Episode 173 - How to give great birth support
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host,
[0:03] Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD. And each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey.
[0:24] Welcome to today's episode of the great birth repellent podcast today i am talking to you if you are a partner a doula a care provider friend or parent whoever you are if you have been the nominated support person for a woman who has invited you into her birth space this episode is for you so i want to give you as much information as i can to help you prepare to be the best support person that you can possibly be. If you are listening to this as a woman preparing to give birth, this is one of those opportunities that you can share this episode with your support team so that you know that they're ready and prepared to nurture you and advocate for you during your birth. And I've really done a brain dump on this one. These tips are in no particular order, I would really suggest just getting a pen and paper and jotting down the points that are of interest to you. Anything that sounds interesting that you really want to remember, jot those down. This is in no particular order.
[1:32] First. In the interest of keeping this podcast completely free to you, the listener, this episode is sponsored by my dear friend and birth prep extraordinaire, Poppy Child from Pop That Mama. She is a doula and hypnobirthing practitioner and her online hypnobirthing course, The Birth Box, has my vote. It has already helped thousands of women get ready for their labor. And you know me, I am so picky about what I will endorse, but I get behind the work that Poppy is doing. What I love about the birth box is how practical it is, not only for the birth, but it also teaches you tools for pregnancy and for your life with kids. In the birth box, you'll learn tools of how to manage pain, how to stay steady when labor gets intense, and it might, and even how to advocate for yourself in medical settings. So it's all about giving you knowledge, confidence, and a mindset that actually works when the big day comes and for the big days that will follow.
[2:40] And there's a little cherry on top. In the birth box is something called the oxytocin bubble. It's a full album of soundtracks designed to guide you through labor and birth so that you can stay in the zone. Honestly, it is incredible. So the birth box is rated five stars across the board. And with my code, MELANIE, in capital letters, you'll get 25% off. So if you're preparing for birth, go check it out. You'll be so glad that you did. The link is in the show notes below this episode.
[3:17] Okay, let's go. How to be a great support person in labor. I'm about to lay it all out. First, let's define what support is. There are a few definitions of support and a number of them suit our purposes today. So the first is to agree with and give encouragement to someone because you want them to succeed.
[3:41] Nice. Another meaning is to hold something or someone up or to bear the weight of something or someone. And these two definitions, I think, really help to explain what your job as a birth supporter is going to be. Being strong, bearing weight, agreeing with and encouraging her because you want her to succeed. And when a woman says something like, I had no support, what they're conveying is that no one that was with her was on her side. No one was encouraging, in agreement, or wanting her to succeed. So you may have been there physically, or women may have somebody with them physically in the room, but if you're not there helping her to succeed in her intentions and decisions, then she might feel abandoned even though you were there the whole time. And I'm going to offer you an analogy to help really explain what support during birth might look like. So preparing for birth is like preparing for a marathon, specifically a 100-kilometer marathon, one of the big ones. Your birth might not be as hard as a 100-kilometer marathon, but if you're prepared for that, at least you are prepared for birth, however it pans out.
[5:00] So long distance runners will tell you that just as important as your physical preparedness for a marathon is the mental game. It's the same for labor. So no level of preparation will allow you to have full control over what your body does in labor, but you can have full control over your mental game. So grit and mental toughness can get you over the line in the intense stages of hard labor, but it's just part of the puzzle. So you also need a crew, a support crew who is just as invested in your marathon or birth plans as you are. So imagine you reach race day, you've got all the gear, the bags, you're all packed, you're in the car together, you're with your trainer, your coach, whoever you're bringing. And they're there to help you get to the finish line and give you the nourishment and encouragement and the gear that you need to finish this marathon. on. So you're on your way there all together and one of them says, I'm a bit worried you're not going to make it. Are you sure about this? And they start to plant seeds of doubt and then you start the race and you get to your first stop and your crew's waiting for you and your coach says, you aren't really going as fast as I thought you would at this stage. It looks like you are really struggling with the way things are going. So I don't think you're going to be able to finish.
[6:30] Nonetheless, because you're prepared, you've got some mental grit, you persist, you're ready for this. You put the preparation in so that you can keep going. You just dig into whatever internal motivation you've got, tap into your own positive internal dialogue. But then at checkpoint, the last checkpoint you're 75 kilometers into your marathon it's getting hard and as you approach one of your team members is holding up a sign and it says it's going to get really hard from here you're looking really tired you haven't got what it takes.
[7:05] Imagine, when I say it like that, we can all see that these are not helpful support people. A runner, a marathon runner or an athlete would never keep these people around as supporters to rely on them during a marathon. So gathering a team for birth is the same as gathering a team for a marathon. They are there to tell you what you need to hear, to give you the resources you need to perform at your best and to get the outcome that you're aiming for. They're there to help you achieve your personal best to put in your personal best effort but if your birth team is full of people who say negative things who don't believe you who believe in you and who throw off your mental game they could sabotage the whole birth with their own negative mental attitude regardless of how prepared you are what you need in birth is the same as what you need in a 100-kilometer marathon. You need all the preparation ahead of the game, but on the day it's about mental toughness and a good support crew who will be on your side. They're supposed to spur you on, believe in you, encourage you, and give you everything you need to help finish the race when it gets hard as well. The people that you have with you could be the make or break of your mental game in labour. So take a moment to consider who will be with you at your birth.
[8:33] Are they on your side? Can they care for you when things get hard or can they care for you when you might want to give up? Do they have the robustness to defend and advocate for you? So take a moment, just take stock of the reality of who is in your corner and
[8:54] they might be exceptional. They might be fit for purpose. you may have full confidence in them or you may just now be realizing that they're not the right person to have in your corner as a support person and if you've realized that you have the wrong people in your support crew that's okay because it's a great thing to realize that before you get to the point where you're in labor and they've abandoned you the important thing is to acknowledge that they don't have what you need so now you can fill that gap with someone else and this doesn't mean they can't be there so you know you might be sitting there thinking gosh I'm not sure that my partner has what it takes to fully support me in birth that is a great realization to have now, because now you can fill that gap with somebody else doesn't mean they're not going to be there it just means you can't rely on them for specific types of support.
