Who should be with me at the birth?

Birth Supporters

Since time began, women have given birth in familiar surroundings, with one to one care by loving, experienced women - mothers, sisters, aunts, friends. If you look at any birth art going back thousands of years, women were cared for by women. Birthing has always been sacred to women - as Frederick le Boyer calls it "the secret garden of women". It is a time of such intensity, such intimacy, a right of passage from being a woman to becoming a mother - birth is magical, mystical, powerful. A time when a woman can be both powerful and vulnerable, a time when she is so connected to those around her and yet is completely solitary, a time when she needs privacy as well as a hand to hold, a time when she opens up the most primal part of her body and soul.

For centuries men were forbidden to be involved with birth - in some countries it was a deed punishable by death.

However in the last 100 years, the culture of giving birth has changed so dramatically, predominantly by moving from the home to hospitals, where a vital element of care has been lost from the whole process. In general women are no longer given one to one support, let alone by someone they know. Instead they usually cared for by a number of midwives with whom they often have had no previous relationship. This lack of one to one care has without doubt, had a profound impact on the level of confidence a woman has in herself and her carers, as well as so often leading to a more negative birth experience.

In addition the birth environment has changed to such an extent that the key factors necessary to enable a women to birth instinctively, peacefully, primally have been stripped away - the feeling of being safe, private, unobserved, dark and warm. Giving birth in hospital with a complete stranger or three is so far removed from how women have always birthed, how women birth best.

Since the 1980s, it has become the norm for fathers to be at the birth - regardless of whether they really want to, or arguably should be there. Fathers are effectively thrown into an arena of which they have very little knowledge - maybe having attended a class or 2, watched a bit of discovery health or at a real push actually read a book on childbirth. They are often left alone in the delivery room with their partners of hours on end with our a real clue as to what is happening and how they can be of best use to the mother. Men in general are so used to "doing", to "fixing" that there is often a compulsion for the father to be doing something to support or help the mother. This in itself can be enough of a distraction to the mother so preventing her from turning her focus inwards and tuning into the birthing power that she inherently has within her.

Guaranteed, for some fathers, being present at the birth is a treasured and awe inspiring event. However, for many, birth can be a terrifying ordeal, which they feel obliged to attend, completely unsure of how they can really help their partner, or how they will cope. They are often so scared by the whole event that it is the fathers who inadvertently lead their partner to having additional medical intervention during labour, when it may not actually be necessary. A father who is pumping out adrenaline can not help but project this onto the mother who will in turn absorb their fear and so become more tense and so scared about what is happening. A father who does not understand the intricate emotional dance of birth would not know that when she is showing signs of self doubt, that this is in fact a wonderful sign that she is close to birthing her baby. It is often at this time that the father calls in the medical team to "do something"!

Who should be with me at the birth?

When planning who to have at the birth, it is important that you remember, it is your birth and that you will benefit from feeling as relaxed and confident as possible. You have a choice, and being honest now, about who you want to support you will pay off many fold.

Step 1 - Think carefully about who, and what kind of support you may need during the labour.

Step 2 - Have an open and honest discussion with your partner about how you feel.
If either of you have any concerns, then discuss alternative options such having a close friend, family member or Doula to provide additional support.

Step 3 - Discuss the kind of things you would, and would not like your birth partner to do, the kinds of intervention that you may or may not be open to and any fears or concerns that either of you have. By talking about these now, it will help with decision making and avoid any mis-understandings or underlying tension during the birth.

Step 4 - Spend time together preparing for the birth by learning and practicing different techniques such as massage, visualisation, relaxation and breathing. Valuable advice and practical skills can also be gained from attending classes such as the NCT, active birth and antenatal yoga classes.

Do I need support at the birth?

Physiologically a woman needs no "support" to give birth - her body is perfectly designed to birth her baby unassisted. However, she can greatly benefit from emotional and practical support, especially when she has chosen to give birth away from familiar surroundings. Key factors, which will help her relax and let go, are that she feels safe, unobserved, does not feel judged and has focused, continuous care.

Some women benefit from physical support such as massage or being held, while others may not want to be touched at all. Some mothers gain tremendous encouragement from verbal support such as being told how well she is doing or focused counting through each contraction, while others will find that distracting.

