Leg Holding How-To

Posted by matt on April 23, 2014
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From the Field Guide to Being an Awesome Birth Partner:

When a woman is trying to push a baby out, it can be helpful for her to widen the birth canal by moving her legs to the side and toward her head.  While it’s theoretically possible for a woman to pull her legs back by herself while still pushing strongly, it’s not the best use of her energy.  You may be asked to “hold her legs”, or notice the opportunity yourself.  Your wife will guide you by moving her legs to where they need to be.  Your part is to hold them there during a contraction so that she can push, then gently move them back to a resting position.  It’s easier than it sounds, but be ready for it.

That paragraph pretty well covers the basics of leg holding.  It makes sense when you’re there, going through it, but it does help to know what to expect and to be ready for it.

Here are a few other notes:

  • She only needs her legs held during pushing, which is toward the end of labor (Stage 2, as it’s called).  She probably won’t want her legs held too early or too late in the process.  Once the baby is born, holding her legs will just annoy her.
  • You’ll probably only hold one leg.  A member of the medical team will most likely take the other.
  • She’ll only need her legs held in certain pushing positions.  If she’s trying different pushing positions, you might be able to help in other ways (maybe holding her steady during a push).
  • The leg positioning you’re after goes something like this:  lie on your back with your knees bent and your legs flat on the floor.  Let your legs fall open, apart from each other.  Then, keeping your legs as far apart as possible, bend your legs at the hips to move your knees as close to the same-side shoulder as possible.
  • Pull gently but firmly (don’t pull too far, pinch/twist her skin, or anything uncomfortable like that).  When you’re done, slowly and gently return her leg to a resting position.

It’s not complicated, and isn’t always necessary.  But if she starts pulling her legs back, help her out.  She’ll appreciate the help, and even more than that, she’ll appreciate that you’re paying attention and trying to help her before she asks.

Encourage. Don’t Discourage.

Posted by matt on April 16, 2014
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The previous post talked about the importance of providing emotional support.  This post is going to examine using words for emotional support, and the importance of making sure the words you use are encouraging.

As a birth partner, you want to keep the spirits of the laboring mother up.  If she gets down on herself, grumpy, or starts feeling like she just can’t do it anymore, her birth experience is going to be more difficult.  Not only that, she’s going to remember the experience less positively.  In turn, that means, while she may appreciate help you provided, she’ll still associate you with a less-positively-remembered experience.

Bummer.  Wouldn’t it be nice to be associated with an experience that she remembers as positively as possible?

Let’s examine some American wisdom literature:

Oh, give me a home where the buffalo roam,

and the deer and the antelope play,

where seldom is heard a discouraging word

and the skies are not cloudy all day!

The poet reminds us that an experience remembered as pleasantly as critters frolicking in a sunny field cannot include discouraging words.

The generic sports movie coach might give his team some “tough love” early on.  But how often do they make it to the championship game, head to the locker room at halftime, only to hear the coach say “You know, boys, y’all really don’t have what it takes.  I know it’s a close game, but I can’t see that second half going any better.  Sure can’t see us winning.  But I suppose, let’s get out there and not embarrass ourselves too badly.”  Doesn’t happen.

So don’t get into the birthing room and be discouraging.  Here are a few things that might come to mind that you shouldn’t say:

  • “The nurse doesn’t think you’re doing very well.”
  • “You look tired.  And we’re barely getting started.”
  • “Can’t you make this go any faster?”
  • “I thought we’d decided no epidural.  Why can’t you stick to the plan?”
  • “I have a feeling you’re going to need a C-Section if you can’t do better.”

There are many, many other things that can be discouraging.  Think before you speak, and look for words that build her up, give her hope, remind her she’s not along, and give her extra strength.  Here are a few suggestions:

  • “I’m proud of how you’re holding up.”
  • “You can do it.”
  • “I know you can do this.”
  • “I’m here with you.”
  • “That’s good, keep it up, you’re doing great.”

Keep these in mind as things to say if you can’t think of something encouraging at a particular moment.  Having some fallback phrases in mind can be helpful during stressful parts of the birth process, because you don’t have to feel as on-the-spot to come up with words and make sure they’re encouraging.

The tone you use matters, but that’s a different post.  For now, just remember that your tone needs to match the words you’re saying.  Encouraging words with a distant (or worse, discouraging) tone will undo any good of the words, make the poor laboring mother feel unsupported, and you’ll have to fix the problem you created for both of you.

Use encouraging words, with a sincere and encouraging tone, and you’ll be well on your way to being an awesome birth partner.