[9:49] And in these circumstances, you could consider inviting a robust friend or a family member. Maybe your mom is really robust and awesome, just always encourages you when you have to do hard things. But if there's no one in your life, in your immediate circle, who you think will be completely comfortable in the birth space and be able to egg you on to get through those little hard stages, consider hiring a robust, prepared support person. And this could be a doula. So just remember at birth, you are the athlete. No one can run the race for you, but you can choose a crew that is going to be 100% on your side to enhance your chances of meeting your own expectations and of finishing that 100 marathon, 100 kilometer marathon.
[10:38] So what does a great support person do? Remembering that support people are not just important for low intervention birth options or for the hard long ones with without pain medication every woman it doesn't matter what type of birth you're planning every laboring and birthing woman needs a robust support crew it doesn't matter what type of birth you're planning companions are necessary regardless because every birth is big. So here are my tips for support people. Doulas, partners, friends, family, midwives and doctors alike will all benefit from understanding what the basic needs are of a woman during labour, what kind of support they need from the people around them.
[11:27] Again, as I said, no particular order. But the first one I'm going to offer here is always be on her side.
[11:37] During labor, women are particularly vulnerable. Their mind and body leaves this present state and goes into labor land. And that makes her vulnerable. She's not fully capable of making complex decisions or having in-depth discussions. She is focused and busy laboring. So she's relying on you and on her support people to advocate for her. And this requires you to both be on the same page, but also for you to 100% be on her side. You've got to have discussions ahead of time to find out what she's planning so that you know what to advocate for and so that you know how to always be on her side. There might be a scenario that's playing out in birth and somebody may ask a question or ask what you want to do. And if you already know the answer to that, she doesn't have to leave labor land to give an answer. You can be confident and say she doesn't want that or yes, she does want that. She will be happy for that.
[12:34] In labor if you abandon her and take the side of a doctor or a midwife or somebody else in the room she's going to feel completely alone completely vulnerable and she's going to go along with it because she doesn't have the right support that she needs in order to make her preferences a reality and that's a recipe for disappointment and resentment at the very least but at the most she could end up with long-lasting birth trauma as a result of feeling abandoned during her labor and birth.
[13:09] Always be on her side. If I say nothing else, if you hear nothing else through this episode, the number one way to support a woman through labor and birth is to always be on her side.
[13:24] Okay, the second thing to being a great birth support person is putting your body on the line.
[13:30] It's going to be challenging. Just like she's in the middle of something really hard, you're in the middle of something really hard. Supporting women through labor and birth can mean working really physically hard in order to help her through every single contraction. But you may also be working mentally hard to put your own fears in check and your own experiences in check you're really prioritizing her and so that might take some mental game on your part to keep focusing on her needs instead of your own so as you prepare your mind for what it means to be a support person you can imagine your job being physically available to help during every contraction. So what am I doing as a support person? I'm making myself available to help her through every single contraction. You may need to hug her, massage her, get her a drink, hold her hand, wipe her nose, take her to the toilet, put her pants on, take them off, help her change position, hold her up, a cool washer, some comforting words, whatever she needs. She's working really physically hard, but you're also going to be working hard physically.
[14:42] And it might mean that you've got to put your own physical needs aside for a minute and realize that if it's her first labor or there's a long labor you're probably going to get tired alongside her just as she's working hard you'll be working hard too same process different roles so this is a reminder just to consider your physical needs as well so she will have packed a bag she will have packed whatever she needs in her birth bag. But consider packing yourself a go bag, support person go bag, that has everything that you need in order to sustain yourself through a potentially long labor as well. Snacks, change of clothes, caffeinate, drink bottles, toiletries, whatever you need to freshen up.
[15:28] So you've got to bring your A game. So pack a go bag for that. Okay, number three, stay present. Our biggest problem as a society is that we are all super distracted and we have trouble focusing on one single thing. And usually phones are the cause of that distraction. So staying present doesn't just mean keeping your body in the room. It's about being fully present in what's happening in the room. So turn your phone off, put it away, don't be distracted by it. You've got to be locked into and engaged with whatever is happening right in front of you and be ready to respond to her needs without being distracted by something else. So be interested and invested in the thing that is happening today. It doesn't happen very often and although it is usually a day in your life, You and your partner are doing something in that one day that actually creates a long-term transformation. It can be a positive transformation or a negative transformation, but you can never escape the transformative power of labor and birth. Imagine being...
[16:44] Absent, mentally absent from that moment because you were distracted by something as menial as a phone. This sticks in the memories of women. Birth is a lasting memory for us. So we remember our births forever. And if she remembers that you were completely there for her, so supportive, that is a recipe for long-term satisfaction for her birth experience. And couples also have this amazing opportunity during birth to fall more in love with each other. Birth is a unique oxytocin-soaked scenario. And they say that oxytocin is contagious. And what we now know is actually oxytocin can act a little bit like a pheromone. So everybody around the woman, if she's bathed in the oxytocin of birth, the hormone of love and bonding and of labor, then you've got this opportunity to.
[17:43] Fall so much more deeply in love with each other and bond over this day this experience of birth if you're present you can fully capitalize on the oxytocin of labor and birth so if you can limit the number of distractions that get in the way it allows you to fully be present and fully immersed in her needs but also the extensive other needs and the positive transformation
[18:08] that can occur for you both. Now, number four is to be interested and invested.
[18:15] So becoming interested and invested in the birth means working out ahead of time while she's pregnant, how you can be the best support person ever. So you might just need to ask it, what do you need me to know? What do you need me to do in order to prepare for this birth? And probably if you're listening to this podcast or if your partner or friend or daughter has recommended this podcast to you, she's probably been learning a lot and preparing for her labor and birth and she wants you to know what she knows. So you could start by learning everything that she wants you to know and make it your job to understand what plans she's been making for her birth, what her preferences are, what she wants, what are her desires for this birth. And then you can both get on the same page. better off to find that out during labor than trying to discover it during birth when she's in it so that's going to take a little bit of pre-preparation and time on your part to fully get on the same page with whoever it is you're going to support through labor and birth now number five this is a big one encouraging words.
