Dad/Partner Myths Debunked

I thought I should post some debunked myths regarding doulas and how they work in conjunction with dads or partners (or whoever is accompanying the laboring mama).

The Doula and the Partner: How They Work Together to Help the Birthing Woman

by Penny Simkin, P.T. - Author, Doula, Childbirth Educator, Birth Counselor

When a doula discusses her role with women or couples, she may feel a little uneasy when asked exactly what she has to offer.
She may find it difficult to give an answer that reflects her usefulness without seeming that she is bragging. The most common question regarding doula care for birthing couples: what about the woman's husband/partner/loved one? There are many valid concerns often raised by couples considering doula care for childbirth. For example:

1. Partners who have taken childbirth classes may wonder, "Why bother with a doula?" The classes theoretically prepare the father or loved one for that role, and it appears that a doula is redundant.

2. The doula might interfere with the couple's intimate experience, since she is nearly a stranger to them.

3. The doula may try to make the woman have the kind of birth the doula wants, not what the woman and her partner want.

Some couples worry that the partner will be pushed out, that the doula will assume that she can do the job better and will relegate the partner to a minor role. On the other hand, some women worry that their partners will not be able to help very much, but are hesitant to suggest a doula for fear of hurting the partner's feelings. And some partners want help, but they feel insecure about their ability to meet all of their wife's or loved one's needs.
Here I will discuss some of the myths or concerns about doulas, along with the realities. They may clarify how a doula works with a woman's partner.

Myth #1: If a woman has her partner, the doula becomes redundant.

Reality: The doula may be the only person at the labor beside the partner who is there solely for the emotional well-being of the woman. The nurse, the doctor, the midwife have other priorities that compete with the emotional care of the woman; for example, breaks, shift changes, clinical responsibilities, office hours and hospital policies. The doula has few or no other priorities. She stays through shift changes, and until after the baby is born. She is not just another stranger with the couple. She has the woman's needs as her sole priority.  In some cases, the couple will bring several other friends or family members into labor with them. Sometimes these people can be uncertain of how to help, which leads to confusion and actually adds to the woman's stress. The doula can direct and coordinate the efforts of a group of people, giving them all something useful to do, so they work as a team on the woman's behalf.

Myth #2: The doula "takes over," displacing the partner and interferes with their intimate experience.

Reality: The doula can actually bring the couple closer. By making sure that the partner’s needs are met (food, drink, occasional back rubs, and reassurance), the woman and partner can work more closely together.  The doula allows for the partner to participate at his or her comfort level. Some partners prefer to be there only to witness the birth of their child and to share this experience with the woman they love. They may not want to play an active role and do not want to be responsible for the woman's comfort and emotional security. The doula can fill in and allow the partner to participate as he or she wishes, without leaving the woman's needs unmet.
When the partner chooses to be the major source of emotional support, the doula can supplement his or her efforts by running errands, making suggestions for comfort measures, and offering words of reassurance, and comfort. During a long tiring labor, she can give the partner a break for a brief rest or change of scene.
For the partner who is shy, uncertain, or unversed in his or her role, the doula suggests simple but truly useful tasks, such as timing contractions, holding the woman, supporting her in a particular position, massaging her. In such situations, the doula might take the lead, but the partner plays an important secondary role.
While the doula probably knows more than the partner about birth, hospitals and maternity care, the partner knows more about the woman's personality, likes and dislikes, and needs. Moreover, he or she loves the woman more than anyone else there. The combined contributions of partner and doula, along with a competent, considerate and caring staff give the woman the best chance of an optimal outcome.

Myth #3: The doula has her own beliefs about how the birth should go, and imposes it on the woman or couple.

Reality: The doula's true agenda is to help ensure that the woman's or couple's agenda (their birth plan) is acknowledged and followed as much as possible. If the doula is thoroughly familiar with the couple's wishes and their birth plan, she may actually think more about it than the couple, especially when labor is intense and things are happening rapidly. The doula can remind the staff or the couple of some items on the birth plan that are forgotten, but which later might be important. Sometimes if a birth plan is not followed, the couple later look back with regret or disappointment.  The doula helps with decision-making by asking questions that will ensure that the right information is given to the woman or couple so that they can make an informed decision. She may also suggest alternatives (like waiting awhile) for the couple to consider. She does not, however, make decisions for the couple.

