Drafting a Birth Team
There’s probably no time when you need more support than when you are amid labour and childbirth. Physically, you can’t do much for yourself but focus on overcoming the latest contraction and finding the most comfortable position. And emotionally, you need support, reassurance and a perfect cheerleader to keep you going when you want to call it a day. This is why it is so important to have a supportive and helpful birth team behind you.
Nicole Senadenos from Cleveland, Ohio, is in her third trimester, anxiously awaiting the big day and doing prep work for her birth. “We had our hospital tour and got to see the labor and delivery rooms,” she says. “The tour was guided by a couple of the nurses, but you don’t know who will be on duty until you get there. The nurses said it’s usually just one nurse and one doctor, unless the doctor needs extra help or they suspect fetal distress.”
Senadenos has assembled a small birth team, with just her husband being there for support. “My husband and I decided that we wanted this to be a special ‘us’ time,” she says.
When putting together your birth team, there are many options to choose from. But how do you know which people to pick for your team?
The Starting Line-up
Obstetrician: Evaluating, Explaining and Offering Options
Probably the most familiar member of the birth team, an obstetrician is a doctor who has completed a specialized residency in pregnancy and childbirth. The OB/GYN is someone you will most likely be quite familiar with from your prenatal checkups. Through these visits, you should have a feel for your doctor’s approach to birth and discuss early on your expectations and goals to make sure you and the doctor are the right matches. When it comes time to deliver, your OB/GYN will be instrumental in the delivery.
“The obstetrician helps the woman in the birthing process by evaluating her and her fetus and helping her to make safe choices,” says Dr Susanne Bathgate, an obstetrician at George Washington University Hospital in Washington D.C. “The obstetrician helps the woman avoid complications and choose interventions when they are appropriate.”
Dr Bathgate says during labour, a woman can expect her doctor to update her regularly about herself and the fetus and how work is progressing. This is done through a series of checks, including blood pressure, temperature, fetal heart rate and cervical dilation. If complications should occur, the doctor should provide all the options for how to remedy the situation.
OB/GYNs also pay close attention to how well the labouring mom is dealing with pain and can offer options for improving the comfort level. “That pain relief might be non-medical such as walking, position change, massage or pressure point therapy, or medical like medication or epidural anesthesia,” says Dr Bathgate.
Obstetricians try to provide women with the birth experience they want but are always ready to switch game plans if there appears to be a problem. Dr Bathgate advises women to discuss ahead of time how they envision their child’s birth. “We both want a healthy mother and a healthy baby, but sometimes women have other expectations,” she says. “I can explain why doing things a particular way might work better for a woman in another circumstance and that despite having expectations, there are some things that cannot be predicted in advance. It is important to be flexible during labor, and my job is to evaluate the woman’s health and pregnancy and what we know about the fetus and help her to have a safe and satisfying experience.”
Midwife: A Woman-Centered View of Birth
Midwives now account for almost 10 per cent of U.S. deliveries. It is a common practice for women to choose a midwife for prenatal care and labour and delivery. Midwives can attend homebirths, hospital births (Nurse-Midwives or CNMs) or deliveries at birth centres (Direct-Entry Midwives or DEMs). Many women choose a midwife because they feel she can offer a different style of care than a doctor.
“Midwives provide patience to women, especially first-time laborers who often take more time and still fit within a normal range to give birth,” says Susan Moray, spokesperson for the Midwives Alliance of North America (MANA). “Midwives offer encouragement.”
Midwives typically spend between a half-hour to an hour with patients discussing the mom-to-be’s feelings at prenatal visits. Moray believes this helps a woman bond with her midwife, which can relieve some of the stresses of labour.
In general, midwives follow many of the same procedures as obstetricians during labour, such as checking blood pressure, fetal heart rate, dilation and position of the fetus. However, a midwife tends to focus more on natural remedies, such as suggesting a homoeopathic treatment to speed up labour or alternatives to pain medication.
It is important to note that there are some slight differences in the schooling and approach of different midwives. DEMs are independent and typically educated through apprenticeship and college study that does not involve nursing. They do not usually work in hospitals but instead operate at birth centres or attend homebirths. CNMs have been certified by the American College of Nurse-Midwives in midwifery and nursing and most often attend hospital births, although many also practice out of birth centres.
