Q&A: How to help a friend during labor and delivery

Amanda Too writes:

"I need some advice from women who have been through labor and delivery. My friend is due with #2 today and has asked me to support her as a last-minute stand in.  Her husband is apparently useless during labor and her doula has become unavailable. I had a C-section with my twins and didn't take any childbirth classes. I labored for as long as possible before I called the doctor (4 cm with contractions 4 minutes apart), but I've never experienced or witnessed the mid or final stages of labor and delivery. I need some fast turn-around training--any good videos I could check out from the library? Or just some advice from women who have been through childbirth? How can I best support her without much experience or training?"

What a lovely thing to do for your friend!

The first thing I'd say is to get a good book on labor and delivery. All you really need is to understand what happens during the stages of delivery, so it doesn't matter a ton which one you get (they'll all have info on the stages of labor), but my all-time favorite is The Big Book of Birth by Erica Lyon (my full review of it is here). If you get this one, bring it along with you, as it's got info on basically every kind of intervention you can get with pros and cons listed nonjudgmentally, so it would be a good resource to have on the fly.

I don't have any video recommendations, but maybe someone else out there does.

From the perspective of someone who's gone through two vaginal deliveries, I'd say that your role is really not going to have anything to do with the physical process. She's done it once, so things should go smoothly this second time. She's going to need you there for emotional support. There are certain points in the labor in which your mind plays tricks on you and you think you can't do it. If you can step outside the situation a little and help her realize that she *is* doing it, that's what she's primarily going to need from you.

Also, a note on what I've observed: It seems like there are only two kinds of second labors for women who delivered vaginally the first time. (If anyone has a different kind, please post it.) The first is a fast, intense labor. If the first time it took 24 hours from start to finish, this time it'll take 6-8, but it'll ramp up faster and be way more intense. The second is a long, pokey, half-assed labor that may take a day or two (or even three) with contractions not very close together, and then at the end it slams into gear suddenly and the active part is only an hour to three long.

Both ways seem to be "normal," and I haven't heard anything anecdotally about any differences in length of pregnancy, sex of baby, blah blah blah for the two types. The pushing stage is much faster the second time, too, so if you want to see that, stay in the room.

Does anyone have suggestions for resources for Amanda? Or reminiscences on second labors and deliveries?

Comments

[enu]

My second labor was wayyyyyy shorter, but, so's to not frighten people, NOT more intense than the first. I had exactly one hour of "really bad" which was a lot fewer hours of "really bad" than with the first. I would just characterize it as "a hell of a lot easier and ridiculously shorter" than the first. Wishing friend the same!

For friend - she prolly doesn't need you there for anything technical. She just... needs you there. Tell her she's doing great, you love her, this is all so worth it, there will be an amazing new person on earth very, very soon!

[MrsHaley]

We do love to talk 'birth stories' around here -- I can't wait to read all of today's comments!!

My second labor was very much like @enu's -- WAY shorter (5 hours start to finish, 45min. of hard labor, 3 pushes) and MUCH easier (which I attribute to being unmedicated, YMMV).

I did the job Amanda Too describes for my friend for her 3rd. It was wonderful! The book I used for reference (for her and for my own #2) was "To Have and To Hold: A Guide to Childbirth and Early Parenting" (I just scanned Amazon and don't see it. Sorry!). Mostly I encouraged her, got her snacks and drinks, held hands and massaged her and cheered and coached her through the stages.

I enjoyed it so much and found the experience was very bonding. I hope it's joyful and uncomplicated for you and your friend, Amanda Too! You'll do a great job -- she already knows that ... that's why she asked you!

[Chris]

OK, I'll third the a lot shorter and easier the second time around! I had an epidural both times so I can't speak to the intensity but I think my second time was easier because I wasn't induced.

First time: 17 hrs. start to finish (including 2 hours of pushing)
Second time: 8.5 hours with only 15 minutes of pushing

[Cynthia]

Uhm, the pushing being faster part kind of scares me. My first (granted, a "medically nescesary" pit-induction) involved 10 minutes of pushing.
I'm pregnant right now, is the baby just going to fall out this time?!

[rayner]

There is an alternative method which when I tried it out in Hawaii in 1981 over 180 mums found it significantly reduced the pain and stress during labour. It took about 20 minutes of strenuously exercising the body to excrete the adrenaline, which is usually the culprit, in failure to progress.

Once this adrenaline is discharged, the birthing mother can tolerate the presence of relative strangers that are in her birthing environment.

We are mammals and throughout history, birthing mammals require privacy, quiet and low light. Unfortunately modern birthing methods do not provide any of those three things.

Once the fear, fight or flight syndrome has been activated, adrenaline floods the labouring woman's system and her cervix will either clamp shut or will not open to the size necessary to allow the neonate to easily pass through.

That then produces the often unbearable pain that can occur, in most women that have a hospital birth or one in which relative strangers are present.

The neonate is being squeezed between two opposing muscles. One which is designed to pass the baby down the birth canal. The other uterine muscle which is activated by the adrenaline to prevent the birth of the baby until the coast is clear.

