“Yes, You’re Going to Die, but Probably not today.” Reflections on how to Support Laboring Women.

By  Donna Harel, PhD.

I got down to the eye level of the woman struggling on the toilet in front of me. Catrina grimaced and searched my eyes, pleading for relief. Crying out, she asked, “Am I going to die?“

I took a deep breath and smiled. “Yes, you’re going to die,” I said, “but probably not today.”

I dispensed this little bit of wisdom off the cuff with my childbirth student as she labored in her apartment. This simultaneously uncomfortable and comforting reality has carried me through many of my own darkest moments and has encouraged some of the people in my life. Your world may be falling apart. Or at least it feels that way. One day you will die. Probably not now. Let’s see what we can do to get you more comfortable in the meantime.

In over 13 years, I taught natural childbirth to more than three hundred couples. I sometimes provided them phone and text support as they faced decisions in their labors — I never provided advice and instead reminded them of what we learned in class as a framework to make decisions. Catrina and her husband, Brian lived in the apartment across the street, and we had built a friendly rapport during our class together. So when she called just after bedtime to ask for support — her doula would only meet her in the hospital — I had no trouble leaving my family for a little while.

Her labor had progressed pretty rapidly, and by the time I wended my way through the dimly lit, carpeted halls of her building, I could hear quiet moaning outside her door. Brian didn’t look exactly helpless as he answered the door, but he seemed pretty relieved to see me. Someone else to bear witness to Catrina’s pain for a while. And in some moments during labor, that’s all a support person can do.

He led me towards the bathroom. He had kept the lights in the apartment low. Good, I thought, someone had listened in class. Bright lights make most laboring women anxious. No one gives birth in caves anymore. Still, elements that can support a woman turning inward, and not cause her to feel in high alert (such as bright lights, loud noises, machines that go “ping,” people chatting or saying worrisome things), can help keep at bay her stress response, which both hurts and undermines the efficiency of labor.

What was I doing here? I had only attended four other births: my own birth; a hospital birth of a woman whom I had never met (outside of seeing her baby emerge from her body for five minutes); and my two births as a laboring mother. I was born in the typical fashion of 1970s white, middle-class America. My mother’s OB turned to the anesthesiologist and said, “Shut that woman up!” So they knocked her out and extracted me from her body. She awoke to a scrubbed and tubbed bundle in the isolate next to her.

The first birth I ever witnessed took place during my senior year of college. I was visiting Andy at the hospital during his internship, and one of the OB residents invited me to sit in on a labor. When Andy’s pager jolted me awake (we’d squished together on a cot in the intern’s call room) at 3 a.m., I bolted upright and stumbled, already nauseated from the jarring wake-up, through the quiet halls of the hospital towards the labor and delivery floor. As I entered the birthing room, I was confronted with the sight of the laboring woman squatting on the birth table. She barely registered the presence of the people around her, and I was just another face in the parade of hospital personnel she encountered during her labor. As she grunted her way through the process of birthing her third child, I felt my nausea rising, both both the adrenaline of my jolted awakening and from the starkness of the scene. With one great big roar from the mother, another person was suddenly in the room. Holy crap! I have no right to be here, I thought, but wow! Then mom reached for her baby, but the doctor handed him instead to the nurse. Again, holy crap! Far off from becoming a mother myself, this amazing scene gave me a little hint of the power of birth and of the problems of how we do birth in our society, which would propel my journey into birth activism.

As a budding anthropologist, I had a clear sense of birth as a human experience and how it was constructed differently in different contexts. I wanted to explore alternatives to the misogyny of the “biomedical industrial complex,” which in America constructed birth more as a “crisis in need of management” than as a normal part of human experience. By that point, I had spent a few years hanging around homeschoolers for my dissertation research. Many of the mothers in my study cited their natural childbirth experience as formative in their instinctual trust of themselves as parents. Finally, I wanted to go for the adventure and differentiate myself from the experiences of my mother and my mother-in-law.

Married to a physician who felt most comfortable with the hospital setting and who was socialized through his training to see birth as inherently risky, I did not seek out midwifery care, and at the time I knew nothing of doulas. I found a doctor known for her support of natural childbirth, and we took a birthing class with two other couples. Andy and the other two moms were fluent in the language of medicine: one was a chiropractor, and the other was a nurse practitioner. All three of them had a “got this” attitude.

Still, during our last class, when all three couples huddled around a bucket of ice water, the three moms immersing our hands in the ice while our partners tried to support us, I had two reactions: first, a complete desire to escape; then an appreciation that the other women were doing this, too. The inescapable sting of the ice creeping up my wrists commanded most of my attention. I felt my neck and shoulders tense. I tried to relax, but it was a struggle. I envisioned legions of women before me feeling this all-encompassing sensation. This vision, along with a singular sense of grit, propelled me even as my instinct was to pull my hands out of the water before the 90-second timer went off. The partners stepped up big time in this first taste of what trying to support a laboring woman actually might be like. Andy’s steady, firm hand, running clockwise circles on my back as he leaned in, suddenly made me feel a little better. I felt both comfort and security. We could do this.

The ice water turned out to be an interesting analogy for labor. The discomfort can be inescapable at times. You can play with it: notice its quality, find the edges of where the pain ends. You can try to relax the rest of your body (tensing other parts really does amplify the discomfort). You can tune in to the voice of the gentle guides around you, you can tune them out, and tune into your body. You can visualize: calm scenes, cute baby parts, warm light, a vise or a fist squeezing your partner’s testicles (if your partner is male). You can get quiet, hum, scream, sing, and rock. You can appreciate its purpose (each contraction brings you closer to the birth). Whatever you do with it, labor involves discomfort.

And others, to a limited extent, can support a woman in labor. They can rock, soothe, massage, guide, coach, protect from surrounding distractions, and stay with her. They can advocate for her dignity and safety. They can bear witness to (and cheer) her experience. They can be, as one student put it, “a rodeo clown to distract the doctors and nurses so she can have peace and quiet.” They can watch, in awe and in love.

So, after a pretty powerful experience in my own labor with my daughter Ella, and in an effort to goof off from writing my dissertation, I became a birth junkie. I trained in one of the major methods of natural childbirth in the U.S. This method highlights the role of the partner as coach and birth companion and offers a heavy dose of “consumerism” — teaching expectant couples what is normal in labor and how to be good (informed) consumers of maternity care services. I tried to promote safe, empowered births and postpartum experiences for the families I taught.

My birth activism had an arc: the insufferable assuredness of a new convert; the predictable moment of sticking my foot in my mouth; the eventual comfort of knowing my material well enough to know when to take a soft touch and when to be more vociferous about what I wanted to share. Eventually, it stopped being my life goal to empty all the hospitals of birthing women, and I returned to the core principle of wanting to support families in having safe and empowered births, however they defined them.

Still, I initially felt ill-equipped to support Catrina as she labored on the toilet in front of me. And seven years of teaching expectant couples how to give birth “safely and with dignity” hadn’t really prepared me for the intimacy of this moment. Shouldn’t this be her husband’s job? Where was the doula? Why was I here again? Oh, yeah, she asked me.

And when I really looked into her face, I saw not only a woman in labor crying for reassurance, but also an infinity of moments as a parent and from life on this planet. I conjured a genuine smile. It turned out that her infinite moment of pain did come to an end. She now has an amazing daughter, who, like my own kids and children of all time, have split their parents’ worlds wide open: a mess of pain and suffering and joy and goop. And snot. So much snot.

I’ve reminded myself of this in my darker moments, and I hold it up to others when I bear witness to their burdens. Whether this comforts or scares you: You are going to die. But probably not today. How can I help?