This post is a combination of direct quotes and paraphrased summaries of Penny Simkin’s public lecture, Making the Most of Your Birth Experience, at UCSD Medical Center on October 7, 2010. I apologize for switching between second and third person but am leaving this information in the form of organized lecture notes. Penny Simkin is a physical therapist, co-founder of DONA, doula and childbirth educator who emphasizes the importance of providing women with compassionate care in labor.
A woman never forgets her birth experience. She carries that memory to the grave. No long-term studies have been conducted on whether or not this applies to fathers or co-parents. Therefore, a woman’s birth should be as good an experience as possible.
Some things we can control, but some things we can’t. While we can work on self care, at some point we need to work on letting it go and letting the universe take over. There’s no way of controlling it, even with Pitocin. We don’t know if it will be a straightforward labor or have glitches and need to just take things one step at a time
You can control some of the choices you make. Many decisions are key and some of these choices do determine how your birth is going to go. It is important to note that there is no single right choice for everybody. Know what your options are and feel the one that’s most comfortable for you.
Choice of Care Provider and Location
Simkin teaches a home birth education class and a hospital birth education class on different days of the week and loves them all. When weighing options of where to give birth, finances and what insurance plans cover, if relevant, are very important factors. Open these questions early in your pregnancy.
One of the most critical choices expectant parents can make is the choice of care provider. If you are uncomfortable with care provider now, it doesn’t get better. If you feel unheard, disrespected or are questioning practices, it isn’t too late to switch.
Seattle, for example, has lots of variety in available services. Simkin urges women to keep their minds open, as this important decision will influence the type of care that she gets.
In Canada, the maternity care system is different than in the United States, with family doctors catching 40% of babies. Midwifery is just getting started and midwives are trained to follow the woman. If a woman wants a home birth, the midwife follows her. If she prefers a hospital birth, the midwife has privileges there.
If you’re not satisfied, don’t feel that you’re stuck. Some couples change with one or two months to go in the pregnancy.
Simkin was the first to write about birth plans back in 1980. A birth plan is an opportunity for you, the expectant parents, to tell the staff what’s important to you.
In the throes of labor, it’s really not feasible to advocate effectively for yourself, as active labor isn’t really a great time to keep mental lists of preferences.
More important than specifics are ways that you can help the staff to get to know you and get behind you. You want to recruit the nurses and docs to get behind you. When they feel they know something about the woman, they are more likely to feel a bond and make it special for her.
First, tell them something about yourself so they know what is important for you. The second and most important part is to detail specific preferences. For example, Simkin had a client who couldn’t get the positive result of a birth defect screening test out of her head and it was causing her tremendous anxiety. An amniocentesis verified that it was a false positive, yet the woman felt extremely worried about her baby. She explained that she was extremely scared in her birth plan and that she could use extra reassurance that her baby was okay. The staff was happy to oblige, remaining positive and extra-encouraging. They wouldn’t have known to be that reassuring had she not written about her fears in her birth plan.
A birth plan could also be a place to disclose early childhood sexual abuse and express one’s discomfort with vaginal exams. A note in a birth plan to please perform as few as possible and to take it slowly could remind the staff to take it easy.
If a woman has had a previous stillbirth, the birth plan is an opportunity to let the staff know that old feeling might surface. Instead of everyone being a stranger, the birth plan is an opportunity to inform staff of anything that’s important to you, even something as simple as “I’ve never been sick a day in my life and never been in a hospital… hope it’s nice!”
Keep it to a bulleted paragraph. Nobody has time to read pages and pages of text. A general list of preferences will go further than an itemized menu of what is acceptable and what is not. If you feel less is more, this is a chance to let the staff know what you hope for. If you prefer a more medicalized approach and feel safer with more technology, let the staff know that.
Another thing to request is for informed consent along the way. Something like, “Please keep me informed. Please explain to me what you are doing and let me know any risks and benefits” can remind the staff that you want to be kept in the loop, unless you prefer not to know.
Compassionate Care and Memories
In a longitudinal study begun in 1968 and spanned 15 to 20 years, the women who felt most satisfied with their birth process felt they were well cared for by their doctors and nurses. Memories are crystal clear of the quality of care. Women could quote the nurses. They had “flashbulb memories” and remembered everything that was happening. Twenty years later, some women wept, expressing remorse or sadness about feeling lonely and disrespected. Two women said it was the best day of their lives, like climbing Mount Everest. The care they received enabled and empowered them to feel like they were doing a great job, regardless of how they gave birth.
There were natural births, medicalized births and complicated deliveries in both groups and satisfaction was based more on how they were treated.
Simkin co-founded DONA and feels that her work with doulas is the most important thing she’s done in her 40 year career.
We can’t control how the labor is going to go. We can control how we care for women.
At the time of founding DONA, there was a huge nursing shortage and maternity care was already moving quickly in the direction of technologizing birth, which meant that nurses, doctors and midwives had the added responsibility of recording and inputting data in addition to everything with which they were already tasked. The role of labor support dropped down the priority list for nurses as a result, as there were simply not enough hands and time to do it.
Klaus and Kennell conducted some studies in Guatemala in which they assigned a grey haired woman to sit next to a laboring woman and hold her hand, telling her how she beautiful she was, how great she was doing and other warm, reassuring words. The women in the experimental group expressed feeling more satisfied and prouder of their babies than the control group.
Look into getting a doula.
Look around for classes that will supply what you really need to know. If you want to go into your labor without using pain medications, look for a class that gives you what you need to achieve the degree of participation in your labor that you wish. Childbirth education has gotten away from that, streamlining classes for busy professionals and the first thing to go seems to be comfort measures.
Partners, do you know how to press on a woman’s hips if she’s having back pain? If you don’t know how to help her, she will need an epidural. Can you breathe in a way that will enhance relaxation? The woman who learns to do this has a chance to extend herself as she wants to. “To have you motivated to do it, to want to participate in your birth, I feel like we’ve failed if you don’t have the tools to do it.” (Simkin)
The Birth Survey
Pregnant woman and partners: Simkin encourages you to go the TheBirthSurvey.com and see information about local providers. After giving birth, there is a survey for you to answer.
Sorting Out Emotional Issues
To make the most of your birth experience, look into and examine any personal issues, uncertainties and emotional issues. It really makes sense that if you are anxious about birth or becoming a parent, having dreams, or had terrible parenting yourself and are scared about doing it differently, you should TALK ABOUT IT rather than hoping everything will be alright. See a counselor or social worker if things are coming up for you, or take to someone who can help you identify and strategize how to work through stuff.
Are you planning to be at birth? What will your role be at the birth? Are you being pressured to play a certain role? This is a big load to put on you if you’re going to be the mainstay of support and wonder if you can measure up.
What role do you want to play? See if there’s a way that you can find a role that works and take the opportunity to be yourself during your partner’s labor. Many men are excellent at labor support. Some men are not. There is nothing wrong with that point of view.
Be very honest with yourself and partner. If you’re wanting to be there but not sure you can live up, get a doula. Take it easy on yourself if you’re setting very high standards and having anxiety. You can be a person that is helping but not responsible for everything. Whether it’s hand-holding or tasks or being the sole provider of labor support, talk about it. If you are afraid of birth, a doula could be in charge of reassuring you that those sounds (pain) are very normal for a woman in labor.
Part II of the lecture will be posted next week.