In summary, the doula helps make the birth experience to be as rewarding and satisfying as possible. As one father said, "I heaved a big sigh of relief when she (the doula) walked in. I hadn't realized how much pressure I had been feeling. She not only calmed my wife, she calmed me down."

Advantages of Having a Doula

In an article in the Pediatrics: A Journal of the American Academy of Pediatrics, it is stated that "At the present time, the demands on labor and delivery nurses are so great that they can spend less that 10% of their time providing supportive services.  By adding continuous doula support in six random, controlled trials , there were reductions in cesarean deliveries by 50%, use of forceps by 40%, and requests for epidural analgesia by 60%, and a 25% decrease in labor length.  This study showed the value of doula support for all mothers whether laboring alone or with a partner." 

Interestingly enough, in the same study, having a doula provided a significant positive impact on the mother-child bond.

     The long-term advantages of doula support during labor may be even greater for the baby, as 

demonstrated in 2 studies that examined changes in mother-infant interaction following doula support. Investigators in Johannesburg observed the psychological health of the women and infants in both the control and supported groups 6 weeks after delivery.1,10 There were favorable effects of doula support on the subsequent psychological health of the women and infants. At 6 weeks there were impressive postpartum behavioral differences: a significantly greater proportion of doula-group women were breastfeeding (51% compared with 29%), and the doula-group women were significantly less anxious, had lower scores on a test of depression, and had higher levels of self-esteem. These maternal qualities would be favorable for the development of the infants. Not only did the supported mothers show more positive behaviors with their babies, but they more often rated their babies as better than a standard baby, more beautiful, more clever, and easier to manage than did the control mothers, who perceived their babies as slightly less beautiful and clever than a standard infant.

"Many women are aware of the improved clinical outcomes for both mother and baby associated with doula care during labor and delivery (Table 1)." (Ann Fulcher, CLE, CD)

TABLE 1. Benefits of Doula Care

Randomized, controlled trials assessing the role of the doula demonstrate benefits in the following outcome

measures:

• Shorter labors
• Reduced need for pain medication
• Fewer episiotomies
• Fewer operative vaginal deliveries
• Fewer cesarean sections
• Improved neonatal outcomes
• Better mother-infant interaction
• Improved breastfeeding rates
• Greater maternal satisfaction

After reading this article, as well as hearing it in my training and experiencing it first hand, it's interesting for me to know the reason for a doula.  A doula is there for one reason and one reason only...to provide continuous support for the mother.  Whether or not another woman is present (i.e. sister, mother, friend, partner), the doula generally has the ability to remain calm and neutral.  The doula should not take it personally when the laboring woman is shouting at or cruel to her.  The doula will know that it is what the momma needs to do at that moment to deal with what she is experiencing. 

A client told me today, "I felt like I could get angry at you or at [my husband] without fear that it would be taken personally.  I knew that [my husband] would have you as support, to give knowing glances.  I could focus on my labor and not worry about how I was being toward anyone."

What Does a Birth Doula Do?

"So, everyone in the delivery room has their place.  The doctors, the nurses, my wife...so if you're there, where does that put me?  Will I just get to sit on the side?" 
That was a question from my first client's husband.  It's a common one.  What exactly will a doula do?  Will she replace the partner? 
The answer...absolutely not.  My favorite quote regarding this topic is from Susan Cassel .  She lead my toLabor doula training.  She said, "If a doula is doing her job, it's like she's not even there.  She goes unnoticed."  That is not to say that a doula just sits and does nothing, but she guides the players so that they are doing all the movements themselves.  The partner, if there is one, is doing what he or she needs to be doing.  The laboring woman feels comfortable in being herself.  The doula is simply there to encourage, inform and assist the laboring woman in her journey to bring forth life. 
There are many different types of doulas out there, just as there are many different personalities and belief systems.  Some doulas only do homebirths amongst midwives.  Other doulas work solely in hospitals.  Some believe circumcision is heinous and will advocate against it.  Others think it's a family choice.  There are doulas who walk into a hospital and starts to bark orders about birth plans and such.  There are doulas who walk into a hospital and just wait, watch and listen until the time comes for her to pipe up. 
The combinations are endless.  It is important, if chosing a doula, to find the right one for you.  You might want to try reading The Birth Partner, by Penny Simkin.  This book is not only for doulas, but for anyone who may be accompanying a woman into labor.