Friday, May 9, 2008

Your husband at your side?

So what is a Dad's role during labor and delivery? Is Dad an active coach? A quiet bystander? An anxious disaster and distraction? The perfect support person? Or just another family member in the waiting room?!?

When Mr. Red and I were attending law school and expecting our 2nd baby, we took a course in husband coached childbirth (the Bradley Method). One particular woman attended the course--alone. Her husband wasn't "comfortable" attending the births of their children. It was her second child, and first attempt at natural birth. She was planning a homebirth with a doula and midwife. No husband. How crazy I thought (not the homebirth but hubby's absence). Sure childbirth is a messy thing, but so is war. And so is changing diapers. It seems the same rationale could be used to excuse men from all sorts of "messy tasks." Come on, man-up, I thought.

At the time, I thought this particular couple's approach was the result of an overzealous theology related to the "proper" roles of men and women. But maybe I was wrong? Just this week Danielle Bean linked to two very interesting articles discussing the presence or absence of men in the delivery room.

The first article seems to suggest that men should be more "prepared" for the intensity of childbirth experiences. It claims that most childbirth courses are very fact oriented and very focused on women. I think this is an excellent point, and it would do men well to be more prepared for the intensity.

The second article, written by an OB who has delivered thousands of babies, suggests that men don't really belong in the delivery room. He argues that childbirth is best left to a woman, her doula, and an experienced midwife. He also argues that the high rate of C-sections and interventions during childbirth are partially the result of an anxious husband causing his wife tension during labor and delivery. According to this doc, if a man leaves his wife alone, she will usually deliver faster, and with less complications.

While I agree that anxiety plays a major role in L & D complications, I think to blame the husband is bordering on absurd. In my own humble opinion, the high rate of interventions during L & D is the result of our overly-litigious society, AND an overly-medicalized approach to L & D. Viewing birth as a procedure rather than a natural process is the problem. Now I'm not saying there isn't a role for medical intervention. A good OB is a God-send in a medical emergency. My point is only that there should be an underlying assumption that birth is Natural and good. Most of the time, a laboring woman should be left alone to deliver her baby w/o all the medical hype--and she will do a great job! Most women seem to experience A LOT more anxiety as a result of hospital policies and procedures. Things such as difficult nurses, mandatory IV's, a lack of fluids and food, being forced to lie flat on your back in bed, being continuously strapped to a monitor, or a room-full of medical personnel cause the anxiety, not the presence of the husband.

Now, that being said, I think men should do a lot more to prepare themselves to take on a supportive role during labor. Obviously each couple has to make their own decisions about how they would like to birth their children, and the role of each dad will be different. But that being said, I think it is really unfair to suggest that having dad present usually results in more anxiety for the mom.

In my own personal experience, my best and only natural birth was with Augustine (my 4th baby). It was the only birth where my husband was the most important person in the room. His support was imperative for me to succeed in birthing my baby quickly and naturally. I wanted him by my side, I needed to look to him for strength.

On the contrary, I spent a good part of my labor with Charlie (my 3rd baby) alone (I'll spare the details of how this happened). My labor with Charlie had more interventions and was, in my opinion, my worst birthing experience. I was keenly aware of Mr. Red's absence and felt very alone.

Obviously, each woman needs to decide what birthing environment will best help her to relax. I can't emphasize enough the importance of relaxation to a positive birth experience. But to suggest that men don't belong in the delivery room, or to blame them for overzealous doctors and hospitals is not only unfair, it is borderline absurd.

I'd love to hear your thoughts on this...

19 comments:

Bethany said...

I agree with you Red.

The thought of NOT having my husband in the delivery room with me makes me even more anxious and upset. I tend to be a pretty anxious and nervous person to begin with. If I had to face delivering OUR child with only the help of strange nurses, on call doctors and if I had chosen, a midwife or doula that I had known for a whole whopping 9 months. I guarantee I would have needed a C-section. Not just from a tension induced lack of labor progression, but from my blood pressure hitting all time highs.

I realize that some men are perhaps so uncomfortable in the delivery room that perhaps they are more of a hindrance rather than a help. However for someone to blanketly say that men should not be in the delivery room while the wives are giving birth, makes me distrust that person. Not to mention the pastoral ineptitude he shows in not taking into consideration the wishes of his patients (which does include in the father) in wanting to be present for the miracle of birth.