This is an outdated mechanism which is still operating to the detriment of most birthing mothers. It was once most useful in more primitive times, when mothers had to be alert to the possibility of predators in her environment.

Predators which would, once they had been sensed, activate the adrenaline in her system and delay the birth until the pregnant mother had time to either flee or fight of the predator.

This primitive mechanism is still active in women, who become highly sensitive to aliens or relative strangers in her birthing environment who will trigger this mechanism.

It can be a relative who the labouring mother still has unresolved issues with. A father, well meaning who tries to take control, or an overbearing midwife who also tries to take charge. Such people who are there ostensibly to help, will activate this primitive mechanism, until either they leave or the mother has an anaesthetic, so that she will become numbed to their presence and birth can then take place.

The solution is for the mother who wishes to have a her baby in a controlled environment, with all the fail safe professional help and equipment available, and yet have an easy and relatively pain free birth. To beat the mattress or pillow strenuously for about twenty or thirty minutes until the adrenaline has been discharged.
Go to raynergarner.com for research articles on this and related subjects. No charges, donations or payments required. A non profit information only site.

[Erin]

In addition to support and encouragement, she also might need physical support. You've probably seen this on TV, but often the labor support person helps by standing by the woman's head, and either helping hold her head up as she pushes, or holding one of the legs. Head support *really* helps during pushing (I pushed for 3+ hrs and could not have done it without my husband holding my head). (The nurses will help you with this.) Also she might need something like a back rub, or if she's not just laboring in bed, she might want you to stand with her as she labors standing up (she would have to hold onto you for support, maybe arms around the neck as you both sway - this can be a very soothing method of reducing labor discomfort, though for me it worked much better when the other person was my same height).

Other than that, frequent, quiet, and emphatic repetitions of "You're doing a great job," are almost always appreciated by a laboring mom.

But I would also talk to your friend. Since she's given birth, she might have a clear sense of what she might want (or NOT want) from you.

[Moxie]

Erin, it's possible that the hospital will let her push in a more natural position, in which case she probably won't need head support. The head support comes into play when they have you on your back. Why are hospitals still doing that, when they know it's counter-productive?

[Erica]

The other suggestion I'd have is to have conversations with her friend so that she's aware of her friend's birth plan and how she'd like the birth to go (naturally, whatever)--then with that information in hand, be her advocate. I'm assuming this is a hospital birth, so she'll want to be prepared to serve as the liaison between the hospital staff and the laboring mother.

If possible, she might want to talk to the doula who can't be there, just to get ideas of what she can do to help the mother during labor.

[L.]

I had no indication that my first labor was coming (other than I'd reached my due date!). Once it started, it progressed quickly into active labor and lasted 7.5 hours start to finish (unmedicated). My second labor took a long time to get started--woke up one night with contractions that petered out, the next night nothing and then woke up in the morning in early labor, spent the morning in early labor and didn't progress past 4 cm, then went home and immediately shot into active labor, which only lasted 2 or 3 hours (also unmedicated).

I attribute the slower start the second time around to being nervous about the arrangements for my first child's care, and ironically to being nervous about getting to the hospital on time given my speedy first labor.

I agree with @Erin--ask your friend what she wants and needs; she will know, in large part. Also, similar to Moxie's comment, I think you can most be of help during transition. That will be the time when she really truly thinks she can't do it; even if she knows intellectually that this is characteristic of transition, she will be in enough pain (if unmedicated) that she won't be able to take a step back and tell herself this. If she's at 7 or 8 cm you can take the place of her thinking brain and tell her, "You're in transition. You're almost there. You can do it!" That was the most important thing my doula did for me.

I labored in a tub, so YMMV, but my doula also helped by suggesting different positions, supporting my head and shoulders and legs, adjusting the water temperature, pouring water over my exposed parts, massaging or putting pressure on parts of my lower back, and offering a gentle stream of encouragement.

It is lovely of you to do this for your friend.

[Cathy]

Well, my second turned into an emergency c-section. My first induction was fairly textbook, but quick, plus 3 hours of pushing. My second induction was moving through the same route (maybe a little faster) until El was having decels on the monitor when I was complete or nearly complete. Pushing made it worse. Sitting up made it better. Emergency section (10 minutes from when the doc said let's go to the baby crying.) and the cord was wrapped around her neck three times. I was damn glad I already had an epidural.

So, having someone around to help remember to pull down your gown to cover your nether regions when you're getting wheeled to OR is helpful. And there's still the potential for the unexpected, even in the second delivery.

[thebigmeow]

I can't recommend acupressure highly enough. I wish I had known about it when my sister was labouring. look here for a great pamphlet covering the relevant points:
http://acupuncture.rhizome.net.nz/Acupressure/download.aspx

I was one of my sister's support people when she had her boy, and I spent my time rubbing her back, massaging her feet, making sure she had water and music when she wanted it. I also spent a lot of time reassuring her husband who is a bit of stress head and does not cope well seeing her in pain. I just explained that thing were progressing and it was fine, the pain was bad but not abnormal etc. When it came to pushing she was very tired and having trouble focusing, so i helped her with her breathing and her focus.

