tension pain, which is to be avoided at all costs!The keeper of the cave is the phrase I use to describe the birth partner. Back in prehistoric times a woman might have given birth in the safety of a cave (or some other private space). The entrance would have been guarded by the caveman; he would have been in charge of physically protecting her birthing space from potential predators or attack. The woman, physically vulnerable when in labour and giving birth, would have been unable to defend herself. Of course, the new baby would also be vulnerable and unable to protect itself from an attack. You still see this behaviour in the animal kingdom today: when the female is giving birth, often the male or a group will protect the space and keep guard.
Nowadays, hopefully, you’re not giving birth in a cave! You’re a lot more likely to be in a birth centre or hospital, if not at home. Of course the space no longer needs protection from savage animals and there should be no threat of attack. However, the role of the birth partner – the keeper of the cave – has certainly not become redundant. The role has evolved: the environment may have changed but the need to protect the space in order for Mum to feel safe and relaxed, for her body to soften and open and for birth to happen, is just as important as it ever was.
Birth partners play an essential role in labour and birth and need to a) be recognised for the important part they play and b) understand themselves how important their presence and involvement are. A good birth partner can make the world of difference when it comes to birth.
Of course, the birth partner doesn’t need to be male, although it is relatively common for dads-to-be to take on this role. Depending on your situation, your birth partner could be your mother, another family member, a friend, a doula or, of course, your partner could be a woman. It doesn’t really matter who the birth partner is as long as they make you feel safe, they understand your wishes and you trust them to advocate for you if necessary. Knowing that you have a birth partner you trust – by your side to support you, and on your side to advocate for you – enables you to let go of what is going on around you, channel your focus and really relax deeply into the experience.
When it comes to protecting the space these days, it’s less about physically defending Mum from attack, and more about shielding her from interruptions, which can be frequent, especially in a busy hospital setting. These interruptions, however routine or mundane, can negatively impact the progression of labour. The more frequent the interruptions, the more frequently Mum is disturbed and the more significant the overall impact. Interruptions do not aid relaxation and therefore need to be kept to a minimum. At worst, frequent interruptions from strangers can cause Mum’s labour to slow or even stall as she starts to produce adrenaline, which we know results in the surges becoming less efficient, labour becoming longer, little progress being made and also for everything to feel more uncomfortable. This can cause mums to enter the negative cycle of fear tension pain, which is to be avoided at all costs!
A simple way to protect the space from unwelcome interruptions is to have a copy of Mum’s birth preferences clearly outlined in writing, and to ensure that everyone providing care also has a copy and has been requested to read the document. Hopefully, this will be enough to ensure Mum’s wishes are respected, but if not, birth partners will need to step up and advocate for Mum at this point. This is the modern-day version of early man protecting the space from attack. You do not need to be directly confrontational. I appreciate this doesn’t come easily to everyone and, in any case, will probably be unnecessary, but it’s possible to be polite whilst insisting that the birth preferences are read and respected. Remind those present why you want the space to be calm and quiet, and how you are working to help Mum achieve a state of deep relaxation. Let those who are providing the care know that you’ve been learning about hypnobirthing and practising the techniques. I’ve no doubt that, in the vast majority of cases, you will encounter midwives who will go above and beyond to support and accommodate Mum’s wishes and you will have no issues whatsoever. But, in the unlikely event that you do face opposition, be prepared to stand up for Mum and protect that space – metaphorical spear in hand!
Think back for a moment to the ‘perfect’ environment for natural birth – the environment that animals instinctively choose. It’s a dark, quiet and private one. Hospitals tend to be the exact opposite: brightly lit, noisy, busy and full of strangers. Now you may well be choosing to birth in a different setting to avoid just that, and that’s great, but if you are opting for hospital or indeed transferring into hospital for whatever reason, you need to be prepared to transform the room, making it as close as possible to that dark, quiet, private space that is optimal for birth. You have your five senses checklist to help you with this and a well-packed birth bag full of everything you need to make this happen.
I devised this ‘traffic light’ system idea a while ago to help birth partners understand what their role might look like on a surge-by-surge basis and I think it’s pretty useful (if I do say so myself!).
So here goes . . .