That's just my opinion though.

Kat said...

Very interesting post, Red...

I did find that having a doula at my birth (for my second child) was a great experience all-around. Janet (our doula) was really wonderful - she guided my husband in how he could ease my discomfort, she helped me to feel more in control, and she was kind and friendly with the nurses and doctors. I'm seriously considering having a doula at my next birth, still in a hospital and DEFINITELY with my hubby there if he can be, but I think it would enhance the experience for everyone.

It would be hard for me to labor alone, I don't know how some of you have managed!!

B-Mama said...

This is an issue facing many of the spouses of our nation's military, sadly. I can recall a few of the women in GG's unit giving birth solo while their husbands were away--I can't even imagine and am so glad we never faced such an endeavor! I feel for them... and have a hard time believing that a doctor would prefer it all happening that way!

Most surprisingly for me was GG's apparent interest and enjoyment of the births of our boys. I thought, for sure, he would be up "on my end" to avoid the blood, etc., but instead, he was "down there" with the doc, in awe of all that was happening. I was so proud of him and so happy he seemed to relish the experience.

We've yet to endure a au natural labor, but I can venture to say he'd be even more vital in such a circumstance. I'm all for having him with me come early August for the birth of our third. That is, unless he's in the middle of taking the bar! We pray not! :)

Mary Alice said...

I am blessed to have a spouse who has a good relationship with my mother, and so my "birth team" has always been both of them together. For me, there could not be a better combo. They keep each other calm and light throughout the situation, try to make me laugh (usually failing), and the support of an additional person takes some of the stress and pressure off of my husband during longer labors. This time there was a bit of a trial to deliver the placenta and my husband was able to stay with me while my mom was with the baby, which was reassuring and beautiful. When the twins were delivered, it was so nice to have two sets of hands to hold the babies and to support me.

In many ways, the greatest gift of having my mother and husband together at the births has been the way that they have bonded over it, and I also think that having Dad there promotes his early bonding with the baby.

Juris Mater said...

I think it's conceivable that a husband's absence could slightly lower adrenaline or whatever levels and allow a woman to tap into her primal side.

But that's not the end goal during labor. I'm sure that I've never been more in love with my husband than when I've completed a natural labor and birth in a quiet, non-hospital room with most of my labor spent with only him by my side. There's something about his intense concentration on me and his presence during my suffering that make me feel like he's voluntarily bearing my cross with me.

In my last birth (last week), my punk-granola midwife, big tattoo showing forth on her backside from above her scrubs, sat down on my bed a couple hours after the birth and after her shift was over. Tears filled her eyes as she talked about how moved she was by my husband's demeanor and words to me during labor, and she had only met my husband a few hours before. She's NOT an emotional type. But who could not be moved by hearing a husband say "you've never looked more beautiful", "thank you for doing this for our family and for me", and "you're so strong and so heroic" as his wife sweated and cried?

Also, I think I gain strength from his strength and feel more secure, less scared, with him there, like Bethany said in her comment.

Amanda said...

New reader and poster to the blog...

In my limited experience I considered the childbirth class for my husband, not me. He was not reading the books, watching the birth shows on TV, or learning about other women's experiences online. In fact my option was a Bradley birth class or a hospital run class (at a hospital who has some of the highest C-section rates in the nation). I chose the hospital class because my husband would have missed the majority of the Bradley class due to work related travel. To me there was no point if he wasn't there.

There isn't anybody I would rather have present for delivery. If something were to go wrong, who else would I trust to make the best decisions for our family? It did make him uncomfortable to think about having to make difficult decisions, but it would be much worse for him if he didn't even have that option.

And how much greater is that first moment of pure joy as you hold your new baby in your arms when you can look up and see that feeling reflected in your partner's face?

k said...

Hmmm, so timely. Just went to a baby shower of a good friend who expressed concern over her husband in the delivery room. He is a worrier and pretty intense in his devotion/need to help which is sweet most of the time but I understood her concerns about him being "too much in my face" while she was trying to concentrate on pain management.

Having said that, I agree with what Kat & Alice seem to express in their posts which is the idea of a "birthing team" whether it be another support woman (mom/friend) or doula.

