23 Mar How to Talk to a Woman in Labor
Is your best friend giving birth soon, and has she asked you to come? Is your daughter wanting you near during her delivery? Perhaps you’re the partner of a pregnant woman and want to know how best to support her.
I so often witness the emotional process of a visitor to birth. There’s the trepidatious knock, the peek around the corner, the explosion of excitement into the room (sometimes with a balloon or gift). This is usually followed by an awkward physical crouch and whisper “Oh, sorry! I’ll be quiet!” and the rest of the conversation held in half-whispers and side glances at other support people. Some visitors leave as soon as they can. Some maintain the chipper excitement, not realizing the magnitude of the experience unfolding in front of them.
Some visitors have the notion that the birth will be another baby shower. Noooooo.
so many forms of NO.
Of course this misunderstanding makes sense! In our culture, we lock birth away in an ivory tower. In my childbirth classes, one of the first questions I ask, “Has anyone been present during a labor or birth before?”. It’s a RARE instance that someone has. So yeah, most people do not know what to expect nor how to BE during a birth. We’ve never seen it.
The pictures of birth in our head are often informed by sitcoms and dramatic movies. While a few aspects of these scenes can happen, the vast majority are caricatures. The sweating, screaming, angry mother. The dopey, stressed, passive father. The asshole doctor. This isn’t the norm. (I mean, yeah, it happens occasionally. Caricatures come from SOMEWHERE.)
Caricatures, I say! (from “Baby Mama”)
Remember this one (from “Knocked Up”)?
Everyone in their prescribed roles.
So here, my friend, is your guide to how to talk to and be with a laboring woman. You can also find some great ideas in my hand-out “Cheat Sheet for Partners” about supporting a woman through birth. Take these tools, read them several times, be an A+ support to your friend/daughter/lady.
First of all, the most important idea to take with you into a labor room is SENSITIVITY and OPENNESS. Truly, I have no idea what the vibe of the room will be like. But the over-arching attitude will be that of paying attention to what DOES the room feel like. What does this particular laboring woman in her particular environment seem to need? Remember: SHE SETS THE TONE. SHE’S THE BOSS.
But if you walk in expecting a couple of common scenarios I’ll outline below, you’ll be set.
When a woman is in labor, her brain is changed. The powerful hormones of birth require that some everyday function takes a break. Specifically, the frontal lobe, the Neocortex, takes the day off. I like to say these parts of the brain go dark. As a result, she may be
- Non-verbal (which can sometimes come across as being abrupt or rude. But it takes a mighty effort for a laboring woman to eek out even a few words.)
- Slow to respond
- Lose sense of time (or any math capabilities)
- Averse to bright lights and noise
- Easily overstimulated
The part of the brain that IS firing like crazy is the limbic system. It’s sometimes referred to as our lizard brain, the part that’s in charge of basic functions and instincts. As a result of this supercharged area, she may be:
- Highly intuitive to everyone’s mood and state of being
- “Zoned out” and in her own world (we actually call this “laborland”)
- Rocking or swaying rhythmically
- Have her eyes closed or look a little drunk when she does look up
- Making some sexy noises (long, sustained moans)
- Leaning forward, eventually to being on her hands and knees
- Wanting to feel safe and secure, sometimes close to her intimate partner
- Gravitating towards small spaces with few people
The combination of these brain function shifts mean that she may seem animalistic. Primal. Other-worldly! Now that you know this is normal, you can pay close attention and let her lead you. Observe what she’s doing. Notice her intuitive behavior. Be a student of birth.
WHEN YOU ARRIVE
Before you walk in with any expectations at all, use this time outside the door to get yourself ready. Pause and take 15 slow, deep breaths. This can be particularly helpful if you’ve been rushing to get there. You’ll be calmer after this, and you’re going to mirror the laboring mother’s presence in that calmed state. (after 10 years of doula work, I still follow the 15 breaths rule.)
When you first walk into the room, smile at her. But again, curtail your energy until you know what the vibe of the room is. Watch during a contraction or two to see how she’s behaving and how people around her are supporting her.
Be attentive to: the lighting (darkness is a sign that things may be more intense), what other people are doing (are they close to her? In physical contact? Sleeping?), and her physical position (leaning forward onto things and people can indicate that labor may be further along).
NOW you’ll know how to be with her. If you’re still unsure, continue to be measured and observant. Better to bring quiet curiosity rather than exuberant distraction.
SHIFTS AND CHANGES
In early labor, a mother is more like her normal self. She speaks normally and functions in her day-to-day manner. If you happen to be present through this part, again, she sets the tone. Respond to her as you normally would.
When labor begins to pick up, she may need to stop talking and focus during contractions. You may notice a growing restlessness. If you see her face or breathing change with the beginning of a contraction, pause what you’re saying and be present. Match your breathing with hers. This subtle change in your own body is so reassuring to her, even if she can’t hear it. She knows you’re with her.