When I had my second, my aunt was with me and she routinely wiped my face with a cool, damp cloth. It was amazing how much that helped! Just the bit of cool on my brow and cheeks inbetween contractions was such a relief and really did refresh me.

A big thing to remember, too, is that you're not there to make decisions for her. If she asks for your opinion, rephrase the question back to her and don't push one option or the other. If a decision needs to be made and she isn't able to, her partner or the midwives will make it.

HTH

[Erin]

@ Moxie, I wish most hospitals were "allowing" women to push in more natural positions, but many aren't. It's really frustrating! Besides, there was no mention of the kind of birth the woman in question was hoping to have. Since most women get epidurals, most drs will require them to push on their backs. (I actually did have an epidural but WAS allowed to push in different positions, including squatting, but whenever I was on my back, I was weak enough to need help!)

[Sam]

This is perfect timing for me; I also just had a friend ask me to be her birthing partner for her 2nd child! (I am thrilled and scared to death.) In her case, her husband probably won't be in the room, they are going through a divorce. I did pick up "The Birth Partner" by Penny Simkin the other day at a bookstore and flip through it. I've had a doula tell me it's a great resource.

I'll be reading the comments with great interest. I've given birth (vaginally) once, and neither my husband and I went to any childbirth classes. I read "The Big Book of Birth" incessantly in my last month, though, and will pick it up again. During my birth, I tended to believe my husband when I was laboring - he would simply repeat the doctor & nurses, or tell me I was doing GREAT, and man I believed him like he was Jesus himself on the Mount!

[Margot]

@L, 8:44a.m....you are describing me, today, to a tee. I am due *today* with #2, and my first labor was 7 hours long, unmedicated. I too am stressed about care for my son while I'm laboring/at the hospital, and I'm afraid it's going to slow my labor progress. I'm also worried about not getting to the hospital in time if my labor is even faster than the first--which by hour #2 had progressed to contractions 2 min apart! But who knows, right?

To the OP, knowing your friend's birth plan will help a lot, and asking her what she does *not* want. For instance I wanted to be in different positions but I didn't want people patting me or rubbing my arms/back--that kind of thing was too stimulating. I also didn't want a lot of "atta girls" or excessive chitchat about how things were going. I needed quiet, and to be kept hydrated, and for my doula and husband to hold my legs for pushing! I definitely did need them to keep me sane during transition, when I thought I couldn't make it, and tell me it was all going just as it should, and that the light at the end of the tunnel was getting really close!

[Moxie]

@Erin, sometimes I wish we could just knock it all down and start from scratch, you know? The whole "allowing" thing is the first problem...

[MrsHaley]

@Margot - Good luck, sister! I hope things go well for you!

@Erin/Moxie -- IME, most hospitals in this area (mid Atlantic - very rural) are allowing any position and most nonmedical assistiance (tub, ball, etc.). There are probably 8 hospitals in our 50-mile radius, all of which are as hands-on OR hands-off as the laboring mother prefers. I was kind of thinking the medical establishment had moved away from insisting a laboring mother gets 'hooked up' and stays prone throughout the process?!? Certainly any medically safe options the mother chooses are ok with the hospitals around here. Maybe it's regional?

[Janel]

The Birth Partner is a really useful book if you have time to peruse it.

As for how to help, I would say keep your ears open to what she's saying. When I was in labor I spoke in a whisper, especially during contractions. At one point I told my husband not to touch me (it was nothing personal) and he didn't hear me. It was the midwife who repeated what I had said so that my husband got the point. I'm still grateful that I didn't have to spend the breath and energy to say it again.

[pennifer]

Nothing new to contribute, but I want to second Moxie's recommendation of The Big Book of Birth. It hits just the right note (no scare tactics), has good/useful birth stories, and is just a great resource. It's the only thing I read for my birth prep.

You'll do great!

[obabe]

Three labors and all were about the same-first 7 hours (water broke), second 8 hours (just started with contractions) and third I was induced and was 5ish hours. The most painful (I get epidurals) was the second kids labor before I got the epi. What helped the most was counterpressure from my husband-maybe grab a tennis ball for your bag. Other than that, I pretty much enjoyed l+d, besides for my boys tendencies to have the cord wrapped around their necks multiple times (the second 2 deliveries-first was just compressed...) second kid I delivered in the OR we were so close to the section. My OB jokes my deliveries give her gray hairs!
Basically I'd ask your friend what she wants (epi vs helping with an unmedicvated birth) and go from there. You're doing an awesome thing-dont forget the camera!!!

[Amy]

My husband is the World's Greatest Labor Support Person. We've had two kids - with the first one I was in labor for 3 hours, 45 minutes; with the second I was inducted (cytotec and then water breaking after four hours) and from the time he broke my water (and it started to hurt) until the end was only 1 hour 9 minutes.

I guess I have a very social cervix, because my dad, step-mom, sister, AND husband were in the room for #2, along with half the hospital (they turned on the lights and sirens because the doctor wasn't gonna make it!). Beating on the pillow, huh? That's very interesting...

I digress.

