Childbirth educators should be realistic about what might happen during labour. One of the reasons parents come to prenatal education programmes is to find out ‘what birth is all about’. They want us to tell them what to expect so that they can be prepared for the events that lie ahead. They assume that knowledge is the key to coping better with labour and the new baby and that if they just have the right information in advance, all will go well.
It certainly sounds feasible! The trouble with expectations like these is that major life events rarely go to plan and this can lead to disappointment with the eventual birth experience for the parents. We too may feel let down if parents constantly find reality is different from their expectations, and this can lead to burn out and frustration on our part.
It is not possible to predict the future (yet!) so anticipating what will happen during the last weeks of the pregnancy, labour and birth and the early days with the new baby will be impossible. This uncertainty is a major concern for parents, especially those who have the impression that all they need is ‘good preparation’ for everything to run to plan. The ridiculously limited nature of many prenatal programmes (a typical example would be four sessions of two hours each) may reinforce the idea that all it takes to achieve competence as the parent of a new baby is eight hours of lecture attendance!
The reality – that no one is able to predict the events to come – must be addressed squarely, right from the start. We must help parents shift their view from dogged tunnel vision to one of acceptance of the unpredictable nature of birth and of readiness to embrace the unexpected with flexibility and tolerance. Taking on these tasks need not be gloomy and negative – indeed, fostering a sense of adventure can be practical and exciting.
The basic strategy will be to help them develop useful skills and tools for managing the sea change that is involved in becoming a new parent. Incorporate ‘problem solving’ strategies as often as you can into your presentations to give parents a chance to hone their skills and gain confidence. Ways of doing this can be found in an earlier article *.
Developing realism also means being honest about the possibilities ahead. We have a responsibility to let parents know of their options and choices, even if we know they may have limited success in finding or using them at our local maternity unit. Our programme must not be biased or censored in any way – it is not fair for us to make assumptions about other people’s attitudes to risks, or to persuade them to our viewpoint. ‘Telling it like it is’ can be done using positive language to minimise creating fear and anxiety. For example, evaluate the way in which you describe the birth process. Contractions are often ‘intense’, ‘productive’, ‘business- like’, ‘organised’ and ‘powerful’. This is much more useful than describing them as ‘pains’, which may feed into fears of not being able to manage the hours labour will take. Other suggestions for presenting birth and parenting realistically include:
● Being careful about the use of birth plans. The very title ‘birth plan’ suggests an organised approach to the process, when the reality is often very different. It can be useful to have parents construct a list of ‘wishes’, ‘desires’ or ‘needs’ as these can form a very useful basis for good communication with care givers. However, try to encourage the listing of open-ended requests rather than dogmatic demands. For example, it is more useful to state’ I want the freedom to adopt any position I need to use during second stage’ rather than ‘I want to squat for the birth’.
● Bring new parents into the group to talk of their experiences. Pregnant parents relate much better to peers with a new baby than to a professional who seems so much more competent than themselves. Let the new parents have the floor and don’t try to filter what they say – if they seem excessively negative, throw in a question such as ‘what have you discovered from this experience?’, or ‘looking back now, is there anything you would do differently another time?’ to draw some positive reflections from them.
● Encourage parents to draw on other experiences in their lives as a basis for developing action plans for this new adventure. Many will have had considerable experience with managing change, dealing with professionals, seeking and using technical advice, handling other people’s feelings and reactions and developing management strategies to get a job done. These skills can be transferred to this new situation, bringing a touch of realism that can be reassuring.
● Enable them to develop practical strategies they can apply in various situations. Men, in particular, like to know what they can do if a problem occurs. They hate feeling helpless when a situation obviously demands action. They like to ‘troubleshoot’, diagnosing the condition at hand and devising ways of working it through for a positive outcome. It may seem negative to focus on ‘problems’, but this is a realistic approach, given that hospital staff seem to see any deviation from their concept of ‘normal’ as a problem that requires either proactive action or intervention.
● Show videos that include difficult moments and realistic scenes of labour. There are some that show transitional behaviour, women making noises and the enormous effort of second stage. Talk about what the woman is doing and discuss the actions that her care givers and supporters are taking. An interesting alternative is to use audiotapes of women having contractions, pushing in second stage, newborns crying etc. These can be particularly powerful in creating realism. Try taping the sounds in labour ward as the baby is born – you will be amazed at the level of background noise, the comments of the staff, the instructions being given and the reactions of everyone in the room.
● Encourage parents to seek answers to their own questions about hospital-based care and its policies and routines. Send them off for their labour ward tour armed with a list of questions they can ask, such as ‘where are the mats and beanbags kept?’, ‘where can I get drinks and snacks for myself and partner during the labour?’, ‘where are the bath and shower located so I can use them for easing the pain of labour?’. You may know the answers to these questions; however, encouraging the parents to seek the solutions for themselves gives them a chance to interact with hospital staff, judge their openness to the requests and assess potential difficulties. Their discoveries can then form the basis of later problem- solving exercises as parents devise ways of having their needs met during labour.
Once of the most useful services we can perform as educators is to let parents know that pregnancy, labour and birth are not always rosy, blissful experiences or hard, impossible or complicated. Straight talking, avoiding euphemisms and providing accurate, non-emotional descriptions will all help get this message across. Honesty is an important element too – we must not try to gloss over hospital management policies for example, but let parents know the possibilities so they can ready themselves to negotiate appropriately. All of this can be done in a positive way, with the emphasis on their ‘right to know’. Parents are much less likely to come to the reunion saying ‘you never told me it would be like that!’ if we try to be as realistic as possible from the start.
* Robertson A. When you’ve got a problem…The Practising Midwife 1999; 2(7): 46-7.