Sunday, May 24, 2009

Can Your Husband Be Your Doula?

It seems like a very long time ago that I posed this question! In fact, I think it was two weeks ago. I bet y'all had about given up on me to ever write the post. You would not believe how much I have gotten done around my house over the last two weeks, in preparation for summer vacation. So, while those things have gotten done, the blog has suffered. I apologize.

I also knew that I have so much information on this topic, so much to say, that I was probably a bit overwhelmed to sit down at the computer to write it. I'd like to post some of the email from a former student/Bradley-teacher-in-the-making that started it all:

"There are a few things I think Bradley has a little off, and I think the whole idea of the husband being "the" labor help person is one of them. It probably sounds preposterous, especially since I am looking into becoming a Bradley instructor. But I agree with Martha Sears in The Birth Book where she says that it is better for the husband to be freed up to be "just" a husband to his laboring wife by a doula being there to help. I think you may agree with me slightly, since I remember you encouraging our classes to hire doulas if we could (and at the time thinking, "Why would we hire a doula? We're taking this class. This--husband--is my doula.").

Now, I am not saying that Bradley should not teach about husbands' involvement. I think it is one of the biggest reasons Bradley is one of the best preparations for natural birth. However, I believe that one of its greatest strengths (educating the husband about the physiological components, benefits and risks of different choices, as well as ways he can be a help in labor) is also a great weakness (raising the woman's expectations that he will be all these things she's been taught in class, even if that person doesn't remotely resemble who he has been throughout the pregnancy). In my experience, it did not happen that way, and I felt let down by my husband that he wasn't there for me the way that I needed him in Ruby's labor. I don't think I would have felt as let down if my expectations not been raised with the Bradley books and classes. What I eventually came to grips with is that I just can't have those kinds of expectations for my hubby (suggesting things, being observant, thinking of things on his own--like food, drinks, frequent bathroom breaks, how to make me more comfortable, verbal encouragement, the works!) and it does not say that he is a terrible husband because he didn't remember to do those things. When it comes to things like this, he is happy to do them, he just DOESN'T think of them himself. Especially on birth day. He needs coaching, and I am not the kind of person to do that while in labor. I just want him to KNOW."

Our results from the poll a couple of weeks ago were:

Can Your Husband Serve as Your Doula?

Even better! 30%

Are you kidding? 13%

He did alright. 56%

Hurray for the dads that did "even better" than a doula could have! I was surprised that the "Are you kidding?" category had so few votes! The majority, as I expected, fell into the "He did alright" category. This is where I would place my husband.

Thank you, also to those who contributed their experiences with their husbands and/or doulas. Some great comments. There was no right or wrong answer, obviously.

Quick history of "doulas" in America: Before birth moved into the hospital, approximately 100 years ago, men were not a part of birth. Birthing women had their mothers, sisters, aunts, best friends, and midwives attend their births. When birth no longer took place on their own turf, they could not take all these women with them. They were alone. Male doctors administered drugs that wiped women out entirely. The nurses, having several women to tend to, were all the female companionship a woman would have as she gave birth. Needless to say, her needs, emotionally and physically, were not met.

In the 1960s and early 1970s, the doctors and hospitals began to be pressured to allow husbands in the delivery room. Dr. Robert Bradley, with the publication of his book, "Husband-Coached Childbirth" advocated for women to birth without intervention or medication with their husbands "coaching" them through the experience. This was an exciting time for women and their husbands. A funny side-note to this time period: They wanted to give the husbands something to do, so the job of cutting the umbilical cord became his. They figured that he couldn't mess this up and he would feel like he had done something significant. It's really rather demeaning to think this is all the husband can do when it comes to birth.

In the 1990s, we started hearing the word "doula" or labor assistant. My first baby was born in 1996. My sister-in-law, who happened to be a doula, was present at our birth, and without her, I am certain that I would have had a C-section. And while I never paid an actual doula money to attend my subsequent births, I was always surrounded by my friends and family. And, of course, I had my Bradley-trained husband! (He was fantastic on the 4th birth!)

Many of the women who commented on their experiences, said that their husbands were a better doula with later births. There are many things that play into this: First of all, he has been through it before! But perhaps even more importantly, he has listened to his wife talk about what she likes and doesn't like in labor, probably many times over the years! He has attended other births and that gave him knowledge and experience. He knew what to expect. Imagine hiring someone who has attended dozens or hundreds of births -- the experience she brings is beyond helpful -- not just for the laboring mother but for the father-to-be.

There is a page in the Bradley workbook that is titled "Whose Job Is It?" Fortunately it appears in Class 11 instead of Class 1 because if I was a husband, looking at this list, I'd have to insist that she have an epidural because I didn't sign up for this! It is a list of 50 things that Dad should be doing. So if the mom has a C-section or an epidural, does that mean Dad failed at his list? He didn't do his job? It's just too much to put on a new dad.

With that being said, I do feel like my Bradley class prepares Dads extremely well for labor and birth. He comes away with good general knowledge of pregnancy, labor, how to help his wife in labor and birth, interventions, avoiding a C-section, consumerism, questions to ask, adjusting to life with a new baby, and breastfeeding. But the fact remains, when his wife is dilated to a nine, but the cervix has a lip, will he remember what positions are good to help with that? Maybe, maybe not. But a doula, who sees this very often, will know how to help. It's like the comment in the beginning: a lot of husbands want to help, but often need to be told how to help. Even with 12 weeks of class, a lot of husbands will not think of helpful laboring positions depending on what "symptom" mom is having. The more one reads about and attends births, the more experience and expertise they will have. In my expereince as a Childbirth Educator, the dads are not the ones reading about birth!