My husband holds my hand. He makes lots of direct eye contact. He tells me I'm doing great. He helps correct the time warp that I go into during labor - it feels like time stops. He'll tell me, "They're going to check you again in 5 minutes," or something. He wipes my face with a cool, wet washcloth. He gives me sips of water. He rubs my back. He "slow dances" with me (standing up helps progression, and swaying back and forth, with support, feels better than standing still - also prevents you from locking your knees and passing out!). He distracts me and makes me laugh. During the pushing, he said, "Oh honey, I can see her head!" which is what gave me the strength to push through the "ring of fire" and finish pushing out my first baby.

I'd have a really in-depth talk about what kind of birth your friend wants to have, and then do everything you can to help her have that birth experience.

You're very lucky - I'd love to help one of my friends through labor.

[Cloud]

I haven't had my second yet, so I can't answer Moxie's question on that. I will say that the time in my first labor when I most need support was when I was trying to hold still through contractions to get the epidural. Which, of course, is when Hubby had to be out of the room because he can't really handle needles and the epidural needle is big. Luckily, there was an excellent nurse who helped me.

Other than that, I just really wanted Hubby there for the company and the support.

[Erin]

@ Mrs. Haley - Not keep bringing the subject down to birth practices more generally, but I think the hospitals' willingness to allow for movement and different positions depends greatly on whether or not the patient is asking for a birth without medical interventions (ie natural). Once there is an induction, pitocin for failure to progress, or epidural, she will be hooked up to a fetal monitor and usually compelled to stay in bed on her back. Since the majority of women have epidurals, I think it's safe to assume most women are laboring in bed and giving birth prone. But you're absolutely right that it is regional. I hear the area around NYC has alarming high rates of interventions/ C sections, whereas your area might be more hands-off. (I'm also mid-Atlantic now and happy to hear what you say!)

@ Moxie, I completely agree with you. Let's start over, and get rid of the "allowed" first and foremost!

Oh, and Obabe's comment made me think - the camera thing is definitely something to talk to her about. Many women really want a picture of the baby right away (ie while he's still attached to the cord, or right after). In contrast, I absolutely did not want a camera in my delivery room, and did not allow a picture of my DS to be taken until he was 6 hrs old.

[lara]

second labor was 3 hours, only 10 minutes in the hospital and pushed 4 times. alot faster and not as intense. i felt like i had alot more control (maybe i was more aware of what was happening?)

my husband just gave huge encouragement - you can do it, let me squeeze his fingers (hard!), and generally was just there for me. he counted during the contractions (iphone has an app for this which helped during early labor) to help me know when it would be over.

getting in a bathtub (our hospital allows that but not birthing in it) is key for getting through transition if that is an option (especially if you want a natural birth)! good luck. what a great honor to help your friend during this very special time.

[Clare]

@Mrs. Haley: It may well be regional. I had my first son in an exurb of Boston, delivered by a midwife at a small hospital. She encouraged me to labor in various positions.

Second son was born in the wilds of northern Michigan, about 5 hrs north of Green Bay, which was the closest "big city." Hospital there was extremely traditional/conservative. No VBACs, no midwives, 40% c-section rate. A young (early 30s), female, mother of 4 OB delivered my son, and I was hooked up to a monitor as soon as I checked in, and told to stay in bed. I didn't (kept unplugging the stuff so I could walk around), and it annoyed the nurses to no end. In the birthing class I took there, the l/d nurse pretty much said outright that C-sections are the way to go, and when I mentioned I had my first son (nearly 9 lbs) in an unmedicated birth, she gave me a dirty look and told the class it was unusual and not something to expect.

So, know what your friend wants, and help her advocate for it. My husband had my back in my second birth, and it went as well as could be expected in that hospital.

[Bonnie]

Oh man, this gives me hope that maybe (if/when we have) #2 it might be easier, and maybe I would do it vaginally again. I was in labour for 3 days. Painful, 1+ minute long contractions, always 4-7 mins apart, for 3 days straight. No sleep for 3 nights before I was finally admitted into hospital, 6cm. Then it was another 15 hours until the baby appeared, yanked him out with forceps. Needless to say I was medicated (thank God for modern medicine), then passed out right after the baby was born. Tearing was so bad (3rd degree) + stitches + sex that is still painful + terribly weakened pelvic floor muscles that are still not back to the way they are. I'm contemplating opting for C-sections the next time(s) around.

[SarcastiCarrie]

Bonnie - If you do go for a c-section (if you ever decide to do this again), don't let people make you feel bad about it. If you make the decision with full knowledge of what you're doing, that's great!

Speaking of which, I have had two c-sections and it would have been nice to have an extra person around both times. My husband went with the baby and then I was just left by myself in post-op recovery. So, a friend to chat with or go see the baby and bring a photo back on her camera would have been awesome.

[Susan]

Not to keep bringing things down to birthing practices, but it can be helpful to know what's possible: I had a pitocin induction with no epidural and was allowed to move around and labor in whatever position I wanted -- including in a tub and walking around the hospital -- and delivered in a squatting position rather than prone. My point being that having to be hooked up to a monitor does not mean you HAVE to be prone. Most hospitals have mobile units that allow you to move around while hooked up to both a drip (for pitocin) and monitors.

[hedra]

No time to read comments, dangit!

My rec for book: The Birth Partner. Read it, bring it with you.

