Birth is always with us. Like the food we eat, the air we breathe, the sleep we sleep and the death we eventually arrive at. It is an integral part of human life with its own set of rhythms and tunes. Yet in today’s technological world, how many mothers enjoy a birth that is undisturbed and without fear? How many babies are born in their own time?
The benefits of social support around the time of childbirth are re-presenting themselves within our collective consciousness however. My feeling is that we need to go back to basics and reconsider the fundamental needs of the birthing woman: an environment where she feels private and safe with trusted attendants who share a positive attitude to the pain and process of labour and birth.
The expectant mother may not be wholly aware of the considerable impact that her environment and the people attending her can have on the way she gives birth. Labouring in an unfamiliar place, with strangers randomly entering the birthing room, can disturb your birth process – slowing it down or bringing contractions to a halt – to the point where you may lose touch with your instincts and be disempowered into accepting medical intervention to bring your labour to its conclusion. The true implications of ‘pain relieving’ and augmenting drugs are that they too cause disturbance, by disorientating your consciousness or numbing your pelvic floor muscles, and by interfering with the way your body produces the hormones that are vital to the natural ongoing progress of your labour and birth (1).
While some women feel comfortable birthing in a more private space such as at home or in a small midwife led birth centre, despite evidence to the contrary (for a straightforward pregnancy), many parents still believe that hospital is the safest place to give birth. You may feel differently about your chosen birth environment once you understand the significance of privacy and peacefulness however. Once you know that noise and questions can prevent you from withdrawing into your primal brain and that fearfulness can encourage the release of adrenalin which overrides the vital flow of the essential labour hormone, oxytocin. Once you are reassured that feeling free to move around and instinctively take up any position you feel is right, and that having the presence of a trusted birth attendant to quietly ‘be’ beside you, encouraging you to work with rather than against the pain, can bolster your chances of experiencing a safe and gentle birth (2).
Traditionally, expectant mothers have always gathered female family members and close friends around them for support and companionship during the time of childbirth. The mother-to-be chose these confidantes to uphold her birth instincts, support her intuition, hold her birth space and protect her ‘babymoon’. Yet with over two generations of women having experienced principally medicalised, interventional and often traumatic birth, how well equipped are relatives or friends to effectively support today’s birthing or new mother (3)?
You may therefore look to your midwife, who is legally responsible for your clinical care, also to provide social support. If you are able to employ an Independent Midwife, one who shares your philosophy on birth and parenting, it is likely that your individualised emotional, physical and spiritual needs will be met and that you will go on to experience a gentle birth at home. Under the NHS system, your maternity care may be less appropriate however. While many hospital and community midwives are practising instinctively and sensitively, with women centred focus, open to supporting the mother or couple in whatever they wish the birth of their baby to be, sometimes, through circumstances beyond her control, the NHS midwife may not able to offer the standard of care she would like (4). Furthermore, as mothers, grandmothers and sisters themselves, it may be the midwife herself who brings fear into the birthing room, perpetuating the myth that birth is a saga (5).
It is important therefore that, as the expectant mother, you are supported to consider carefully, not only the place in which you choose to give birth, but also the people you choose to have around you at that time. While every mother’s circumstances and every baby’s birth are unique, the key is being aware of what feels right for you and your partner. You may have already made the decision not to invite your relatives into your birthing room and be feeling prepared enough, as a couple, for any potential lack of continuous presence from your midwives. Alternatively, you may have chosen to access additional social support by enlisting another mother from your local community in whom you are happy to place your trust, or by engaging a doula.
The doula will usually have undertaken a period of preparation and have attained a level of knowledge and experience in labour, birth and parenting further to her own personal experience as a mother or a woman. This does not, however, necessarily mean that she is a better support person. Finding someone with whom you share a similar philosophy on life, birth and parenting, someone with whom you feel safe to be yourself, is what will make the difference to you, and your partner.
Never offering advice or clinical care, the role of the doula is to listen to your hopes and fears and to point you towards a range of resources from which you can both prepare for birth and parenting in the way that is right for you. She can also act as your advocate should you need an additional voice to speak up for your birth plan in the labour room. Evidence has shown that having the additional continuous one-to-one support through labour from a chosen trusted female confidante, who is not part of the hospital system, lessens your chances of experiencing a caesarean or other interventional birth by up to 50%. (6,7,8). When your newborn has initiated his own birth process and experienced a gentle birth without any drugs, he will be alert, able to root and suckle instinctively and keen to engage eye contact with his parents. The social support provided by a doula during your early days as a new parent has also been shown to encourage your enjoyment of established breastfeeding and lessen any possible risk of postnatal depression (8,9).
Time to honour the ceremony and spirituality of childbirth is often left forgotten in the throes of a disturbed, rushed or fearful birth. Another advantage of the lay supporter is that she focuses on protecting your memories of birth and early parenting so as to preserve the special moments and spiritual aspects surrounding the time that your baby was born (10). You may also find that she is happy to lead a Blessingway to celebrate the end of your pregnancy and gather good wishes for the time approaching your baby’s birth, or a Naming Day ceremony for your new baby. Some doulas bring art skills such as belly casting or therapeutic painting sessions for mothers to enjoy. Others may be additionally trained in pregnancy or baby massage, able to apply and share their skills with new parents. Indeed it is possible that the essence of the childbirth companion could be the very catalyst that is needed to rekindle women’s ancient collective memory of how celebrated and glorious birth can be.
Having access to the sustained social support that is right for us, during the time around childbirth seems to make sense, therefore, in creating a real difference for the whole birthing family and in bringing community back to this special event. The expectant mother, if supported in locating the birth space and birth support that is right for her, can feel confident in her innate ability to give birth consciously and gently, paving the way for the positive health and wellbeing of both mother and child. The father can discover his own level of confidence and joy in his role in the birth and parenting of his son or daughter. The baby is trusted to choose his own right time to be born and supported to breastfeed with ease.
Adela Stockton, Feb 2010
Adela Stockton is a doula, doula trainer (Birth Consultancy) and author of ‘Birth Space, Safe Place: emotional wellbeing through pregnancy and birth’ (Findhorn Press 2009). Adela can be contacted through her website at www.adelastockton.co.uk
- Buckley S (2009) Gentle Birth, Gentle Mothering Rev Ed Celestial Arts: Berkley
- Odent M (2007) Primal Health Rev Ed Clairview Books: East Sussex
- Schear L. Doulas and Daughters MIDIRS Midwifery Digest, June 2007, vol 17 (2), 185-187
- www.independentmidwives.org.uk (accessed 23/06/08)
- Leap N. No Gain without Pain! Paper presented at Enriching Midwifery Conference, Australia, March 2000, for Birth International, PO Box 366 Camperdown NSW 1450
- Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth (Cochrane Review) IN: The Cochrane Library Issue 2, Chichester, UK: John Wiley & Sons, Ltd. 2004
- Klaus M, Kennel J & Klaus P (2002) The Doula Book Perseus Publishing: Cambridge, MA
- Pascali-Bonaro D & Kroeger M. Continuous female companionship during childbirth: a crucial resource in times of stress or calm Journal of Midwifery & Women’s Health 2004, Vol 49(4), 19-27
- Golbert J. Postpartum depression: bridging the gap between medicalised birth and social support International Journal of Childbirth Education 2002, 17(4), 11-17
- Berg M & Terstad A. Swedish women¡¦s experiences of doula support during childbirth Midwifery 2006, 22, 330-338