Learning Objectives
By the end of this section, you will be able to:
- Explain the importance of the partner or support person during the process of labor and birth
- Explain the importance of the family to the person who is laboring
Not so long ago, people birthing in hospitals in the United States experienced labor and birth without support people present, in a medicated state, and with little to no memory of their birth. The shift in our culture to include spouses or partners, trained birth support people like doulas, and even photographers or videographers has occurred slowly. Research shows that the presence of these support people, especially those experienced in birth like a doula, can improve the experience of the birthing person, reduce trauma, and improve health outcomes (Sobczak et al., 2023).
Partner and Support Person Adaptations during the Process of Labor and Birth
Some partners feel empowered in their role as a non-birthing partner; others may feel disempowered and unsure of their new role. Some partners rise to the challenge and provide excellent labor support that meets or exceeds the quality of a trained birth doula; others are less prepared or too overwhelmed to provide support in the way preferred by the birthing person (Saether et al., 2023). The experience of both the birthing person and their partner can be improved by taking preparatory classes on labor, birth, and the postpartum period and discussing the birth with experienced parents (Vanderlaan & Givens, n.d.). The planned support person should be prepared to experience the sights and sounds of birth, know their own limits or needs, maintain their own hydration and nutrition so that they are able to provide support, and have any unanswered questions addressed before the onset of labor so that they feel prepared. Nurses can support the birthing person’s desired level of involvement of the support person by asking the patient or by reading the birth plan.
Some birthing patients are unable to have their desired partner with them at the birth for multiple reasons (military, no longer in the relationship, unavailable). The nurse can be an emotional and physical support to the patient. A doula can also be the support person. Doulas often have basic training in physical and emotional support of laboring people and may have certification. Doulas can suggest position changes and comfort measures, as well as be a reassuring presence at the bedside. Research shows the addition of an experienced support person can improve birth experiences (Sobczak et al., 2023). In the current birth culture where trauma can occur, the necessity of support cannot be stressed enough. This is especially true if a birthing person is a person of color or belongs to another marginalized population.
Family Adaptations during the Process of Labor and Birth
Which family members are present during the four stages of labor is a very personal choice that may be impacted by the route of delivery, birthplace policies, health issues or the presence of infection, the health of each relationship with the birthing person, and cultural expectations. During the COVID-19 pandemic, restrictions on support people caused worsening of outcomes and an increase in negative experiences of birth as well as postpartum mood changes like depression, according to research (Shuman et al., 2022). Historically, family involvement during pregnancy included giving advice, helping prepare for birth, and attending the labor and birth; this involvement decreased stress and increased emotional security (Hawkins et al., 2021). Nurses should be prepared for supporting birthing people and their families by providing education, reassurance of the normality of labor and birth experiences, and family access to the extent the laboring person wishes it. Each family will have differing needs for their birth based on personal, societal, and cultural expectations. Prioritizing this support can improve outcomes and experiences for families.
Legal and Ethical Issues
Surrogacy
Surrogacy can be a significant ethical or legal issue with varying levels of complexity based on the circumstances and the state where the pregnancy occurs. Nurses need to be aware of surrogacy laws, facility policy, and plans for security around these very unpredictable pregnancies. For example, consider the following situation: Fetal heart rate decelerations are present, and the birthing person is a surrogate for two intended parents who are present for the delivery. The provider recommends moving to a cesarean birth immediately for fetal protection. The birthing person declines and requests alternative options due to the risks of surgery to their body. The intended parents demand the surgery begin immediately. What are the laws in the state? What are the facility policies, and what is included in the contract in this specific case? This is just one example of conflicts that can arise that nurses should be prepared to navigate or escalate through the proper chains of command.