My rec for support behaviors (having done this twice, now, as a non-professional doula):

1) Be her dogs-body with the nurses - getting ice chips is one task, but also being the humanizing face ('real people' notice) by being respectful and considerate of the nurses. Concretely, I bring either food or hand lotions for the nurse's station. They work hard, they get little respect, and a little humanizing of THEM (recognizing their efforts rather than taking them for granted) tends to get a 'likewise' back.

2) Praise, encourage, and ask. Detailed praise (as is best overall - 'you really kept pace with that one, I could see how you kind of reached up and slid over the top of the contraction and then down the other side - that was great'). Detailed encouragement ('For this next one, follow your voice - did you hear how you went high pitched? stay low, and open, that's good, just like that. You're doing GREAT.'). And be prepared to ask questions ('do you think you can do one more of those?' and 'do you want to try the birth ball?' or 'is stroking your arm working? would your leg be better?', etc.) - some of this is in the book The Birth Partner, too.

3) Avoid minimizing feelings, but you can shift all tone more positive if she gets discouraged. Be impressed with her, more than she is. (You will be, anyway. Trust me, even having done it, it is AWESOME to watch someone do this!) Be in awe even if things go 'wrong' or she needs extra medical help. Don't encourage medical help unless you know she wants it, though (let her choose, rather than setting up what you'd have done). That's probably the hardest part.

4) For me, thinking of the laboring mom as my sister or my daughter works better than my friend - it is a really intimate place to be with someone, and 'just friend' wasn't quite the right feel for me. But that may be just me - maybe feeling mom-ish might be BAD for some people!

As for labors, my second was BOTH slow and sputtery and fast, but never intense. (Three days of on/off rounds of contractions, but once it STARTED, it was 4.5 hours, but not intense until they put me on Pit because they THOUGHT it was going to take a while. Ha!) Last go was also fast but not intense. So you can get easy fast labor, too. First was hard work (not too hard, just definitely work!), and long and slow - I wouldn't call it either easy or hard, but it sure was LONG.

My mom had easy-fast, easy-slow, hard-fast, and hard-slow, with a general trend toward easier as she went, but not really an orderly progression. Plus she had a few breech births in there, so that rearranges things. My grandmother (paternal) had her third labor be the hardest (ruptured, actually), despite it being her smallest baby (10 lbs was the smallest, 11.6 was the biggest - and she was 5' 11" if she stretched, and a size 2)... my little sister's were all fast, and each was easy until transition (she didn't even notice labor until 6 cm, twice), then hard at transition. So I don't know that there's really a clear trend in my family other than each is different, except when they're not.

Regardless, congratulations, and good luck! It is REALLY cool. Seriously, really really cool. And what an honor to have been asked. I have two posts on one of the births I attended, not sure if they'll help: http://hedra.typepad.com/hands_full_of_rocks/birth/

[marci]

little practical tips -

give her two fingers to squeeze or hold & squeeze her hands in a 'hand up, palms crossed, fingers over side with pointer' grasp (gosh, that's hard to describe - i hope you can see it. i know this is non-pc, but like a 'brotha' handshake. sorry, i'm just trying to get a hard idea across in print), not a handshake grasp or interlaced. those two positions don't hurt you. and mimic the intensity of her grasp so she's getting some grip back & not squeezing a limp fish hand.

chapstick or the equivalent - hospital air is dry dry dry.

a great shot for pictures if she wants them is from over her shoulder - much less crotch that way, lots of baby.

it's fine not to count for the pushing. if the md or cnm or your friend is a 'counter', count slowly, don't shout numbers (easy to get carried away!), and start over if she takes a fresh breath.

i third or fourth 'the birth partner' as a good resource, very practical.

you'll be fine! have a great time & report back.

[meggiemoo]

I had 2 unmedicated births, the 1st in a birthing center, the 2nd at home. My DH was by my side for both, and my sister attended both.

The first birth, she took pictures and brought food, drink and flowers (which was much appreciated). The 2nd birth, we needed her there to entertain our 3y.o., so she stayed downstairs with him watching a video until I was pushing. (She still brought awesome food and flowers that time.)

When I'm laboring, I close my eyes and go inward. I don't want anyone talking too much, or touching me beyond what's necessary. I just hold my DH's hands tightly and listen for any instructions from my midwives.

Definitely ask her what she likes/dislikes during labor. Bring a camera if she's ok with that (we would have had no pics from the 1st if my sister hadn't taken them), and bring some snacks for post-delivery.

Oh, and my 1st labor was 6 hours, with 45 min. of pushing. 2nd labor was 4 hours, very fast and intense, with about 15 min. of pushing. I loved both of my births, but I'm also happy to be done! :o)

[hedra]

@MrsHaley, there's been a very strong shift recently toward less intervention more support in this area, definitely (Mid-Atlantic). I was so amazed that the nursing staff were actually running interference to make sure the OB didn't come start asking for pushing 'too soon' with my friend's birth. Like, they wanted to see the top of the baby's head before the OB walked in the door and took over. To the point that they'd kind of obfuscate the details to ensure that happened, provided there were no signs of distress. They encouraged 'laboring down' without intensive pushing (let the body and the baby do the work). They also were really amazing about trying to get her body to take over after each induction increment, and while that meant a LONG induction, it also made it very clear that it was not being taken away or controlled, it was being given given given as much as possible. That plus the hospitals around here have really implemented the idea that things like immediate suctioning can cause the baby to crash (shock reaction at the visceral level) and they let the baby clear fluids on their own unless there's a genuine medical need... it is a totally different world than just 4 years ago. Last two years have seen some radical changes implemented. Very very cool.

