Who will join you in the birthing suite?

Some experts say husbands and partners should keep away from the birthing room but really it's up to you who gets to be there on the big day, writes Sarah Tennant.

For many women, who's attending the birth is a decision that's fraught with the kind of tension normally associated with planning a wedding. Will your mother-in-law be offended if she has a smaller role to play than your mother? Should you invite your childhood best friend you dropped out of touch with years ago or your new co-worker who really "gets" you?  Should you hire a videographer? Do you want an event staffed by experts or amateurs? Does your partner really want to be involved at all? And whose day is this anyway?

Just as with wedding guest lists, it helps to start with the principal cast. Mother and baby pretty much have to show up. Who else?

The experts
Most women take the presence of a midwife or two or, more rarely in New Zealand, an obstetrician, as a given.  When I've asked other women, "Who did you have at the birth?" often I'm told, "No one." Meaning, "Just the midwife and my partner."

Women in New Zealand generally have the luxury of getting to know their midwives before the birth - even if a disproportionate number of midwives seem to go on holiday just before the due date! Even the back-up midwife has usually done a prenatal visit or two so women aren't birthing with a stranger.

That said, unfamiliar personnel do tend to creep into the birth room. My sister-in-law remembers a stream of doctors, nurses and midwives tromping through her room during her hospital birth. My mother had her first baby at a teaching hospital, being stared at by medical students. Not surprisingly, many women find the presence of these observers inhibits labour.

At the other end of the spectrum, some women opt out of trained assistants altogether. Unassisted childbirth, also known as "free-birthing", involves women taking complete charge of their own labours. Many labour with their husbands, friends or children present but midwives are not invited. Not surprisingly, this is a controversial practice. Home-birthers are quick to distance themselves from the free-birthing movement, pointing out that home birth's impressive safety record is tied to the presence of skilled attendants. No good studies exist on the safety of free-birthing.

Ideally, a good midwife is as unobtrusive or hands-on as the mother desires. I preferred my midwife to stay out of the way and let me do my thing, stepping in only when needed. Other women like a midwife who hugs them and cracks jokes between contractions. It's not uncommon for a woman to switch midwives partway through pregnancy, until they find one whose personality and birth philosophy clicks with her own.

The partner
Another obvious birth attendee is the baby's father. Since the husband-pacing-the-hallway days of the 1950s, the pendulum has swung to including fathers at births and antenatal classes as a given. I even had a few pitying looks when  I turned up sans husband to a Nappy Lady workshop - all the other mothers had their partners with them, I reported reproachfully when I got home.

Renowned obstetrician Michel Odent made waves when he declared that men could be as much hindrance as help in the birthing room. Odent claimed that men tend to secrete adrenalin in the presence of a labouring woman, thus messing with her oxytocin levels and preventing her from entering the primal, non-rational, calm headspace required for an efficient labour. Partners can also adopt the stereotypical "fix it" mentality common in males, trying to push their wives into epidurals to get rid of the pain.

More controversially, Odent stated that witnessing childbirth can cause men to experience postnatal depression and even destroy the sexual attraction to their partners.

Opinions on the blogosphere are divided. Many women recounted - fondly or otherwise - their husbands' fumbling attempts to help during labour. Some men panicked, some became distant, some relieved their tension by bossing around the nurses, while others became engrossed in the machines that go ping.

Many women "demote" their partners during subsequent births. As one woman put it, "My last two births did not include him and it was so much more peaceful."

On the other hand, plenty of women insisted they couldn't have done it without their partners. Many men, even those dubious about birth beforehand, step up to the plate and massage, pass cold drinks, squeeze hands and wipe hot foreheads with the best of them. And whether birth is a joyous or a traumatic experience, going through it together can give couples a newfound respect and appreciation for each other.

The kids
For some women, having the new baby's siblings present at the birth makes for a magical family experience. Others flee to a hospital or birthing centre just to get away from the kids.

