One of the most demanding tasks during your pregnancy will be putting together your labor team. A labor team is the group of people who will be with you as you labor and give birth. Some will be paid by you either directly or through insurance. Others will participate because of a deep love and concern for you and your baby.
For pay or not, the only people who should be with you during labor are those you have invited. The birth of your child is an exciting event that many friends and family may want to participate in. However, no one has the right to be with you unless you have invited them. To determine who should be invited to attend you while you labor, you need to ask yourself some questions.
Does this person help me feel calm, comfortable and capable?
Is this person interested in helping me, or watching me?
Does this person share my birth philosophies, or will she be disappointed in my decisions?
Do I want this person with me?
Has this person expressed interest in being with me while I labor?
Is this person prepared to assist me?
Do I have time to properly prepare this person to assist me?
Is this person willing to learn how to assist me?
Is the relationship between this person and other members of my team on good terms?
Will this person be a benefit to me in labor?
Let's take a closer look at some of the members of your birth team, and your relationship with them.
Doctor or Midwife
Usually, the first person you hire is a doctor or midwife, and the choice can be frustrating. In some areas, there may be only one or two professionals, while other areas have more than two phone book pages full! Where do you begin?
Ask friends and relatives who have had children in your area about their experiences. What did they like about their midwife, and more importantly, what did they NOT like? Remember that her goals for labor may not be the same as yours, so what she considered a hindrance in a caregiver, you may consider desirable.
Many women get nervous about interviewing a medical professional, but there is no reason not to. Remember, a doctor may be a medical authority, but she is not your authority. She simply knows a lot about the human body. You are hiring her to be your consultant, to give you information so you can make decisions. You wouldn't hire an interior decorator without first hearing some of her thoughts and ideas about design. The same should hold true with birth attendants. Don't hire someone who wants to make your labor something different from your desires.
The interview may be the only chance you get to discover if this practitioner provides services you are interested in purchasing. Be sure to ask your questions carefully, listening to the answers and asking for any clarification necessary to understand his or her point of view. The following are some suggestions of questions that will get to the real heart of the matter. Think about what you want to know and ask that. Questions such as "how often do you do episiotomies?" leave too much room for vague answers such as "only when they are necessary." What you really wanted to know was, "In your opinion, what makes an episiotomy necessary?"
Under what circumstances would you recommend that I be induced?
What treatments do you recommend to clients who are diagnosed with gestational diabetes? or group B strep positive?
In what ways do you support a woman who wants to have an unmedicated labor?
Under what circumstances would you recommend that I not attempt an unmedicated, vaginal birth?
What are some reasons I might have to labor in bed as opposed to walking around?
What are some reasons I might need continuous fetal monitoring?
What indicates to you that an IV is necessary during labor?
What indicates to you that an episiotomy is necessary during labor?
What are the benefits you have seen from squatting for second stage? or changing positions during second stage?
How much time do you spend with a laboring mother?
What has your experience been with doulas at labors?
In some areas, there are opportunities to labor and give birth at home, in the hospital or at a birth center. In other areas, hospitals are king and any other options are difficult to find. If you choose a homebirth, you have complete control over who will be with you in labor. If you choose a birth center or hospital birth, your attendants will depend on who is on duty when you are in labor. The nice nurse who conducted your hospital tour may not be in that day, and you might get stuck with someone whose personality clashes hard with yours.
Getting recommendations from women who have given birth in your area is a good place to start. The best way to ensure a good birth place fit is to tour each facility you are interested. During the tour listen carefully to the policies of the institution, and don't be afraid to ask questions. Observe the staff and try to interact with them. If you get a chance, ask the staff about their experiences. Get a copy of the birth statistics. This may be given to you as part of the tour information. Knowing the percentages of medicated births and surgical births may help you avoid institutions whose statistics are above national averages.
Although your specific experience may be different, here are some general observations about the benefits and drawbacks of the options you may have for a birth place.
