Wednesday, January 6, 2010

On Dads in Labor...

This is a delicate issue, and I've composed and revised at least 5 versions of this post - no exaggeration. First of all, not all birth dads are actually husbands yet. So I kept feeling unsure about the title "On Husbands in Labor." That said, if I have to use the words "husband or lover" every time I refer to a birthing dad, you're going to become really sick of me really fast. So from here on out I want to simplify and use "husband" as my blanket term for all men who participate in a wife's/lover's labor.

The most delicate thing about this issue, however, is that I could very easily offend a lot of men (if any indulged me enough to read this). I could also offend a lot of women on behalf of their husbands. I could sound very accusatory and make men sound like they are unhelpful or are inadvertently sabotaging their wives' birth experiences. That's the last thing I want to do.

I do want to make one thing clear, however, and I'm just going to be blunt. A husband's support and involvement is crucial and will have a profound impact on his wife's labor. If you are interested in going unmedicated but your husband disagrees with your desires, you will be facing a very uphill battle once you are in labor. There I've said it, and it's T.R.U.E. True.

Pregnancy is a very challenging time for a woman. She is going through so many physical and emotional changes. She is likely to experience a fair amount of self-doubt, and her perception of how her husband feels about her will greatly impact how well she deals with stress and other challenges.

If pregnancy is a challenge, labor is a Herculean task. It can not only be painful and exhausting, but it can be frightening. Even if a woman is feeling pretty good during much of her labor, there is almost always a point where self-doubt begins to set in. A husband's reaction to that self-doubt will make all of the difference in the world.

I want to back up though, and I hope you don't mind me doing it. I want to share a little about my husband and the changes in his attitude about childbirth through the years. He and I have discussed this, and he has given me permission to use him as an example. I really appreciate his openness, and I hope that I can do justice to what a great person he is.

When I was about 6 or 7 months pregnant with our oldest child, I finally found some time after work to sit down and read some of the magazines that came in our "Welcome" packet at the doctor's office. For many months I had been debating in my head and was inconclusive about whether or not I wanted to labor with or without an epidural. At this point I was still loaded with fear over labor and had no confidence that I'd "be able to take the pain." Just the same, the question still hovered over my head about whether or not an epidural was a safe, wise option in childbirth and a good option for me with my personality.

In one of the magazines I was reading, I found an article that gave suggestions for coping with labor pain unmedicated. It discussed some of the risks of an epidural, most of which I had not heard about before. It also discussed some of the benefits of unmedicated childbirth. Interestingly enough, in the 5-6 months that I had known I was pregnant, I had not heard even one very positive story about an unmedicated birth. In fact, any time I mentioned to friends or coworkers that I was interested in unmedicated childbirth, I usually heard horror stories or was mildly teased about my interest. One friend sent me a cartoon of a hospital room that had been torn apart. Everything was damaged, the doctor had a black eye, and the mother sat happily cuddling her newborn baby. In the caption, the doctor was saying to the husband, "Sir, next time you may want to convince your wife to consider pain medication in labor." It was a very cute cartoon, and I took little offense to it; but I'll admit that it didn't help me very much. :)

Back to my evening of magazine reading: After I had read and considered the article on natural childbirth for awhile, my husband came home. Instead of asking him to read the article and tell me what he thought of it, I just sheepishly mentioned that I was interested in learning more about unmedicated birth. Thinking that my interest was only mild, he shared that he wanted the labor to be a happy experience, and he was concerned that if I was in terrible pain then it would be a miserable one. He also gently mentioned that I don't have a very high pain tolerance. (And he's right, by the way).

I must admit that I was a little disappointed that he wasn't more open to the idea, but I had my own fears and insecurities on top of his skepticism. I had so little confidence and conviction that I didn't pursue it any further with him. From that point on I hoped to not need the epidural while expecting that I probably would.