I think a key role of our midwife was reminding my husband (since he had taken a Bradley class with me) of ways to support me. This allowed him to help me in constructive ways and also feel involved. I think for our next child I would tell her ahead of time to do this even more and discuss with him things that I know I need, because he did mention having periods where he felt like he should be "doing" more.

Having said all this, he still gets misty eyed just thinking about Jack's birth so I can't imagine denying him that experience and while I was definitely in a zone for a lot of my labor I think I would have felt more anxious if I had not known he was close by.

texas mommy said...

Thanks for posting these articles, Red. This is definitely an interesting topic (even more so when you are in your third trimester). Mr. I and I have have talked about this quite a bit. He felt that the most important thing with respect to his being present and able to help was his knowledge base before birth. We did the full set of Bradley classes, which I would recommend even if someone is unsure of natural birth. He knew what to expect, what the possibilities were and how to make an informed decision if/when needed. He just felt very prepared, which, in the case of our first, was such a blessing as there were decisions to be made during such a prolonged labor.

Having been in the traditional hospital setting the first time and a birth center the second time, Mr. I STRONGLY preferred the birth center, honestly, maybe even more than I did! He said he felt like he was in a battle in the hospital trying to protect me from unnecessary interventions, distractions during labor, etc.

But at the birth center, the midwife or birth assistant could quietly suggest something to him and he felt no pressure to be defensive since our desires for labor/birth were the same. This was Mr. I's perspective.

During intense labor with very little time between contractions and transition I am unable to talk, literally. So I count on him being my advocate. Being able to trust him to make decisions is a huge relief. I know he feels helpless at times, but his being present and being able to silently pray for me is also very wonderful.

Juris Mater said...

One more thought: do you all think maybe this idea of keeping the husband absent so he isn't "sexually traumatized" by seeing a baby emerge from "down there" sounds a little contraceptive--as in separating babies from the marital act? I totally buy the idea that it's good for spousal relations to remain shrouded in some mystery and modesty. But I'm not feeling too much sympathy for the husband who loses his attraction to his wife from seeing the natural end of the marital act--a baby's arrival--and the other function of the area that the baby comes out of! Keeping him out of the delivery room in the interest of his future attraction is a little sterile in my opinion.

Right Said Red said...

Ah, Juris Mater, you hit the nail on the head! I totally agree and think that the idea of keeping men out of the delivery room is very much the result of our contraceptive culture. I feel the same way about men who can't deal with women breastfeeding.

Kerry said...

b-mama,
I heard there is a great doula service that caters to military moms. I think they give their services free if the spouse is deployed during a birth.

Interested readers can find it at http://www.operationspecialdelivery.com/
It's called Operation Special Delivery. How sweet.

Melinda said...

Hi all,

Like pretty much everyone who has commented, I like having my husband with me during labor and birth, not because he's such an awesome birth coach, but because, well, I like having him around pretty much all the time.

That said, the woman in Red's birth class is one of my best friends, and it may be interesting to note that she has now had THREE completely natural births, two at home and one in a hospital. Her decision to give birth without her husband in the room (he is always there with her through her labors, which are measured in days instead of hours) is based not on any particular theology, but mutual preference. Their marriage is great, and he is a hands-on dad who doesn't seem to have any problem dealing with the messiness of family life.

I agree with you, Red, that dads, whether nervous or not, are not to blame for the way birth happens in America, and a generalization for or against their presence in the delivery room misses the point altogether.

My husband makes me feel more comfortable while I'm laboring, but while I think that a woman feeling comfortable is important to the process of labor, I think the more important factor in having a natural birth is having a birth attendant who shares that goal. While some dads might be great advocates, and others might be overly nervous, the vast majority are somewhere in between. The fact is, dads don't have a lot of birthing experience, if they have any at all. The person I want with me when my babies are born is the person who has helped hundreds of women labor and deliver naturally. This should be my primary OB or midwife, but if that isn't possible for some reason, a doula is probably a great idea.

Arming yourself (and your husband) with information is essential, but I think the best thing to do with that information is to use it to pick the right doctor or midwife so you can trust their advice when things aren't going according to birth plan!

Right Said Red said...

Melinda,

Amen to your thoughts on a birth attendant sharing your goals. I always feel bad for friends who tell me they are using a doc who doesn't deliver many babies naturally. It's really important to set yourself up with the right birth team.

