Building Your Birth Team
Assembling your birth team will be one of the most important steps you take as you plan for the birth of your baby. If you aren’t convinced that your doctor or midwife shares your same birth philosophy now, you cannot expect their philosophy to match yours during labor, so carefully consider who you want to care for you and your baby on your baby’s birth day. In addition, research shows that having continuous labor support clinically benefits both women and infants, resulting in less use of pain medication, fewer obstetrical interventions and cesarean sections, shorter labors, higher rates of breastfeeding, improved mother-infant bonding, shorter hospital stays for babies, and more positive birth experiences overall.1
The purpose of last week’s Choices in Childbirth’s free Healthy Birth Choices Workshop: Building Your Birth Team—Focus on Support was to allow expectant parents hear from couples who thoughtfully assembled their birth teams and how their choices influenced their birth experience. Hopefully, by the end of the evening, participants developed a clear idea of how the care provider and continuous labor support person they choose can impact their birth experience, and are closer to determining which type of care provider and labor support people they want on their birth team.
Three new mothers attended the event to share their stories, and Mother-Friendly Care Provider and home birth midwife Cara Muhlhahn came to share her perspective on building a supportive team for birth. Collectively, they shared important lessons for expectant mothers and their partners who want to feel supported as they welcome their babies into their lives.
You can switch care providers at any time
Emily birthed her first baby just 6 weeks ago. She told us how she had hoped to birth with a group of midwives at a hospital but because they suspected she had a heart palpitation, the midwives recommended she give birth with an obstetrician, so she switched care providers at 25 weeks pregnant.
When “labor day” arrived, she labored at home for a long while, with the support of her husband. Emily went to the hospital to have her baby’s heart rate monitored, at the suggestion of her doctor, and returned home (after laboring outside in the park, leaning on every street sign, bus stop, and park bench through contractions) because her cervix was 4 centimeters dilated. She continued to labor with her husband and doula by her side. She later returned to the hospital, just in time to birth her baby, which took only three pushes.
A well-rested partner can offer more support
Reflecting on her birth experience, Emily shared that she was glad she let her husband sleep when early labor began late at night so that he had energy to support her during active labor. Although Emily wanted people nearby to support her, she labored a long time alone in the bathroom, swaying on a birth ball and timing her own contractions.
A “birth intern” can offer a helping hand
Emily is also grateful to her sister “who was completely clueless [about birth]” who brought food to her husband and assumed the role of “intern” who could simply follow directions.
A doula can offer reassurance
Emily also shared that when her doula arrived, her husband felt a complete sense of relief; he stepped outside to take deep breaths and returned to Emily’s side, ready for a new stage of labor. The doula was able to reassure Emily and her husband, apply pressure to her hips, encourage her to eat, and support her wishes at the hospital. When she considered hiring a doula, Emily said she “realized it is a lot to put all that on one person [her husband]; it’s a long time for one person to be your rock, and I know he will be, but [a doula could really help].”
Your partner and your doula can help you to advocate for yourself
Emily went on to say that although she was told it was “hospital policy,” she refused an IV and a helplock and no one took her blood or performed a sonogram. She said, “Everything we tried to fight in the hospital we won, because we did it nicely… The most important thing is, know that you are the one in charge and you have more control than you think you have; you can get what you want.” Emily’s supportive team—her husband and doula—helped her to advocate for herself.
Choose a care provider who is on the “same page” as you and your partner
Cara Muhlhahn added that Emily’s success at refusing routine medical procedures might have something to do with her doctor’s relationship with the hospital, which reemphasizes the point that it is important to choose a care provider who shares your birth philosophy.
Jessica’s third baby is 4 months old. She told us about the birth of her first baby at a hospital with an obstetrician. She received pitocin and an epidural, and her cervix dilated to a full 10cm. The doctor then threatened to perform a cesarean section because the baby’s heart rate was showing decelerations. She used a mantra to move her baby down and her doula applied acupressure to her legs, and she pushed her baby out in one mighty push.
A doula can put you at ease as you make important decisions and motivate you to go on
Looking back on her first birth experience, Jessica described her doula as “super helpful.” The doula was calming, and encouraged Jessica to labor at home… she even helped Jessica to put on her pants! After Jessica labored for 18 hours and felt exhausted from lack of sleep, the doula helped her to feel confident about her choice to get an epidural. When it was finally time to push, with the threat of a cesarean looming over her, it was her doula that said that she could push harder, and Jessica did just that.
A doula can offer suggestions to your partner for how to support you better
“Having a doula at my hospital birth was essential,” Jessica said. “The doula knew what to do and my husband didn’t feel left out.” The doula knew when to step away when necessary. When Jessica pushed in an upright position, she held onto her husband “who was like a really strong piece of furniture—like a dresser—I was literally hanging on to him.” Jessica later said, “It’s his baby, too, and the doula was extremely helpful with giving ideas and suggestions to my husband.”
Now a yoga instructor and feeling like superwoman, Jessica planned to birth her second baby at a birth center with a midwife, and she had a very fast labor. She arrived at the birth center with her cervix already dilated to 10 cm, and 20 minutes later she birthed her baby. The friend who was going to support her didn’t make it, but her husband was there! For her third baby, Jessica planned the same set-up but her baby was born 4 weeks early due to an undetected chorioamnionitis. Her midwife attended to her on the labor and delivery floor of the hospital.
Choose a care provider and a care facility you can trust
Reflecting on her third birth experience, Jessica said that her satisfying birth experience relied on the close relationship she had with her midwife. Choosing to birth her baby at a birthing center within a hospital also made Jessica’s transition into motherhood for the third time easier. “Pediatric care was there for me; after care was really great, too.”
