“Good preparation can facilitate an easier birth, faster recovery, more effective breastfeeding and a healthy bond between parents and baby. Preparation is also, crucially, about preventing psychological disorder.”
“Women show the pregnancy physically but are not encouraged to live it, to show the anxiety, the tiredness and the muddle-headedness. It is this ability to feel and show the changes in pregnancy, labour and postnatally that enables both mum and dad to best meet the challenges of parenthood.”
The early European explorers wrote descriptions of tribal childbirth that seem amazing in our technological age. Women working hard in the fields would stop only when labour contractions became overwhelming and birth was imminent. They found a quiet place away from the rest of the tribe attended by another trusted woman, and gave birth, returning to the tribe with the newborn shortly after. Birthing accidents were rare and recovery fast. Why?
Mind preparation – the benefits
Tribal women remained physically fit, which was important, but even more relevant, was their psychological preparation. These women were confident in their bodies’ abilities and they had a clear focus. They also had informational support from wise elders. Such psychological preparation is so important for pregnant women and their partners today. Good preparation can facilitate an easier birth, faster recovery, more effective breastfeeding and a healthy bond between parents and baby. Preparation is also, crucially, about preventing psychological disorder.
The statistics on postnatal psychological disorders are alarming and I see the results of such problems in my practice every day. Beyondblue, the national depression initiative, estimates that one in seven Australian mums are at risk of developing post-natal depression. Post-natal depression interferes with mother-baby bonding, seriously affects the quality of a mother’s life and makes couple relationships difficult. Studies in Australia, the UK and US reveal that some six percent of new mothers may also have PTSD; Post-Traumatic Stress Disorder, something that occurs when a mum’s nervous system is highly overwhelmed by childbirth perceived as a threat to life. This seems to occur where mothers are highly anxious and ill prepared and where health professionals do not notice or attempt to alleviate mum’s distress. Depression and post-traumatic stress decrease the effectiveness of the ‘holding’ the mother is able to give to her child and may contribute to behaviour problems in young and school-age children. Prevention of such disorders is crucial and mind preparation for birth is one major way to achieve this.
How do I prepare?
Mind preparation before a modern-day birth is a process of taking time out to experience all the feelings you have about pregnancy, birth and caring for a child. “It’s about trying to slow women down enough so that they are willing to feel and live their pregnancy,” emphasises Jane Suttle, a Sydney-based Infant Mental Health professional who helps families adjust to the pregnancy and postnatal year. Jane runs classes for pregnant couples and postnatal groups where mothers can discuss their feelings and needs after birth. Jane’s practice philosophy is based upon her view that twenty-first century life promotes a dismissive stance towards childbirth. “It’s seen but not lived,” remarks Jane. “Women show the pregnancy physically but are not encouraged to live it, to show the anxiety, the tiredness and the muddle-headedness.” It is this ability to feel and show the changes in pregnancy, labour and postnatally that enables both mum and dad to best meet the challenges of parenthood.
When do I start?
Mind preparation for parenting should begin before conception, ideally, but this is rare. The pregnancy may be unplanned with no time to contemplate what is to come. Even couples that do plan the right time to have a child, may work out the finances, move house yet think no further about the psychological changes involved. Couples who make time to attend pre-natal classes may get so caught up in the breathing and pain relief issues of labour that they do not have mental space to think about the pregnancy, mum’s changing body, the baby’s changing features and how they will face the task of providing emotional support to this baby and to each other.
It is just these issues that need to be addressed for the birth of the baby to herald the beginning of a positive family life and timing is important. The first trimester is a period of excitement at discovery mixed with the grinding tiredness and sometimes nausea that many women feel. Simply coping with these factors is momentous. Once this phase passes, around fourteen to sixteen weeks, the opportunity arises for discussion, reflection, sharing of thoughts and feelings about the future. This fits nicely with the quickening, mum’s first sense of the baby’s movements in the womb, which occurs somewhere around sixteen to twenty-two weeks of pregnancy. Planning for birth can now begin!
The six-step planning process
Psychological preparation for birth encompasses many things; it is not simply a matter of jotting down a hurried birth plan and hoping it all works out. Good preparation means thinking about the transition to parenthood, being truthful about how parenting may affect you and working out strategies to manage the difficulties that will undoubtedly occur. It is all about making childbirth real.
1.Reviewing your past
The first step in birth preparation is strangely enough, all about looking back. This step may usefully be called, ‘ Getting to know you’. A couple can take time out on their own or visit a counsellor to look back on their lives to date and to work out the kind of people they have become. Together, you need to review your childhoods, look at the role models your parents were and work out what aspects of your own upbringing you value and want to pass onto your own child and what aspects hurt you and need to be discarded. Ask each other, “What kind of person do you feel I am?” and listen to each other’s opinions. With the help of your partner, you can begin to see whether you are calm or anxious, perfectionistic or laidback, extrovert or introvert and how such traits may affect your parenting. It also helps to talk to each other about the highs and lows of your life and how you dealt with these.
2. Couple communication
The second step in preparing for birth is to strengthen the communication between you as there is no true partnership if it is based on poor communication. You are different people with different backgrounds and ideas and you can only stay together as a team if you can talk to each other openly and honestly. This also requires being able to listen.
