It is not easy to be continually present with a woman in labor. Watching someone in pain, observing emotions of fear and self-doubt, and trying to encourage a woman who just wants the labor to be over demands a great deal of giving on the part of the support person. Wouldn’t it be easier just to give the laboring woman an epidural and not have to be bothered with coaching her through each contraction?
Perhaps easier, but not better for the woman or her baby. Recent research indicates that continuous labor support, beginning prior to active labor, can:
- reduce the need for anesthesia or analgesia in labor
- decrease the number of births requiring the aid of forceps or vacuum
- decrease the cesarean section rate
Lamaze’s Healthy Birth Practice #3 is ‘bring a loved one, friend, or doula for continuous support’. You might wonder why continual labor support is needed, when every laboring woman has at least one labor nurse caring for her. Isn’t a family support person or a doula a duplication of efforts?
In its systematic review of continuous labor support, the Cochrane Review determined that optimal results were achieved when the support person was not an employee of the hospital where the woman gave birth. Nurses generally work in shifts, so the support person could change one or more times during labor. Nurses are expected to adhere to hospital policies, which may not always be in the best interest of the laboring woman. A support person who is not an employee may be able to help the laboring woman advocate for herself. Finally, nurses seldom have the time to simply sit with the laboring woman and be there for her. In fact, with most nurses having to care for multiple patients at a time, the typical scene in a hospital birthing unit is groups of nurses clustered around a central monitoring station, intensely scrutinizing the fetal heart rate patterns of their patients and entering chart notes into the computer.
The emotional energy needed to support a laboring woman is another factor in lack of continuous support from labor nurses. Many nurses have never been educated about the benefits of unmedicated labor, nor are they familiar with comfort measures outside of IV medication or an epidural. They may be distressed at witnessing a woman’s pain, or hearing her vocalize during contractions. A support person who understands the benefit of normal labor without drugs, and who is willing to witness the woman’s pain and walk with her through it, can provide a tremendous amount of courage to the laboring woman who isn’t sure she can do it.
A recent experience I had with a laboring woman underscores for me the value of support. She was nearly complete, and looked at me with pained eyes, saying, “I just don’t think I can do this any more. I really want an epidural”. Part of me wanted to do something–anything–to take away her pain. The other part of me understood the benefit of laboring without interference from drugs or an epidural. I replied, “If you really can’t do it any more, I’m not going to tell you that you can’t have some help. But I want you to know that you are very close to being done. I’ve been watching you labor, and you are working with your contractions just beautifully. From my perspective, you are coping just fine, and I don’t think you need an epidural.”
When I saw her in the office a few days after the birth, she was beaming with pride and pleasure at having a normal birth. She told me, “I really wanted to quit. But when you told me I was doing fine, and I didn’t need the epidural, that was all I needed to hear. I figured that if you thought I was doing fine, that I could keep going!”
Continuous labor support for all laboring women is not the norm in the United States today, but it should be. Through this simple act, we can make progress in reducing the c-section rate, decreasing the number of assisted vaginal deliveries, and making normal birth truly the norm again.
References:
Childbirth Connection. Cochrane review on effects of continuous labor support. Retrieved 11/21/09 from: http://www.childbirthconnection.org/article.asp?ck=10128
Lamaze International Education Council. Continuous labor support. The Journal of Perinatal Education, 04 Spring; 13(2): 16–22. Retrieved 11/21/09 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595190/
MedScape Today. Non-pharmacological approaches to relieve labor pain: continuous labor support. Retrieved 11/21/09 from: http://www.medscape.com/viewarticle/494120_3
One Comments to “The gift of continuous labor support”
[...] But several bloggers explore the difficulty hospital staff face in providing effective labor support. Carol Van Der Woude writes that Dr. Lamaze made sure everyone in his hospital who came in contact with the laboring woman was trained in his relaxation and comfort techniques whereas today there is much variability in the support skills of hospital staff, as machines and procedures transform nursing into a technical rather than a supportive role. In a similar vein, Rosie at Rosie’s Adventures in Birth and Beyond debunks the notion that hospital staff can consistently provide excellent support and privacy, pointing out that a doula can be a knowledgeable companion creating an intimate space for the woman and her partner amidst the unfamiliar hustle and bustle of a typical labor and delivery floor. Nicole, a hospital-based midwife who blogs at It’s Your Birth Right gives her own take on why a doula can ease the uphill battle many women face to have a natural birth in the hospital. Janelle, another hospital-based midwife and new to the blogging scene blogging at Birth Sense, also explores the difficulty of getting consistent, quality support from hospital staff, acknowledging that labor support is hard work that not everyone is cut out for. [...]