Supporting the Birthing Family’s Perspective

By: Gail Tully |
July 12, 2018 |
Preparing for Birth

In many birth settings providers meet parents in labor for the first time. Typically parents seem to accept provider recommendations and routines without much questioning. But these parents may have expectations that aren’t voiced, such as being seen as special in their role to bring forth life or to be cared for compassionately by sensitive doctors and midwives. When parents don’t express expectations, the provider may easily assume they share the same expectations the provider has, in the natural human tendency to suppose agreement. I mean, ultimately everyone hopes for and wants a healthy baby, right? The challenge comes from seeing unexpected expectations as negating the desire of the provider and staff, or the parents perceiving the provider’s desire for a procedure as negating their need. Values clash… or do they really? Is that whats happening when the parents want something personal or different than the routine or recommended procedure? On a practical note, meeting the parents needs may seem to stretch the care giver’s comfort zone or available time. Stress rises for both parent and provider. There is a way to create a mutually nurturing scenario and meet the needs for parent and provider in the vast majority of birth experiences.
Identifying needs first and using available resources to meet the mutual needs is a skill of many astute providers, nurses and doulas. Once parents and providers express their needs, for instance, for monitoring and for freedom of movement, then mutual strategies can creatively arise. In this example, a birth ball beside the hospital bed within the reach of the monitor cords allows the birthing person to sit on the ball and sway while the nurse records contraction pattern and fetal heart rate. . Our capacity to reach mutual solutions might be seen to include variables of time, tools, temperment and trust.
Factors the provider faces are adjustments in behavior and assumptions around:

  • Autonomy
  • Informed Consent/Informed Refusal
  • Compliance
  • Birth Plans

Birth plans are common today and can be a to-do list for desired care or a no-list of interventions. One physician calls the birth plan a diagnostic tool to the birthing person’s personality. I’d like to suggest the birth plan as an invitation to consider personal needs in the birth process, especially around self determination and dignity.
Birth plans are popular in the birth education and doula movements and accepted by parents in such circles as a way to secure autonomy and the information to give or refuse consent. A common addition to a birth plan list is to “discuss reasons to do an intervention first.” Difficulties might arise when the birth plan is seen as an dream or set up, or an inconvenience to a provider with a high value on efficiency. A common comment nurses say they hear from colleagues is that the person with the “four-page birth plan” will end their labor with a cesarean. The assumption is that the person with a birth plan is controlling. Yet, when is the need for control in a process full of unknowns somehow unusual? The need for control is not really the issue. The issue tends to be how the person who seeks control is considered or feels themselves out of sync with the staff or provider’s work flow or the beliefs that support that work flow. Let’s turn around worrisome thinking about the birth plan to give everyone more satisfaction in their birth or birth work. Identifying physical, psychosocial and emotional needs without judgement allows each person room to be present with their objectives before how things are going to go or not go are described in force or rigidity. Fears on both sides of the admission desk are quickly alleviated.
Trust between parent and provider weighs upon the sense of presence felt with each person feeling held in the attention of the other with value, interest, and consideration. We begin with a little intention for efficiency due to the office schedule, but with breath and softness in the breath.

Hearing the Perspective of the Pregnant Parents

We believe health is more than vital signs. Being heard by the provider is a leading variable of satisfaction in childbirth. A parent held in high regard is shown to gain confidence in themselves and attunement to their child. Strong attachment might be thought of as a healthy result of birth, compared to, for instance, birth trauma, whether that be physical or psychological which, leaves the parent feeling unheard and treated as a task first and a person second. Personal dignity is a patient right within the health care setting. Provider satisfaction is a natural result of giving quality care and the resulting emotional and physical wellbeing of those cared for by that provider.

The social nature of giving birth is well met by providers who can enter the perspective of the parent(s), match language when it helps establish trust and improves communication, and meet parents where they are so to gain mutual cooperation for their wellbeing. It’s not an “either/or” decision. No one has to abandon their own perspective to consider another’s perspective, to hear and respond to needs. Simply slowing down and including one another’s needs in the professional relationship opens the boundaries to include personalized solutions and medical services for the actual needs of the parents. When we turn toward the birth plan as expressed need, we avoid conflict over strategies and actually start connecting the people to a quality experience. By seeing the birth plan as an attempt to express a deeper need, the provider can create a map with the route to excellent service.

When parents come wanting a specific approach to childbirth, such as Spinning Babies®, for instance, the provider’s spirit of open curiosity welcomes discussion. Warmth is felt. Learning occurs and needs are more easily met. Once that repore’ connects unusual labor positions or techniques are met with open curiousity and support.
Offering care is a dance of perspectives. True care begins with taking in the view and sharing the route from there.

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