By Aimée Sturley, Doula (HCHD)
originally published in February 2018
As a doula, the question I’m asked most often is, “How can I make sure that I (and my partner) get the birth we want?”
My answer is always that you need to make sure that you create a support team that fills you with confidence. The question, then, is what is support? It really does vary! For one person, a gentle touch and a quiet, reassuring voice reminding them that they are strong will create a sense of strength and support. For another, that could be their greatest irritation.
For first timers, the question of how to figure out what will be good support can be a confusing one, especially when you hear in your prenatal class and from friends that sometimes things don’t go as planned. Nonetheless, you can still have a pretty good sense of what will likely be supportive and what will drive you bonkers.
For those who’ve given birth before, previous experience can be both helpful (if you know even better this time what you need) and unhelpful (if thinking about a previous birth makes you anxious about ensuring you get what you need).
Some things to consider:
- What are you like in your day-to-day?
- When you are undertaking a challenging task, do you like to have someone there to encourage you along? Do you do better when you can just focus internally?
- How do you respond to various kinds of stress? What helps?
- What tends to make you worried or anxious?
- What kind of touch do you like? What kind of touch makes you uncomfortable, or hurts?
- What makes you feel that someone is respecting you?
Answering these questions for yourself can be a starting point for thinking about how you can talk with your birth team about what support means to you. Everyone wants to be the best support possible for you; in the absence of info, they will simply do the best they can with their general knowledge and years of experience. With specific info about *you*, they can hone that expertise to serve you throughout your birth.
How can I get my caregivers to best support me?
Ask questions and be clear about your decisions and preferences in your prenatal visits. Listen carefully to what your caregiver tells you, and always assume the very best intentions on their part. They are there to offer the very best of their training and experience. They want you to understand what you can expect from them. Share your feelings and thoughts so they have a good idea about where you are coming from.
Some useful questions to ask about any given topic are:
- What are you comfortable with in this regard?
- When patients have decided to go beyond your normal comfort level, how have you handled that?
This is not to set up an expectation that you and your caregiver will be at odds with one another, but just to get an idea for their feelings around patient autonomy and how they communicate, should differences arise.
If you leave a visit feeling badly about the questions you raised, that might be a cue that you need to speak with your caregiver at greater length about your relationship and what you expect from them in terms of listening and respecting your voice. In labour, it’s a lot harder to do. If you don’t come to a resolution that feels right in your gut, try again, perhaps with support from a staunch ally, or by approaching the conversation from a different angle. If you are unable to resolve that gut feeling, you may want to ask around about switching providers (your prenatal instructor, doula, or knowledgeable friends might be able to help you here); it’s never too late to make these inquiries, as last-minute openings are usually available.
Find yourself a doula
Unless you have strong feelings against it, having a doula is one of the best things that you can do to ensure that you look back on your birth with a feeling of satisfaction. If you feel overwhelmed by the cost associated with hiring a doula, find some doulas who are
recommended to you, or that you find online, and ask them about sliding scale and/or fee instalments; even a doula who can’t accommodate your request may have helpful suggestions for who else you could try. Whoever you chose, make sure that you feel confident in their ability to support you, no less than any other member of your care team.
A doula is someone who will be by your side to make sure that you are treated with respect and dignity, and that your voice is heard. Although they cannot speak on your behalf, they can certainly remind you of your options and let you know what questions to ask every step of the way.
A Word About Cervical Exams
This deserves its own category, because in the media and (often) in our own experiences, cervical exams are done at the behest of the care provider and are not presented as being optional, when in fact, your body is always your own, and – especially in this area – you have the right, and the responsibility to yourself to be honest and clear about what you want and need. Are you concerned about the introduction of bacteria? Do you find internal exams to be painful or anxiety-provoking? Do you want to know that you can ask for exams to ease particular fears you might have? These are legitimate reasons to talk with your care provider about requesting, minimizing, avoiding, or refusing internal exams. You can give your reasons or keep them to yourself. This article about the evidence behind prenatal cervical exams, has some helpful advice that can be applied to exams in labour as well.
Birth Plans: A Good or Bad Idea?
Communicating your wishes and needs in a birth plan is vaunted by some and denigrated by others. I feel they can have a place, but it does pay to be aware of the effect that they can have on your mindset, i.e. what happens to your state of mind if your birth doesn’t go according to your plan?.
Be specific: If you feel that particular preferences are important for you to communicate to your team, make sure you are very clear about what you mean. For example, indicating that you would rather not have your waters broken unless it’s medically necessary is only half the info; the other part is: what does that mean to you and to your care provider? This is important to talk about before the birth. And make sure that you bring your questions with you, written down, or nine times out of ten, you’ll leave the appointment and think of all the things you’d intended to say! Deeper discussions with your caregiver are a great part of creating a document like this.