 (There are more encouraging, supportive, comforting words in the Field Guide to Being an Awesome Birth Partner.)

Emotional and Physical Support

Posted by matt on April 9, 2014
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Men, you probably don’t realize this, but the single most important type of support you can provide is…

Take a guess.  Is it “emotional support” or “physical support”?

Emotional support means things like being loving, reassuring, holding her hand, helping to distract her when she needs it, and helping her to focus when she needs to.

Physical support means things like getting her water when she’s thirsty, helping with comfort techniques, holding her leg while she’s pushing, and we will even include things like helping make sure she gets pain medication or an epidural when needed.

On the one hand, touchy-feely stuff.  On the other, tangible things-I-can-do.

You’re probably thinking it’s not even close.  You’re right.  Not even close.

While researching the Field Guide to Being an Awesome Birth Partner, I heard a story.  A young lady headed to the hospital to give birth.  For reasons that don’t affect the story, she ended up having to go alone.  She didn’t have a support person that could come with her.  Not the father of the baby, not one of her parents, not a sister, not a close friend.  I felt bad hearing that.

It turned out to be a fairly long and painful birth.  Because she didn’t have a support person with her, the nursing staff filled that role.  From what I understand, they always had at least one nurse there just to be a support person, in addition to any nurses there for the usual medical tasks.

Finally, the baby was born, she got a chance to rest, and at some point, she was given some sort of “how’d we do” survey about the birth.  One of the questions was something along the lines of “On a scale of 1-10, how enjoyable was your birth experience?  1=awful, 10=rainbows and unicorns”

She put down 10.

Someone on the hospital staff noticed the answer to that question, and went to talk to her, thinking she had, perhaps, misunderstood the rating scale.  After all, it had been a long, painful birth–not just by the new mother’s experience, but according to the opinion of the medical professionals as well.

“Oh, no, I understood it.  I meant to put ten,” she said.  “Yes, it hurt a lot.  But I’ve never felt more loved and supported in my life!”

So there you have it.  Emotional support, at least to a woman in labor, is usually far more important than anything you’ll provide in terms of physical support.

So, men, while those physical support skills are important, being able to provide emotional support will be much more important to the woman you love.

It’s not even close.

Why He Hasn’t Read That Book

Posted by matt on March 26, 2014
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This one’s for the moms-to-be out there.  Men, you’re welcome to read it.  (If you do, read it to see how that lines up with your reasons, not because you’re looking for excuses!)

You may have noticed that there are a lot of baby and pregnancy books out there.  You probably own some of them.  Your hospital or birth center may have handed you a copy of What to Expect When You’re Expecting.  Your family and friends may have given you some for a baby shower.  You might have bought a few yourself.

First-time mothers, especially, are curious about everything that’s going on.  Your body is changing and there’s a tiny little person growing inside you.  That does all kinds of weird things to your body and brain.  It’s comforting to know that there’s a reason your hip hurts, or that you’re not alone in craving unusually large amounts of guacamole, or that your sudden urge to “nest” is normal.  Odd, but normal.

With these books being so useful, comforting, and informative, you naturally expect your man to read one or all of them as well.  For some reason, he doesn’t seem excited about the idea.  And he just hasn’t quite gotten around to reading the book yet.

Why is that?

Frankly, part of the reason is that the books aren’t intended for him.  They’re written for you, the mother-to-be.  It’s not that he can’t or won’t read a book that he’s not the intended audience for, it’s that it’s much harder work to stay engaged with the book.  If he’s being “asked” to read it in the first place and is already feeling a bit reluctant, the audience mismatch can be enough that he’ll give up by page ten.  And before you protest that the books are equally applicable to anyone, look at the cover (yes, judge the book by its cover!):  a color scheme tested by the publisher’s team to appeal to women; words about “you” having a baby; a picture of a smiling gal with a bulging belly?  Yep, that tells him that it’s aimed at you, not him.

Another reason that doesn’t apply to every book you ask him to read is that, to be honest, some of them seem just plain weird.  Because everyone has a different definition of “weird”, I won’t assume that what I find weird is also weird to your man.  And that’s exactly why you shouldn’t assume that just because you think “12 Chainsaw Juggling Techniques for a Healthy Baby” was awesome and he should read it, that he won’t end up thinking it’s weird and not wanting to read it.  (By the way, I don’t think that book exists, but it sounds awesome and I would read it.)

Another part of the reason he might not read that book is that it’s just plain long.  What to Expect When You’re Expecting is over 600 pages.  Over six hundred pages of stuff that might not interest him and might get weird?  “No thanks!” he thinks.  It might be chock-full of good information, but his this-is-more-work-than-it’s-worth alarm is going crazy.