Definitely advocating for what they want is good, but taking a tour of the hospital and asking about the things the mom might want is good. It was so nice to ask about birth balls and have the nurse say 'oh, sure, we have a bunch of those, nothing better for turning a posterior baby!' instead of (what I heard with M&R's birth) 'Um, I think we have one somewhere.' (Okay, different hospitals, too, but I have heard even the hosp I was avoiding has upgraded their response to encourage less time on meds, more movement, more instinctive body effort, less medical effort.)

[Katherine]

I'm assuming since you're friend wanted a doula that she is trying for a natural, drug-free birth. I wanted the same with my second after a long induction and epidural led to a very sleepy baby which led to all kinds of breastfeeding problems.

So we went with a doula the second time around and it worked out wonderfully. I was able to birth naturally with no epidural. It's important that she can try different positions to find what makes her most comfortable during a contraction. For me it was standing and leaning over so my belly hung down. Since I had trouble getting from sitting to standing once a contraction started I sat on an exercise ball between contractions so I could just bounce up when one started.

And laboring in water is wonderful. We have a pool so I could still stand and lean over. But a deep tub with warm water would have been lovely too.

Hospitals aren't always cooperative in letting you stay out of bed and lying on your back is the most uncomfortable labor position imaginable. So we stayed and labored at home as long as possible. We were lucky in that we live 5 minutes from the hospital and my doula used to be a labor and delivery nurse. She knew exactly where I was in the process and could even check my cervix. So we cut it really close. I arrived at the hostpital dilated to 8 cm. and delivered about half an hour later. You probably don't want to cut it that close but consider staying home as long as you safely can.

Once at that hospital just be an emotional support and an advocate. Push for her to be allowed to stand or do what makes her comfortable.

[meggiemoo]

@Hedra, that's awesome to hear. I've never birthed in a hospital specifically to avoid the unnecessary interventions, but I know that a lot of women feel safest in that environment (or need the extra technology if they have complications). I was really blessed with two uncomplicated, low-risk births.

I love that they aren't suctioning out right away, too. I had read that suctioning out the nose and mouth doesn't really help, and can hurt, as you indicated. My midwives just let my babies clear themselves. If they started sounding "liquidy", they'd turn them on their sides. So much nicer for the infant.

And I hope that everywhere, unless there's a *true* emergency, OBs, nurses and midwives are putting the newborn to the mother's (bare) chest immediately after birth. Lots of research that it regulates the baby's temp and breathing, and starts the bonding process.

[Heather D]

I took a birthing class based on the Birthing From Within book by Pam England. One of the most helpful pieces of advice given to the husbands/labor coaches was to anticipate the birthing woman's needs rather than ask questions that require her to make decisions and activate the logic-processes in her brain which may be taxed or sort of offline during the harder parts of labor. For example, if it seems like some ice chips or sips of juice might be helpful, bring juice and offer it rather than offering choices that require a decision-making process. If she doesn't need or want something you offer, it will be clear! Other things besides sips of juice you might anticipate her needing: help shifting from one position to another, chapstick, a cup with a bendy straw that allows her do drink while lying down, offering to set up a hot shower or tub, etc.

Other than that, I think offering encouragement, validating any feelings she's having - good or bad - supporting choices she makes along the way, and helping to sort of "protect" her birth space so that if nurses or doctors are coming in and trying to administer some kind of treatment or procedure, that you advocate on her behalf as needed. Maybe that means someone comes in and says "we're going to have to break your water" and your friend looks distressed, so you would want to jump in by calmly asking questions of the doctor and making sure your friend is okay with decisions that are being made.

In general, the Birthing from Within book - which is way too crunchy for some - offers lots of good suggestions about how to support a laboring woman. Might be another good one to have at your side. You might also want to bring something for yourself like a knitting project or a book for the times when your friend may just need peace and quiet and you need to be present but not sitting in awkward silence!

[Melissa]

I haven't read through the comments so I don't know if this has been said but I think THE most important thing you can do for your friend is know how she wants her birth to be and then be her advocate when she can't. Know what is okay and not okay if decisions need to be made.

[Sharon aka Mommie Mentor]

Haven't read any other posts and I only have a moment but wanted to chime in.

I've had the privilege for supporting 3 women in birth as well as giving birth to my 2 at home, it's a miraculous experience. I also began my career by studying to be a midwife.

The nurses are there to do the medical stuff, so don't stress about what you know and don't know. Your job, as I see it, is to be the bridge from mom to the nurses and to be the ground for her.

What does the mom want? What are her thoughts about how to bring her baby into the world?