Juliana attended the event with her 2 1/2 week old baby. She told us about her home birth and how she had planned on having her midwife, her husband and her doula as a support team. In the end, an unexpected friend provided her with wonderful support until her husband, who doesn’t have a cell phone, arrived after his evening work shift. Her wonderful midwife came with two support people and her doula turned out to be “disengaged” and less supportive than she had hoped.
It’s nice to have both medical and non-medical support
One of the attendees shared that she was still undecided about getting a doula, and hearing Juliana share that her doula was “the least supportive” seemed to increase doubts that she might need one. This stirred comments from the other two new mothers. Emily quickly shared that she has never heard anyone say that they regretted having a doula. Jessica added that it’s nice to have non-clinical support in addition to your medical team. She shared, “I had a friend come who actually studied to learn how to be a great birth partner; you have your medical team in place and then [other] people who you want around.” She added, “The most important people are not always the people who are closest to you.”
Consider who can support you during pregnancy as well
Jessica said she didn’t feel she needed a doula for her second birth, but she chatted with the doula she had for her first baby and realized she was afraid of giving her up. Talking about her feelings with her doula inspired Jessica to use her yoga practice to help her prepare for birth: as her belly grew, she began to give up when a pose was challenging, but she decided to continue to do her asanas even if it was difficult. She later applied the same thinking in labor.
Juliana also described for us how yoga helped her to prepare for her baby’s birth. “I did yoga therapy in preparation and the woman I studied with had a similar take as my midwife; she said, ‘Do as much as suits you but don’t feel like you have to do this every day.’ Similarly, Juliana’s midwife helped her to understand that her body was “going to do its thing.” And sure enough, when it was time to push, no one had to tell her to do it; she just “subtly began pushing.” Emily added to Juliana’s thoughts, “The mind is powerful; you can do it.” As you prepare for your baby’s birth, it can also be important to consider who can support you emotionally and physically in ways that doulas are not always trained (yoga).
Choose a doula carefully and set clear expectations
Juliana suggested that maybe her doula was less supportive because she was inexperienced. Because she did not feel an experienced doula was within her and her husband’s financial means, they hired a low-fee, doula-in-training. In the end, Juliana had the support of six different people—her husband, the doula, a friend, the midwife, a friend of the midwife, and the midwife’s assistant. Although Juliana was not aware of what everyone did, everyone had a task (including massaging her legs and back). Juliana said she had hired the doula to support her husband because he wasn’t going to read any of the books or attend any birth classes. She explained, “He is completely supportive of my choices but I knew he might freeze up when things happened… I should have made sure he was present for all my meetings with the doula. She answered all my questions, but she wasn’t mentally present [at the birth]. I thought about asking her to leave. She was a new doula, had attended three births. I should have asked for her references. She didn’t follow through in a professional way and hasn’t done a follow up with me.”
A doula can give you mementos to remember your baby’s birth
Even hearing this, Jessica continued to defend the role of the doula. She said, “Another nice thing is that the doula was a witness in a different way than anyone else. My doula wrote me a really special story about the birth. No one can do that but your doula.” Emily added, “They can take pictures, too.”
Only invite support people who will allow you to “let go”
When asked about advice for assembling a birth team, Cara Muhlhahn said, “I don’t advise having lots and lots of people at a birth, although I’ve seen births where that really works for people. Birth is really intimate, and often times people go late. Hype grows to a clamor and then it’s hard to let yourself just be and have a baby. [Having lots of people around] ups the ante of performance anxiety.” Cara even joked about telling family that the baby is due later than the due date, just to minimize the pressure women feel to go into labor.
A doula can provide support that a husband or partner can’t
As for doulas, Cara added, “A doula is not a husband. Either one can be great with emotional support. Dad’s inherently feel helpless and get really emotionally exhausted. A doula who is experienced knows where you are in labor. A doula can say, ‘That is really great! That is cervical change!’ A doula knows what a dad can’t know, and [she] will know what to do.” Cara added, “If you are having the baby in a hospital, [the doula] knows everyone’s agenda like you don’t; a doula can help make you aware and help you to advocate for yourself.” She added, “A doula can offer reassurance with concrete information; a good doula will not make your husband feel left out, and your husband may want to take a nap.
Consider who can support you after the birth of your baby
Juliana recognized that postpartum doula support might have been helpful also. “Everyone left and my husband just started crying,” she said. “We had no plan; people came in the morning but there was this moment of ‘now what do we do?’”
Meeting facilitator Laure mentioned that relying on friends can be helpful for postpartum support, and Cara shared that a midwife (or other care provider) can help with referrals.
We at Choices in Childbirth hope that hearing from a sample of new parents and a Mother-Friendly Care Provider helped participants (and blog readers) to understand the importance of thoughtfully assembling your birth team. Hopefully the workshop has inspired you to carefully consider your own philosophy of birth so that you can confidently choose your care provider and someone to be your continuous labor support. For partners especially, we hope that you now have a better understanding of what is involved in supporting the mother during labor and birth and whether you intend to be her primary support or invite someone else to join your team, whether that person be a friend, family member, or doula.
Cara’s final words explaining how to plan for the unexpected might sum the meeting up best: “You can’t figure all that out ahead of time; rely on your birth team to help you.”
Interested in hiring new or experienced labor or postpartum doula support?
Hodnett ED. Caregiver support for women during childbirth (Cochrane Review). In: The Cochrane Library, Issue 1, 1999. Oxford: Update Software.
Thank you to our guest blogger, Wendy Ledesma, a doula and CiC’s Public Health Intern. To learn more about Wendy, visit her profile on CiC’s Mother-Friendly Provider Network – http://choicesinchildbirth.org/network/provider/884.