Her needs will also vary according to the different stages of labour. Often simply having someone present in the room is enough. However, all women benefit from not having to make decisions or respond to questions, from minimal distractions and from being in an environment where she feels safe and at ease.

A good birth partner does not seek to "coach" or tell her what to do, but is someone who quietly observes and picks up on her needs and emotions, giving her verbal encouragement as well as physical and mental support to help her relax and allow her body to birth her baby.

Many couples who realise that it is OK for the father not be the sole supporter, and even not to be at the birth at all, are turning to professional birth supporters or Doulas.

Is a Doula right for me?

In recent years, more and more women are once again seeking support from other women, including Doulas and independent midwives, who offer consistent one to one care.

More and more research is showing that women who receive one to one care of this kind, have more normal birth outcomes, reducing the level of intervention, shortening the length of labour and enabling women to have a better birth experience.

RESEARCH has shown that having a doula present at a birth ;
" Shortens first-time labour by an average of 2 hours
" Decreases the chance of Caesarean section by 50%
" Decreases the need for pain medication
" Helps fathers participate with confidence
" Increases success in breast-feeding
Findings from "Mothering the Mother"
Klaus, Kennell & Klaus, 1993

"Doula" (pronounced "doola") is a Greek word meaning "woman servant or caregiver". In the context of birth it refers to an experienced woman, usually a mother herself, who offers emotional and practical support to a woman (or couple) before, during and after childbirth. A doula believes in "mothering the mother" - enabling a woman to have the most satisfying and empowered time that she can during pregnancy, birth and the early days as a new mum. This type of support also helps the whole family to relax and enjoy the experience.

Birth doulas are trained and experienced in childbirth. They have a good knowledge and awareness of birth physiology BUT the doula does not support the mother in a medical role - that is the job of the midwife/medical staff.

The services offered by a doula vary greatly according to the needs of the mother-to-be / parents-to-be. A doula's role is flexible to fit in with the given situation e.g. the type of support will differ for a first time mum to that of a woman who has children already. Every birth is unique and therefore every woman's experience is also unique.

A couple will meet the Doula several times before labour in order to get to know each other and to discuss their hopes and concerns. These meetings may include discussing your birth plan, coming on a tour of the hospital, meeting your midwife, talking through fears and concerns, relaxation or hypnosis sessions and simply getting to know each other.

The Doula will then be with you from the time you go into labour and will stay with you throughout the birth, giving you her constant and focused attention. A Doula is often a great support for the father, should he choose to be present at the birth, as she can show him techniques such as massage or relaxation as well as helping with decision making and ensuring that he is well looked after.
A Doula will charge between £300 - £600 for her services before and during the birth (regardless of how long the labour takes). Many doulas offer a post natal service at an hourly rate, to help you care for your baby, provide support with breastfeeding and help keep the house in order.

"Being a Doula is the pinnacle of my work - It is such an honour and privilege to accompany a women on her journey through pregnancy and to actually be with her during the birth. By the time of the birth I have usually built up such a strong bond with her - one in which she has trust and confidence in my presence that when I walk into the room on the day of her birth I can see and feel her relax and sink into the calm quiet confidence that she can birth her baby in a relaxed, safe and peaceful way.

It is so wonderful to watch her grow in confidence and to see her trust her body and to literally flow through the birthing. She knows that I am totally there for her - to talk to, to laugh with, to hold on to, to cry with - she knows that I will not judge her or make her do something she is not happy with - she knows I am there to protect her and to love her - it is such an intense experience and I know my presence helps make her birth something so special. And then to be there to see her bring her baby into the world - to see her become a mother, to watch her glowing with pride and sense of achievement - and then to be able to hold a tiny, beautiful baby - what other job would give you such an incredible experience?" Maggie Howell, Doula and Natal Hypnotherapist.

Amy's story
"The birth of my son, James has been an amazing journey. The first steps in my journey involved me making a big shift in my thinking about birth. This was helped by my sister and friend's positive experiences of birth and then by a course my husband and I undertook with Maggie Howell in natal hypnotherapy. This course helped us learn how a woman's body is made to give birth; the emotional phases a woman goes through when giving birth; techniques for working with my body while it gives birth and above all, the importance of mentally getting out the way and allowing my body to do its job.

