her of it when she loses it herself. This can be a fine line and may require some intuition. First, you are probably not a doctor or midwife. But even if you are, in this situation, you are the labor support, not the ultimate shot-caller. Mom and her healthcare provider get to do that. Consider yourself a consultant. If you know that momma firmly doesn't want an epidural and you know her personality type will be really disappointed if she doesn't have her wish in that regard, it would behoove you, when she starts to doubt herself, to be encouraging of her current progress. It's not likely to be helpful to say, "you may not have an epidural." Arguing with a woman in labor is tantamount to insulting Ronda Rousey's family, to her face. You want to know what it feels like? Be my guest, I'll bring the ice packs. Furthermore, she can have an epidural. She can have whatever she wants. It's not your position to tell her what she can and cannot do. Your job is to ensure her that she is capable of anything. Encouraging a woman in labor that she is capable of anything will help achieve mommy's goals and fulfill your purpose as labor support. Not to mention that you won't get hit. Bottom line here, you are to help mommy get what she wants out of labor. Don't do this by being a drill sergeant. Do this by confidently ensuring her that she can. Do all that you can to instill confidence in her ability to have the labor she wants. Labor doesn't always go as planned. See, "Know the Birth Plan." for advice on dealing with the unexpected.
4. Act as a window, not a mirror.
If you're doing your job right, mom is going to love you and remember you fondly for the rest of her life as a helper in a most important time in her life. Don't let that outcome be your goal. This is not your rodeo, it's hers. When she looks to you, help her to see where she wants to be, her own power. Don't tell her about your experience. Don't tell her about your life. And don't tell her where she is, remind her where she's going! Be a window to the ideal scenario that she has painted for you. If labor is going slowly, don't give up and don't bring attention to the fact that labor is slow. She needs to have something to look forward to. A mirror tells her what she is doing, a window shows her where she can go. Keep the focus on her and what she has already told you she wants to do.
5. Select a smell, a sound, and a sight.
I mentioned bringing an ambiance kit. This is why. What do you think of when you visualize a hospital? Injuries? Sterile, hospital smell? Pain? Doctors giving orders and patients asking questions? Not exactly the ideal environment for the single happy reason people go to the hospital. Childbirth is a full-body-and-mind experience. If most of the senses are taking in stressful stimuli, mom is going to feel stressed. But, magically, if you bring in some calming essential oils, calm, meditative music, and something encouraging to act as a focal point, many of those senses that would've been occupied with stress are now relaxed and ready to have a baby. I remember during labor with my daughter, several doctors, nurses, and midwives (it was a big hospital, so we had a lot of care providers) commented on how nice and peaceful the room felt when they came in. The lights were low, there were soft, breathy tones in the background, and the room smelled of fresh lavender. I have my sister and doula to thank for that.
- Take mom to Whole Foods or any store that sells quality essential oils. Why not candles, room sprays, or a good 'ol-fashioned-car-freshener you might ask? It's because those items contain a lot of fillers and, simply put, they're not strong enough. Have her clear her mind and smell a few different ones, taking a break in between each scent. Ask her how the scent makes her feel. Some are invigorating, some might make her gag, some should make her feel calm or even sleepy (that's what you're looking for). Try lavender, ylang ylang, bergamot, and frankincense. Buy one or two different oils, no more. You don't want the hospital room smelling like a Rainbow Gathering.
- Next, take some time to listen to some meditative tracks with mom. Ideally, you will help her find something that will play for several hours before repeating. The tones should be low, mellow, and droning, but not annoying. A friend asked if classical music would be okay. I would generally advise against that because classical music is great at invigorating and activating the mind, which is great for study. In this case, we are trying to induce an empty, calm mind. Try this out on her and see how it makes her feel. You can even see if it helps her sleep at night prior to being in labor.
- Finally, ask mom (fairly close to the date) if she has the outfit for bringing baby home in picked out, a special blanket or gift for baby, an ultrasound picture, or another item of special significance that will help her focus on why labor is worth it. Tuck it away until labor is progressing very well and things become intense. If she begins to doubt or fear, and you are already trying the other suggestions posted here, pull out her special item and ask her to focus on it during contractions. Encourage her by explaining all the pressure and pain is getting her closer to the moment when she will hold her sweet baby. For me, one of the most encouraging sights was when the nurse came into the room to set up the warming table for the baby with a fresh blanket and soft light.
6. Know the birth plan.
If mom has written the birth plan down, ask for a copy and get to know her wishes. Hopefully, she has included a fairly flexible plan including what pain relief she wants/doesn't want, and under what circumstances she will concede to more interventions than the ideal for her. She also hopefully outlined what to do in the event of an emergency. Does she want you to stay with her, or with the baby if he or she needs to go to the NICU? Whatever her wishes, no matter how mundane or bizarre, make sure that you know them.
