The Subtle Impact of Interference

As labor doulas and childbirth educators, we prepare our clients with information about routine interventions. We go over the benefits, risks and alternatives to these interventions, equipping parents to make the best decisions for themselves and their babies. But no one has to place a needle in an arm to alter the course of a labor. There are less obvious, more subtle factors affecting our clients’ births.

All the good birth books talk about the phenomenon, but we don’t really have a name for it. I call these influencing factors “interference”. I define interference as words, attitudes, actions, or situations that can affect the process of labor and birth. When I was a girl, for something to be called sexual harassment someone had to actually put their hand on a breast or a bottom. Today, we understand that sexual harassment can be much more subtle: an inappropriate joke, a lewd calendar on a wall, the unwanted touch of a hand on a back. Interference is like that. They can be subtle, maybe almost imperceptible, but they can also be quite powerful and can have a powerful effect on labor’s progress.

Some interference comes in the form of words, even though the words may not be intentionally harmful.

• A nurse enters the labor room and cheerfully announces, “We’ve lost the baby.” Family may hear this and interpret it to mean their baby has passed. Having attended several births and having heard many a nurse make such a pronouncement, I know that their baby is still alive and well. What has actually happened is that the baby or the electronic fetal monitor has shifted and the machine is no longer picking up baby’s heart tones.
• A client is working toward achieving a VBAC. A care provider or labor and delivery nurse sticks a head into the room to ask, “Has she ruptured yet?” The question is likely intended to determine if the water has broken. Our client may hear the word “rupture” and the biggest fear surrounding VBAC, uterine rupture, may be triggered.
• Even something as simple and well-intentioned as a nurse offering sympathy to a client who has been laboring a long while can have an impact. “Oh, honey, are you still here? We already delivered down the hall!” A laboring client may interpret this comment less as “I’m so sorry your baby isn’t here yet” and more as “The person down the hall did it right and you’re doing it wrong.”

The attitude of birth attendants can have a tremendous impact on someone in labor. Labor opens our clients physically, emotionally, psychologically and they are especially receptive and attuned to picking up on the emotional status of others in the room. A person in labor can often FEEL the anxiety of others present in the birthing space.

• A care provider who has fear about laboring with a VBAC
• A family member who is afraid about baby being born at home or in the water
• A partner who does not understand why their significant other doesn’t just go ahead and get the epidural
• A mother or sister or partner who cannot understand why a VBAC is so important to their laboring loved one

Any act that causes clients to fear for themselves or their babies will certainly affect the course of labor. It is common knowledge among birth workers that our clients birth best where they feel safest. Something as simple as hospital workers coming in and out of the labor room can cause a person in labor to turn and look to see who has entered their space, moving our client out of “Labor Land” back into the real world. Incidents of obstetric violence are all too common and can have all too great a negative impact on the progress of labor.

Interference can be situational and seemingly harmless. I live in a large city and have worked in 33 local hospitals. At the foot of the bed in 32 of these hospitals, right in the eyeline of the bed’s occupant, is a clock. No one in labor should be looking at a clock. It is far too easy to get sucked into what I think of as labor algebra. The thought process is this. “I’ve been in labor for 10 hours. I’m 4 centimeters. Carry the one…. I’m going to be in labor until I die.” It is most certainly not the intention of the hospital decorators to impede labor, but that clock definitely does the trick!

• Hospital gowns typically leave behinds hanging out, leaving their wearers feeling vulnerable. If there is an emotional association (a sickly childhood, years of infertility treatments, the death of a loved one in a similar gown), the gown can be quite a trigger. Putting on the gown may make our clients feel that they have become patients.
• Limits on the number of visitors can also cause an emotional impact. It is not easy to have to choose two or even one: your mom or your partner or your doula.

There is not much we can do as doulas to prevent the occurrence of interference. We can, however, lessen their impact.

• Prepare your clients for language they may encounter. “Complete” means you are 10 centimeters and ready to push. “Lost the baby” means the monitor is not picking up baby’s heart tones. The word “rupture”, when spoken casually and in the clear absence of emergency, is usually referring to the status of membranes.
• Reframe potentially interfering comments. “What did they have down the hall? We’re having a girl in here and you would be so proud of how Alex is laboring for this baby!”
• Encourage your clients to select their birth attendants carefully. Remind them that their birth space is sacred, that they will be feeling particularly open and vulnerable and that they are not only entitled to protect their space, but obligated to do so for the benefit of themselves and their babies. Help your clients process with their significant other and family members why their birth experience is so important to them. Remember you have TWO clients and they are both having a baby. Help the significant other to see birth as the peak experience it is.
• Aid your clients in setting up their birth space so it feels safe for them. Does your client need signs on the door to remind others to softly announce their presence when they enter the birthing space? Do you, her doula, need to tell your client who just came in? What will your client wear to birth? Who will be present? Can partner remove the clock from the wall or just throw a pillowcase over it?

Interference can make or break labor progress and how your clients remember their births. Interference is subtle and largely self-defined. We are in a unique position to introduce the concept of interference and to discuss them prenatally with clients. As with so many other things, the preparations we make with our clients are crucial to minimizing the impact of interference on birth.

Debbie Hull BS, CLD, CCCE Debbie began learning about birth in 1996 when she became involved in the local Houston birthing community. She believes that it is the most precious and sacred of honors to be invited to care for a woman and her family during their birthing time. Debbie is a doula in private practice and has been privileged to attend over 350 births in many homes and birth centers and over 30 hospitals. Her work has taken her places she never expected to go, including becoming a radio show host! Debbie regularly guest hosts Whole Mother on the local public radio station. Debbie is proud to be the mother of two amazing formerly breastfed and home-schooled young adults. To reach her and register for upcoming trainings, please visit www.debbiehulldoula.com or email her at debbiehull.doula@gmail.com.