Support and care throughout labour and birth
Labour can be a very frightening experience for women, especially first births. In addition, women will experience physical sensations ranging from discomfort to severe pain. Helping the woman to be as relaxed as possible and aware of her situation can help minimize the physical pain and emotional distress of labour and birth. Women can be helped with this by receiving adequate care, timely information, comfort, support and reassurance during labour and birth. It is also important to maintain respect and courtesy whenever possible by explaining what you are going to do and why, and by being courteous to her and her family. It is equally important to maintain respect for privacy throughout the birth, by keeping the woman covered as much as possible for all procedures, or by providing curtains.
It is important to be familiar with the birth and emergency plan (refer to Session 7) and to know if the woman and family have any preferences regarding labour and birth. If a skilled attendant respects the woman's and family's preferences regarding labour and birth they are more likely to have a better birthing experience.
In the birth and emergency plan, a woman will have also indicated a companion to support her during birth, and this childbirth companion can take on a central supporting role.
Supporting the role of the childbirth companion
Women should be encouraged to have a companion of her choice present during labour and birth. Some women like to have their husband or partner; others prefer a close family relative, friend, or a traditional birth attendant (TBA). Experiences from different settings have shown that the best person to have as a childbirth companion is often an older woman from the community, someone who has had children herself. However, encouraging the husband/partner to be more involved with the birth, where it is acceptable, may also be beneficial for the whole family. Birth is a very emotional experience and for some people (especially the husband/partner) having more active involvement can make the whole process particularly special.
Talk to the childbirth companion, either with the woman present or alone, to understand their feelings and wishes. Give the birth companion practical information about his/her role and offer advice on things he/she can do to help the woman. Providing support will draw on your skills and awareness of gender and social norms (e.g. the counselling context) within the broader community. The childbirth companion and skilled attendant should work together as a team during labour – plan (as a team) how to do this in advance when you discuss the birth and emergency plan (Session 7) with the woman during her antenatal visits.
It can be useful to talk to the childbirth companion during pregnancy or at the onset of labour to find out how much he/she already know about labour and birth, and to discuss with him/her what they might expect to see and what he/she is expected to do. You should encourage the companion to give support using local practices which do not disturb your work (and the rest of the health team) during labour or birth. The companion can also help and encourage the woman to move around freely as she wishes and to adopt the birthing position of her choice.
Discuss with the woman in advance any situations when the birthing companion may not be allowed to remain in the room. If the health facility currently does not allow birthing partners to remain with women who are giving birth, consider opening this topic up for discussion with your colleagues. Even if you decide that companions cannot be there for the actual birth, you might consider encouraging them to be there to support the woman during labour or to assist with breastfeeding and postnatal care. Sometimes if there is little privacy in the birthing room it can be easier if the companion is another woman instead of a man. Suggesting that women be encouraged to bring a female childbirth companion can often overcome issues related to lack of privacy in the birthing room.
Activity 1
20 minutes
To draw up a list of roles the childbirth companion can fulfil.
Draw up a list of tasks that the childbirth companion can carry out during labour. Think of the possibilities, including practical tasks, emotional or supportive roles. How could he/she help in the birth of the baby? Can he/she cut the cord? Try to make your list as complete as possible.
What are some tasks that the childbirth companion should avoid doing? Why should they avoid doing them?
Review your list with others in the facility. Does the facility have any regulations that you need to consider before finalizing the list?
How can you best use the information you have drawn up to support a childbirth companion in assuming the role? Consider producing material to be given out or a checklist to go through with childbirth companions. When would be the best time to discuss this with them?
Our View
The key role of the companion is to help support, encourage and reassure the woman throughout labour. The companion should always try to be with the woman and praise and encourage her throughout the process. The companion can also carry out simple tasks such as helping her to breathe and relax or rubbing her back, providing sips of water as allowed, wiping her brow with a wet cloth, or doing other supportive actions.
It is important to tell the birth companion what they SHOULD NOT DO and explain why:
DO NOT encourage the woman to push.
DO NOT give advice other than that given by the health worker.
DO NOT keep the woman in bed if she wants to move around.
DO NOT administer any local herbs or medicine.
Women who are supported by a companion of choice during labour and birth often have a better birth experience
Communication
During labour maintain communication with the woman and her companion. Maintaining communication means informing the woman whenever possible of everything that is happening and everything that you are doing or planning. Explain all procedures that will be carried out, even minor ones. This will help to minimize anxiety and provide reassurance that things are routine. Before you carry out any procedure, seek permission. This is part of courtesy and respect. You should also discuss any measurements or results and their implications with the woman. Keep the woman and her family informed about the progress of the labour. Labour can take many hours. Women need to know how they are progressing. Women who have experienced labour before still need to have information on their progress because labour is different for each woman.
