The midwife — from the German “with woman” — watches just out of the mother’s line of sight, available but unobtrusive.
In this space I have been critical of the way hospitals do birth. While I am grateful for medical interventions when they are needed, typical hospital management of labor sometimes causes the very dysfunctions mothers go to the hospital to be safe from.
How? The hormones of sexual reproduction, which drive birth, are very sensitive and easily disrupted by standard hospital features: large, impersonal, clinical spaces; noise and bright lights; strangers who watch you, touch you, look for illness, and are poised to medicate you. In this psychic atmosphere her birth (sex) hormones retreat, and the result can be a slow and painful labor in need of medical salvation. Birth is blamed, and the hospital that nudged the mom’s body into dysfunction gets a pass.
This happens, yes. And sometimes hospitals do birth right. Sometimes the space and the staff manage to be what expectant parents want: safe and supportive of her physiology. I was recently privileged to be a labor companion to a childhood friend who gave birth in just such a hospital. Today I want to use this space to acknowledge their achievement, and also to point out specifically what made them so successful.
The room was comfortable and furnished thoughtfully. It was dim. The clinical apparatus were hidden away cupboards. There were abundant pillows, sheets, and blankets in the cupboards. The mother’s bed was infinitely adjustable, but there were options to assist an active birth, such as a birth ball and birth stool, so she didn’t have to stay in bed. There was a mini-fridge for the parents to store their food. There was comfortable seating, including a fold out bed, for birth companions.
The staff treated my friend like a person, not merely a patient. They greeted her as soon as she arrived. They knocked and entered the room. If she was having a contraction, they waited until it passed to continue speaking – an acknowledgment of her work. They went up to her head, extended a hand, and said, “I’m Dr. Goodmanners. You can call me Firstname.” They went on to say they knew she was in good hands with the midwives and nurses, but they – obstetrician, anesthesiologist – were on the team, too, if she should need them. It reassured her to know so many people were supporting her before she needed them. They also welcomed the mother’s support people – her husband, mother, and me – as if we belonged, rather than treating us as interlopers.
This sounds so basic, right? But hospitals are very hierarchical (which facilitates efficiency and swift action) and the “patient” status has a way of stripping mothers of their humanity, so manners are not always observed. They were here.
The nurses knew how to support physiologic labor. Oh, the nurses! When medicine was needed, they knew exactly what to do. But until it was, they used the high-touch, low-tech “medicine” that works so well in birth:
- They spoke to her in quiet, calm voices;
- They believed in her fiercely and admired her work frequently;
- They used reflexology to diminish her nausea and counter-pressure to relieve back pain;
- They helped her to be active, rather than simply saying, “Feel free to move”;
- They stayed with her, available but unobtrusive, gently encouraging presences, rather than limiting their interactions to medical monitoring.
In short, they loved her. The word “love” may seem at odds with the clinical detachment we expect of hospital staff, but it needn’t be. In the event of an emergency, detachment helps the staff do their jobs. In the absence of an emergency, though, detachment works against birth. For her birth to have the best chance of working well and being comfortable, the mother needs to feel safe. When she feels loved – actively supported, respected as a mother, seen – by all who are present at her birth, she will feel safe.
I’ll Have What She’s Having.
My friend didn’t luck into a place like this. She did the legwork – researching and interviewing to find the best fit for her – during her pregnancy so that she could surrender to labor in their care on her birthing day.
I’ve written about how to find the right provider and place in “How to Make Your Own Luck in Birth, Part 1: Planning,” “Can the Birth Plan. Pick the Right Provider,” and “Achieving Shared Decision Making in Maternity Care.” To recap here, pay attention to two things during your prenatal appointments:
- How the place and the provider make you feel during your prenatal appointments. They should increase your confidence and joy, not your fear.
- How your providers talk about birth. They should like and trust it, not treat it condescendingly or as an adversary.
Do you have a great hospital experience to share – in birth or otherwise? Shout out to your helpers here!
Join the discussion 9 Comments
“The staff treated my friend like a person, not merely a patient.” So much goodness in this post, Allison. I am becoming more and more selective as I choose practitioners to guide me through health issues. I can’t help but think if someone is conscious and caring with regard to bedside manner, he/she will be equally conscious in practice. As I read your post I was reminded of a book I read recently where the author described the hospice center in which her beloved spent his final days. I was moved to tears on more than one occasion while reading that book. In short, they ‘loved’ him. Yes, that. Thank you for another great read.
Thank you, Sue Ann. I agree that end-of-life care has a lot to teach us about beginning of life care. Hospitals are typically poorly designed to handle both ends of the spectrum, because hospitals are designed to treat illness. Birth and death don’t always feature illness, so what do you do? High touch, low(ish) tech!
Another good reminder of how important it is for both doctors and facilities to see patients as more than just patients. A hospital that can see a patient’s humanity and act accordingly in response to that humanity requires legwork to find, but is obviously worth the effort.
It DOES require legwork to find — I think of it like going on dates. You wouldn’t settle for the first one, would you, when you’ll be spending so much time together!
My third birth, 23 years ago now, was a wonderfully supported water birth, in hospital – I will always be grateful for the staff there, supporting me to have the birth I hoped for – yes,a great hospital experience.
I love it, Mary! Thank you for sharing.
I was a nurse for some years (not a midwife) and there are some parallels here with how to treat every person in hospital, not only labouring women, and yes, there is definately a form of ‘love’ there, I identified with that description very strongly. X
Thank you, Penny! I’m sure you were a wonderful, loving nurse.
After reading this post, I cannot begin to imagine how hard it must be for those other mothers out there who do NOT have such a thoughtful and comprehensive approach to labor for their birthing day. And as for “love”… I would say, but of course, that is EXACTLY the place where a mother would want to introduce her child to the world.