[19:27] Being encouraging. Your job during labor is to encourage her to keep going in the same way that a coach would encourage an athlete who's doing something hard to keep going, like Tour de France or something. The people on the sideline encouraging people to go on to find the most deepest pockets of their energy and motivation and scrape the bottom of the barrel and use that to keep going towards the goal. So your words need to be formulated in a way that are going to push her to get every little bit, last little bit of effort and courage that she has left and help her apply that to labor and birth. It's a really big job that she's doing.
[20:11] Offer encouragement. And the words that you use will be your own and ones that perhaps you already know she loves to hear.
[20:19] Number six, and this is a really practical one, but a lot of people don't think about this.
[20:24] Is number six, do everything else that needs doing in your household and in whatever, however the household organization needs to run has actually now become your job because she is in the middle of labor, the person you're supporting, the woman you're supporting, which means you need to do everything else that's needed to be done that she maybe would normally do, and now you're responsible for all of the rest of it. And I know this might sound crazy to say, but I've been in enough households to know that there is a percentage of the population where they have a very clear delineation of roles in the household. And perhaps the partner has never fully understood the household management role that their wife or girlfriend or partner has taken on. And I know that sounds very stereotypical, but honestly, I've been involved with the care of families for over 18 years and there's a category of partner who does not understand what it means to manage a household. So if that's you, that's totally fine. I understand there's different roles in the household and something that you've all agreed on. But now it's your responsibility to make sure that the roles that your partner was doing before you go into labor.
[21:50] They're properly delegated so now it's time to be debriefed on the day-to-day running of the house how you know a household runs like a business there are standard operating procedures and rhythms and routines that happen and your partner is the CEO of the household and it's time to understand what her role has been so that now you can take over not only while she's laboring and giving birth but in the weeks following when she's recovering from birth and caring for the baby and feeding it's going to be your role to manage and organize the household so if you haven't already if you don't already understand how your household works now is the time that is something you can do to prepare to support your partner.
[22:33] Now, number seven, if you're going to be an appropriate support person, you need to understand your own feelings about birth and work out how to prevent them from negatively impacting the birth space. This is a big one because culturally we have been groomed to fear birth because we don't really truly understand it. So sometimes people have never seen or experienced anything like birth until their very own baby's being born. And so we all have our own personal feelings about birth so before you get there see if you can tap into how you feel like if you thought right now birth some of you might be thinking oh my gosh I'm thinking blood, fear, screaming, noise, drama, danger that might be how you feel about birth something you might just be excited you might be relaxed you might be ready for it you might not be scared of birth, but it's important to understand where you sit on that spectrum.
[23:34] If you believe that birth is a super normal event and that's just something that women's bodies are capable of doing and that it usually goes well, then you have what we call a physiological mindset and you're probably not too frightened of birth and that's going to show in the way that you care for your partner while she's in labor. However, there are some guys and girls that believe that birth is really dangerous and risky and that it's a medical situation and it could go wrong at any time. And that's a more medicalized idea of birth. And if that's where you sit, you are possibly really scared of birth. And that is going to change the way that you behave in the birth scenario. You might act out of fear instead of what your partner needs. You might make decisions based on things because you're scared instead of focusing on what she needs. So check in on what your philosophy is and see how that aligns with your partner's philosophy. Are they matched? Are you both super scared or are you both super chilled or is there a mismatch? And this means that you might need to do some work about how you can manage that during labor of birth so it doesn't negatively impact on the decisions and the way that you engage with your partner during birth.
[24:56] Okay, this next one I feel like I've given you this idea already.
[25:00] But number eight is to give constant support and help through each individual contraction. It depends on who you're supporting. You know, your wife, partner, daughter, sister, friend, whoever it is that you're supporting, she might not want to be touched, spoken to. She might not need your presence during her labor and birth in the early part. Maybe she'll decide she needs it later. But if you have in your mind that you're going to give constant support and help work through every single individual contraction, you've understood the role of a support person. So I know I've touched on this already, but she's not going to get a break from labor. So imagine yourself not getting a break from supporting her in labor. And this is where the multiple support people can come in real handy so you can take turns and share the care. So you're a human. You need to go to the toilet and eat and rest and hydrate and, you know, practice some personal hygiene as well. So if it's a long labor and things are really going on, it's getting really hard, you might need to consider who else you're going to have there in order to completely meet the laboring woman's needs. And somebody who's really great at this are doulas. And they don't replace the other support people. They offer support and care
[26:23] to everybody around the edges. They can tap in and out as needed.
[26:28] They're a really great insurance policy on the support front. So the idea is not that now that you've got a doula your partner's off the hook they don't have to do anything the doula frees up your support people to support you fully while managing things in the periphery and each doula is different but I would encourage you if you feel like you need extra support and you don't have the right people in your corner consider searching for and hiring a doula who really matches your needs and this would just mean interviewing them and we've got some great Birth Rebellion podcast episodes all about doulas. I'll make sure they're linked in the show notes below.
[27:10] So that is, number eight. Number nine, part of being a great support person is listening to the words that the laboring and birthing woman is saying. Pay attention to her words. When women are in labor, we don't actually have a great capacity for telling people what we need. Our brain has left into this labor land, which doesn't rely heavily on words. And so any words that come out of the mouth of a laboring or birthing woman are super important. If she says something to you, she's put a lot of effort into choosing and getting the words out that she feels are important. And so don't make her say it again. Please listen to whatever words she's saying and act on those. Those are really important words. Whatever she's been saying to you is probably the biggest thing that she's been thinking about during her labor and birth. And it's been the only thing she's been able to get out of her mouth. So for me as a midwife, anytime a woman says something in labor, I hold onto those words. What were they? I try and interpret them as best as I can. Those are important words and I act according to what she said. She might say something like, I'm scared. Okay.
