Note to partners: “Whatever you want Dear” is not an effective support strategy!

When you’re expecting a baby, it’s exciting, and maybe a little bit scary, to think about parenting this new human together. What will you name the baby? When will you first take her/him out of the house? Where will s/he go to college….?

But before all of that, starting right now, it’s already time for a team approach.
I know that it’s common for the pregnant individual to take the lead, and often the partner feels the best approach during pregnancy is to step back and just say:

                      “Whatever you want Dear.”

However, there are already many important decisions to make well before your baby’s birthday, during pregnancy, and even during labor. And these decisions can impact all three of you in both the short and long term. What you decide may affect the birth-giver’s and the baby’s physical health, everyone’s emotional/mental health and the health of your relationship with each other and with the baby. How birth happens even impacts sexual health. Furthermore, memories of the birth experience, and how the people supporting you made you feel, last a lifetime (1).

So instead of assuming what you might call “traditional gender roles”, consider working as a collaborative team right from the start!

To be the best possible support for each other, be mindful about asking your partner what their needs are and be assertive about telling them what you need. Most importantly, share this big responsibility for decision making. Because these decisions are important, and at the same time, not straight forward, obvious, or easy to make.

The best choices for your family are unique to the two of you.

I would like to suggest that you may find it helpful to take these 4 steps BEFORE making important decisions:

  1. Research your options using reliable sources of information.
  2. Figure out what kind of birth you want, and plan and prepare for it.
  3. Weigh your personal values, life goals and even your budget, as well as the pregnant person’s health profile.
  4. Then decide TOGETHER.

[A Doula and/or Childbirth Classes, as well as many great books, can help you identify reliable resources, provide information about options, and help you form your plan for birth. A trusted medical professional will help you understand your health profile.]

PictureRemember, some decisions have a broader impact, some narrower, but all are important.

So, to demonstrate how each decision can have a wide range of impacts, let’s consider just one:

          Choosing the medical professional on your birth support team.

This is usually one of the first decisions pregnant people make. Why does the choice of medical professional (MP) matter? You are assembling a support team for the three of you (baby makes three). The MP on the team is a key component, and MPs are not all the same. They each hold different beliefs about birth, follow different models of care, and have differing personalities, opinions, and biases.

Often, pregnant people default to continuing care with their regular Gynecologist, a specialist in “well women’s care”, if the Gynecologist is also an Obstetrician; a physician specializing in “maternity care”. However, it is important that you make an intentional choice, because even if you LOVE your Gynecologist for general care, you might not like their approach to maternity care.

It is important to note that Obstetricians are trained in providing maternity care for pregnancies at all risk levels. If your pregnancy is normal and uncomplicated, however, you may have other options. For example, you could hire a Family Practice Physician, a Certified Nurse Midwife, or a Certified Professional Midwife. If your risk level should change, these MPs are trained to recognize problems and will transfer your care to an Obstetrician.

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So who’s the right MP for you and your growing family?
Let’s consider some key questions that can help you decide.

  1. What is the medical professional’s birth philosophy, and does it match yours? Some MPs see every birth as a potential emergency waiting to happen. They believe labor requires continuous monitoring and being in a location where surgical services are readily available. Other MPs believe that most of the time, pregnancy and birth are normal physiological events. They believe it is possible to recognize the small proportion of pregnancies and births that are higher risk and that there is almost always plenty of time to transfer care if and when it is necessary. Furthermore, some MPs believe the pregnant person can impact outcomes by their behavior, preparation or choices. Others will say that you have no control over what will happen, so there’s not much point in trying to plan or prepare.What do you believe?A comprehensive childbirth class and/or a good book or two can help you figure out your birth philosophy (see resources listed below.)An open and frank conversation when interviewing potential MPs can help you find one who shares your approach.
  2. Is this MP comfortable with, supportive of, or merely tolerant of the type of birth you are planning? Different medical professionals prefer to attend different styles of birth: inductions vs. spontaneous labor, epidurals vs. un-medicated birth, moving around during labor and birth, or staying in bed prone, etc. Some are skilled in supporting you regardless of what position you are in when your baby emerges, others require you to be on your back with your feet in stirrups.First you and your partner need to figure out what you want. Then it’s important to choose a MP that actively supports this style of birth. With a truly supportive MP, you and your partner have a much higher chance of giving birth in the way you hope.After the baby is born, what happened during labor and birth will be something you both review and relive many times. Birth-givers never forget their birth experiences (1), so this is a long term investment.
  3. Who is the authority for final decision making?
    MPs have different beliefs about medical decision making and who gets the final say. Their approach will color the feel of both your pre-natal appointments and your labor and birth. Are your questions welcome? Does this person take the time to make sure you fully understand risks, benefits and alternatives? How much does your partner’s or your opinion seem to matter? [See Dalia’s Soap Box “Who’s Responsible?”]Overall, the MP’s approach will affect your feelings of agency; are you being respected, heard and valued throughout the pregnancy, labor, and childbirth? Or are you feeling ignored or dismissed? Your sense of agency, or lack thereof, especially during a difficult pregnancy and/or birth can impact your future mental health.
  4. Does the MP value the roles others play?
    Does the MP view the partner as an important and helpful part of the team? Does the MP recognize the value of a doula? What about family members or friends you might want to have present? Does the MP welcome others to be part of prenatal visits, or make them feel superfluous? The MP’s approach to each person on your team can directly impact that person’s ability to provide the support that is needed. A perception of insufficient support for either of you can negatively impact the experience and your subsequent relationships.
  5. Bed side manner. In addition to taking the time to answer questions and respecting your point of view, how does this MP approach physical exams? Recognizing that at least 20% of women have experienced some level of sexual assault, there is growing emphasis in medicine on practicing what is called “trauma informed care”. This involves describing procedures and asking permission before performing any exams. [see Dalia’s Soap Box “Permission to Touch”]
  6. Stats:
    For example: What is the MP’s Cesarean section rate? You can ask an MP what their C-section rate is when you interview them. If they don’t know, that in itself is telling.  Note too that the MP you hire may not be the one attending your birth. Since C-section rates per on-call group are not available, the overall hospital C-section rate will be an important predictor of your risk for having a surgical birth. You can find a discussion of hospital C-section rates in Birmingham on BirthWise in Birmingham’s blog here.Why does it matter? Having a C-section effects physical recovery right away, and may also impact long-term health, fertility, and future pregnancies and births. Furthermore, if you or your partner really didn’t want to have a C-section, you may find yourselves dealing with the emotional aftermath of this disappointment. Depression is more common after surgical birth compared to vaginal birth (2). There is also mounting evidence that C-sections may impact the baby’s future health (3, 4).
  7. Protecting your perineum: MP skill level in supporting the perineum during birth differs (see my blog “Avoiding a Tear Down There“). Of course this is going to impact healing and pain postpartum. It usually takes a while to get back to your usual sexual activity after having a baby (sometimes weeks, often months). Poor perineal support lengthens that timeline.
  8. Location: Whether you choose an Obstetrician, Family Practice Physician, or a Certified Nurse Midwife*, your prenatal visits will take place in their clinic. You will have your baby in the hospital where that MP has privileges.  Visits with your obstetrician are the shortest, often only 10 minutes. Midwives and Family Practice Physicians may have more time. A Certified Professional Midwife might spend an hour for a prenatal visit, which may be in their clinic or in your home. Your baby will be born in your home. (*In Alabama Nurse Midwives can only attend hospital births. This is not true in all states.)

