Dad vs. Nurse: Advocacy in the Labor Room (part one)

GUEST POST by Melissa DuBois

Jeanette Mesite Frem, owner/director and executive momma of Babies in Common (BinC) recently posed a question to a group of current and former labor & delivery nurse friends (me included). The question was: How can partners (especially male partners) best interact with a labor nurse when advocating for the laboring mother’s birth plan without causing the nurse to get defensive or creating an adversarial relationship between partner and staff?

The original question was brought up by a dad who had taken a Natural Birth Ready class at BinC and was concerned that he would encounter push back from the labor nurse if he was to ask a question, express doubt or support mom in declining/refusing a medical recommendation or intervention. He wished there was some sort of “trial run” that he could participate in before the big day to prepare him for the role of “labor advocate”. 

Well I had so much to say that Jeanette finally said, “Hey Melissa, how about you just write a blog post!” So here it is!

(Author’s note: I would like to acknowledge the many different and important people that can make up a person’s support team in labor: male or female spouses or partners, family, friends or a doula can all contribute in amazing and different ways. I would also like to acknowledge that sometimes, the person giving birth is a transgender dad. However, this article is going to focus primarily on a male spouse/partner (hereby referred to as “dad”) and a cisgender expectant mother, not because I am trying to be exclusionary, but because there are some very real gender dynamics that can play out between a male partner, a laboring woman and a female labor nurse that I feel can significantly affect a mother’s birth experience. However, the forthcoming tips certainly can apply to anyone who is supporting a laboring patient!)

The “How To” of NCB

If you were to search the internet for “how to have a natural childbirth” you would likely get a list that would include not only the typical “take a childbirth class, read “X, Y & Z” book and write a birth plan” but also a number of philosophies that recommend the partner act as “gate keeper” between the laboring mom and the staff. After all, she’ll be in pain, and so her partner might feel that they need to be her “protector” and above all, her “advocate.”  Even as a natural childbirth (NCB) friendly OBGYN nurse, I have to admit that I cringe a little whenever I hear someone profess that the most important role of “dad” in the labor room is one of “advocate.”

Dad as the “Advocate & Protector”

As a childbirth instructor of 6 years, I stress dad’s role as support (physical and emotional) as well as being a woman's "rock" in labor as more important than their role as "advocate." Yes, of course a dad can be a great advocate for a mother’s wishes indeed, however let’s not forget that:

1. Dads are not experts on labor or birth and they are entering into this experience with very limited, even one sided knowledge
2. Dads are emotionally biased towards mom’s feelings and affected by her emotional state because they love and care about her on a personal level
3. Dads are also going through their own important emotional transformation from “man” to “father” during the labor which interferes with objectiveness

In my opinion, if a dad latches onto his role as advocate ABOVE all other roles, then there is a tendency to take that role to an extreme.  They might speak for the mother when she is spoken to directly by nurses or clinicians. They might refuse medical interventions on behalf of the woman. They might speak in terms of “we” and “she” instead of letting her answer. And while I do not doubt that the vast majority of these partners are coming from a place of love and compassion, in my experience this style of “advocacy” causes great friction in the labor room.

The reality is that in American culture, when a man speaks for a laboring woman, it raises flags in every nurse and clinician’s mind for domestic violence and for emotional abuse or control. You might think this is a farfetched concern, but sadly it is not. All nurses have seen it.  Also, it is not a cultural norm for men to "speak for” women in this country. In addition, medically-legally it is not acceptable for a nurse or clinician to accept a partner’s answers to our questions; in the end we need to hear consent or refusal directly from the woman.

You may ask why this is important. It is important because expectant mothers need to understand that in labor she and her partner can present a united front, but she can't just plan on her partner doing all the talking (e.g. as is advocated for in the “husband-coached” Bradley philosophy). In the vast majority of cases with your average mainstream nurse, If a woman is offered an intervention and only her partner is doing the talking (eg. "She doesn't want an epidural." "She doesn't want pitocin." Or even worse "WE don't want an epidural." "WE don't want pitocin.") it is going to raise flags and promote an adversarial relationship between nurse/clinician and partner.

Now please know, I'm not saying that partners who speak in those terms are all abusive. In fact, when I encountered this situation as an L&D nurse I would dig deeper, try to figure out where the fears were on both sides. I acted like a broker between mom/dad and clinician, trying to get both to see the other's side. I didn't immediately jump to the domestic violence or “controlling spouse” conclusion. But 1) not all nurses take that approach and 2) sadly, I also have seen my share of controlling, manipulative and abusive partners.

Remember, in the end the nurse’s patient is the woman, not her partner.

Male Privilege and the Labor Room

There’s another gender dynamic that is rarely discussed and this is the dynamic between dad and nurse in the context of male privilege.

As I will discuss in Part 2, one of the strategies for working effectively with nursing staff when advocating for a natural birth plan is to “play the game.”  By “play the game” I mean phrasing requests or refusals in a way that makes the other person feel that you are complaint and cooperative even when you totally disagree and have a different plan. In my experience, many men have a hard time with this because many men don't really have to "play the game' in life as much as women do. They can generally ask for what they want, or demand it, and get it. Or at least not get crucified for it. This is not the same with women.

I'm reminded of this Internet gem that describes “Famous quotes the way a woman would have to say them during a meeting.” But I digress.

Here’s something else dads need to remember: Even though nurses are professionals and are an equal and important part of the health care team, we have a long history of not being treated as such, of being taken for granted, of being treated like waitresses, of not getting any credit and of being spoken to like subordinates. This history makes a lot of nurses defensive when partners (especially men) come in with fists flailing, making demands, refusing advice and dictating orders and speaking for the mom.  

So what’s a dad to do?

Stay tuned for DAD VS NURSE: Advocacy in the labor room, Part 2

 

Melissa Anne DuBois, RN, BSN, CCE is an OBGYN nurse that works in the greater Boston area. This picture was taken after 3 years of infertility, 38 weeks of pregnancy, 3 days of prodromal labor and 36 hours of back labor (27 of which were unmedicated). She might very well have ended up with a cesarean section if it wasn’t for her wonderful CNMs, her choice of hospital, her amazing husband and mother and her incredible doula. She is also a BinC mom and breastfed her son until age 3 with the help of the breastfeeding support she received at BinC.