[28:30] What are you scared of? You know, ask a few questions. Not too many. We'll talk about that next. But what are you scared of? Or this hurts. Okay, this hurts doesn't necessarily mean get me pain relief. It means, okay, I need help. And so now it's your job. Okay, okay, this hurts. Okay, I'm going to give you a massage. How about I run a bath? You know, let's try some things that are going to help you. It doesn't mean that she wants to be rescued. It just means she's working hard. She needs more support. All right, next thing we can do. Number 10, don't ask too many questions. So try and understand as much as you possibly can ahead of time so that you have as few questions as possible in the labor and birth moment. When you ask a laboring woman questions, you take her out of her laboring brain. It creates a bit of a speed bump in the labor process because she is forced to re-engage with the real world instead of getting completely lost and taken away into labor land where her body's working more efficiently. So think of a question as a tiny micro intervention. So only ask the ones that are completely and absolutely necessary. Don't ask menial questions like...
[29:49] Do you want a drink? Oh, the number of times I've said to my husband during labor, stop asking me if I want a drink. Just put a drink there. I can see it if I need it.
[30:02] So try and know as much ahead of time so that there's no need for important conversations in labor. So, you know, you want to avoid asking too many questions. And part of this is also to keep other people out of her space so that they don't ask her too many questions. Because this is the other thing that can happen during labor and birth is that other people walk into the room and immediately start asking a laboring woman questions. So if you're already prepared and you know a lot of what she's planning and what she wants for her labor and birth, you can intercept those people, protect her labor space, protect labor land, intercept those people and ask, what can I help you with? We're not going to talk to her right now she's busy but I could probably help answer some of your questions especially if they're minor if they're not major questions and you already know the answer you can answer them on her behalf so that is a way of protecting her labor and birth space from unnecessary.
[30:59] Interruptions and to try and make sure that you don't become one of those interrupting question people all right the next thing is is to this point protect the space and keep things out that will cause a distraction remember she's been lifted away into an alternative universe into labor land she may have tried to consciously block out the external world closing her eyes listening to music she's in her own mind she's her body's doing its own thing do your best to protect that and try not to make her step out of it and engage in the outside world.
[31:40] That will make you the manager of the birth space to keep her safe. Okay, those are some broad sweeping ways to support a woman in labor, but I also want to help you with some practical strategies that can help you support her at home before any care providers are involved. So there is a part of labor that happens not in a hospital, not in a birth center, and if you're having a home birth, your midwife will not be there. There's a whole part of labor where you and her are managing this together. Without a care provider. And anything that you do for her during this early labor at home will translate into what you can keep doing for her as labor progresses on and maybe as you move out of the house to the place where you're planning on giving birth or, you know, you might be staying at home if you're having a home birth. So here is how to support your partner at home.
[32:40] Remembering she is 100% busy in labor. So that means that everything else is up to you. So if your partner is aiming for a low intervention vaginal birth, she might be aiming to stay at home as long as possible. And in this case, she will be in strong labor before making the decision to leave the house or to call the midwife to come to the house. So firstly, ask yourself, does this scenario scare you? Do you feel prepared to be that person who's going to be supporting her through that scenario? And if you do, that's great. And also consider though, while you're supporting her, who's going to be helping with all the other things in the house, like kids, animals, just daily life. Can you do all of that look after her in early labor and also all the house critters children anything that's alive that needs care or is it possible for you to delegate some of that to somebody else so you're fully with your partner or if you're a support person for a woman that you're fully with her and that the other stuff all the life stuff that still has to go on around you is managed by somebody else so consider who could help take over those things.
[33:57] And if your partner's been preparing for home labor, hopefully she or your friend, whoever you're supporting, hopefully she's collected a bunch of pain management tools somewhere all together in a box. And it will be your job to work out and understand what's in there, when you might use them. Have a chat to her about it. This is all something you would discuss together. But if they're all set out in a box and the batteries are in everything if you're using a TENS machine or anything heat packs all these things work out what they are when to use them and make sure they come with you to hospital if you're transferring away from the house.
[34:32] So aside from managing the day-to-day life as well as helping support somebody in labor helping a woman in labor and also knowing what all the pain management tools are going to be and knowing how to use them. The other ways to support her at home before anybody else is involved or before you head off to your planned birth space. Other things that you would be responsible for, the support peer would be responsible for, is setting up the environment. And as I said, the woman is in full mental and physical labor zone. She does not have the capacity to do anything else. So you'll need to set up the labor and birth space at home, things that will increase her comfort levels and that these things will give her more capacity to keep doing the job that she's doing. So think about things like heating up the heat pack, setting out pillows and blankets and birth balls. If you're having a home birth you might consider setting up the pool if she's got any fairy lights or aromatherapy oils anything that she's purchased or collected to build her little birth nest just make sure all those things are in place you could apply the tens machine make sure her drink bottle is filled up help her to the toilet just little reminders maybe time for a little wee. Keep the house warm or cold, just comfortable.
[35:55] Minimize noise and distractions and go about creating a private space that just feels safe and comfortable where she could get naked if she wants to. So basically you want to do everything you can to help her feel comfortable so that she can find places to get comfortable positions. You might need to move a mattress and these are all things that you can set up at home. A little labor and birth circuit or a little labor and birth nest.
[36:22] And the other thing, as I've already been mentioning, spattering through this
[36:26] whole episode, is consider hiring a doula. If this all just, you're listening to this and you think, gosh, I've actually got a really big job to do. And I do agree. I think being a support person is a massive job. And if you can divide the job out amongst a few people, then you're going to strengthen your support team and your support network. And the woman is only going to feel more support, of course, if they're the right people. So the best thing you can do is to recognize your capacity at this time. Imagine how present you want to be and what role you want it to be. And if you can't do all of it, then hire somebody else who can fill the gaps. So either be prepared to get yourself ready for the role that you have to fill or take initiative and the insight and humility sometimes. so you may decide that you need to hire somebody who can fill the gap.