Now I want to repeat again that I don't mean to disrespect my husband. He is and has always been a wonderful man, and he's very far from being a male chauvinist. He just didn't know much about the benefits of unmedicated labor or even the risks of epidurals. He had also heard a story from a fairly close relative about how she had attended a class at a church activity given by a doula, and she left feeling very guilted about her personal plans to have an epidural. He had little knowledge and no positive experience with natural childbirth, and he made a judgment based on what he knew.

Then I had our daughter. It was a disastrous birth. Yes, there have been worse labors and deliveries. Yes, we're both alive and well, and we didn't even need a c-section. It was still a disaster, though. It was both physically and emotionally traumatizing, and recovery and nursing were both horribly impacted by the whole experience. With my little knowledge at the time about labor and delivery, I actually returned to the same OB group with our next pregnancy. I was certain about one thing, though - I did not want an epidural with my next delivery. I did not want to risk a fever or difficulty pushing out the baby again.

Once I'd had the fateful conversation with a neighbor that convinced me that I wanted a Bradley birth, I approached my husband about taking a Bradley class. He didn't argue, but he was uncertain. The class was expensive and a large time commitment - $120 and 10 weeks, one night a week. For us that meant babysitting and extra stress when we didn't have much excess income or time. We had already taken a short class in our previous pregnancy and had experienced labor, and he saw little need for another class. He also admitted that he was unsure how comfortable he'd be with the kinds of people who were very gung-ho about unmedicated labor. From his experience, they seemed a bit extreme; and my husband has a strong aversion to extremes. :)

Despite his concerns, he knew that this was important to me. He also knew that I looked back on our first daughter's birth with pain and disappointment. She was such a joy and worth any difficulty I experienced, but she suffered along with me when I was struggling with intense pain and low milk supply for several weeks after birth. If it could help me feel better prepared for this next labor, my husband was willing to make the time and investment for a Bradley class.

Throughout the 10 weeks of the class, my husband's attitude slowly changed. He never became passionate about me not having an epidural. He did, however, gain a great appreciation for not only the medical benefits of unmedicated birth but also what a positive bonding experience it could be for a couple. He made time to read some of the extra material assigned in the class. He encouraged me to do my exercises, and he excitedly prepared for the labor experience by picking out music and making a birth "wish list" with me. It was very touching to watch how much respect he gained for couples who are willing to put in the preparation and effort for an unmedicated birth.

During our second labor, when our son "Mr. Handsome" was born, my husband was a great support. For one thing, he had learned so much about labor that he sensed I was in labor before I did. I had begun vomiting throughout the day and was in bed most of the time, and he had learned that it was a possible symptom of the onset of labor. He also knew that dehydration wasn't great for a woman who is 40 weeks pregnant. :) Once we were in the hospital, he was very attentive in offering to get me things and checking my comfort level. He consistently massaged my back during each strong contraction, and he encouraged me to switch positions and use the bathroom frequently as I needed to. He was quick to respond to any discomfort I had and seemed to read my cues better than I often did. At one point, when I had gotten in the shower for comfort, he smiled at me and said, "This is a lot more fun than the last time." (The previous time, he could do little more than get me ice chips and blankets and, when I had a bout of vomiting, hold the container for me).

Now it wasn't easy for him. When we had been in the hospital for almost 10 hours and I had been dilated to 8 centimeters for over 5 hours and was getting pretty exhausted and grumpy, he had been rubbing my back all night and was ready to pass out. Once the doctor and I agreed to break my water, however, my husband got a second wind. When my water was broken, my dilation went from 8 to 10 centimeters in one contraction, and I was lying flat on my back. (This was VERY painful.) I derailed for a minute or two. Gratefully, my husband was very comforting and encouraging. He had learned about the signs of transition, and he knew that the end was near. (In fact, I was pushing 5 minutes later.) So as I yelled out, "Please put something in my IV!" he worked to soothe me by telling me that it was okay and that I was doing great. (He was VERY sweet considering I'd just sworn in front of everyone and ripped my hospital gown off.)

