Why do we need support – by Lael Stone

When you ask a mother about the most memorable moments in her life, or what was her greatest achievement or even the time she felt the most pain or fear, many woman will respond with  giving birth.

Whether your child is 3 months, 3 years or 30 years of age, a woman can instantly recall, replay, reflect and tell the story of the day her child was born.

For many woman the birthing process is classed as one of the most challenging, intense and incredible experiences that they will have in their lives, An event that holds a very strong sense memory and a pivotal turning point in who she is.

So this being said, we have to ask why so many woman go into this experience under prepared and not fully supported. Once upon a time mothers, sisters, grandmothers, the elders in the community were there to support a woman through childbirth and the entry in to motherhood. As time has passed our lack of community and family has dwindled, These days a  woman’s first experience of birth and a new born baby is her own. Woman use to be exposed to birth through their sisters, cousins other friends and a safety net and support system was built. Today however we are expected to walk into the great unknown with a barrage of horror stories around birth and an equally frightened partner, holding your hand for support.

When you look at a marathon runner who is about to endure a 40km run, or an Iron man who will spend the next 8 hours pushing his body to the limit. Not only do they prepare and train, but also they surround themselves with support. Some one to give them food and drink, another to massage their weary legs and a coach to inspire, to encourage, to hold them to their goal when they begin to fatigue or want to give up.

This process and support is normal, infact we expect it and yet in childbirth, a similar event of endurance, many woman enter into their experience without the training, the support, and the knowledge.

When I first became a birth attendant I wanted to understand what other woman had experienced. I’d had my 2 children, my first a highly interventionist, traumatic birth and my 2nd an empowering natural birth surrounded by great support.

But that was my story and I wanted to hear from other woman what had happened for them. So I started collecting birth stories from any woman that wanted to talk. I interviewed everyone I knew that was a mother and I’d strike up conversations with mothers at the park whilst our kids played. I wanted a total cross-reference of woman so I could obtain a better understanding across the board. After listening to 100’s of stories I began to see a common thread.

What I found surprising was that nearly 80% of woman felt dissatisfied, unhappy and some quite traumatised by their birth experience. Three main factors kept coming up that woman felt mattered. The 1st was knowledge that they didn’t feel prepared or informed adequately about birth. The 2nd was they didn’t feel safe in their birth environment and the 3rd was they didn’t feel they had the right support. Many women reflected on how important it was having their partner there, but commented that their partner felt just as frightened and didn’t know what was happening.

The role of the doola or birth attendant is to provide support for the birthing couple. Lets talf specifically about what we mean by the word support.Birth support compromises of many different elements, which all aim to empower and educate woman and help them achieve the birth experience they desire, whatever that means to them or whatever way they want to give birth.

A birth attendant meets with the couple whilst pregnant to get to know them and form a relationship, so continuity of care can be established. An understanding is achieved around the type of birth the couple ants and then the birth attendant helps to educate them on how that can best be achieved. For example, if a woman wants to have a natural birth, then the place she chooses to birth is very important. Birth practices today in Victoria are highly interventionist and for a woman who wants to birth naturally a good understanding is needed of how the system works and what it takes to achieve that birth.

A birth attendant is then present for the duration of the birth. One of the main faults with our birthing system is that there is a lack of continuity of care. Even for woman that choose to have a private obstetrician, whilst they are labouring and need the greatest amount of support, they are cared for by midwives they don’t know. An obstetrician won’t be there to hold your hand through the hard parts of labouring and depending on how long you may be in labour and at the hospital for, you may go through 3 shift changes and therefore have 3 different midwives caring for you.  Through my research many woman commented on how at certain times they felt incredibly lucky when there was a midwife that they really connected with and found her support amazing, but then the disappointment when her shift finished and another midwife came on duty that she didn’t really have any repour with.

The benefit of a doula or birth attendant is that they are with you for the entirety of the birth. Through all the shift changes, different staff even different locations, the doula doesn’t leave your side. Helping to alleviate the stresses and interruptions that changing staff can bring.

 There are many statistics that support the benefits of a trained birth attendant.