[37:23] Your purpose is to serve your partner or the woman who's laboring and you can either do that directly by serving them yourself or hiring somebody who can meet her needs in that way. So there's no shame in this, just put her first and make sure that her needs are met whether or not they're by you or someone else.
[37:43] Now in writing this episode, I also asked my husband, what do you think? How do you think men women sisters friends doulas how do we support women in labor and birth he was obviously the main support person at my at our births for our two children okay and this is what dan says from the mouth of a man i'm saying this verbatim don't interrupt their flow they don't generally want to be talked to or asked questions, but be there ready to attend to every need. Think of it like she's playing sport and she's on the court, so you're encouraging her. Don't try and correct her. Mostly men need to be told that they are the number one go-to person for their partner. So it's your job to be massaging, filling up the bath, holding her up when she wants to hang off you. It's about being there and supporting her through it. She can definitely do it. Your job is to support her through it. So don't try and rescue her from it. She's capable of way more than you think she is. Help her go past her limits.
[38:58] That's what Dan says. There you go, directly from a man who did a wonderful job at support through labor. Now, let's have a little chat. One of the roles of a support person is to help the woman with pain relief, pain management. And this isn't about helping her get an epidural or helping her with gas or any other pain medication. That may be a plan. but.
[39:27] I suspect if you've been given this episode, the woman who gave it to you, your partner, your friend, whoever asked you to listen to this is probably going to try and get through labor with as little pain relieving medication as possible. I could be completely misreading it, but if that's the case, here are a few strategies that she might be planning in order to manage the labor pain that you need to be across and aware of. So here we go. here's my all killer no filler list of non-pharmaceutical or drug-free pain management options for labor and birth these can be used both at home or in hospital so hot water bottles and heat packs and it's going to be your job to keep these a right temperature don't make them too hot women who are in labor they lose a little bit of sensation because they're so focused on labor and birth so don't accidentally make them too hot because they really can get a bit burny the most preferred places for heat packs are on lower back or lower tummy.
[40:31] The TENS machine if she's got one of these there will usually be four sticky pads sometimes two sticky pads and you can put them on her lower back in like a bit of a v-shape beside her spine and then two more positioned a bit lower on her back cheeks. Make sure she's all dry before you position these and just start them at a low strength and turn them up as needed as labour gets stronger. Help with ear pods or headphones. Make sure these are fully charged and if you're taking them to hospital, make sure you're taking any charging cables or anything like that.
[41:06] The next great thing for pain relief, and I mentioned it first thing in the beginning of the podcast, is the hypnobirthing technique. So if you purchased a hypnobirthing resource, so something like the Pop That Mama online hypnobirthing resource in the birth box, then if she's been using that to get ready, it could be really handy for you to be familiar with that content and with the hypnobirthing tracks so that if she comes to a place where she's feeling like she wants to activate them you know how to use them you can help her through a bit of hypnobirthing techniques through labor and birth, the next thing you can do is help with position changing she's probably going to want to move and change positions through each contraction and maybe particularly through the last stages, she's going to reposition herself very often so your job is to just help her get comfortable in that. If she looks a bit uncomfortable, she's on a hard surface, can't quite get comfy, have a look around for soft things and ways that you can advise her to help her get more comfortable.
[42:15] Oh, the cold face washer. Don't underestimate the power of the cold face washer, especially towards the end of labor when things are really getting hot and heavy. She's working really hard. We're at kilometer 75 of the marathon and she is hot and just looking for any little ounce of relief a cold washer on the forehead or the back of the neck you know swiping her hair up out of her face and just tidying things up a little bit it says a lot about your presence and your awareness of what she's going through not only is the cold a little bit of a relief it also communicates that you are there and that you're tapped in.
[42:55] She might not notice because her eyes are closed and she's in labor land, but that's just a tiny little reminder of I am here with you. Right, the next thing for pain relief, and this is something that you can use and offer in times of just really full-on intense labor, and that's water immersion. So fully immersing in a birth pool or a deep bath is a perfect sort of later stages of labor strategy to help calm the scenario. I call the birth pool the home birth epidural. So when women feel like they have just exhausted all other options or they're feeling really overwhelmed or really tired and labor is really strong and you just need a big breath and sort of calm the situation and come back to central then you submerging in a deep pool or bath is a really beautiful strategy so if you can feel and sense that things are heightening in the birth zone maybe just take some initiative turn the bath on and tell her later hey the pool or the bath is ready for you to get in if you need it she might have bought some birth combs to use so you know you can make those available to her physical support like massage and pressure points now don't over complicate the massage if it feels good to your partner then you are doing it right So my main suggestions for massage are don't be too gentle.
[44:23] Now the next thing is just like hand-holding or physical touch. So don't underestimate the power of a good, strong, confident hand.
[44:32] On the woman in labor. It says, I am here with you and it can make all the difference to the woman's emotional and mental capacity to keep going. Again, I already mentioned comfortable surroundings and soft furnishings, temperature control, that positive self-talk that you're going to offer to the person who is running a marathon. So positive self-talk for working through contractions and reassuring words to a degree her mind will believe what you tell her so if you are telling her affirming things yes you can do this you've got the strength to do another one you are doing it I'm with you here we're doing this together I'm here with you let's go let's rally then that builds up her confidence and capacity to keep going the positive self talk, all of a sudden she starts to believe it as well. That positive self-talk is about rewriting those signs that exist along the marathon trail. Instead of having signs up to say, no, you can't do this, positive self-talk or talk that you can give in to that woman's birth is about rewriting the signs that she is seeing through labor. If you're saying things like, you've got this, you're strong enough, you're ready for this, you can do it, I believe in you, you're doing amazing. Those are the things that are going to spur her on during those harder times.
[46:00] So those are a few of the little things that you can use at home, but also transfer into hospital or birth center, wherever you're going to birth, things that you can do there. But if you are planning to have your baby in hospital or a birth center away from home, there's going to be a time where you need to travel and transfer.