Once you have entered the second trimester, establish a habit of having an informal family conference once a week. Pull out the pregnancy book and talk about the stage your baby is at. Talk about your feelings that week, good and bad. Regular communication will enable you to begin talking about labour and delivery as that day draws nearer. You both need to air your concerns and your hopes for this time. This will enable mum to communicate her needs to her partner before labour begins, as dad’s major role will be that of advocate for her. A woman rarely articulates her needs well in the middle of major contractions.
3. Establish a support network
“The choice of birth professional is possibly the most important choice a woman will make during her pregnancy,” states Melbourne Midwifery, a private service dedicated to ensuring the birth outcome is the most positive it can be. Take time out in your pregnancy to ask for recommendations, telephone midwives’ and doctors’ offices to get a feel for their practice philosophies and ask questions of the professional you eventually select. Open communication between a couple and their health professional is crucial.
Depending on your needs, other people can usefully play supporting roles in pregnancy and birth. Many women find their own mother to be very supportive “Mums need their mums in pregnancy to bounce ideas off, (for a mum) to keep her daughter in mind whilst the couple keep the baby in mind,” Jane Suttle advises. “If you don’t have this, (perhaps mum is overseas or has passed away), work at developing nurturing support from other sources,” she recommends. Look to your partner’s family, your own extended family and close older female friends.
Couples who lack major supports, perhaps those who are living abroad or who have had family estrangements, can think about using skilled professionals. A specialist counsellor can help support you through the ups-and-downs of this life change. For the birth itself, doulas are an alternative choice for a couple that feels that they need an experienced advocate in the delivery room. Research shows the presence of a doula can reduce the need for pain medication and Caesarean Section and can increase breastfeeding success.
4. Managing anxieties
Every prospective parent feels some anxiety at some time. Anxiety is normal in that it spurs us on to learn about what is to happen and to be ready to care for a new life. However, in some mums and dads, anxiety takes a hold and dims the joy of anticipating a baby’s arrival. Definite techniques are then needed to manage the anxiety, which can unsettle the unborn baby and leave mum depleted physically and emotionally.
The best anxiety relief technique I teach parents is that of deep breathing. You are likely to learn a version of this in antenatal classes but it also helps to understand why it works so well. Anxiety is caused by the brain sensing danger and triggering an instinctive ‘fight or flight’ response where heart rate increases, as does blood pressure and digestion slows. When the danger has passed, the brain triggers the opposite reaction but in people with long-lasting anxiety, the brain continues to sense danger and maintains fight or flight. Deep breathing is a way to tell the brain danger has passed and it can ‘let go’. Lie down somewhere comfortable, place a book on your stomach, slow your breathing to about ten breaths per minute and breathe deeply from your stomach making the book rise and fall with each breath. Practise regularly until you can breathe deeply standing up, without the book!
Another important anxiety management technique is to look to your past and identify other new tasks you successfully negotiated. How did you calm yourself for your first ever exam? How did you cope with your first relationship break up? What skills did you learn from the first serious conflict with a relative or friend? Now use these same skills to add to your anxiety-battering arsenal!
5. Writing a birth plan
As the pregnancy approaches twenty-eight weeks, begin to write your birth plan as a couple. Nothing ever happens exactly as we plan for but it helps to think seriously about what you would like. Who will you call when you first go into labour and will anyone else apart from you two be present at the birth? How will you both manage the early contractions at home? How will you get to the birth centre or hospital? What kinds of pain relief do you think might work for you? What positions may you use to labour and to give birth? What is Dad’s role going to be – to massage, to ask for help, to draw attention to the birth plan? Will you have the baby delivered onto you? If you are to have a Caesarean, who will care for the baby while you are cared for? All these questions, when thought about and written down, help you to visualise how you want to give birth. It gives a sense of control and of being consulted.
6. And afterwards…
Finish off with a “First two weeks plan,” to ensure that the baby in your arms after birth isn’t an enormous shock. “The before-birth and after-birth are cut off completely (for most couples),” emphasises Jane, “yet the baby (who is born) is the same baby as the fetus inside the womb. I bring pregnant mums into the postnatal group to help them bring their baby to life.”
Do your own version of bringing the baby to life. Think about the help available to you once you are a family and write the names of all your helpers on a sign on the fridge complete with telephone numbers. Also write down professional organisations (such as the ones below) that may help. Buy a Baby Book that seems to have good, practical advice. Above all, think about that tiny life you will soon hold in your arms, how you will soothe him or her and how you will soothe yourself and each other when times are tough.
Resources to assist with planning for birth
- Contact Birthrites Australia, which has resources for pregnant couples at birthingrites@zipworld.com.au
- Read ‘The Doula Book – How a trained labor companion can help you have a shorter, easier and healthier birth,’ by Marshall Klaus, John Kennell and Phyllis Klaus.
- For pre-birth breastfeeding information and support contact the Australian Breastfeeding Association at www.breastfeeding.asn.au
- Request the beyondbluefact sheet about postnatal depression by calling beyondblue on (03) 9810 6100.
