Who can support me during labour?
Giving birth is one of the most intense, emotional, intimate and life-changing experiences of your life. Where this is your first pregnancy, going into labour could also be your first experience of being in hospital. If you have chosen a hospital birth it is likely that you will feel apprehensive, a little scared and even vulnerable. At this time, the continuous support of someone that you know and trust is extremely important. Studies show that women who are able to choose their birth partner are likely to report a more positive birth experience.
What types of support might I need?
Where this is your first pregnancy, your labour is going to be an unknown journey, so it can be very difficult to anticipate what support you might need. If this is your second or subsequent baby and you have laboured before, you will have a better understanding of what you found helpful. No two labours are the same however, and everything tends to happen that bit quicker second time around, so your support needs might have changed. Your community midwife and local birth preparation (parentcraft) sessions can help you to think about what types of support you might find beneficial once labour begins. Research studies have identified that the support women need during labour can take various forms:
Informational support has been shown to be very important. This includes providing you and your partner with clear explanations that you both understand as well as, practical advice and suggestions about your care options. This should include discussing the benefits, disadvantages and alternatives associated with each
Emotional support and the continuous presence of a birth partner who will listen to you, offer praise, give encouragement and reassurance during labour has been found to have a positive effect on labour progress
Physical support is a fundamental need of every labouring woman. Labour is rather like running a marathon, only there is only one muscle working – your uterus (womb). As with any sustained exertion, physical support in the form of ‘comfort’ measures can be very beneficial. These can include your birth partner assisting you to adopt various positions during labour/birth; the use of touch and massage and the application of cool compresses and water to soothe and encourage relaxation
Advocacy and knowing that there is someone who will act on your behalf, communicate your wishes and ensure that your choices are not overlooked is also very important. Some methods of pain relief in labour can make you feel very drowsy, so it can be reassuring to know that your birth partner is there to let your carers know what you want and need.
What does the research tell us?
Research has shown that where women feel involved in their care and the decisions regarding their labour and birth, and are supported and listened to, they are more likely to report a positive birth experience. More specifically, studies show that where women are continually supported, they tend not to require as much analgesia (pain relief), progress better in labour and are more likely to achieve a normal vaginal birth. Continuous support in labour is also associated with a slight reduction in the use of cardiotocograph – CTG (electronic fetal heart rate monitoring – EFM) and with women feeling more in control of their labour and reporting a positive birth experience. The forms of support that have been found to be the most beneficial are emotional and informational support, and comfort measures. These have been found to be most effective when they are instigated early in labour and continue to be provided for at least an hour following the baby’s birth.
Who can support me during my labour?
It is very important that when you are deciding who you would like to be your birth partner, that this individual will be able to support all of your needs. Research studies have shown that even where you are accompanied by your partner, having a second support person of your choice present can also be very beneficial. Most maternity units have facilities for two birth partners to be present during labour and the birth (with the exception of operative births ie Caesarean sections).
Your midwife – Throughout your pregnancy you will have received care from one midwife or from a small team of midwives, whom you will have met at your antenatal clinic appointments and got to know as your pregnancy advanced. If you have chosen to have a Homebirth, you are much more likely to have already met the midwife who helps you to deliver your baby. However, the majority of women will be booked to have their baby in their local maternity hospital/unit or Birth Centre. Where this is the case, women will usually meet the midwife who is going to care for them in labour for the very first time. Every midwife would love to be able to provide women in their care with continuous one-to-one support. In reality however, the baby boom and changes to the way maternity services are provided mean that midwives are frequently expected to care for more than one labouring woman concurrently. This might include giving care to women with more complex pregnancies who are at increased risk of developing labour and/or birth complications, or being needed to attend and assist with unexpected emergency situations. For this reason, and, despite the very best intentions, it can be difficult for your midwife to give you the continuous emotional and physical support that she would like to. Therefore, having the continuous support of a birth partner of your choice can be extremely beneficial.
Women often feel apprehensive about giving birth, so the constant presence of someone they know and trust can be incredibly reassuring. Research has found that continuous support in labour helps women to cope much better with the physiological processes of labour and birth. Women often report feeling as if they have lost control over their body; the labour contractions can seem overwhelming. These feelings are perfectly natural – your body is doing what it was designed to do, so having someone continuously at your side reassuring you and giving encouragement can be a huge help.
Your partner – The popular TV series ‘Call the Midwife’ shows how it was once uncommon for fathers to be present at their baby’s birth. In the past sixty years however, attitudes have changed considerably and it is now often assumed that fathers will be there. This approach to childbirth assumes that every father will want to see his baby born and that they are the best person to be there for all concerned. However, studies have shown that while many fathers do want to be present for their baby’s birth, others do not. Indeed, being present at or feeling obliged to witness their baby’s birth has been found to negatively impact on some fathers’ mental health and wellbeing. See also our article, ‘Dads and PND’.
Fathers can feel extremely anxious about supporting their partner in labour. In the same respect, mothers may also worry that their partner won’t be able to give them the emotional, physical and practical support that they will need. For example, their partner’s job might make it difficult for them to be available at short notice (ie when labour begins); there may be concerns that their partner won’t be able to give the continuous support and encouragement needed. Women might worry that their partner may not listen to them or understand what they want during labour; the woman’s partner may not feel confident to act as an advocate and communicate her preferences to the midwife/doctor giving care.
Where there are any concerns or doubts, it is important that you and your partner talk openly and honestly about these before labour begins. Recognising that you don’t feel able to be at your baby’s birth does not make you a bad father. There are so many other ways that you will be able to support your partner and newborn baby in the coming months.
Your family and friends – Research has highlighted the significant benefits associated with labouring women having the continuous presence of someone they know, trust and are comfortable with. Women will often choose to have a female relative or friend as a second birth partner. This might be their mother, sister, or a ‘best friend’. Women’s cultural and religious values can also determine their choice of birth partner – in some cultures the presence of a male is considered to be indecent or shameful. Where this is the case, women are likely to be supported by other women from within their family.
Doulas (trained lay birth attendants) – A doula is a non-professional person, usually female, who has received specific training so that they can give continuous physical, social and emotional support to women and their partners during labour and birth. Studies have shown that labour support offered by a doula is associated with a reduction in the need for analgesia; a shorter duration of labour, reduced obstetric interventions (eg forceps birth) and women reporting a more positive birth outcome that supports their transition to motherhood. Doula support has also been shown to enhance the labour experience of younger women and women in prison.
Complementary therapists – Complementary therapists are individuals who have trained in specific techniques, such as reflexology, acupuncture and aromatherapy. Women will often use complementary therapies during their pregnancy to ease pregnancy-related symptoms such as, nausea and vomiting (morning sickness); back ache, swollen ankles etc. Using these therapies when they go into labour can often be calming, comforting and also very reassuring. Some midwives undertake training so they can also offer complementary therapies to the labouring women in their care; for example, aromatherapy (massage using essential oils).
And finally…
Choosing your birth partner is a decision that will need careful consideration. Many expectant mothers will know instinctively who they want to have supporting them when they go into labour. However, in some circumstances that support isn’t always available or forthcoming. Where this is the case do talk to your midwife or GP; they will be able to advise you and provide information about sources of birth support that are available in your area. Midwives recognise that every woman needs to feel supported in labour and they will do their very best to ensure you feel involved in your labour care and have a positive birth experience.