The final major reason he might not want to read that book is that he doubts there is anything in it that’s actionable.  It’s nice to know that at 10 weeks, baby is the size of a kumquat.  But that’s just information.  And it’s information that you’ll give him anyway, or that he could look up if he wanted to know.  He’s concerned–and probably right–that he’ll spend time reading the book, and come away with almost nothing that he can do or know that will help him or you.  He’s got other things on his mind–like what it’ll be like to be a daddy, and whether the crib manufacturer put all the correct hardware in the box.

You may not agree with these reasons, and that’s okay.  Not every guy feels the same way, and not every guy can articulate his reasons.  In short, the most common set of reasons a guy doesn’t want to read that book is because it’s a non-actionable, long, potentially weird book that’s intended for you and not him.  If you can look at the book through that lens, you might understand why he just hasn’t gotten around to picking it up (even if you don’t agree with him).

Want a book that is actionable, short, and intended for him?  The Field Guide to Being an Awesome Birth Partner is written for your guy, to equip him to love and support you through the birth process.

Birth Partner? That’s Not For Me.

Posted by matt on March 19, 2014
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Yeah, so I’ve read about what a birth partner is, and why I need to be involved, and all that stuff.  And you say that a guy needs to be tough to be a birth partner.  I’m just not that kind of guy though.  I’m not good at being gentle, and I I know I’m going to say the wrong thing if I try.

– Some Guy

Some guys feel like they’re too tough to be a birth partner.  Some guys realize their limitations–they’re not good at coming up with the right words at the right time, or they’re clumsy, or they’re manual laborers with big rough hands.

Knowing your limitations is a good thing.

Letting your limitations loom too large in your mind is a bad thing.  Doing that can focus you on your limitations instead of your capabilities.

To be perfectly blunt about this, you (assuming you’re the father of this particular baby) somehow were capable enough that the lovely woman about to become the mother of your baby chose you.  Start with that.

Being a birth partner can be hard work.  Maybe it’d be easier if you were better with words, or could easily memorize a whole bunch of comfort techniques, or had a medical degree.  But those really aren’t the important things.

The important thing in being a birth partner is to love and support the mother in labor.  That can be as simple as paying attention to her, holding her hand, and telling her “I love you, you can do this.”  If you’re not good with words, figure out what you can do without words–gentle touches, comfort techniques, or smiles might be good options.  If you’re worried about being clumsy, figure out what you can do–smiles and reassuring words while remembering to be a bit extra-careful.

Don’t count yourself out just because you’re not perfect.  You can still help that special woman through labor.  Focus on the things you can do, not the things you can’t.  She’ll be glad you did!

Being an “Advocate”

Posted by matt on March 12, 2014
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One of your roles as a birth partner is to act as an “advocate”.  That’s not a common word these days, so it’s natural to have questions about what an advocate should do.

An advocate is a person that promotes the best interests of another.  Simply put, as an advocate, you promote someone else’s best interests and do what you can to help them through their situation.

That’s pretty abstract, so let’s get a bit more specific.  In the birthing room, there’s a woman busy trying to have a baby.  That’s generally considered a difficult task that can take some effort.  So she would benefit from not having to deal with extra details.

Think of it like she’s a professional athlete, and you’re her agent.  Her job is to play her sport.  She doesn’t need to worry about the details of negotiating a new contract, or calling UnderArmour back about that endorsement deal, or arranging plane tickets to get to that charity event.  That’s your job.  You take care of those details so she can do her job better.

And now, back to the birthing room.  You can be a good advocate or a bad advocate.  I’m going to suggest being a good advocate.  That means understanding what she needs (asking can be helpful), making things that you can make happen happen (say, getting her a drink of water), and making sure her concerns and needs are addressed by the medical staff (“excuse me, nurse, she says something doesn’t feel right”).

Remember that your interactions with the medical staff can have a big impact on the tone in the birthing room.  Be assertive.  That means making sure your (her) concerns are heard and understood, without being aggressive or a jerk.

You’re looking out for her best interests.  That means making sure she’s taken care of, and it also means that her entire support team (you, the medical staff, anyone else in the birthing room with you, people texting or Facebooking) is doing their best to make sure her needs are met and to act supportively.

[There is more about being an advocate, including scripts for being a good (or bad) advocate through requesting a replacement nurse, in the Field Guide to Being an Awesome Birth Partner.]

Don’t Call It “Coaching”

Posted by matt on March 5, 2014
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Some men think their role during birth is to be a “coach”.  In fact, there’s an entire childbirth method that is described as “father-coached childbirth“.