As recognised by the World Health Organisation and according to many independent studies from around the world, where an experienced birth support person was present, the following benefits were observed.

 Such as:
Shortening the length of labour by up to 25%.
Reducing the possibility of a Caesarean by 50%
Helping to minimise interventions such as inductions and epidurals.
Reducing the need for medical pain relief by up to 35%
and a reduction in Forcep use by 57%.

An article written by Scott, Klaus and Klaus reviewed the evidence of the obstetrical and postpartum benefits of continuos support during Childbirth. Twelve individual randomised trials have compared obstetrical and postpartum outcomes between doula supported woman and woman who did not receive doula support during childbirth. Emotional and physical support significantly shortens labour and decreases the need for caesarean deliveries, forceps and vacuum extraction, oxytocin augmentation and analgesia. Doula supported mothers also rate childbirth as less difficult and painful than do woman not supported by a doula. Labour support by fathers does not appear to produce similar obstetrical benefits.

Eight of the 12 trials report early or late psychosocial benefits of doula support. Early benefits include reductions in state anxiety scores, positive feelings about the birth experience and increased rates of breast-feeding initiation. Later postpartum benefits include decreased symptoms of depression, improved self-esteem, exclusive breastfeeding and increased sensitivity of the mother to the child’s needs. The results of these twelve trials strongly suggest that doula support is an essential component of childbirth. A thorough reorganisation of current birth practices is in order to ensure that every woman has access to continuos emotional and physical support during labour.

I know in speaking to many partners there has been a reluctance towards having a birth attendant as there is a concern that she will take over. A birth attendant is there to support the couple and the birthing team. Many partners have reflected to me in my birth research of how they felt out of their depth when complications arose. Unless a partner has been around birth or in the medical profession, they are also entering into an unknown world. What does ARM mean? Or perhaps we want to run antibiotics for GBS? A birth attendant can advise and explain the medical procedures and protocols and help inform you on the best cause of action.

WE are there to support the partner as much as the mother, if there is a long labour, partners can take a break or have a sleep, knowing full well that there birthing woman is being cared for.

I’d like to read a quote from a Dad whose birth I was at.

“ When my wife started talking about a birth attendant I really got my back up. What could she give that I couldn’t do for my wife?” This was an intimate moment and I wanted to be the main support. But when I met our Doula and she came to our home and we spoke about how we wanted to give birth, my attitude started to change. I realised how knowledgeable our doula was around birth and she kept addressing us a couple and what we both wanted. When the big day came I started to freak out. But as soon as our doula arrived, her calm presence and gentle words made everything o.k. When we got to the hospital I felt like we were all a team and our doula was so respectful of our space, especially when my wife just wanted me. I can’t recommend highly enough having a birth attendant, it made the arrival of our daughter so special and sacred and both my wife and I came out of the birth feeling so great about the experience.”

As well as support throughout the pregnancy, sharing information and physical support throughout the labour, with massage and touch, a birth attendant is there to hold the woman emotionally. Most birth attendants or doulas are mothers and know full well what an intense and impactful experience giving birth is. With there own personal experience and understanding of the birthing process they are able to empathise, inspire, support and encourage woman through the intense journey of birth. When a woman is frightened or tired or anxious, a birth attendant can look her in the eye and know how she feels and share the incredible mystery of what it takes to bring your baby into the world.

And on top of all that she can provide at the birth, a doula is there for postnatal support, ensuring the continuity of care. Most doulas visit you at home after your baby is born and can assist with breastfeeding or any concerns you may have. I have also found in my own experience, how beneficial birth debriefing can be. 1 week, 2 weeks or 6 weeks after the birth, I find it is very important for a woman to talk about her birth experience, particularly if there was some form of trauma or dissatisfaction. Having been at the birth, the birth attendant can also give her side of the story and help the mother to explore any unresolved feelings.

Undoubtly giving birth is one of the most incredible experiences of a womans life. We as birth attendants and doulas are all working together to provide a better system for woman that support, honour and recognise the individual needs of each birthing mother.

To have a good birthing experience, not only enables you to feel empowered as a woman, it also gives you the confidence to begin on the path of mothering.