Green The green state is the optimum state and the one we are all aiming for in which the mum-to-be is completely relaxed and at ease. If I refer to ‘the green state’ or ‘returning to green’, this is what I mean: returning to a state of deep relaxation in mind and body, not feeling anxious about anything, with no tension anywhere in the body.
Through practice you will become very familiar with what this lovely green state feels like and will be able to easily switch off to access this state more and more quickly over time.
Red The red state is the one we want to avoid at all costs. This is where a mum-to-be is panicking and producing lots of adrenaline. This causes the blood (and oxygen) to be redirected to her limbs and away from her uterus muscles. Very quickly the surges will become less efficient and increasingly uncomfortable, lengthening the labour. If a mum-to-be hits the red, that’s when the birth partner need to use all of the tools in their toolkit – and quickly!
Amber As you’ve probably guessed, amber is the in-between state. There is some anxiety, some muscle tension. Amber is a spectrum. It’s normal to teeter into amber during a powerful surge. However, if you edge further and further into amber with each surge, you run the risk of hitting red. Therefore, it’s the birth partner’s job to look out for signs that the mum-to-be is in amber (tense shoulders, tense jaw, tight grip, voicing worries) and use the appropriate tool from the toolkit to help the mum-to-be return to the green state.
For example, if the birth partner notices that the mum-tobe’s shoulders are creeping up towards her ears, they might rest their hands on her shoulders and remind her to relax. If they notice that she is gripping something tightly, they might use the arm-stroking technique. If her jaw is tense, they might use an arm drop to encourage her to release and let go. If she is voicing worries and doubting herself, then some reassuring words or positive affirmations might be needed. The birth partner can use any of the tools at their disposal to help the mum-to-be return to the happy green state.
If you were to plot a woman’s progress through the surges on a special traffic-light themed graph, what we’d probably see is that each time a surge builds and peaks, the woman heads towards amber and then, as the surge releases, she relaxes back into green. The birth partner is there to support and coach the mum-to-be through each surge and, once the surge has passed, can use techniques to speed up this return to green. Moving between green and the bottom of amber is fine, and to be expected. What we want to avoid is moving towards red and having no tools to bring us back to the green.
So, birth partners, use the counting during the surge (if that’s what the mum-to-be wishes) and then the other relaxation tools between the surges in the few minutes of rest time. Pause what you are doing when the next surge comes on and return to the counting, then, once it has passed, you can resume whatever it was you were doing: arm stroking, light-touch massage, relaxation reading, etc.
And mums-to-be, remember: it’s all about the green state of absolute relaxation.
I really can’t emphasise enough the importance of the birth partner’s role, and the difference an attentive, supportive, informed and empowered birth partner can make to a woman’s birth experience. It’s easy to dismiss the role of the birth partner as insignificant, because, just as women are negatively conditioned to believe that birth is dramatic and traumatic, we are equally conditioned to believe that birth partners are useless! Think of every movie you’ve ever seen in which birth has been depicted: birth partners (and it’s typically dads-to-be that are portrayed) are shown to be annoying and unhelpful, and even a complete liability and the butt of all jokes.
Just as I encourage women to actively build new, positive associations with birth through watching positive birth videos, reading positive birth stories, listening to positive affirmations and absorbing positive imagery from birth photography, it’s also important that birth partners do the same. Birth partners will benefit from watching these videos and reading these stories because they will get a better idea of what their role really looks like. Without this, the only template they probably have is what they have seen on TV growing up. And that’s certainly not the image we want birth partners to base their expectations on.
Hypnobirthing, as an approach to birth, seeks to involve the birth partner as much as possible. It really is just as much for the birth partner’s benefit as it is for the mum-to-be: an empowered birth partner goes into birth feeling informed and confident and is able to actively (and practically) support Mum through the labour, whilst enabling her to navigate any twists and turns in the best way possible. By doing so, birth partners come out the other side feeling a huge sense of achievement, one of empowerment, because they played such a big part in something so momentous. This, sadly, is not how all birth partners feel post-birth. Many can feel quite traumatised themselves by the birth, looking on and not knowing how to help. They report feeling powerless, unable to help the person they love, scared about what’s happening and left in the dark throughout the experience. And, worst of all, afterwards they feel they cannot ‘complain’ or even share their feelings because the focus is on the Mum’s experience, so they suffer on in silence. Hypnobirthing aims to help birth partners feel involved, to understand what is going on, to have a clear job and a to-do list to work through. Most birth partners I’ve taught over the years have found having a clearly defined list of practical things they can do to be hugely helpful as they navigate the unknown.
