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Book Review – The Birth Partner

April 24, 2012

I bought this as a gift, having never read anything but the Amazon reviews for it. Now that I’ve read it, I have to say I can’t wait until XY has a chance to read it himself. While there are plenty of books out there on the “whys” of attempting unmedicated birth, the how-tos, especially for those NOT in the throes of labor pains, are rather short. I guess most of that info is supposed to come in the childbirthing class? In the Birth Partner, Simkin does a great outline of everything in stages, explains emotions a mother may feel (that she may not be able to clearly express in the moment), and what a partner can do to support them.

The coolest tools I thought she included in the book were her “Pain Medications Preference Scale” and her indications to come up with a code word for pain meds prior to the birth. The Pain Medication Preference Scale is rated from -10 (indicating an maximum unrealistic preference for pain meds, since labor cannot be indicated without the sensation of contractions) to +10 (indicating an maximum unrealistic preference for no pain meds, i.e. unmedicated cesarean birth). This scale provides two things: one, a mother’s preference prior to birth is known to herself, and she has a number she can refer back to to express it, and two, her partner and/or doula can refer back to her feelings prior to the birth in the middle of labor, and help to advocate for those preferences knowledgeably when the mother is already in the middle of dealing with pain. The scale also brings things back to the issue of CHOICE, which is missing from so many discussions of natural birth versus medicated birth. A woman’s birth is her own as well as her baby’s story; she should be able to get through it with as much sense of agency as possible. If her fear of labor pain is real, then she is justified in asking for pain medications; just as much as the woman wanting a natural birth should be supported with non-medical pain relief (barring a cesarean, unless she could bite on a bullet casing like a Civil War amputee). Pain is subjective, so we should HUSH about other women’s choices on the matter. ‘Nuff said.

(Before we do hush, though, it is worth it to note that there are some evidence-based reasons for choosing an unmedicated birth, and it’s worth it to make sure that women are aware of these points before making their personal decisions. Lower rates of interventions and higher rates of breastfeeding initiation and continuation are associated with unmedicated birth. There are also risks associated with taking any major medication and the possibility of mother or baby having a reaction to the epidural. Finally, there’s the annoyance of being “tied down” once the epidural is started: in addition to being stuck on your back, you must have continuous IV fluids and a catheter to take care of your bladder’s business. I find this point resonates the strongest with me: I hate the idea of being “tied down” and the image of an active labor (walking, hanging out on the birth ball, squatting, etc.) appeals to me personally. If I had an extremely long or excessively painful labor, though, I would refuse to feel regret for accepting an epidural: if the pain has already made me feel “tied down” there’s no reason I’d imagine an epidural wouldn’t be a blessing at that point! Simkin also includes a discussion of “pain” versus “suffering” which helps to clarify this issue for women and their birth partners.)

The other cool tool Simkin mentions is the “code word” for pain medications: a tool for women who want an unmedicated birth but aren’t really sure how much pain they can tolerate. Again, going back to the subjectiveness of pain: you can’t really understand how painful labor might be for you until you “try it.” (Note that even if you want an epidural right away, you will still have to cope with some pain until the anesthesiologist is free to administer one (often a 60 minute or longer wait), so it’s worth it for all pregnant women to learn about some non-medicated pain coping tools prior to labor.) Having a code word allows birth partners and laboring women to communicate effectively about whether she is really hurting badly enough that she now wants pain medications. Since even women who want unmedicated birth may be coping by screaming, looking totally exhausted or otherwise scaring the crap out of their partners who aren’t sure how to interpret this behavior, a code word allows the laboring woman to differentiate between “I can do this” and “I need medicinal help” without stopping the screaming (if she wants to scream). The concept seems very similar to the usage of a “code word” with experimental sex common in bondage and S&M communities: when in the zone, the conflict between coping and enjoyment and true pain/fear is hard to interpret safely without a word that lets you communicate effectively with your partner when a line has been crossed. Unmedicated labor definitely takes most women to a place where mentally they aren’t on the same level as their partners, being so in touch with their bodies and the experience of the moment. The code word frees them to still be able to communicate effectively with those who want to help, while letting them still be absolutely “in the zone” for as long as they need to be there.

Overall, Simkin’s tone is explanatory and supportive without sounding judgmental.  She is very focused on the benefits of doulas especially at the beginning of the book, but I still find that this would be a very useful text for birth partners planning to labor without a doula as well. The discussion of rhythm, ritual and relaxation between contractions sets up a good starting point for talking about the finer points of coping with labor pains (which are probably best addressed in a class, though Simkin does include plenty of tools and positions women and their partners can try.) Since you won’t have your birth class instructor in the room with you when you labor, it’s probably easier to just pack this book in your bag before you head out the door (or before you call the midwife over to your house for a homebirth). Must-have reading material for anyone with a pregnant partner!

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