Is It Fear Then?

Is it fear then? A labouring woman’s fear that she can’t continue to cope, even when she is coping just fine? A doctor’s fear, increasingly these days, of legal action if they choose a different path? Of the nursing staff, if they misinterpret the signs? It would appear that there is fear on every side and the person in the middle of all of the fear is the infant himself (or herself). In part three of Kirkey’s investigation surrounding the increase in caesarean section births in the recent past, she looks what seems to be causing these numbers to soar.

In my career as a labour support provider I have had the honour of being invited to more than 200 births. I have had the opportunity to witness pretty much every possible intervention used for labouring, birthing and newly postpartum moms as well as those used on or for a newborn infant. All of that said, I am proud to boast that less than 5% of the moms who have birthed with me, have done so without requiring a caesarean section.

WILL A DOULA HELP PREVENT A C-SECTION?

I have to agree with “Dr. Larry Reynolds [who] says many complications of labour that can lead to interventions are relieved when women are comforted, supported, and aren't feeling kind of terrorized.”

I didn’t respond to this article on the day it was published (as I had with the previous two) because I was at the birth of a lovely wee boy. At one point during the labour the mother, an editor of on-line courses, said to me that having me with them was like “having their own personal textbook but one they didn’t have to open and flip through to find the right page.” As we laughed together at her analogy she went on to tell me she felt better knowing she could ask me any question and that I would be able to answer her. And she DID ask questions. She wanted to know what was happening with her body, her baby and her birth and she strove to make the best possible decisions she could with the information she had. Of course I wasn’t her only resource but I did listen to her, ask her questions and make her feel as though she was capable to deciding what was best to do.

In Kirkey’s piece Reynolds goes on to say that "the environments of birth can be quite intimidating for women and their partners. . . . We know that women who have continuous one-to-one doula support in labour have half the caesarean section rate, half the forceps rate. They have much shorter labour, half the length of labour."

I can’t know Reynolds information to be true, personally, because all of the labours I’ve been to (short of those for my own two children) saw me in the role of labour support. I will say that I have been amazed on more than one occasion, when a couple has looked to me after the birth of their baby, only to tell me that they couldn’t have done it without me. Of course they could have and WOULD have. What I always interpret their words to mean are that they were glad they didn’t HAVE to birth without me present. That is extremely gratifying.

I enjoyed reading about the research of Professor Ellen Hodnett who, in her pilot study, changed the layout and overall feel of the labour room in two teaching hospitals in the Toronto area. She moved the bed out of the centre stage location where it usually is and created a more relaxed atmosphere. Her findings certainly indicate that she is likely on the right track as the study patients received fewer induction/augmentation tools and saw mom-to-be spend significantly less time in her bed. Why is this significant? As Kirkey outlines, “Research has shown that women who labour in an upright position -- standing, crouching, propped up or sitting -- have shorter labours, and fewer medical interventions, including C-sections.”

If, as Dr. Jan Christilaw suggests caesarean sections occur most often due to “dystocia” or some part of baby not fitting well through mom’s pelvis leading to a stalling-out of the labour or “failure to progress,” then why is this happening? We know, quite certainly, that extremely small women can have considerably large babies vaginally. Why do some babies not fit? Perhaps we need to go back and look again at how the labour has been managed.

MOMS ARE EXHAUSTED BEFORE LABOUR EVEN BEGINS

If moms are induced (for being past their due date, having a large baby, etc.) then they are more likely to need to rest a lot during labour. Why? It is physically and EMOTIONALLY more intense to have labour started artificially. In almost every single case of the induction of one of my past clients I can tell you they go into the labour process with significantly smaller reserves of energy due to the stress they have been experiencing leading up to the induction itself. Not to mention guilt at not having been able to go into labour on their own and frustration for being subjected to an intervention they don’t want. Oh and let’s not forget the guilt at having been upset about being induced because we all want “what is best for baby.”

It is not my place NOR my inclination to make anyone feel guilty or upset at all about the birth that they have experienced. It IS my desire to have care providers in general look at the overall picture and examine a little more of the psychology moms bring with them into the labour room. If they have been filled with fear (by their care providers, their friends, their family members or the shows on television) then I really believe those fears need to be met with compassion and understanding and NOT with the condescension and self-righteousness I often see moms receive.

I can and will support a mom with whatever decision she makes. I will provide her with the best information I can find in response to her questions. I will offer her results on both sides of an issue. I will let her make up her own mind, even when I worry because it isn’t a decision I would make. I voice my concerns and ask that she hear me out. However, it is HER body and her fears are just as valid as anyone else’s.

POSTED BY SAM