Dads must be advocates for their wives. It is important, even crucial, that he understand the birthing process, and that they do everything they can, as a couple, to prepare for this life-changing day. Doulas cannot speak for their clients, but husbands can speak for their wives in the delivery room. She will not be able to be her own advocate when she is in labor. A doula is familiar with the birth setting and terms, equipment used, etc., and it is easy for many dads to be overwhelmed by it all, especially the first time through. A doula, as Hannah said, is not so emotionally involved and can often help navigate the way through to a great birth.

Here are the simple facts:

Women have better obstetrical outcomes when they are accompanied throughout labor by a doula. She will provide emotional, physical, and informational support to a couple in labor. The presence of a doula reduces the C-section rate by 50% (!), the length of labor by 25%, the use of pitocin by 40%, the need for forceps by 40%, the request for pain medication by 30%, and the use of epidural anesthesia by 60%.
If you are planning a VBAC (Vaginal Birth After Cesarean), statistically you are more likely to achieve a VBAC with a doula by your side.

Women who have a doula are more likely to report feelings of having coped well with labor and a greater satisfaction with their birth. They report having less anxiety after the birth and even an improved relationship with their partners after the birth. (Perhaps, in part, because the pressure was off of dad and he could lovingly support his wife without the "coach" role.) In addition, women who have a doula report higher self-esteem and lower postpartum depression and anxiety 6 weeks after the birth.

Babies also benefit from a doula being present for their labor and birth. They have fewer neonatal complications, fewer workups for sepsis, and fewer health problems at 6 weeks of age.

If you decide to have a labor assistant at your birth, ask around. Interview. Some cities have "Doula Teas" where you can go and meet lots of doulas and find one you like. Find out their personal statistics. I once heard of a doula that had a 90% epidural rate! That tells you that she isn't sure how to help you! You also might consider having a friend or two with you. Be sure they are supportive of natural birth and/or have given birth naturally.

Congratulations for making it to the end of this insanely long post. I hope you can appreciate why it took me so long to sit down and type it out.

I want to leave you with a single thought: Many times over the years, I have heard couples say how glad they are they hired a doula, but I have never heard anyone say, "That was the biggest waste of money."


Isabel White said...

Great post Donna! I just discussed this with my students on Saturday. I felt that having a doula present at our hospital deliveries made my husband a better coach. Plus, the continuity of care that a doula provides is so important to me (nurses change shifts, doulas are there throughout!).

Sarah said...

Thanks for this post, Donna. Especially the statistics. Do you mind posting where we can find these statistics and how old they are (I know, the post was enough work, right? But I'm a big research fan. I like sources!)

I agree totally with one of the last paragraphs of this post, saying that a mom is likely to have better feelings toward her partner after birth with a doula.

It is for this reason that I wanted to be there for my laboring friend last month. I knew that if her needs were met, it wouldn't matter *who* had met them. She'd be satisfied with the experience and pleased with her husband's involvement. But I also knew there was a good chance that, if her needs were not met and her husband was the only one there for her, it could cause some feelings of disappointment.

And pregnancy and postpartum hormones are enough of a roller coaster, aren't they? Do we need to pile on the difficulty by giving an opportunity for a new mom to question her husband's commitment level, based on his performance at birth?

Hurray for doulas! Oh, and I also agree with you that your classes (even years ago) adequately prepare the hubby as helper/advocate. But it's a lot of stuff to remember, to be sure.

publichealthdoula said...

I was talking to a friend recently who took a Bradley class for her first and had a wonderful birth. She was wondering to me why she would have hired a doula, since she had her husband and he was all she needed. Then later they mentioned that her husband spent so many hours doing counterpressure, the next day his back hurt so badly he could barely stand up! I said maybe a doula would have been a nice extra pair of hands for HIM :-) I've also been at births where dad has come down sick right before labor. Sometimes it's just nice to have a back-up person, even if you want your partner to be the primary support. You're right that I've never heard someone say they're sorry they had a doula! I'm sure those people are out there but most seem to be so grateful and appreciative - even when I think I didn't do very much, it turns out my presence meant a lot.

Christina Pond said...

I think if you are having a hospital birth you need a Doula. Especially for first time Dads....

But if you are having a Homebirth, or Midwife... I don't think you need one... they are just with you so much through the process.

I do think Doulas help Dads be better coaches, and remember stuff as well!!!

Donna Ryan said...

Sarah, sorry it has taken me so long to give you the references on the information provided in this post. I have been reading this enormous, very informative book titled "Childbirth Education: Practice, Research, and Theory," which is where I took this info from. I had to look up their reference on the study with the doulas, and it was from a study done in 1993 by Klaus, Kennell, and Klaus.

Alisa said...

Ok I am a little late in posting- But better late than never.
I think all this depends on what kind of Husband the man is.

We have had different people there for our births-All of them Jay was there- Two of them had trained doulas, one had my mom and then our last was Jay alone.
There are different feelings I have associated with each birth. We loved having the support of a doula. But Jay is the kind of help that we could do it all alone.
I don't think that is the case with most husbands. I don't think that most husbands are committed to really being there for the whole thing. That sounds rude- but some don't have that in their make-up.
I think if you are debating on whether or not to have your husband as your only support, you really need to think about what kind of a support he is in other things.

Jennifer Valencia said...

As a doula and as a mother, I couldn't agree more with your words! I think that's the one thing I really dislike about Bradley- while their information is fine they are putting far too much expectations on a father, especially if he's a first time father.