The Default or The Doula? Why We Need To Talk About Birth Partners Now More Than Ever.
Imagine waddling up to the desk at the maternity ward, labour in full swing. The masked midwife offers you a choice of Room One or Two. They are identical rooms, staffed by the same care team, and you are allowed one support person regardless of which room you choose.
Choose Room Two, she tells you, and your labour will be on average 41 minutes shorter than in Room One. You’ll be 31% less likely to need drugs to speed up your labour and 28% less likely to deliver via caesarean. You’ll also be 34% less likely to report dissatisfaction with your birth experience, 9% less likely to need pain relief and your baby is 14% less likely to require care in the special care nursery.
What’s so magical about Room Two, you wonder, and why would anyone in their right mind choose Room One?
Before you make your decision, the midwife has one last piece of information for you – in Room 1, your allocated single support person is your partner. In Room 2, it is your doula.
While this scenario is imaginary, the dilemma facing pregnant women and individuals in many Australian states right now is not.
The COVID-19 era has seen pregnant parents attending scans and appointments alone, birth education move online, and extended periods of physical isolation. With so much sacrificed already, for a person to hear that their partner’s presence at the birth may not be in their best interest could be confronting to say the least. Nevertheless, these are the statistics from trials involving over 15 000 birthing women when continuous labour support was provided by a trained birth doula, and now more than ever, we need to talk about them.
In the grand scheme of human existence, the time that fathers have been welcome in the birth space is staggeringly small. Across the vast majority of cultures for millennia, birth has been a man-free event, a sacred space with wise women guiding the mother through the birth of her baby.
The medicalization of birth through the twentieth century saw male doctors presiding over births, but even then mere dads were still kept well away from the action. When my brother-in-law was born in country NSW in the 1970s, his father certainly wasn’t in the delivery room – in fact he wasn’t even allowed to touch the child until they were in the car park on leaving the hospital one week after birth! When my now-husband came along in the mid-1980s, his dad held him a few minutes after the birth, but attending the main event was still off the cards.
How different is this experience to the majority of partners of today? While mothers and parents from some faiths and cultural backgrounds prefer to keep the birth environment male-free, the script has almost flipped a 180 in a single generation, with the overwhelming majority of dads and partners present for birth.
When restrictions on hospital visitor numbers on birth and postnatal wards were initially announced, partners became the default single support person. Birth doulas across the country lamented that not only had their work almost dried up overnight, but that many couples were unknowingly walking straight into a waking nightmare.
While men with no more experience in birth than being born themselves and a few hours of online birthing class were tasked with being sole birth companion, highly trained professionals with experience supporting tens if not hundreds of births were literally twiddling their thumbs at home. Some attempted virtual support with families in hospital, but many stopped after finding it too hard to get the right camera angle, too difficult to hear what was going on, too hard to powerlessly watch easily preventable situations unfold upon their screen.
During the pandemic, while health ministers and spokespeople attempted to reassure expecting women and pregnant people that hospital was still a safe place to be, our country’s leading providers and academics predicted our already catastrophic rate of birth trauma was climbing. Stories of less-than-ideal birth experiences during the pandemic have been told widely across both social and traditional media outlets.
Despite this, discussions about improving labour support have centred around three themes: the upskilling of partners, the reinstatement of a secondary rAT-negative support person for birth as has occurred in Queensland, and the need for continuity of midwifery care (that is access to a known midwife through pregnancy, birth and postpartum) as the rule rather than the exception to it. Despite their good intentions, these conversations don’t necessarily help the thousands among us who are trying to plan for a labour that could start at any moment.
What may actually help women and individuals nearing birth in places where a sole support person is allowed is to face facts: that birth trauma happens in our hospitals; that continuous skilled labour support reduces the rates of interventions and related complications; and that anyone who is a passenger in the process of birth will drag you down with them.
In her seminal work “Spiritual Midwifery”, modern childbirth pioneer Ina May Gaskin describes the role of the midwife in directing fathers on how best to touch and support mothers through the birth, in providing comfort and reassurance to him, in allaying his fears. May suggests that if none of these strategies seem to calm him, the best course of action to get labour going smoothly again is often for him to leave the room altogether.
Even without pandemic conditions, our current dominant model of maternity care has them moving between multiple patients. Add two years of backbreaking under-staffing and under-resourcing to the mix and our nurses and midwives are not coping to the point many are leaving the profession. To speak plainly, your midwives do not have the capacity to provide continuous labour support to you, let alone coach your partner through how to coach you as well.
Yes, it is incredible to have the non-birth parent witness a positive birth of their child, but even with the most supportive, loving, engaged partner, based upon my personal experience, we can’t be assured this is how the birth will play out.