Based on your comment, I'm not sure we are talking about the same person, but if we are, I guess everyone is separated by 6 degrees of separation ;-)

Feel free to shoot me an e-mail if you think we have a mutual friend, but I'd prefer not to do it on the blog ;-)

Red.

Anonymous said...

Interesting blog, thanks for the insight.

Regarding the comments about men's sexual attraction being diminished after witnessing the "full-frontal" view of a birth, I don't really think that it's completely outrageous or unusual, or even a product of our "contraceptive" culture. Wendy Shalit, hardly an advocate of that type of mentality, notes in an article that Orthodox Jewish men are actually forbidden from watching every detail of the birth, although they can be sitting at the wife's head saying prayers and offering encouragement. http://www.incharacter.org/article.php?article=55

Spousal involvement of the kind we see today is a relatively recent development, whereas in previous centuries childbirth was something that involved only female relatives and close friends. I'm not saying that such a situation was more desirable than today--certainly in the 18th-19th century women had networks of female friends and family members who mutually assisted each other in childbirth, and those types of arrangements would be fairly rare today. The men were not necessarily absent but did respect women's modesty and privacy with regards to childbirth. I would personally prefer that to having my future husband standing over me with a camcorder to capture every single detail, which a lot of overinvolved husbands do and I think is rather extreme. Thankfully my fiance seems to prefer the "Orthodox Jewish" approach, and I can't blame him!

"H" said...

Hmmm, reading this post I wonder if I need to try to make sure my husband is more prepared for birth, expected 4 weeks from today.

We only took a one-day, 5 hour "prepared childbirth" class, in which we received information about how to identify labor, an overview of the birth process, including videos about what happens with an epidural or c-section, and about 30 minutes of breathing exercises. I spend 12 hours a day working and commuting and couldn't see how we could find time for a class running several weeks. Plus I go to a highly-sought-after Catholic OBGYN practice so I don't have a feeling of Me vs. the Doctor.

I've read a couple of books with much more details about birth, but my husband hasn't done anything to prepare beyond that one day class. His siblings gave him a book for expectant dads for Christmas that is more humorous than serious education, and the advice in that book was that the best thing you can do as the dad during delivery is to not get in the way of the doctors doing their job because they know what they're doing and you don't.

My husband hasn't shown any interest in reading the books I have with more detailed information. Should I ask him to do so? Is there any point, given that it's too late for us to get trained in a "method" of unmedicated childbirth?

Mary Alice said...

"H" -- first of all, blessings to you and your husband as you become parents. Your preparations sound similar to mine the first time around, and I have survived that labor and several others, so first of all, don't let this conversation be a source of stress!

My grandmother gave this great advice, that came from her mother (we are all New Yorkers) -- when you go down in the subway and look around, just remember, everyone who is there was born!

If an unmedicated birth is important to you, one thing that you might do is to talk to your doctor about it, and, in my opinion, pray for a good nurse. The reality of most hospital births is that the nurse will coach both you and your husband through the process, and your doctor will check in periodically and then, ultimately, be called in to deliver the baby. All sorts of factors may go into whether or not you need pain management, including the length and style of your labor, but if you are generally free of complications, a caring nurse can make all the difference, waiting on tests until you are between contractions, encouraging you to try alternatives like a shower or getting up and walking around, giving you a time frame or letting you know what to expect. For a birth without much preparation, the nurse's attitude will also make the difference in whether your husband is encouraged to support you or to get out of the way.

Perhaps, if you feel comfortable, have your husband read this conversation -- then, both of you can talk about what your hopes and goals are, what "story" would you like to be able to tell after the birth? Would it be great if your husband is the one holding your knees and counting breaths as you push? Would it be great if you got an epidural and read magazines for most of your labor while he watched The Price is Right (I had one labor like this, it has it's upsides...).

Other things to keep in mind -- if you have family in town, how soon after the birth are you comfortable with visitors? One of the dad's main roles after the birth can be to make sure that mom gets enough quiet time to recover if that is what she needs.

Okay, just my two cents. By the way, if you are planning to nurse, check if your pediatrician has a lactation consultant available. This wonderful and natural process often does not start out feeling so natural, and if you have support and a chance to ask questions it is more likely that you will get past the tough first few weeks and get to the good part for you and your baby!

Anonymous said...