After a terrible birth experience with my first son, we were determined to have the best possible birth this time. We therefore asked Maggie to be our Doula as we felt so confident and trusting in her knowledge and ability to help us to have a natural birth experience.

On the 24th of April, I woke at 3am to the dawn chorus and feeling a bit peculiar. I soon realized James was on his way. I lay in the quiet stillness of my room, feeling the gentle tightenings of my uterus. After an hour or so I woke Michael, and together we lay chatting, listening to the day awake…full of excitement and anticipation.

We called, Maggie and awaited her arrival. I rested in bed, listening to music. By the time Maggie arrived I'd got a little caught up with timings! Maggie took away my watch and suggested I come downstairs - allowing my son to join in, move around. This was a great move - I think primarily because I disengaged my mind and just got on with being excited about the day ahead and enjoying everyone's company.

Gradually though I had to concentrate more deeply on my breathing and started to try out different positions. I remember the birth had reached a more serious point when I got off my gym ball and lent over it rocking gently. Understanding that this was the next natural phase of the birth helped me to focus on ways I could help my body - for me, this involved deep breathing and changing positions frequently. I constantly kept telling myself too, "Allow your body to do its job"

I had decided to give myself plenty of time to get to the hospital. On the journey my husband recounted a special day we'd spent together which I visualised. We also said, '321, Relax, Emma', a trigger for my brain to let go and relax. I felt myself breathe deeply as I uttered these words.

On reaching the hospital, we realized we'd forgotten our hospital notes. Michael had to go back to get them. At this point I either lost my focus or reached the self doubt phase I'd learnt about. To my relief, Maggie allowed me to hang on to her and took me through a visualization which helped calm me. As soon as Michael returned I felt I could get down to business. As a complete surprise to me, I stood up and began to stamp my feet and say very loudly, "Come, James, come", "Come, baby, come", "Come beautiful boy". It felt so empowering.

When I reached the delivery room I lent on the window sill and continued with the stamping and was soon shouting. I think the whole hospital knew his name by the time I'd finished! The next hour I experienced more as 10 minutes and remember it as moments in time: staring at Michael's face; Maggie and Michael encouraging me to breathe down; Maggie's relaxation music. It felt quite supernatural and above all, my body felt in control. The midwife said that when I felt to push to start panting. I found this a bit confusing as I started asking myself questions: How hard should I push? When? In retrospect I never felt a desire to push, just an amazing bearing down that my body was in charge of, not me…To my delight, when James's head and arms had emerged, the midwife asked if I wanted to deliver him. Instinctively I reached down and pulled him up to me. I was lying on a beanbag and it felt safe to be close to the ground with this little life. James breathed his first breath and took his first cry. What an amazing and perfect sound.

The time after this was one of immense peace, calm and joy. Michael and I just sat in complete amazement, cradling our son, examining every part of him. We didn't feel rushed but relaxed in an atmosphere of joy and peace.

I was particularly amazed how great I felt so soon after giving birth. I was up and about chatting, eating toast, marvelling at my son. I felt ready to get on with looking after him and felt well and elated. The last hour or so my body worked hard, but it wasn't unlike running up a steep, steep hill at the end of a long run. But unlike a run, my body was in charge of making my uterus work hard, not me, in a similar way to my heart beating with or without my help. I wasn't exhausted at this last stage either, having spent the day managing the contractions peacefully and in a relaxed atmosphere at home.

The presence of a Doula gave me and Michael the confidence to trust and believe that my body was perfectly designed to give birth (unlike the medical team at the birth of my first son!). She gave both of us such a strong sense that I could do this. She was a great support to Michael, even giving him a massage when he was getting a bit tired, and helped to ensure that we were left alone when we wanted it and yet right there when I needed her.

James's birth has taught me a great deal: the importance of giving my body and mind good, positive images and thoughts, nutritious food, adequate sleep and ways to relax. In doing so, I feel more able (most of the time at least!) to manage more challenging situations in life…Above all, I am just so happy that the first hours of James' life were so beautiful and that I was happy, well and overjoyed to see him."
Amy and micheal

For more information go to www.doula.org.uk,