We've been educated to think of the woman as the exclusive focus of our care. But the truth is that it is not possible to separate someone from the social context in which she lives - from her partner, other children, family, friends etc. Whilst she is clearly the person most affected by her pregnancy, labour and birth, these events don't only touch her but have ripples throughout her world.
Some women want to include this world totally into their experience, whilst others may want to detach some parts of it. Yet others may want their experience to be completely self-contained. Consequently we must take our cue from the woman and accept the people she wants to include. But equally, she may have areas that are a closed book to everyone - and we need to be able to protect her privacy as far as possible.
Involving others
There are studies that show how chosen family members or friends can be a really valuable support to a woman in labour. Bear in mind, however, that even though she may have planned the support she wants during labour, this may change when the day comes. People she was counting on may not be available, or she may decide at the last minute that she doesn't want them to be present.
You need to follow her lead, although she may also ask you for advice. In helping her handle these relationships you may need to exercise all your skills in diplomacy. These may need to be even more delicate for a homebirth, where you are effectively a guest in her home.
But whatever the environment, you and your support network need to be comfortable with her and her support network. Making sure that everyone is aware of everyone's else's relationship and roles can help with this considerably.
When supporters 'support' too hard...
Sometimes a partner will attempt to act as the chief decision maker and this can be a difficult situation to deal with. It may well be that the woman and her partner have made a 'plan' about what she wants and then, when she has gone into labour, he feels that she is not being sufficiently assertive. He may even feel that she is being convinced to do things that he knows - or believes he knows - she doesn't really want, such as requesting pain relief.
She may, in fact, have changed her mind about what she wants when confronted with the reality of labour. He, on the other hand, may have misread her change of mind as 'influence' and consequently be less willing to be flexible. However, all of these problems can be overcome with sensitive negotiation. And it can help enormously to go over any plan they may have before or at an early stage of labour, pointing out that she may want to (or have to) change her mind about what she wants and preparing them both for this eventuality.
It's always best to try to lower the emotional tone of such discussions and allow people space to reconsider their positions without engaging them in confrontation. Looking at how this situation has arisen can also help you know how best to respond. Has the woman and partner/family built a relationship of trust and equality? Have issues been discussed with the partner/family throughout pregnancy? What role have expectations played?
You may need to protect a woman's choices against an over protective partner, but it will be best for all concerned if you are able to explain that her change of mind doesn't undermine his role or support. If necessary, send him off on an important errand. Remember also that supporters can feel tired, anxious and sometimes excluded - all of which will affect their reactions. Supporters need support too!
Tips and tricks
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Discuss beforehand who she wants present at the birth - what role do they see themselves having? Help to plan a real meaningful role of support for them - perhaps allocating tasks that will make them feel useful.
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Establish clear roles for those present - a partner who doesn't feel able to involve himself can have a really helpful role supporting the birth, for instance in keeping everyone fed and watered during a long labour.
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Accept she may use you as a gatekeeper - to keep away people she doesn't want around. This is not a pleasant task but it is a really important one. If you can, try to find ways of telling people which keep their self-esteem intact.
Further reading
Green J, Kitzinger J, Coupland V (1990) Stereotypes of child-bearing women: a look at some evidence
Midwifery 6: 125-132
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C 2003 Continuous support for women during childbirth.
Cochrane Database Syst Rev. 2003(3):CD003766.
Oakley A, Hickey D, Rajan L (1996) Social support in pregnancy: does it have long term effects?
Journal of Reproductive and Infant Psychology 14: 7-22
Schott J (1994) The importance of encouraging women to think for themselves
British Journal of Midwifery 2: 3-4