Unfortunately, the idea most guys have of a coach is different than what is needed during childbirth.  Many of us have had coaches in our lives that have pushed us to be stronger and better.  We’ve seen them in movies, pushing their teams beyond what they thought was possible (the coach from Miracle, yelling “Again!” as he pushes his team to the point of collapse, comes to mind).

Coaching has its place, but that place is not in a birthing room.  The “father-coached childbirth” method calls for “a loving and supportive coach” who goes through 12 weeks of training with the mother-to-be–which is definitely not the kind of thing that most men think of when they think about what “coaching” is.

During labor, a woman doesn’t need a coach calling out “come on now, we practiced this, power through and get it done!”  She needs a safe voice that she can trust.  She doesn’t need a coach focused on winning the game.  She needs a partner that will love and support her through the process.  (Besides, guys, let’s be real here:  coaches need to know the game, and you’re almost certainly no expert on labor and birth.)

If you must think of yourself as a coach, think of yourself as the best kind of coach for a youth sports team.  The outcome of the game doesn’t matter; what matters is that the players learn the game, have fun, trust the coach, and can’t wait to come back for the next practice or game.  The title is coach, but the role is a supporter, encourager, advocate, and cheerleader.

And if you really must think of yourself as a coach, you owe it to yourself and her to be as prepared as you can be.  The Field Guide to Being an Awesome Birth Partner is a great place to start.

Birth Partner as Fatherhood Training Camp

Posted by matt on February 19, 2014
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This one’s for you guys that are about to be a birth partner for the birth of your first child.  Those of you that already have kids, or those of you that aren’t male (and hence, won’t qualify for “fatherhood” anyway) are welcome to read and try to apply this to your situation.  Also, I will use the term “wife” to refer to the woman who you are helping through labor.  If that’s not the right term for your situation, adjust as needed.  It’s much less cumbersome than “wife/girlfriend/partner/companion/friend/ex-wife/ex-girlfriend/etc”.

The impending birth of your first child is pretty exciting.  It can also fill you with questions.  “Will I be a good dad?”  “Will I have any idea what to do?”  “How am I supposed to take care of my kid and teach him/her everything he/she needs to know?”

Those kinds of questions are common, and they’re questions you’ll have to answer for yourself.  You can be as prepared as you want, but you’ll still have questions, doubts, uncertainty.  That’s normal.  You’re stepping into a new role, one that you haven’t gotten to practice.  It’ll be an adventure for everyone involved.

One of the best things you can do to prepare for fatherhood is to use being a birth partner as a training camp.  During your training camp, you should learn some practical skills you’ll need to know (e.g. diapering and bathing a baby), practice some skills you already have (e.g. loving your wife and being patient through uncertainty), and develop or improve some emotional skills (e.g. putting another human being’s comfort and safety ahead of your own).

I don’t know what kind of background you have:  whether you had a good model of fatherhood growing up or what kind of models of fatherhood people around you in your adult life have been.  But somewhere, you probably have an idea of the kind of father you want to be.  If not, let me give you a vision (and this one’s off the cuff–feel free to develop your own, better vision):  you want to be and you can be a father that is physically and emotionally present for your kid(s), a strong protector and tender enough that your kid(s) will run to you to kiss their bumps and scrapes, a man that’s willing to sacrifice his own comfort and preferences for the good of his wife and kid(s), and an intentional parent that sets a direction for your family that’s best for everyone–all of this because you know that being that kind of father will be more rewarding than looking out for yourself.

So take your vision of fatherhood and apply it now, before your kid is born, and before you officially take on your new role.  Practice being a strong protector by making sure you’re equipped to protect and help your wife through labor.  Practice being tender by equipping yourself to gently comfort her during labor (not just with physical comfort techniques, but with encouraging or distracting words).  Practice being physically and emotionally present by turning off the TV, putting away your smartphone (unless you’re timing contractions), and pay attention to your wife so that you can respond to or even anticipate her needs.

If you take your vision for fatherhood and use that to organize your fatherhood training camp, you’ll be much better equipped to be a father.  And just like a coach might say of a promising rookie “Yep, he had a great training camp.  Throws great, moves great.  He’ll be starting our first game.  He’s got a lot of room to improve, but he showed us that he’s got the tools to succeed”, your wife will be excited about your potential.  “Yep, he’s been a great partner.  Surprisingly gentle, but never gave up, and always put me first.  We’ve both got a lot to learn about taking care of our baby, but he’s going to be–he already is–a great dad.”