When I began to push, he just stood by me and told me that I was doing a great job. And when our son came out all muddy and slimy, my husband burst in tears, hugged and kissed me, and told me that he was so proud of me and the baby was so beautiful. (Incidentally, my son is a miniature of my husband, so you can guess where he got his looks).

In our 3rd pregnancy, I chose to go with Certified Nurse Midwives instead of an OB or family doctor. Though my husband wasn't fully comfortable with the idea of midwives, he had also learned that since I was the one having the baby, my feelings should come first in the matter. During our somewhat complicated labor, his tremendous support enabled me to labor unmedicated despite having a full blast of Pitocin almost the entire time. I personally believe that, had I received an epidural with that labor, I would have needed a cesarean. Even a year later when I expressed insecurity and guilt that maybe I shouldn't have been so resistant to a cesarean with that birth, my husband reassured me that we were in the best hands and had done the right thing each step of the way. When I claim that I was a bad patient, he says that I did a great job with our son and I shouldn't ever doubt the choices we made.

Now my husband has always cared for the baby's and my safety. He has always had my comfort and best interest at heart. When I requested my epidural with our first baby, my husband quickly got the nurse to call the anesthesiologist. He was encouraging and attentive during that labor as well, doing whatever he could to assist me. He felt a little helpless, though. He was limited in what he could do, and he was forced to sit by and watch much of the time. He also understood so little about what was happening. When people announced to us that I would receive this drug or IV or this procedure would be performed, he knew no reason to not consent to things. And I was so gone during that labor that I had no ability to stay really involved.

Can you see why I feel so passionately about couples taking a good class together? :) My husband went from being a compassionate but slightly helpless observer of my trauma to being an active participant in and advocate for my empowerment. Instead of wanting to rescue me from "unnecessary pain," he joined me on my journey and was crucial in making it more positive and safer. I have always adored him, but my love for him has grown so much through these experiences among others.

I want to be clear again that I don't think that unmedicated childbirth is the choice all women need to make. Many women, knowing all of the risks and benefits of the two options, would still opt for the pain relief of the epidural. I do feel, however, that couples should work hard to become educated together - well educated. Whenever possible, expectant couples should make the time and investment for a good class - one offered independent of an OB practice and requiring multiple evenings. They should come in with as equal knowledge and understanding as possible about nutrition, pregnancy exercises, medical procedures, alternatives for pain relief or pain minimizing, the stages of labor, pushing positions, postpartum care, and lactation.

Most importantly, the husband should have a good understanding of his wife's desires about childbirth, and they should both come in prepared to work together to support those desires. If the woman is low risk and would like to deliver with midwives - CNM's deliver in hospitals and they're great! - the husband should give this serious consideration. If she feels strongly about natural childbirth, he should encourage her in her desires and be prepared to give encouragement during labor.

To be more specific about labor, it is very important for couples to take things one step at a time and let the laboring woman give the cues. If a woman wants to labor unmedicated, the husband should be very careful in reading his wife's reaction during contractions. A woman may appear to be in greater pain than she really is, or she may even discover that she doesn't mind difficult contractions because they always come to an end and she gets breaks between them. A well meaning husband might be tempted, at the sight of his wife's grimaces or the sound of her moans, to say, "Honey, if you want an epidural, I totally support you." As kind as the intentions are, this could sound like a vote of no confidence to a woman who is already emotionally vulnerable. So, to be plain, it is a good idea for couples to make a plan that no medication be offered unless the wife first requests it.

Husbands deserve to know that their love and support means the world to their wives, especially during an experience like labor. A loving, knowledgeable, and involved husband who works with and follows his wife's lead during labor is invaluable, and I believe that he receives a great reward in having played such an active part during her labor.

Such a husband can become a "birth partner" in the truest sense of the word.

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