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After Action Report: Natural Childbirth

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Josh Simmons
Josh Simmons

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I set out to write this guide to help myself if my wife and I decide to have another child someday. As I wrote I realized the utility of this knowledge for a wider audience. Most husband-focused, birthing process material I've come across at best isn't actionable, and at worst, is harmful (do yourself a favor and stay far away from any Reddit community dealing with childbirth unless you just want "feel good" information). This text will be useful for a father participating in the birthing process. It would be optimal to read this at the beginning of pregnancy but much of it is helpful at any stage. It may be of limited use for pregnant mothers-to-be to read as well. Much of this writing assumes that you'll be attempting a natural (i.e. no Pitocin, epidural, I.V.) childbirth that will be husband-coached to some degree.

Intelligence Gathering

Antepartum

Take a childbirth class. I'll mention it multiple times throughout this blog. If I could identify the single thing that got me 80% ready to coach my wife through a natural childbirth, it would be the course we took.

We took a Bradley Method course - its goal is a husband-coached, natural childbirth. A very knowledgeable doula taught the course - she had plenty of anecdotal and literature-based evidence to back up everything taught in the course. While I disagreed with some parts of it and some information never came into play, I'd estimate that about 90% of the course was useful and actionable during the process - it was a great use of time.

I'm sure there are other natural childbirth methods but I couldn't give you any intelligent run-through of the pros and cons of them. My wife simply selected Bradley Method and we went with that.

Postpartum

Read up ahead of time but have one “oh shit” book that you can go to. For me, The Baby Owner's Manual by Borgenicht has been perfect for this. BOM is illustrated and written like a car service manual. There are diagrams for everything - from swaddling, to burping. Diagrams are very helpful when you're running on two hours of sleep. You don't want multiple books - more decision fatigue for an already fatigued papa.

Physical readiness

You will be pushing your body very hard during childbirth too. If you are not, you're not doing enough to help. Due to this, start viewing yourself as an athlete preparing for a hard race now. You will be going extremely long stretches without sleep, holding counterpressure postures for what feels like an eternity, and likely not eating optimally during labor.

How to Train

Shoot for a good balance of cardio and strength workouts. Listen to your body when you need to rest - but you should be pushing. If your workout doesn't cause a bit of fatigue, ratchet up the intensity.

What worked for me was to workout six days a week. Three of those days were cardio - typically outdoor running (heat resistance training outside in Arizona) with an occasional hike on days I felt a bit beat up. I did strength training on the other three days - focusing on functional movements (pull ups, push ups, dumbbell presses, planks, and goblet squats). I typically like to do more hypertrophy based routines but decided it would be better to “train for the event” which meant functional strength.

Rest for a week before the due date. Don't stop moving but drop cardio and weightlifting. Instead - do some easy walking on your workout days. I was very in tune with my body around this time and felt a wave of lethargy two weeks before the due date. I believe that this was my body telling me to conserve my strength for the birth.

How to Eat

This is far more individualized than training but I can offer some overarching guidance. Prioritize protein. I believe that animal protein is best. Calculate your lean body mass (search the web for a calculator) and aim to eat 1 gram of protein per pound of lean body mass. For one week log your calories in the MyFitnessPal app to keep tabs on this. You'll get a feel for it. If you feel like you've drifted, log another week to see where you're at.

If you're on cooking duty, make sure you're accommodating your wife's dietary needs as well. She will need to be eating optimally to provide for the baby and to be in optimal condition for the birth - her diet might differ than yours, for example, I eat a carnivore diet and some fruit. I do not eat grains or vegetables. My wife was eating more of a traditional "clean" high protein diet. I would cook meat for us, but also make sure to have vegetables and rice or high quality multigrain bread for her meals. This is not a time to experiment with new diets - stick with what works. If you don't have sufficient knowledge to challenge the status quo of what a "healthy diet" is.

Eat clean. Cut all shit out of your diet. Not only because you want to see your son/daughter have children of their own someday, but because it is easier to resist food cravings than it is to coach labor with a fat physique. Maybe that's harsh but I've run a 5k while fat, and a 5k while lean and the former feels like being waterboarded. If you have quite a few pounds to loose, you might look into intermittent fasting during the first trimester or two before trying to build a lot of strength.

Your wife will have cravings. Unless it becomes the norm, indulge her in those occasional cravings. There will be nights where you will have to bring her ice cream while you snack on some mango slices. You will do this because you are a man and you are not eating for two.