There's no evidence that having well-prepared children witness a birth is likely to traumatise them. Most kids are pretty matter-of-fact about childbirth. During my pregnancy my three year old happened upon me while I was watching a graphic birth video. She watched intently and said with a big grin, "That baby came out of the lady's parts! He's so cute!"

Having kids present might not be all smooth sailing, however. Sensitive children may be disturbed by Mum screaming or grunting, but more likely, it's the kids who will disturb the mother. Young children in particular may want to splash around in the birth pool, demand snacks and stories, or even want to breastfeed mid-contraction.

Some mothers get around this by appointing a dedicated "child wrangler". This works particularly well in a home birth environment - the babysitter can watch the kids at the other end of the house during the "boring" part of labour, and bring them in - or take them out - when things get interesting.

The gang
Having a bevy of female labour supporters has a long tradition. "God's sibs", or gossips, used to turn up at births and provide a loving party atmosphere.

Not everyone finds the idea of sorority birth attractive - personally I can't think of anything worse than giving birth with my (much-loved) sisters and girlfriends present. However, as long as everyone present is supporting the labouring mother (rather than just rubbernecking), having friends around can make the birth experience easier and more pleasant.

Another option is hiring a doula. From the Greek word for slave, doulas are not midwives, but hands-on birth support people. Because they don't have medical responsibilites such as note-taking and checking foetal heart tones, doulas are free to get their hands dirty with the mother. Swaying, chanting, massaging, wiping foreheads, even hopping in the birth pool - these are things a doula might do which a friend or partner may not feel comfortable doing. Perhaps because of this, one study found that women with doulas tended to have shorter and less painful labours. Dr John H. Kennell went as far as saying, "If a doula were a drug, it would be unethical not to use it!"

Making the list
Before issuing invites, it's worth bearing these recommendations in mind:
🌼 Only invite people who get along well with you and each other. If your mother and mother-in-law can't stand each other there will probably be tension in the room, no matter how devoted they are to you. Think back to previous occasions - were they able to put their differences aside for you and work harmoniously (on your wedding day, perhaps)?
🌼 Invite people who will support and help you, not to "experience birth". Birth is indeed a fascinating experience and many people are keen to witness it regardless of how well they know the mother. But don't let yourself get sucked into being a photography project or an anthropological data point. Someone who is dead keen to see the birth as opposed to helping you through labour may make a fuss if you decide part-way through to kick her out, or need her to take care of an older child during the moment of birth.
🌼 Don't invite anyone with whom you feel the need to be dignified. I'm sorry if this comes as a shock, but it's highly likely that anyone who attends your birth will see you poop, bleed, vomit, strip off all your clothes and cuss like a sailor. If you don't think you could look your aunt in the eye after that don't invite her. Some women say reassuringly, "During labour you won't care who sees you naked." But that's not actually true for everyone.
🌼 Make sure your attendees aren't squeamish. I know one woman who changed her mind about inviting her mother to the birth after she made disgusted comments during a birth video. The last thing you need in labour is someone saying, "Eeeww".
🌼 If young children are present, have a wrangler available. This shouldn't be the same person you'll be relying on in the sticky moments.
🌼 Don't burn bridges! According to my first midwife, a fair percentage of first-time mothers don't want their own mother at the birth… until the labour pains kick in. An "I'll call you if I need you" approach might be wiser, and more tactful, than, "Heck, no."
🌼 Only invite people who support your birth choices. A friend of mine left her mother off the invites because her mother was very uncomfortable with the idea of a home birth and my friend didn't want the extra stress.
🌼 Don't invite anyone out of guilt. The privilege of attending a birth shouldn't be confused with family politics. You don't have to invite your mother-in-law because she lent you money to buy a car, nor your sister because she's single and your mother is worried she'll never get to experience childbirth, nor your cousin because she invited you to her labour. Last but not least, If it all gets too much, have the baby, then call everyone and tell them about your "sudden" birth.