These are just eight of the many things you might consider when choosing a MP. The best way to find the right one for you is to interview a few – act like a consumer, you have options to choose from. (Think about how much time you might spend researching and testing out a new/used car you plan to purchase.) Interviews should be free, and they don’t have to include a physical exam or anyone taking their clothes off.

I’ve limited this blog to just one of the choices you make, together, during pregnancy, labor and birth. There are many more to think about. Given the importance of this experience to yours and your baby’s health, it’s worth spending some time researching the options.

Remember, whether or not you and your partner started this parenting journey together, you can help each other navigate this maze of decisions. It’s a heavy burden for one person to shoulder alone.

Although the person giving birth always has the final say about pain management during labor, there are lots of other decisions to make both before and after!
Together
you can decide what’s important to you both, what feels right, and what are the best and safest decisions for YOUR family.

Resources:

BirthWise in Birmingham’s FREE Open House. A virtual meeting where you can ask experienced doulas about options for pregnancy, labor, birth, MPs, doulas, childbirth classes and more.

BirthWise in Birmingham’s A La Carte Childbirth & Postpartum Classes offer a menu of classes to prepare for childbirth, breastfeeding, and getting started as parents. You can take any combination of classes. There are discounts for bundling and for clients using a BirthWise doula.

The Birth Partner by Penny Simkin is a comprehensive book written specifically for supporting a loved one through pregnancy, labor and birth.

Natural Hospital Birth: The Best of Both Worlds by Cynthia Gabriel is a great book to prepare for labor in a hospital.

Ina Mays Guide to Childbirth by Ina May Gaskin is full of accounts of real births in an out of hospital setting.

References:

  1. Simkin P. Just another day in a woman’s life? Women’s long-term perceptions of their first birth experience. Part I. Birth. 1991 Dec;18(4):203-10. doi: 10.1111/j.1523-536x.1991.tb00103.x. PMID: 1764149. https://pubmed.ncbi.nlm.nih.gov/1764149/
  2. Tonei, V. Mother’s mental health after childbirth: Does the delivery method matter? Journal of Health Economics, Volume 63, 2019, Pages 182-196, ISSN 0167-6296, https://doi.org/10.1016/j.jhealeco.2018.11.006.
  3. Neu J, Rushing J., Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis. Clin Perinatol. 2011;38(2):321-331. doi:10.1016/j.clp.2011.03.008 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/
  4. Sandall, J. Tribe, R.M., Avery, L., Mola, G., Visser, J.H.A., Homer, C.S.E., et al. Optimizing caesarean section use, Short-term and long-term effects of caesarean section on the health of women and children. Volume 392, ISSUE 10155, P1349-1357, October 13, 2018 https://doi.org/10.1016/S0140-6736(18)31930-5

Related blog posts:

Dalia’s Soap Box: “Who’s Responsible?”

Dalia’s Soap Box: “Permission to Touch

BirthWise in Birmingham: “Hospital C-section rates

Dalia’s Soap Box: “Avoiding a Tear Down There

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