Why We Should Be Protecting Our Birth Partners...
To have a birth partner in labour is not a privilege. It is a fundamental right held by all pregnant women. Regardless of the type of birth she has.
But it is a right that so many women are being denied during this Covid-19 outbreak. Women are birthing alone and unsupported by those they need the most. And ironically, it is potentially even more important to have that safe and comforting person with you when birthing a child during this pandemic.
So why are women having to birth alone? Well, as there is a growing amount of uncertainty surrounding Covid-19, hospitals are taking some pretty drastic actions to prevent what they categorise as “risk of exposure”.
Here in the UAE, most hospitals have reduced birth partners to one asymptomatic person. How completely sensible and manageable. But there are also places that are prohibiting birth partners altogether.
There are a couple of hospitals here that have banned Dads from entering the operating theatre for caesarean sections. Imagine going in for what is not just major abdominal surgery, but is also the moment you become parents and your world changes forever, and not being able to have your chosen person there for support.
Now these birth partners are usually Dad. If the birth partner is the Dad then they have most likely been living with their partner the entire time the epidemic has been going on. They are allowed in the labour room and on the postnatal ward. So is risk of exposure really the reason here? I am wondering if it is more likely a reluctance to provide the partner with the required amount of PPE (Personal Protective Equipment) to enter the operating theatre in order to protect stocks.
Some hospitals are claiming it is a DHA (Dubai Health Authority) rule. Strangely I also work in a DHA governed hospital and have heard of no such rule. Nor have I had confirmation of this rule from the DHA themselves. So this is telling me it is your hospitals choice to allow women to go without support in labour. If this is the case for you here in the UAE then I strongly suggest that you reconsider finding a hospital that will allow a birth partner under every situation. At this point it is important to remind you that if you for any reason need a general anaesthetic for a caesarean section, we never allow Dads or birth partners in the theatre.
Now don’t get me wrong. I am all for restricting visitors during this time. We don’t need to increase anyone’s risk of exposure, patients, families and staff alike. More than one birth partner, whilst ideal, is not sensible, BUT to remove support altogether is inhumane.
Just to drive this point home let’s revisit what we know about support in labour and why it is crucial for women to always have access to this.
We know continuous support during childbirth is a WHO (World Health Organisation) recommendation (WHO 2018). And according to a Cochrane Review (gold standard evidence) women who receive continuous support in pregnancy and birth:
Are more likely to give birth vaginally
Are less likely to need an assisted delivery (forceps, kiwi cup)
Are less likely to take pain medication
Report an increase in satisfaction with birth experience
Are less likely to have babies who have low APGARs at 5 minutes (babies born in better condition)
So physically and emotionally, having continous support has its benefits. But why is this?
We all know about the fight or flight response that releases high levels of epinephrine, triggered by fear (potentially stemming from feeling unsupported during birth). When this occurs the research tells us that it can have a knock on effect on fetal heart rate patterns, uterine contractions, can create a longer active labour and result in low APGAR scores.
These can be applied to any type of birth. Fear is the major instigator of the fight or flight response. So why would we remove the one thing that we know has been proven to reduce fear in mothers.
Giving birth in a hospital can be anxiety and stress inducing for many women. These feelings can then begin a cascade of feelings such as lack of control and disempowerment. A birth partner is there to advocate for a mum. To ensure that her needs and wishes are met in the best way and to ensure that she remains empowered throughout the entire birth.
They are a crutch that helps a woman steady herself against the institutional norms that plague labour and birth in hospitals.
From a midwives point of view I find it absolutely essential to have a birth partner present if that is a mother's choice. To have someone who knows a woman inside out is a very useful tool to understand what she is going through, to notice deviations from her normal thought pathways or processes, and it undoubtedly helps build a rapport!
All birth professionals want to enable the best start in life for every baby, and also to enable the best start to life as a mother, that in itself is a rebirth of sorts after all! The physical, emotional, and psychological benefits of having a support person present for your labour are profound and far reaching, and can have an impact long term. I for one believe we must acknowledge the effects that denying this may have on women, babies, couples, and families.
Now I am going to digress a little... bear with me! On the flip side of all of this I cannot deny that reducing the amount of people in a labour room has been a welcome change. Having multiple relatives present does not often allow labour to progress well physiologically, it is far preferable to create a quiet, calm environment with as few interruptions as possible to enable the labour hormones to be maintained at peak level. Having fewer people present has also allowed me to fully utilise the tools I have accrued during my training and throughout my career when it comes to supporting women in labour, as rather than interacting non-stop with 10+ friends/relatives I am actually able to completely focus my attention on the woman I am caring for in order to appropriately respond to her needs.
It has been so positive seeing the realisation (here in the UAE) that a midwife can in fact do it all. We have you covered physically as well as emotionally and mentally. We are having fewer disturbances and really getting to bond with women and their partners.
Where we have previously been written off in this country as ‘only providing the clinical aspect’ and treated as such we are now getting back to the roots of our profession.