Getting into active labor, the contractions start to ask for more (from her, perhaps from you). Now she’s likely needing to move, change positions, even lean on people. Again, follow her lead. Silence through contractions is like gold. She already has enough stimuli happening IN her body – more can throw her off.
If you ARE wanting to encourage her, there are helpful ways to do so:
Watch for any signs that she’s coping well: a relaxed face, relaxed body, slow deep breathing, long sustained (usually low pitched) moans, rocking or swaying. Encourage these.
“That’s right. Go towards that.”
Or if she loses a coping mechanism that was working, encourage her to come back to it
“soften your shoulders again.”
“find that sound that helps you.”
Reassurance that she’s doing a good job is so helpful. Anyone, anywhere completing a physical task benefits from encouragement.
“You’re doing beautifully”
“You’re so __________” (whatever you notice she’s doing well)
“I’m amazed by you”
At the end of Active labor, in “Transition”, her requirements intensify. The sheer physicality of her task is apparent. She may be vomiting, shaking, calling out, crawling around, gripping people or things tightly, moaning, sweating, passing bloody show, etc.
Even if you wanted to encourage her through this time, she may not hear you (over her own coping noises). Encouragement between contractions is usually welcome. If you see that she’s losing her rhythm or seems to “lift off” during the peak of the contractions, you can shift into a more stabilizing, directing role. Depending on the situation, I may say things like:
“Come back to that breath. Exhale now. Inhale now…”
“Force yourself to relax. Make your body do it.”
“You can do this. Let it be strong.”
“Make that nice low sound that matches your contraction.”
“No one could do this better.”
I definitely make a concerted effort to BE the way I’m encouraging HER to be. I always aim to match my breathing with hers. I may exaggerate that breathing so that she hears it – it can keep her rooted in her rhythm. I may have to remind her several times through several contractions to stay with her breathing.
It is so normal, and even a hallmark of the Transition portion of labor, that she may say she can’t do this or needs help or wants drugs. This is not always a sign to run for anesthesia. The decision for pain medication is rarely made with a single sentence. It is more often an unfolding decision that takes conversation (between contractions) and time. Depending on what she decided prenatally about pain medication, your response may vary.
During the second stage, pushing, the energy often shifts. The room may fill up with more people, there may be more lights and chatter. The mother, herself, often seems to come back from Laborland and be more present (the hormones are shifting! Like magic!). Here women often prefer lots of verbal encouragement and energy.
Again, this is a time to pay attention to what seems to be working. Some women really do appreciate the energy of support. Some want to just focus quietly. You can always ask her between contractions if the verbal encouragement helps her.
If a laboring woman has an epidural, the mood may be less intense. If her pain medication has fully taken the pain away, then she may be resting or perhaps in a darkened room. As always, take stock of what the mood is like. Adjust yourself to it.
For more information about supporting a woman with an Epidural, please read my post “How to have the best (damn) Epidural”.
You may be surprised by some things – medical events or just the behaviors of a birthing woman. You may be overwhelmed or stressed. I sometimes see the mother of the laboring woman having a particularly challenging experience. Tears are common. OF COURSE she feels empathy and pain for her – this is love!
This stress is what YOU are having to cope with as you support someone in labor. Everyone at a birth copes – whether it’s with contractions or exhaustion or the intense urge to take the pain away. If you get overwhelmed, it’s ok to tap out for a break. As long as the laboring woman has support, excuse yourself to the bathroom or to walk around the block.
Come back to that slow, deep breathing that you started with. Take notice of what your stressed mind is telling you about the situation. You don’t have to believe these thoughts – but observing them gives you some detachment (which can be healthy coping!). Then come back to that breath again – this gives your body the signal that everything is ok.
VARIOUS WARNINGS (things I’ve learned over the years)
– Unless she asks you directly, avoid giving opinions about medical choices. She has her medical staff for that.
– Avoid suggestions for pain medication unless you have talked about this ahead of time. It’s terribly demoralizing to a laboring mom to hear from a loved one that they believe she needs pain medication.
– If you need to express frustration or share your experience, find someone not directly involved in the labor room to talk to. You are there to support the parents. While you also may need support, the laboring couple can not be that support.
– Some words that don’t work so well during contractions: “Relax”, “Breathe” (These direct suggestions just don’t work. They’re loaded with connotation in our society.) Say them in a roundabout way – “use long, slow breaths.” “Soften your face.” etc
– If you have questions about what’s happening, pull a staff member or doula to the side (out of mother’s earshot) to ask them.
And remember, you don’t have to do it perfectly. You have been invited into a sacred space at an important time. The laboring woman has invited YOU because you are special to her. While keeping this primer in mind, do not be afraid to still be yourself and bring your love to her. That’s the most helpful thing you can do.