She may close her eyes and go deeply inside herself to manage the birth. If so your job is to keep the room quiet. I believe that birth is a sacred experience. Since babies are going from a silent warm environment to the outside world I like to encourage women to create a silent low light space for the first hour or so and allow the baby to be welcomed into the world gently.
That's me.
Again what does the mom want?

If her eyes are open, then your job, as I see it, is to lock eyes with her and breathe with her if she wants that. This is where she may think her husband falls down. She may want to connect with another to keep her grounded as this experience roars through her body. There is so much energy going through the body as labor progresses women tend to pull back from it.

I found that the key is fall into the energy and not retract from it. You can see women become apprehensive as a contraction comes on and they seem to pull away from their body. they hunch their shoulders and look like they are trying to leave their body, this slows labor down.

It's hard to be fully present and meet that energy full on. She may need help to manage it, that's where you can meet her eyes, and help her control her breath.

Remember one thing. If the mouth / jaw is tight this can dramatically slow down labor. A soft mouth, a relaxed jaw opens the pelvic floor. Breathing is what allows the jaw to relax. Sound also allows her to release tension. She can moan, express a sound or do what ever she needs to do. This is not a social situation, all social rules are canceled and she can make any sound she needs to help her advance the baby.

You don't have to have had birthing classes. Follow her breathing. Since she has had a child before she probably instinctively knows how to breath. If not ask a nurse to remind her and again follow moms lead.

Allow yourself to take the journey as well. At transition, when things go from passive labor to active labor most women begin to loose their minds. They don't think they can do this. This is a sign that things are progressing. Be gentle with her, and as Moxie said remind her she is doing it, and her body knows what to do, and all the help she needs is right here with you, the nurses and Dr's.

That portion lasts from 1 -10 minutes and then she changes and gains the strength of a lion.

Enjoy.

[auburn]

Haven't read comments so may be repeating but I would just talk to your friend and ask her specifically what type of support she wants and needs. Especially find out what specific things her husband is useless at so you can step in in those areas without stepping on his toes in other ways. lol.

ie. he may be good at the physical support (Back rubs and leg holding) but lousy at advocating for her wishes. Or maybe it's the opposite. I don't think there is one type of support that works for everyone in labor and I don't think you necessarily need to know much about labor to be a good support. You just need to know what she wants to get out of the experience (besides the obvious healthy baby of course). I know that I didn't want massages or anyone to even talk to me. I wanted my husband to be there to do what I asked of him (mostly fetch me stuff like chap-stick and juice) but didn't want a lot of hands on help with anything and definitely did not want to be touched. I found out that I'm a solo laborer for the most part. But I had to tell him that. He obviously couldn't read my mind.

[KateW]

As someone who delivered my 2nd 8 weeks ago, I can offer my experience: 1st labor, hard and long (unmedicated) - I learned a TON about what I want and how to ask for it. 2nd labor, quick and easy - seriously, I didn't even think this was it until my water broke less than an hour before baby was out. All I really wanted from my birth partner (DH) was company and a familiar face. And someone to take pictures after.

ok, I know I lucked out, but L&D doesn't have to be scary! It can be funny, joyful, and even boring sometimes.

[marci]

one more tip, about sounds. i absolutely agree that whatever sounds are helpful to her need to be the sounds she uses! but the majority of the time, that's low, deep sounds, like 'moo's and moans and 'uuuuuuuhhhh...' really try to keep her away from high distressed sounds like screeches and screams and squeaks. i agree with sharon that tight face/mouth hinders labor, and some women end up scaring themselves with those noises.

[Cloud]

Thought I'd chime in on the birthing practices thing. I'm in San Diego. In the hospital at which I gave birth, it was the epidural (and not the pitocin) that required me to stay in bed. I was in fact encouraged to get up and move around even after the pitocin. Once I had the epidural, I could be in any position I wanted in that bed, but I couldn't get out of it because they were concerned that my legs would give out on me, due to the epidural. The bed adjusted to be quite upright so even though I didn't end up wanting to get up, I wasn't flat on my back.

I also had a "self administering" epidural- I controlled how much medicine I got. This allowed me to dull the pain but still feel the urge to push, which was perfect for me.

I was induced (my water broke before I went into labor), so I had quite a bit of time in the hospital but not in a lot of pain to ask these sorts of questions. If I hadn't, I would have wanted my support person to ask for me.

[the milliner]

Have to second @Marci's little tip of the strong hand hold. Doula on one side & DH on the other was the only thing that got me as far as I could in my try for having a natural labour w/ my one & only.

FWIW on the on the labouring/delivering on your back discussion: I had every intention to labour in any way but on my back, and to use as many techniques as possible (tub, ball, massage etc.). The hospital was cool with this, which was great. At 2cm I went into the bath. It was awful. Too hard on the butt. Tried the ball. Felt awful too. Tried standing, leaning over the bed. No good. The only thing that felt OK & let me concentrate on my breathing (yay yoga!) during the very intense, 30-seconds-in-between-at-6-cm contractions was lying on my back in bed, with the death grip on DS & our doula. No talking. No eye contact. Nothin'. I was in the zone. Delivered on my back as I had an epidural in the end. Six pushes, 10 minutes, and he was out. So it really was not an awful experience.