In the absence of direction, your care will be the best that they can provide without specific info about who you are and how to best support you. If you hired a counsellor, and didn’t discuss your goals, the counsellor could do their best by just starting out with questions about your relationships, or your childhood. If you told them that you wanted to improve your ability to create clear boundaries while being close to someone (for example), that would provide a guiding principle for their work with you. The same is true for nurses, midwives, and doctors.
It may be helpful for a birth plan to be re-imagined as a “birth preferences” document. This implies an understanding that birth can be unpredictable. The answers to the questions I posed at the outset of this article are great to include in your Birth Preferences; they can help the care team to understand who you are and how best to help you. In a recent episode of The Birthful Podcast, the guest speaker introduced a great new way of thinking about birth plans/birth preferences documents. Her offering is the term, “Birth Principles”, which I think is brilliant. You can hear the whole thing here.
First Two Hours Postpartum
Here’s another topic that often falls under the radar when considering a birth preferences document. Those first moments with your baby are so precious and vulnerable, and you are at your height of lovingness and gratitude to those around you; if you don’t have your wishes written down, you are unlikely to bring them up if the routines of your care team move things along differently. Help them to help you by letting them know what you want, and (again) be specific! For example, for most caregivers in Vancouver, physiologic (aka, “delayed”) cord clamping is now the norm; but different parents (and different caregivers) have different ideas about what that means for them. If you’ve spent some time learning about how long it takes for the baby’s blood to transfer from the placenta into their circulatory system, preferring that the cord not be clamped for x number of minutes, don’t be afraid to bring it up at a visit and to write that down as well.
How long to you want to have your baby in your arms, skin-to-skin, before weighing and measuring are done? Remember that, in the first hour, you’ll not only be snuggling your baby but also:
- Birthing the placenta.
- Cutting the cord (unless you’re having a lotus birth),
- Getting frequent checks of your and baby’s well-being. These include heart rate, temp, and, for you alone, blood pressure.
- Commonly, though not always, having uncomfortable and, at times, painful external uterine stimulation to prevent postpartum haemorrhage.
- If necessary, getting stitches for a perineal tear.
It’s usually in the second hour that you get that uninterrupted calm and the cozy cuddle that you probably envision. If you’re at the hospital, the room is no longer full of people, checks on your and baby’s health are less frequent, you’re all cleaned-up and tucked into bed, and any pinpoint lights that were required for immediate postpartum care have been turned off. If you ask for two hours of uninterrupted skin-to-skin time with your baby, you get this whole second hour to just marvel at your little one and hold them close.
Do you want erythromycin ointment for the baby’s eyes? The standard blood panel? The vitamin K shot? Your caregiver should bring up these options when you are close to your 38th week.
Do you want the care team to say anything about the baby (comments on its size, sex, beauty, cuteness, etc.), or do you want to discover these kinds of things for yourself?
Would you like to have as much quiet in the room as possible after the birth?
How do you want to approach feeding your baby? If you are breast feeding or chest feeding, do you want to try on your own first? Do you want help from anyone who can offer? Or do you prefer to get help from a particular person? If you are planning to use formula, do you want your care team to keep quiet about the benefits of breast feeding?*
Do you want the care team to give you a little time together as a family as soon as possible after the birth, without anyone else in the room?
If you are in the hospital, do you want a “please do not disturb” sign for your postpartum room? You’d be surprised at the numbers and types of visits some hospitals allow. Who might be knocking at your door? You’d expect, of course, any guests you admit, your primary caregiver, the paediatrician, the lactation consultant, and your nurse, but don’t forget about food service, cleaners, someone who has the wrong room, and the hospital photographer! A sign on the door lets everyone know that only those who really need to attend to you should be knocking.
Take a deep breath
If all of this feels overwhelming, remember that your care team recognizes that this is a special day. Birth never fails to be amazing, whatever path it takes! But for you and your family, this is the special day. The desire for a safe delivery for you and your baby is a given, but you also deserve to be heard and respected, and that’s a great guiding principle to start with.
*There could be many reasons for someone not wanting to or not being able to breast or chest feed, and the moment of birth is a particularly vulnerable time; not a great time to feel judged!
Aimee Sturley was a birth doula in Vancouver for fifteen years, and a perinatal massage practitioner for sixteen years. She now offers prenatal and postpartum services to families in the Owen Sound area, in Ontario.
“I love the work I do. It provides me with the opportunity to always be learning more about what it means to be present and aware; a witness to human strength, caring, and vulnerability.”
Pure Harmony Families