On one occasion, I witnessed a mother who had certain wishes for her delivery, but, due to unforeseen circumstances the care provider was changed at the last minute and the new provider did not read her birth plan. He immediately assessed the situation without asking her opinion and proceeded with what he thought was best. Regardless of the ideality of his choice, the mother was left feeling helpless and uninvolved in her own care. Things turned out okay, but her birth situation was not a positive memory when it could have been. The entire situation could have been avoided if her birth support person simply knew that he could have advocated for her wishes, or if someone had read the birth plan.
7. Learn how to use your voice to keep things calm.
Women, especially pregnant women, and very especially women in labor, are sensitive to the tone of your voice. If you are unsure of what is going on, it's likely to come through in your voice. Now it's not a cardinal sin to sound stressed but, as labor support person, the focus is to keep mama calm, even if you are not. When people stress out, they tend to breathe less and talk louder, higher, and more. Practice the following suggestions well before the big day. Try approaching a stressful situation at work using some of these. It couldn't hurt.
- Lower the tone of your voice
- Lower the volume of your voice
- Slow the cadence of your speech
- Use simple, positive, repetitive phrases like: you're doing wonderfully, things are going well, it's going to be okay (maybe save this one for labor and delivery. It might sound weird if you say that to your boss or coworkers.)
8. Know the labor and delivery team, and where you fit in.
Nobody likes a know-it-all. And chances are, no matter how much time you spend on the internet doing research, you are not going to know the most about what's going on in that room. When in doubt, say less at first while you observe or, ask a question. Yes, you are there to advocate for mom's wishes as I have mentioned above, but do so with tact and grace. Start by introducing yourself if given the opportunity. And it never hurts to include gratitude as part of your introduction (as an aside, even if your care is not great, expressing gratitude for it is likely to make it better. At least it won't hurt anything). Doctors, Nurses, Nurse-Midwives, and Midwives are people too. They have feelings, normal stresses, personal lives, successes and failures just like you. Treat them like people. Ask them how their day has been. Treating them like people will help them feel like people, and in turn, they will treat you like a person. If you start off this way, you become part of a team rather than just an extra person in the room.
9. What you need to know about transition.
Transition is the last part of labor before pushing. If mom has an epidural, transition will probably be just like the rest of labor, maybe a little more intense. This section is specifically for moms who are trying for an unmedicated labor. There is an excellent description of this type of transition here. Where you have played an important role in labor up to this point, things here may be different. If mom needed a lot of physical contact during labor, do not be surprised if suddenly she withdraws, becomes quiet, feels irritated by touch rather than calmed by it, or even frantic and unsure of her abilities to handle labor without intervention. A lot of times, with an epidural or without, transition can be signaled by nausea or vomiting. That can unsettle mom. In my opinion, and here I can only speak from personal experience, transition is the time when having a baby becomes very real. It can seem chaotic, intense, and climactic, and it is the time of labor that culminates in and ends with the irresistible urge to push.
Help mom here by reasserting that she is capable and strong. Encourage her by letting her know she is getting close. If you haven't already, pull out the special item you have tucked away and show it to her (ex. if it's a blanket, tell her soon she will be able to wrap up her baby in that very blanket). Coach her by reminding her that transition is the shortest part of labor, but it's very intense. But keep in mind that all mommas are different. If she asks you to back off and leave her alone, back off and leave her alone.
10. What to do when baby arrives.
Excellent work. Mom has seamlessly shifted from transition to bearing down, and the baby is now born. There is a brief, tense moment that has occurred in every delivery I have attended once the baby is out but before his or her first breath is taken. It feels like everyone in the room holds their breath too. Then there is a gurgle, a cough, or a cry, and the tension is broken. It is one of the most precious moments of all life, in my opinion. If everything is normal, the health care provider will probably place baby on mom's chest and go back to work delivering the placenta and stitching up any tears. Some nurses will probably help baby to "pink up" by rubbing with a towel or blanket. At this point, if you are the father, I have no advice for you. Just do what comes naturally. Take in the moment. If you are an additional support person, my advice to you is to enjoy the moment quietly and begin to fade out of the picture. A new family has just been formed, and you will always be part of this experience, but now that everything is fine and the mountain has been summited, it is time for mom, dad, and baby to bond together. Give it a few minutes, if appropriate, ask if there is anything you can get for anyone, take pictures, and be around, but not underfoot, until you are sure it is okay to leave.
And with that, I leave you to embark on this wildly fascinating process that has been going on since the dawn of humans. This is all the knowledge I can give you, and it can only help to be aware of the things I have told you here. You may see that labor goes very differently for you and the momma you love, and that's okay, too. Everyone will ultimately have their own story. I hope that reading mine has helped and I wish you the very, very best of luck in yours.