[46:19] And this is a time of disruption for a laboring and birthing woman. So part of your role as a support person is to make this transition as smooth and gentle as possible you want to make it so that she has minimal shock and stimulation from the outside world so keeping things dark and quiet and calm and low stress and making sure that you and the other support people are managing all the logistics of moving into hospital so that she can stay completely in the labor zone. So here are a few tips of mine that you can use to make sure that the transition into hospital is peaceful and as less disruptive as possible. So as I said she'll be laboring you'll be in charge of all the logistics. So have everything that is going to be going with you to hospital have it all ready either in the car or at the door so that there's a quick exit you don't have to carry too much. So pack up everything that she's been using in the home for pain relief and take it with you. If she's been using it at home, don't just leave the house without it all. She's going to need to keep using it in hospital. All those heat packs and TENS machines and drink bottles and all that stuff, take it with you. So next, don't forget her drink bottle and remember to pack one for you too. Heaps of snacks to take to the hospital. You may want to feed your partner in labor. She's probably going to be hungry and believe it or not, Hospitals are like a food desert within out-of-business hours.
[47:49] Go with a packed lunch. Prepare to be able to feed yourself and her.
[47:53] So make sure the car's all ready before you go to hospital. So she might want to use the back seat in labor. So if you could take out any car seats and tidy that up a bit, all the crumbs, so that she can get comfortable in the back of the car. Because if labor is really, really strong, she probably won't be able to sit down properly in the car. So consider taking some pillows, towels, and things that can help her stay comfortable for the journey. And again, she can wear her eye mask to block some things out.
[48:24] Headphones, take the TENS machine and heat packs, anything that is going to help with pain relief in the car while you transition and anything that's going to help block out external stimulation is going to help make that transition to hospital a bit more calm and less disruptive to her labour process. One thing you'll also be responsible for is calling the hospital to let them know you're coming in or to be communicating with the midwife. So just make sure that you have all of those numbers saved in your phone ahead of time so that it's easy for you in the moment to communicate with whoever you need to communicate with. If you're going to hospital, let them know you're coming in. And also, this is an advocacy strategy here. Make sure that you express to them what you need. For example, I'm coming in, I'm coming in with my wife and our doula or my wife and her sister or partner or whoever you're taking with you and give them a little bit of an idea of what she's planning. So for example we're coming in and we're planning to use the water so can you make sure that you get us a room that has a bath or whatever you want to tell them we're planning on whatever you're planning and then that means that they can get ready ahead of time allocate a midwife to you who is comfortable with whatever the birth plans you have and it's the first step into sort of setting the scene for what they can expect from you when you arrive.
[49:54] Also, remember phone chargers. This is like classic thing to forget and your go bag. The other thing is, is she's been laboring at home. She's probably half dressed, if at all. So just help her get dressed for the hospital, a robe, some pants, pajamas, something easy. Just remember some of her maternity pads and make her comfortable for the trip. And when you get to the hospital this is the other really logistically frustrating thing for support people and I really feel for you trying to manage all this again the woman who you are with who you're supporting she's just laboring and birthing she doesn't have to can't do anything else you're responsible for getting her there parking the car making sure you've remembered everything carrying everything in while also helping her through every single individual contraction that she's having and can I tell you getting into hospital birth units is a real pain in the ass sometimes the corridors are endless the doors there's poor signage it can be a really tricky time particularly if it's night no one's around she's in full-on labor so when you get to the hospital consider calling the birth unit and asking can you please come and pick us up with a wheelchair. At the very least, the woman who's in labor doesn't have to walk herself into the hospital. And that means that you can carry all the gear.
[51:23] But here is where I think extra support people and extra hands really shine. That really awkward transition into hospital where the logistics of just getting through the door are very complex. I've seen some people have to drop the woman off and then go and park the car and bring everything later. And she's sort of in this weird no-man's land of getting herself into the birth unit. So consider a second person, if only just, for that transition to hospital. Now, when you get in, when you finally do get in, again, you're managing all the logistics, but there will be this admissions process where they want to see maybe a yellow card or some notes or get some information. Again, you want to try and keep the woman in the labor zone, blocking out as much as you possibly can, just get her into the room as soon as you possibly can and avoiding all these bright hallways and lots of people.
[52:19] When you do get in there put all the gear that you've bought put it onto the bed and raise up the bed so that she can lean on it and if you put all everything that you've bought and raise it up this you can even like take the brakes off and push it to the side of the room if if you need to but now you've actively completely redefined the role of the bed in the hospital, Now, hospitals, there are endless papers and literature written about the impact of the birth bed in the birth space. And typically what happens is the very first thing that will happen to a woman when she arrives in hospital is, hey, hop up onto the bed. We're going to check your baby and do a vaginal exam. It's this bizarre initiation process that really is usually not medically indicated, medically unnecessary. There's no evidence for these kinds of things. However, this is what can happen. It can be really uncomfortable. Not all women want to do it, but it does put them in a position of vulnerability.
[53:26] So if you immediately take control of the bed, it's almost like capturing the flag. You have claimed and taken over the territory of that room. You've said, we own this space and we're going to use it as we see fit, not as you want us to use it. So enter the birth room with the mindset that you own it assume you own the birth room and there's heaps of academic research on this idea of territory and the birth space you.
[53:57] Ironically the staff in the hospital also assume that they own that territory and that they can use it however it benefits them but you can flip the script just by altering the use of the bed and claim it as your own territory act as if it's your own you don't have to say to them i hear this is my territory this is our birth room but by controlling those powerful elements you've.
[54:23] Subconsciously just claimed it as your own. Now, the other way that you can control the game is instead of agreeing immediately to the hospital admission process, you know, they have an admissions process that they want to get through. When you arrive, there's certain paperwork, certain sort of check-in moments, boxes that they want to tick, and then they go, ha, we have admitted you to hospital. Just take control of that whole thing and just ask, hey, we're going to need some birth mats, birth stools, pillows, extra buckets, anything you can do to make the birth space comfortable before any of the other logistical stuff needs to be done. All right, see if you can mimic what you had going on at home. See if you can immediately start to mimic that in the birth space now that so she can get comfortable in the birth space and resume her labor. Again, this is all a lot easier to manage if you have a doula or other robust support people with you. You can also dim as many lights as possible as you can in the birth space and advocate for her. So again, you're protecting her space. Talk to the staff on her behalf if you can. All right. Now, this brings me to my next point about supporting a laboring woman in birth.