A doula is a professional labor attendant. She knows ways to keep you comfortable, and may help educate you before the labor. There are as many varieties of doulas as there are birth philosophies.
The types of doulas are as varied as the types of women who are going to labor. Some have highly developed clinical skills, allowing them to do cervical exams and diagnose problems during labor. Others have trained themselves to be constant companions, never leaving the mother's side and never tiring of giving positive feedback. There are some who are trained in Lamaze, Bradley or Hypnobirthing. There are some who will speak to the medical staff for you, and there are some who will not speak to the medical staff for you.
When interviewing doulas, pay attention to the style of doula she is. Does she perform the services you would like at your labor? Does she share your birth philosophy? Do you enjoy her personality? Do not hire a doula you do not feel comfortable with. Regardless of the way she practices, there are some things that all doulas do. These skills and techniques are what make a professional valuable during labor.
Resource for Comfort Measures
Having a doula is like having your very own talking labor guide. They not only know what helps during labor, they also know when it helps and how to do it. She can either perform these comfort measures herself, or help your family or friends to support you with comfort measures. Your labor partners will feel more confident knowing that they are doing the right thing.
A doula not only encourages the mother to keep going, but she encourages the labor support to keep going as well. The process of labor can be long, and it gets hardest just before it is over. A labor support professional can keep you and your labor partners focused during the most intense part of labor, helping you to manage any discomfort or pain.
Help Explain Options
A doula is also a source of information about ways to handle your labor. Medical attendants do not always have time to get into all the options available, and all the risks and benefits for the options they do give. A labor support professional can help you ask the right questions to know what options are available, and what each option consists of. This can help you make better informed decisions.
Family and Friends
Friends and family who labor with you have the most freedom in the way that they participate. While some family members may participate fully, rubbing your back and helping you sip water; others may feel awkward and unsure of their usefulness.
Generally, good choices are individuals who have an interest in the health of the mother and baby, and are supportive of your desires for labor. Those who support you during labor should train with you, attending childbirth classes and practicing the relaxation exercises with you to understand how they can best help you. This will prepare them to work with you as you labor, encouraging you and assisting with comfort measures.
Sometimes an individual is important to your emotional support, but seems to offer no additional comforts to your labor. You may find that giving these individuals jobs other than caring for you will allow them to be with you, without them feeling like a fifth wheel. Tasks such as updating family members, taking discreet photos or video, or running errands such as getting food and drinks can be helpful to the labor team.
Childbirth Suport Research
Hodnett ED, Lowe NK, Hannah ME, Willan AR, Stevens B, Weston JA, Ohlsson A, Gafni A, Muir HA, Myhr TL, Stremler R. Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial.
Nursing Supportive Care in Labor Trial Group. JAMA. 2003 Jan 8;289(2):175-6.
In one hospital in my area they have implemented one to one nursing in response to the research about continuity of care. However, in this study on nurses acting as doulas the researchers found that having nursing staff act in the doula role does not affect the "likelihood of cesarean delivery or other medical or psychosocial outcomes of labor and birth" like the presence of a doula does.
Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth (Cochrane Review)
In this review Hodnett and colegues found that "women who had continuous intrapartum support were less likely to have intrapartum analgesia, operative birth, or to report dissatisfaction with their childbirth experiences." They noted that, "In general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available."
Their conclusion was that all woman should have continuous support during labor.
Hodnett ED. Continuity of caregivers for care during pregnancy and childbirth (Cochrane Review)
In this review, Hodnett assessed the differences between "continuity of care by midwives with non-continuity of care by a combination of physicians and midwives." Continuity of care by midwives was associated with:
- less likelihood to be admitted to hospital antenatally
- more likelihood to attend antenatal education programs
- less likelihood to have drugs for pain relief during labour
- newborns were less likely to require resuscitation
- less likelihood to have an episiotomy but more likelihood to have either a vaginal or perineal tear
It was noted that it is unclear whether these results are caused by the continuity of care or by midwifery care.