“A DEM’s role is to support and assist the birthing parents in their journey through pregnancy, labor, birth and postpartum,” says Moray. “With clinical skills, intellect and intuition, they inform parents if anything falls outside the range of normal.” Following the “Midwives Model of Care” means these midwives will monitor all aspects of a mother’s well-being, provide hands-on assistance during labour and delivery, minimize the use of interventions and identify any problems that may require an obstetrician.
Labour and Delivery Nurse: Multi-tasking and Experienced
In the hospital, labour and delivery nurses provide hands-on help to the attending obstetrician. From monitoring labour progress to supporting the awaiting families, most labouring moms depend on the support team of labour and delivery nurses. Nurses can provide a wealth of information and support to the labouring mom and family. By prioritizing the needs of a patient, these nurses are skilled in quick thinking and flexibility.
Having a general background in medical nursing with a registered nursing license, a labour and delivery nurse has completed either a Bachelor of Science in nursing or an Associate’s Degree in nursing. Additionally, they must be educated in neonatal resuscitation and fetal monitoring.
Hospital shifts are constantly changing, so there is no way of choosing your labour and delivery nurse. However, in many instances, there is more than one nurse per mom. These nurses see many patients each year, which gives them the unique perspective of overseeing probably more births than any of the other birth team members. After delivery, care shifts over to the postpartum nurses.
Doulas: Continual Support for Mom
Virtually unheard of a decade or two ago, the doula has taken her place as an increasingly popular birth team member. Essentially there to provide emotional support for the labouring mother, doulas are experienced in keeping moms-to-be calm, comfortable and secure.
“The doula provides a lot of emotional security,” says Ann Grauer, president of the Doulas of North America (DONA). “Doctors and midwives need to attend to their tasks and nurses might change shifts, but the doula will be there the whole time. The doula can also be an emotional support for the father because he may not have remembered everything the doctor said or know exactly how to comfort his laboring partner.”
There are specific steps to help you find the right doula. Certification by DONA International means a doula has been trained in childbirth and evaluated by doctors and families after actual births. “Go with your gut feeling and choose a doula who is the best fit for you,” says Grauer. “Interview doulas over the phone then have an in-person consultation. Make sure the doula is in agreement with your philosophies and that she is focused on helping you, not promoting an agenda. We like to always remind doulas that this is the mother’s birth, not theirs.”
Grauer also points out that doulas can be used for high- or low-risk pregnancies with a midwife or OB/GYN. “We are for every kind of birth, every family,” she says. While providing attentive support, Doulas can also be the best helper a labouring mom can have, from propping up pillows just right and helping her get around to doing all the little things that become so important in a stressful situation like labour.
Labour Coach: The One You’ll Lean On
The labour coach can be a husband, mom, best friend or sister. Just about anyone close to you that you feel can be a great support. The coach should attend birth classes with you and understand your birth goals. If, for instance, you have your heart set on having a drug-free birth, a coach can offer alternatives and distractions when you feel like it’s time for the epidural. From back massages to yelling, “Push! Push!” your coach can relieve some pain, offer a familiar, comforting touch and inspire you to be at your best.
Choose a person who knows you well and is calm and relaxed under pressure. Don’t feel pressured by a close family member who wouldn’t offer the support you need. Sometimes dads-to-be aren’t able to attend childbirth classes or don’t feel up to the intensity of the job. It is always best to have more support than less, so you may feel a sister or best friend will be better at helping you through labour. Dad can still be there and offer his unique emotional support.
The Cheering Gallery
Delivery rooms have gotten more extensive and more family-friendly, allowing more people to be there during delivery. This can be both a good and bad thing. It’s great to have a crowd cheering you on when running a marathon or shooting a basketball, but too many family members can be a distraction. Think about the people with who you want to witness the birth of your child. Will you want someone to be in charge of videotaping the event? Think about assigning tasks to other family members who have expressed a wish to help.
Whatever team you choose, it is best to keep your feelings at the forefront. Who will support you the most and give you the help you’ll need? These team members will become your most valuable players.