[55:38] It's about advocacy and setting expectations early. And I know this all sounds like a lot. already what I'm describing the role of a support person is significant so you can see why I've suggested dividing it up amongst a few capable people but what could be really amazing and what maybe sounds a bit nicer to you is if you could be completely with her with the laboring woman.
[56:04] And then farm out all the other roles to other people like a doula a doula can do a lot of this background managing. All the stuff on the outside could be done by a doula while you are just working with her in labor. She's still getting contractions all the way through this, all these little disruptions that happen through labor and birth. So in the early part of going to hospital, in this sort of flurry, when things are a little bit busier, then a doula can really help you set the scene and settle into hospital. You know, going into hospital is a real assault on the senses on both yours and hers and it can really trigger your nervous system it's a new location your partner's in labor you know there's this whole huge transition and if you can ease that with extra support people it might be a solid investment. So now I want to make a few points about how to advocate during labor because this is going to be one of your roles as a support person, And unfortunately, there is a culture within maternity care, and this will be different if you're planning a home birth or a birth centre birth, or if you have a known midwife as your care provider, you might be a little bit protected from this.
[57:19] There is a culture within maternity care where providers can act in a coercive way. It's kind of embedded into the maternity care system and a lot of practitioners don't even realize they're doing it. But they will try and coerce and manipulate women into making decisions that they want them to make or particular ones they want her to make. And these decisions might not align with her plans for birth, but it's really hard for the woman in that moment to navigate that coercion and the strategies that care providers can use to try and convince women to change their original plans. And in the midst of this, in the midst of trying to labor, the woman can lose the strength and capacity to fight for herself. And she just kind of gives in to whatever the coercion is trying to direct her to.
[58:08] I'm not saying that all care providers are doing this and that all care providers are not on your side. You know, a lot of care providers are working under their own fears and many of them have an allegiance and a responsibility to hospital policies. They have their own time constraints.
[58:27] It's a really hostile scenario in maternity care. So I don't want to paint them as, you know, the devil. They're not there to try and sabotage your birth. but there's a culture that exists in maternity care where care providers either knowingly or unknowingly coerce women into decisions that they weren't originally going to make. So my point is that the labouring woman is vulnerable to suggestions. She's not able to defend herself. She doesn't have as much capacity to fight for herself and to fight what she really wants. It's really hard to talk in labour. Even to think in labour is really hard and so that becomes part of your role is to advocate for her you're becoming her mouthpiece or protector to guard the space so one of your roles is going to be to defend your partner from things that she doesn't want and there's a fine line between think you know there's routine things that get done in labor and birth and then there's medical things that get done in labor and birth because it's actually a necessity and so all the preparation leading up to the birth is about you and the woman trying to work out what things are usually done routinely and what things are usually done in a medical setting and how you feel about those. Some early decision making before being in labor can help you be prepared to advocate for herbs.
[59:48] And part of the role of being a strong advocate is to be able to see what is happening around you. And one of these things is recognizing and navigating escalation policies and processes. And this is where I want to tell you about the process of escalation. So if you decide to decline something that a hospital would normally routinely do or that they genuinely believe that you need, and you decline it, there's a chance that they're going to escalate that conversation. So what I mean by that is you might be speaking to the midwife who's already caring for you or whoever's caring for you. And then because you've said no to something that they wouldn't normally do, they will send in the next person. It could be a doctor, a more senior doctor, a team leader, the nurse in charge the midwife in charge and the process of escalation starts so although the hospital staff might think that they're just offering you more layers of education maybe they're thinking maybe she's not really aware of the choices that she's making.
[1:00:58] What they're actually doing is layering on more and more pressure from higher and higher authorities in the hospital system. And the result is that the woman is feeling pressured to accept the recommendations because the woman runs out of energy to keep negotiating with this escalating barrage of hospital staff. And so the woman relents and just accepts whatever it is they're trying to get her to do just to stop people from coming in and talking to her. She's tired of fighting for what she wants. And this is where the support person can really shine. So if you are confronted with this process of escalation and you recognize that you can see what's happening in the room, that a new person is coming in to talk about the exact same thing that that woman just declined, then there are a few strategies that you can use to diffuse this process and protect the birth space.
[1:01:55] So one strategy is to ask for more time and slow down the decision-making process. So you give them a timeline, for example. The midwife might come in and say, hey, we'd like to do another vaginal exam. It's been four hours since your last one. Your response, if you know that your partner doesn't want that, thank you for that suggestion. We don't want one right now, but let's revisit this conversation in two hours, three hours, four hours whatever you want maybe in one hour we want some more time or we're doing this right now we will think about that in an hour's time or we'll just have 20 minutes to have that conversation and think about it you don't have to accept it on the spot realize that you have time you can this is what I call expanding your time bubble and cushioning around yourselves as much time so that you can control the speed at which interventions are delivered to you or speed at which care is delivered to you and this is part of owning the territory and owning the birth space you control the pace at which you will accept or decline things and avoid the pressurized situation of having to make decisions fast.
[1:03:14] And so part of owning the territory is managing who has access to the laboring woman. If she's in labor, she doesn't need three or four new people coming into the room during this escalation process. There's this other weird thing that happens in hospitals. I've noticed that when a woman comes in, the doctors feel like they need to go in and introduce themselves to the woman just in case they need to meet again. It's a huge interruption in the birth process women don't actually want or need to meet an emergency care provider we don't know all the people at the accident and emergency unit if we turn up we don't really care who they are what their name is we just need the care and the skill that they've got so you know if if you know that she wants to be left alone.
[1:04:06] You can, excuse me, who are you? What are you doing in the room? This, you know, it's okay to ask people why they've entered your space and help manage that from a distance. And so as a support person, you position yourself as the gatekeeper.