Just wanted to give the other side of labouring on your back. I can imagine that if you have to push for an extended period of time, it would be rough to be in that position. And of course, every birth is a unique experience. Totally agree that the problem is in the 'allowed', not in the actual doing it or not.

[Anna]

@ Mrs. Haley- I have a theory that small, rural hospitals are generally kinder to women giving birth. I live in semi-rural Northern California and had a fantastic waterbirth with a midwife at our hospital.

My friends birthing in major hospitals in big cities? Lots of pitocin, emergency c-sections, pushing while laying on their back, etc., even when birth plans indicated a desire for few interventions. (Kaiser San Francisco, yes, I'm looking at you!)

I think these big hospitals are probably great in dealing with emergencies and really serious illnesses, but they also approach birth as a process that requires medical assistance in ALL cases.

If I lived in a major metropolitan area, I would aim for a home birth. Here, I know my hospital will let my body do its work--and has all the resources to deal with an emergency.

[CaliBoo]

I totally agree with Heather B's comment re: a laboring mother doesn't want people peppering her with questions. If someone else asked me what I wanted I was going to go hide in the janitor's closet.
To the OP - try to push her to drink as much water/juice/whatever she can tolerate as possible. If she's really laboring and isn't getting IV fluids, I would say at least 2-3 cups an hour. Being dehydrated makes the mental game even harder, not to mention doing the physical work.
Good luck to you both, and PLBBTT! to the doula who bailed at the last minute without arranging for a backup.

[meggiemoo]

ah, yes, the moaning. I'm a moaner when I labor...mostly low, deep moans. I remember my first mid-wife, when we heard screaming coming from the other bedroom in the birthing center (NOT what you want to hear when you're a first-time birther), said, "Screaming wastes energy. Don't scream and keep your face relaxed."

Personally, no one had to remind me to moan...I don't think I could have stopped moaning if you put a gun to my head! It's as inevitable as pushing is. But I can understand why some women would feel self-conscious about it if they were in a setting they didn't feel comfortable in.

[JeCaThRe]

I third (eighth? no idea how many times it's been mentioned) The Birth Partner by Penny Simkin. We used that book preparing for my last delivery, and it was as good as the Bradley class we took for my first.

[Barb @ getupandplay]

FWIW when I had my son, the staffers in the hospital were great at letting me try different positions to push. After an hour of pushing, my doctor suggested that I try laying on my back (well, more semi reclining) and in that position I was finally able to make some progress and my son was born shortly thereafter. Just another perspective that not all hospitals are going to force you to do something you don't want to and that sometimes squatting doesn't get you there. :)

[Katie B.]

I am a doula! This is a fantastic thing you're doing for your friend.

Books: Again, The Birth Partner. This goes in my bag when I'm heading to a birth (note to self, must repack bag this weekend...); it has really great reference guides for everything from medications to position change suggestions. I also love Ina May's Guide to Childbirth.

For helping mom: Find out what she wants. Go with her energy, but help her be focused on the process. When she hits the "I can't do this" wall, I fourth (or whatever) the suggestion of "you ARE doing this!" For pushing, remind her to keep her bottom relaxed, and to put her effort low, not high. During my birth (unmedicated, 14 minutes pushing), the best thing my doula did for me was to remind me to push through my bottom, not my face.

For advocacy: do NOT speak FOR the parents. Rephrase things as needed, ask questions of the staff, remind the parents of things they wanted, and answer questions if mom and dad are too busy to give the staff the information they need; if decisions need to be made, help negotiate for time, and support their voices, but don't speak for them. If mom's too busy to speak (very likely), be with her so that dad can talk to the staff.

For yourself: wear comfortable clothing. Wear layers - hospitals can be cool. Bring a water bottle and a snack for yourself, and cash for the cafeteria (or whatever). Bring something to pass the time if need be - knitting or suchlike.

Being a doula is totally amazing; don't be surprised if you get addicted!

[Stacey]

You have to know your friend, and her personality. I am a Really Type A. And hubby and nurses "giving praise" and telling me "you're doing great" just pissed me off. I just wanted everyone to get out of my face, let me push and get this over with!

Of course, this was after 35 hours of labor and more than 2 hours of pushing, so likely anything would have pissed me off!

I'm not doing that again. Baby bear will be an only child!

[Mother in the Making]

Reading all these great comments with avid interest! My first labour was 11 hours (induced); we are currently trying again (after two miscarriages...) to get pregnant with No.2: Will I deliver in a few hours this time around?!

Good luck to the OP and her friend; you are a lovely human being to be doing this for her!

[Ladre]

All these stories are making me misty eyed! Is it selfish to hope a friend gets pregnant soon so I can gat-crash the delivery?

Labor #1: From first contraction (I didn't even know what it was, just thought my back hurt) to delivery w/ epidural: about 24 hours. Pushed 6 times.

Labor #2: Went in for an internal as my due date was rapidly approaching and I think my OB might have helped things along by poking around in there with his big mitts. A little pictocin (sp?) and another epidural...a few hours and 3 pushes and that was it.

Amazing experiences! Loved it all. :)