Congratulations, H, on the impending birth of your child!! My husband came to classes with me, which was fine, but far more important as it turned out was that he had read on his own my copy of La Leche League's The Art of Breastfeeding. I encountered just about every problem there was breastfeeding our first who was born 10 years ago when there was only ONE part-time lactation consultant at our hospital. In any event, my husband encouraged, instructed, protected, and consoled me every inch of the way through the first six weeks of breastfeeding, even going so far as to help me pump. No one else was willing or able to do that except for him. And truly he became in my eyes my St. Joseph because of his willingness to help me with that. Every birth of mine has been different, and I can't imagine his not being there, but helping me with breastfeeding was PRICELESS!

"H" said...

Mary Alice, thanks for the good ideas to consider and reassurance! My biggest problem is that I don't have any "story" in mind. I've never felt strongly about medicated vs. unmedicated and I get so much conflicting advice I don't know what to think or want. All I know is that I don't want a C-Section! (Duh, like anyone does.)

A friend of my mother-in-law is a postpartum doula, who gave me a "gift certificate" for 2 hours of lactation help for a baby shower gift, so that takes care of the nursing part. She also said she'd be willing to meet with me and my husband some time before the birth to talk about our goals and answer questions. Maybe that's the best opportunity for us to figure out what we want!

Mary Alice said...

Anon, you make a good point, not just about breastfeeding but parenting generally, the birth is in fact only the beginning, and the best way to prepare for parenthood is to have common goals and some plan to achieve them -- as you and your husband did with breastfeeding.

H, definately meeting with the doula sounds like a great idea, and you may come to an idea similar to the one I had before my first birth : look, I have no idea what this is going to be like, so generally I am going to try to do it without drugs but if I can't handle the pain I am open to having pain management with medication. For most of us, there comes a time when you are going to beg for the epidural, and one question is, do you want your support person to try to talk you out of it/find alternatives or try to get the doc as quickly as possible?

Also, it is great that you have a good relationship with your OB and trust him, so definately talk to him about it. I had an OB who I really trusted and I asked him flat out with the twins if he would recommend an epidural and he gave me a lot of significant, medical reasons in favor. This was the same doctor who had, in a previous birth, talked me out of it by explaining that if I did not have one I would have the baby within an hour, but if I did I might be at it all night.

I am not a doctor, so don't take this as medical advice, but my experience has been that by the time the pain is so bad that you want a huge needle in your back you are probably getting close anyway, and could get through it with the right support. That said, the end of my labor goes fast, and there are often circumstances that change things...for example, back labor can be really exhausting, of if you have labored over night or for several days as some women do, you may need an epidural to get some rest in order to be able to push.

The hospital makes a big difference, too, with my natural birth the nurse pretty much left us alone (it was my second, and we were fine with that), I was free to move around as much as I wanted, get in and out of the tub, use the bathroom, walk around the room, etc. This makes a big difference. With my fifth, I was forced to stay in bed with a monitor on while they tried and failed repeatedly to establish my blood type by jamming a needle into my arm. I had no way to manage the pain, and my mother and husband were told to get out of the way, the nurse would not even let my mom hold the puke basin for me! I am pretty bitter about that one, but I did have an epidural because, in that setting, I just could not manage the pain.

With the twins, the doc was worried about the position of baby B and was willing to try a breach delivery but only if an epidural was in place, so I took that over a higher chance of c-section. As it turned out, that pregnancy was really tiring and by the end I was just not "up" for marathon of labor, I had a scheduled induction with epidural.

I have had two epidurals, and both were "good" in that I could feel well to push, etc. The part that was tough was the transition to pushing. In a natural delivery, there is an adrenal rush and a very natural flow so that when it comes time to push your body just knows what to do, you are in a sort of zone with the contractions and you are so glad to be moving on to the pushing, whereas with an epidural you have not been feeling this pattern and it can be hard to catch it to push at the right time. Also, pushing hurts even with an epidural, but in a natural birth it is actually a bit of a relief, whereas with an epidural it is a shock to the system.

Okay, so sorry if that is TMI or if I have scared anyone out of having babies, even after my last difficult birth I am well aware that the end goal is to get the baby out of you, which is definately something that I always want badly by the ninth month, and from that stand point I can't say that any of my births have been failures.

When my first was born, and they said "it's a boy" my first words were well, lucky him, he'll never have to do that! But, I always come back for more, they are just so darn cute after you clean the gunk off!