Finally, we have talked about how birth partners need to advocate for mums and ensure their wishes are respected and how they need to take charge of maintaining a calm, tranquil and dimly lit environment, but aside from all of that, which falls under the gatekeeper/keeper of the cave analogy, birth partners also have the job of supporting mums through each and every surge using their toolkit. This is why sometimes it can be helpful to have more than one birth partner. Each time Mum experiences a surge, birth partners, it falls under your remit to count for her, offer words of reassurance and coach her through, offer drinks and snacks when appropriate, encourage her into good U.F.O. positions and help her return to the green state between surges using either light-touch massage, positive affirmations, arm stroking, the arm-drop technique or your guided relaxation exercises. Birth partners are no longer relegated to the corner of the room to act as an onlooker but play a crucial, hands-on role in the birth.
It’s probably worth mentioning that it’s totally normal to feel overwhelmed or nervous about what lies ahead, especially if you’re being a birth partner for the first time – it’s that common fear of the unknown, coupled with all the negative imagery and stories we have been fed our whole lives. But know that, firstly, you’re on the cusp of something truly incredible. Couples who have done hypnobirthing together regularly report feeling that the birth experience was a shared experience, that they felt like a team and that they worked together to bring their baby into the world. Many report feeling very close and connected to one another throughout the experience, and as they share the magical and miraculous moment of birth. It really can be wonderful, although I appreciate this is not what you normally see on TV. Secondly, know that just by being present in the space, even if you do nothing else, you are offering reassurance for Mum. You are the familiar person, the trusted and chosen birth partner, in what can be an unfamiliar environment. You are the anchor. You are the keeper of the cave.
Home birth of first-time mum Katie – from the perspective of her birth partner, the baby’s father, Jonathan
I arrived home at about 9.20am to find Katie in the bath. We looked at each other and knew this was it. We both cried at this point as we knew we would be meeting our baby soon. We sat and chatted for a bit about what was going on, then started to time the contractions as they were pretty frequent and getting more intense. ‘I don’t think it will be long – you better get the pool ready’ was her instruction. So I dutifully scurried off and got cracking. I got the pool inflated and turned our living room into the nest. I drew the curtains, put the music on, sprayed the room and watched the water trickle into the pool. Honestly, it felt like I could have filled it quicker with a mug! They say a watched kettle never boils. I can now add ‘a watched birth pool never fills’ to this.
I had called the triage before I started getting the room ready and they said the on-call midwife would ring. Katie came down and was now really working hard with her surges. She was focused and in the zone. Since the pool was still not ready for her she just leant over the birth ball. I kept her hydrated, offered light-touch massage and tried to be positive but calm. It was at this point that the midwife called. She was on another call and would be about half an hour.
The pool was finally ready, Katie got in and you could see the change in her – she just totally relaxed and ‘sunk’ into the warm water. I think it was about now that I ‘lost’ her, she was totally in the zone, it was quite awesome to watch: she was just breathing through the surges. Our midwife arrived at this point and I felt a bit of relief that I was not on my own anymore.
The next bit is all a bit of a blur really. We had regular heartbeat checks and things progressed really well. The odd time she struggled to find a beat, but I knew not to panic as sometimes they are hard to find. Things started to get a bit closer now and the midwife was checking Katie from behind. Katie entered the down phase about now. She had the fight-or-flight transition moment we spoke about on her course and I knew it was my job to calm her down. She was looking a bit hot so I grabbed some ice and just stroked it up and down her arms, whilst telling her how amazingly she was doing – that she was so close. I went down the ‘business end’ just as Katie had a massive surge and was lucky enough to see my son’s head crown. This was an incredible moment and one I will always remember. I rushed back to Katie, held her arms and said: ‘One more push, babe, and we get to meet our baby!’ And lo and behold, one more push and he was here. Our baby had entered the world!
Katie was incredible. She hardly whimpered through it all, had zero pain relief and we had a super-quick birth – just four hours or so. My advice for soon-to-be-dads is to listen to your instincts, dig in and prepare to be amazed.