Monday, October 08, 2007

Too many cooks?

My client had her baby over the weekend. All went well, though it was a very long induction.

When she delivered, the following people were in the room:

birthing mother
mother's husband
1 midwife
2 nurses (mama's and baby's)
2 pediatricians (some low heart tones and meconium)
1 doula
2 grandmothers-to-be
3 great aunts-to be
3 second cousins once removed-to-be

At the moment of the baby's birth, one of the girls (maybe 11-13 years old?) fainted. It was completely chaotic.

I think women should have whomever they want with them at a birth. But do they really know what they want?

For all the effort we put into "informed consent" for medical procedures, we don't put much of any into the ramifications of a crowd at a birth. Moreover, familial pressures and expectations can be far stronger than those we worry about from the medical establishment. It's one thing to say no to a procedure; it's quite another to say no to your mother!

In this case, my client repeatedly had to ask her guests to quiet down so she could concentrate. I have seen this at many births with a crowd. Folks are bored or nervous and turn to small talk to pass the time. The birth room becomes the equivalent of a breakfast nook.

What do you think? Should there be limits on birth guests? How does one deal with guests who are disruptive to a birth if the mother isn't asking them to leave?



Anonymous Maica Preoteasa said...

I am all for crowd control at a birth, usually in numbers but not necessarily in numbers.

I, too, have seen mothers suddenly regret inviting a "cast of thousands" to their births, and I have also seen a mom realize in an instant (although much too late) that the *one* friend she invited was absolutely the *wrong* person to have there. In 7 years of doula practice, I have seen just a handful of dads who really wanted to be there and took great pains to try to understand and support the mother, even attempting to sprout some sort of intuition in some cases. Among the other dads I've seen, some tried to take control of the situation (by getting angry or sulking, watching tv, being hostile to staff, not showing up, using juvenile distraction) thereby reorienting all attention to themselves and affecting mother and her willingness to birth.

Then again, I have seen things work out really well for large families -- one in particular stands out in my mind. They seemed to have a code of behavior among them -- there was only peace in that birthroom, and people accepted my suggestion as the doula that they take a break if things were getting intense for them. There was reverence at that birth, despite the fact that there were many people there.

I guess what it boils down to for me, is that it can work any way you slice it as long as the mother realizes her reasons for admitting so many people to the big event and lays some ground rules (before the fact). I think it gets harder with a grand assembly of people, but having the *one wrong guest* is also a train-wreck. If Mother wants Auntie Madge and the cousins there, it should be because she wants them there and has prepared them for it, rather than because she *should* ask them to be there. There has to be an ejector seat, operable by the Mother or by her proxy. The guests need to know that they may be asked to leave for a period, and that it is more about the mom than them.

10:57 AM  
Blogger Anne said...

I always tell clients, "You can never have too many supportive people at a birth. You can have too many spectators, but if people are genuinely supportive, there's always a job for them."

Sometimes a crowd is just what the mom needs to bolster herself. I was at one birth where there were two nurses, a midwife, two friends of the mom, the husband, and me. We all had direct physical support that we were doing - except the husband, who was supporting the mom by praying for her. She really thrived on all the physical and spiritual support.

I like Maica's idea of asking moms to remind their guests ahead of time that they may be asked to leave. I've never had to eject someone permanently, but I have asked a crowd to give the mom privacy for a while.

I once heard a good rule of thumb for women deciding whether to invite someone to their birth: Would you be comfortable throwing up in front of this person? If not, then ask them to come visit after the baby's born!

12:52 PM  
Blogger mamasara said...

I also discuss the crowd scenario with clients in our prenatal meetings so they are aware that they have choices if the time comes to move people out of her room. If too many people becomes a distracting factor for mom, I ask her if it's alright for some to leave and let her tell me who is OK to leave. I then either let them know or discreetly ask the nurse to show them where the waiting room is so that "mom can get some rest".

BTW, my word verification for this post begins with vjj, the name Oprah has given her vagina. Weird.

1:32 PM  
Blogger clara said...

I kind of think it should be the same number of people who were there when the baby was put in there in the first place, plus an attendant or 2. If people want to watch a birth, watch the Discovery channel. I've done it both ways, big group to just my husband & dr. Its kind of cool to keep it intimate, for me anyway.

8:28 AM  
Blogger Shells said...

It is highly unfortunate that family members cannot "read" the mother out of respect for her.

During my labor, I had my parents and my (then) husband. I needed the support of my mother desperately. I had a sister in law and her family that wanted to be there, they showed up later than expected, came in, spent some time with me, but then realized that I was going through transitional labor and couldn't concentrate or talk and that they weren't much help. They kindly left, without anyone saying anything, and waited outside. I found out later that they were waiting just outside the door and could hear the excitement of birth but they were far enough away that I didn't have to think about them at all. That is respect for the mother, even when she cannot tell you what she would prefer.

11:31 AM  
Blogger reeciebird said...

I asked my mom to be at my first birth, and really regretted it. I thought she would be a huge support, but she brought my sister - just home from Iraq - and I felt like she was running the show rather than me. I was naked from the waist down and getting on my hands and knees with every contraction. I had no privacy and realized, too late, that I needed some.

Recovery was worse. I felt awful after a cesarean, had a bad drug reaction, and two more family members came who arrived after the baby. One talked on the phone while the other spent her time informing the nurses that they needed to do more for me. I had not personally asked any of these people to be there, except my mom. She invited everyone else, assuming it was a family affair. It wasn't until my doula came in to check on me and said, "I'm going to leave you alone now and hopefully you'll be able to get some sleep," that everyone else took the hint and left. Later, we even had relatives who showed up unannounced after being asked to put off their visit until we were at home.

My second child was born at home and it was wonderful! No one was invited and no one came! My doula and husband were there for labor, and my midwife and assistant showed up in time to catch. Next time, I may not even have a doula.

4:45 PM  
Blogger doulicia said...

Thanks, all, for sharing your thoughts and stories. I like the distinction between supporters and spectators that several of you make.

In this case the woman seemed to know there would be many in the "spectator" category but not realize until too late (I feel for you at your first birth, Reeciebird) that spectators can really be a hindrance.

I think the important piece is, as MamaSara and anne point out -- to have expectant parents prepare their families for last-minute changes to the "ya'll are invited" plan.

9:14 PM  
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5:37 PM  

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