Birthing in early 2019, I was fortunate to have both my husband and doula at my child’s birth. Assisting me at home from early labour, my doula recognized it was time to phone the midwife a couple of hours before delivery. Conversely, as my baby started inching its way down my birth canal, my lovely husband (the man who had done all the courses, meditations, hip stretches and pressure points with me for weeks) still thought there was a good 3 hours or so to go, until the doula told him the baby was coming now and to stop moving about and sit with me. (Later, he would tell me he I was screaming so loud he thought I was dying. Both midwife and doula later agreed I “wasn’t that loud - for birth”).
Basically, if my husband hadn’t had the doula there, he wouldn’t have had a clue what was going on or when I needed help. If my husband hadn’t been there, my doula would’ve had it covered.
I often wonder speak with women and wonder how their births (in both the public system and private hospitals, which actually have worse intervention rates even for low risk pregnancies despite the expense) may have been different if a doula had been there to help. As we all do at least once if not multiple times in labour, these women had reached the point where they said “I can’t do this, just get it out of me!” They recall partners telling them they’re “doing great”, but not very convincingly, and the pain intensifying. They recount men wide-eyed and rushing for the buzzer or calling to a midwife in the hall, a flood of people entering the room and ending up in stirrups with forceps being pushed inside them. They ask me about incontinence and self-loathing and how can they possibly go back for another child after that?
How could this birth, this body and this family have looked if someone who knew, understood and lived birth could explain what was happening to these mothers in their moment of panic? Someone who could have calmly talked through the benefits and risks of intervention, or simply looked these mothers in the eye and said “you’re already doing it, your baby is nearly here. Breathe with me”?
As a postpartum support professional, I do not attend births and obviously cannot guarantee a brilliant birth experience by engaging a birth doula even if I did. What I will say though is this – we need to stop pretending that the way we birth doesn’t matter, and assuming that our romantic partner is the best person to have as our supporter.
By all means, if you are having a homebirth, a planned c-section or have birthed six kids together already, absolutely have your partner there.
If you are having a hospital birth and have a unicorn partner who is well-versed in the normal physiology of childbirth, the pros and cons of different checks and interventions, and believes in the process of birth as a transformational and sacred rite of passage, maybe they are your ultimate supporter.
If your partner is female or was socialized as a woman this conversation might be completely irrelevant, and they could be all over it and a brilliant help.
If, however, your partner has been raised on words like “seeing your wife give birth is like watching your favourite pub burn down – you want to look away but you just can’t”, they may be most useful in dropping you and your doula at the entrance, parking the car, and keeping their pacing energy outside the delivery room rather than in it.
Of course there are other factors at play too, like linguistic considerations, doula availability and financial barriers. In such circumstances where having a doula just isn’t possible, perhaps your mum, an aunty, sister or friend who has birthed their own children may be up to the task of helping you relax through contractions, pepping you up when needed, and standing up for you so you don’t get steamrolled by arbitrary policy and procedure. Also note that a student midwife doesn’t count as a ‘visitor’, and would stay with you alone rather than moving between patient rooms like other hospital staff.
Ultimately the choice is yours, and your final decision is none of my business. Still I would argue that just as partners don’t need to breastfeed to bond with their baby, they don’t need to witness the birth to be an involved parent. Research shows over and over again that it is time spent in active care of the baby that develops necessary parenting skills and rewires all parents’ brains towards nurture and love.
Despite the expressed intention of the vast majority of partners to be “all in” with their children, only around a quarter of Australian dads and partners take the two weeks of government-paid partner leave they are entitled to after the birth of their child, and as little as 2% taking primary care giver’s leave during the first year of the child’s life. If our partners are unwilling to challenge their own workplace culture to spend time with their newborn and bleeding, healing, leaking other half, why should they have the unquestioned right of attending that same child’s birth?
I can’t sugar-coat this – discussing the realities, statistics and talking through each of your preferences might be a very difficult conversation, but you won’t know for sure until you have it. Indeed, it might be take a surprising turn - a UK survey found 3 in every 10 dads who attended the birth of their firstborn wished they hadn’t been in the room for birth, and only 1 in 10 said they felt “useful” during the labour. Perhaps it would be a weight off their shoulders to have an open invitation to express their fears or even their preference not to attend the birth. In such an instance, having a skilled and/or supportive person guide them through helping you labour at home and making the call of when to go to the hospital might actually help them to move beyond their fears about birth, and put their focus on how they can practically care for you and your baby after it.
Whether we like it or not, if you’re expecting a baby soon, this is a discussion that needs to be had and a decision that needs to be made. There will be so many hard conversations to have as parents about the way you raise your child. It is worth both parents keeping an open mind and viewing this is a good practice run for the emotive and at times challenging communication that lies ahead.
Still, as the one birthing this baby, the decision on who supports you at the pointy end of birth is ultimately yours to make, and your partner’s to respect. You have a right to feel safe, supported and have the best chance at experiencing the birth you want. After nine months of growing a small human and with a lifetime of caring to go, you deserve it.
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