Encourage self-care
Labour can sometimes take many hours and there are a number of things you can do to encourage the woman (and her companion) to help her through the process. Encourage the woman to bathe, shower or wash her genitals at the onset of labour and as often as she feels she wants to. Encourage her to move around and get into the position she feels most comfortable in. It is also important to encourage her to drink fluids and eat as she wishes throughout labour (as long as a C-section/surgery is not indicated), and to empty her bladder frequently. You can also teach her breathing techniques. Teach her to notice her normal breathing and then encourage her to breathe out more slowly, or to pant at the end of the first stage or at the height of a painful contraction to prevent pushing. During the birth of the head, ask her not to push but to breathe steadily or to pant.
Following the birth of the baby, it is important to maintain communication with the mother and childbirth companion and inform them of how the baby is doing. Encourage skin-to-skin contact, and put the baby directly on the mother's upper abdomen and cover both of them, ensuring skin-to-skin contact that will help to stimulate breastfeeding. Keep them both warm in the immediate hours following birth. It is also important to offer the mother drinks and food as she is likely to be dehydrated following labour.
Talking to the woman
Often during labour, especially if a birth companion is present, health workers can sometimes talk about the woman as if she is not there, or talk about her to the companion. Anything you have to say should be directed to the woman. If you need to talk about her with colleagues or with the companion, you should go elsewhere. Demonstrate respect – talking about her when she can overhear you is not respectful and not inclusive. It also may make her feel she is less in control of the situation.
Dealing with distress
Labour can be distressing for women and their families, regardless of whether there are any complications. Women may scream or shout, or they may become uncooperative or difficult. As a health worker it can be very hard to deal with women who are distressed in labour. It is important to remain calm and focus on maintaining your professional relationship. Under no circ*mstances should you raise your voice, complain that she is doing something wrong, or physically or verbally abuse her in any way.
Women can become even more distressed if the labour or birth becomes complicated. It is important that those around the woman remain calm. You are used to seeing difficult labour and birth, but most women are not. Similarly her childbirth companion or family may also become distressed. Try to reassure them all and advise them to remain calm and supportive to the woman to help her through the labour and birth. It is especially important to maintain communication with the woman and her companion if there is a problem with the baby. If you have to take the baby away immediately following birth, explain to them as soon as you can what is going on and what you are doing.
Support and reassurance
Labour is physically and emotionally demanding. Women need to be praised, encouraged and reassured that things are going well and that they are doing what is necessary for the safe birth of their baby. We all respond better to encouragement and support. A woman who is discouraged or made to feel she is doing something wrong is less likely to endure her labour well.
Let the childbirth companion know his/her job is to encourage the woman to do what she feels she needs to do to feel comfortable during labour. This may mean walking around or changing position frequently. Some women like to be held, or to have their backs rubbed or to have someone to help them with their breathing.
REMINDER
Work with the woman and her companion to find out what she wants to do and how she wants to be supported and helped through her labour. Ask open-ended questions, paraphrase and provide feedback on what she has said for clarification. Avoid giving her orders. You can make suggestions that may help her but respect her choices if she does not want to follow your suggestions.
Confidentiality and privacy
The companion also needs to be kept informed on the progress of the labour and of any complications or difficulties. First, find out from the woman how much or what information she wants shared with the companion, and what she wants to remain confidential. It is best to find this information out during pregnancy when you are discussing her birth and emergency plan (Session 7). Be careful to maintain the confidentiality and privacy (both seeing and hearing) of the woman. If you have to carry out any physical examinations ask her whether she wants her companion present, and get her consent before you touch her body. Refer back to the guidelines on confidentiality you made in Session 5.
Encourage women to change positions and find what is comfortable for them
What did I learn?
You have considered the ways you can help to support and encourage a woman during labour and birth. You have considered how to involve childbirth companions in a caring way and how to maintain courtesy, confidentiality and respect.
You have learned to support the woman by encouraging her to move into positions she feels comfortable in and to walk around. You have also learned the value of the role of her birthing companion, and of the need to provide accurate information on her labour progress or any complications which may arise.
Make some notes in your own words following this session to help you remember and revise the key points. You might also consider asking a colleague whom you trust to comment on your interactions with a woman and her companion during labour and birth, particularly during the stressful times of a birth where the woman might be in distress and uncooperative.