[1:04:22] You, along with her, obviously, you're not keeping her hostage, but she trusts you to act as a gatekeeper to keep her safe during labor and birth. And my other piece of advice is to stay calm and steady but strong and firm so raising your voice or becoming aggressive could actually lead to you being evicted from the birth room if the care providers are feeling threatened or challenged by you they may call security and have you removed I've seen this happen before so be super careful stay calm and respectful in control you don't have to adjust your position or change your decisions. It's just about not being aggressive, being polite so that the people who are also caring for you feel safe in the space. And I mentioned this before. I alluded to the idea that it's really hard for women to get words out when they're in labor. So say something is happening and a care provider says to her, hey, I would like to do this and she says no okay you've got your answer she said the no once don't make her say it again she worked hard to push that out she obviously really seriously knows what she wants so take her words seriously and then be her voice from here on in don't make her keep fighting she already said no so now it's your chance to be on her side take her side and continue saying no until she changes her mind.
[1:05:50] So, here's a little summary of those strategies that I just talked about for advocacy and I'm going to include a few little script words here. Some things that you can write down and use if you feel like you need them and if you're not sure what to say during labour and birth to help with advocacy, having a few little scripts, a few little lines or prompts to remind you of words that you could say can be really helpful. Scripting hard conversations is not a new thing. So it can be a really nice memory jog if you're feeling a bit lost in a heavy conversation.
[1:06:26] So here are some advocacy strategies for you as a support person to help advocate for a woman in labour. If we're making some hard decisions, ask. Ask for more time. You can slow down the decision-making process if it's not an emergency. You can own the territory. So rearrange the room however it is you need to make her as comfortable as possible and then act as a gatekeeper to prevent people from interrupting her during labour and birth unless it's absolutely necessary. You are the supportive gatekeeper. So you could ask questions that need to be asked in order to make big important decisions and maybe only take the most essential information back to the woman. If she says no to something, don't make her say it again. Take her words seriously and be her voice. If she says no and a care provider persists in trying to give her or convince her to say yes, that's where you can step in and remind them she said no.
[1:07:26] So don't make her fight she's already said no always take her side it's hard to speak in labor so you will be locked in and paying attention to every word she says they are important and now it's your chance to speak as her mouthpiece now in order to be able to do this you need to know her plan so that you can advocate in a way that is not keeping her hostage the idea here is not to get her the birth that you want her to have it's to get her the birth that she wants to have so you need to understand her decision so that you can advocate on her behalf. Be polite and be civil so you don't get kicked out. And some scripts to consider if you need to write some phrases down, some scripts that you can consider that will help you advocate on her behalf. First one, she said no, so you can't do that. Second one, we need some more time to think about that, we'll let you know when we've made a decision.
[1:08:25] Third one, and these are starting to escalate now. Please don't ask again. We've already given you the answer. If we change our mind, we'll let you know. Number four, if you need some information about the situation, you can ask, is there immediate danger here or do we have time to make a decision? There are a number of scripts that you could use and that you could come up with yourself. Those are just a few that I've found really helpful.
[1:08:53] Okay i've got two last things that i'm going to share with you in this episode firstly how to help when things get hard and secondly how to sabotage labor and birth so here we go as a support person here is how to help when things get hard there may be a point in labor where she hits a wall she doesn't feel like she can go on it all feels too hard and she's ready to abandon
[1:09:18] her plans and do something else. I've seen this happen for lots of women. Doesn't matter where they're giving birth, they might be at home, but it happens everywhere. Labor can get really, really hard and strong at the end. She's at the 90 kilometer mark of that 100 kilometer marathon and things are feeling overwhelming and she's digging deep to get to the end. And here is where your strength comes into play. Don't abandon her at this hard point. It's time to get her across the line. So just prepare yourself that labor could get really hard at some point and this is where all of those strategies of encouragement, physical support, incredible belief in her ability, these all come into play. So you might need to talk her through every single contraction, egg her on through every single moment, offer different solutions, fill the bath, offer massage. Hard you could be saying things like okay we knew this was going to be a hard point I'm here for you you can do this let's get this done now is the time to rally.
[1:10:21] At the end there and in those really strong moments, she's going to need a new level of support, a new level of positivity, and it's time for you and all the other support people to rally right at the end. So when things get hard, just activate that positive self-talk, massage, support her body, increase the strength of the TENS, submerge her in a bath, not with the TENS, offer to put on a shower give her all the support you've already been giving and just but rally this is like the end point imagine you are egging her on towards the end of that 100 kilometer marathon line.
[1:10:59] Now, if we flip all this, how to sabotage labour and birth? Firstly, get distracted by your phone and be in the digital world instead of the real world. Number two, take everyone else's side over the labouring woman. Number three, forget to offer her a drink and don't help her to the toilet if she needs to wee. Number four, make her get herself comfortable during labour and think of your own needs above hers.
[1:11:28] Number five tell her she can't handle it she's too weak and she's not going to get to the end number six constantly interrupt her through labor with questions and your unprepared stupidity, number seven don't do any preparation leave things to the last minute forget stuff at home and don't do the things that you are responsible for number nine I think I'm up to number nine don't take an interest in preparing or contributing and number 10 don't do what she asked you to do and tell her that you are tired okay there you go that is a crash course in how to be a great support person or partner and if you found this episode helpful i'm going to leave a list of other great birth rebellion podcast episodes in the show note below their clickable links and so there are other episodes that relate to being a support person in labour and birth.
[1:12:26] I'm Dr. Melanie Jackson, and I will see you in the next episode of the Great Birth Rebellion podcast. If you want to be a great support person, go ahead, click the other episode links down below and prepare yourself for the most amazing transition known to man. To get access to the resources for each podcast episode, join the mailing list at melaniethemidwife.com And to support the work of this podcast, wear The Rebellion in the form of clothing and other merch at thegreatbirthrebellion.com. Follow me, Mel, @MelanietheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
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