Emotional Readiness

Begin journalling occasionally early on in the pregnancy. Start to observe yourself - are you getting mad at trivial things, do you feel stressed, are you able to maintain a reasonable work-life balance, how do you feel about your child, did you plan to conceive? Notice those trends - work to create a peaceful environment by addressing any concerns or rough edges.

Three suggestions on when to seek therapy:

  1. You just have a hunch you need it (listen to that).

  2. You have tangled with anxiety/depression/mental health before.

  3. The issues you are journaling about are recurrent. Everyone has a bad day sometimes but are you having weeks of bad days?

I won't spend too much text justifying why therapy is so important - definitely want to do a post on it soon - so I'll just say err on the side of caution and get therapy if you think you might need it. If you identify with point 2 above - it's non negotiable, get your ass in therapy even if it's every other week.

Why am I so adamant about assessing/treating mental health? I've struggled with anxiety and panic my whole life and had done CBT which helped triage those conditions when they arose. Something shifted in my brain when I knew I would become a father. Over the first trimester, I gained the ability to admit to myself that I had a very abusive childhood - my mother had “factitious disorder imposed on another” (look it up if you want to get creeped out). The memories were never “repressed” I just chose to not think about them throughout my whole adult life - I was white-knuckling my way through by masking my trauma constantly. Whatever shifted inside of me because of conceiving was like kicking a log loose in a jam - I was able to start working through my trauma in therapy which feels great but it will have huge benefits for my relationship with my daughter.

I'm going to write a blog about this when I'm more ready, but for now I will just reiterate - cut out one hour of TV-watching time per week and go to therapy instead, it might change your life and you owe it to your kid to prepare the best you can to give them a better childhood than you had (even if you had a better one than me).

Post Partum

Your job doesn't end after delivery!

Paternity Leave

It's so strange that a lot of men I talk to that are my dad's age brag about how they returned to work really quickly after the birth, that they “needed to get out of the house”. That's a shitty attitude. I'm speaking from a privileged position due to my employer's paternity leave package - if it's not financially feasible to take much time off - do not feel guilty for a minute. I just want to provide some info on what is working for me and make sure you exhaust all possibilities to get as much time as possible with your new child.

If your employer offers a leave package - use that sucker up! Use all of it. Don't feel bad about it. Work can wait. I am taking two months off up front and two months off later in the year. Normalize taking all of your leave as a father!

If your employer doesn't offer a leave package here are a few things I would look into:

  • Can you use some kind of disability leave to get partial pay for a while?

  • Can you switch jobs to an employer with a leave package - even if it's a lateral move pay-wise? It's pretty common in my field - I had roughly the same leave options at my last job, but most of the jobs I worked at before my most recent two had insulting leave packages. Not sure how common it is in other fields. Double check that you're eligible for leave within whatever time window you'll need to take it before signing on the dotted line!

  • Would your employer be able to keep providing your benefits during an unpaid leave? Figure out your monthly burn-rate - if you saved for nine months could you just pay for living expenses out of pocket for a few extra weeks?

  • At the baby shower could you ask for cash donations that go towards unpaid leave?

Your Wife's Mental Health

I rewrote this section a few times to figure out what I want to say. Here is the essence of those writings.

The hospital will tell you that the first two weeks are going to be very hormonal so it's hard to tell if the mother has postpartum anxiety/depression until after that point. I have no idea if that's true because we got some very bad advice from various members of the hospital staff, but it at least gives us a goalpost so that's what we're using. At about two weeks postpartum - begin evaluating mood for signs of PPD, PPA, etc.

My real take? Fuck "two weeks" and just book therapy right away, like week two if possible. Why? It's low effort/high reward. Look for a provider that specializes in postpartum care and offers video appointments (you don't want the stress of leaving your newborn on top of everything). If you have insurance - flex that insurance. If you don't, then telehealth options like BetterHelp might be useful (and are reasonably price out of pocket, although quality control seems loose). Your wife likely won't have a clinical mood disorder after birth, but she'll be stressed, this will give her an hour to talk about her stresses every week which could prevent them from blossoming into something more severe.

Having a support network

I didn't understand “it takes a village” until the past few weeks. I've always been a “go it alone” type and I'm slow to trust people. I hate bothering people for favors. Could I have taken care of everything during labor/first week? Maybe, but it would have pushed me far out of my window of tolerance. So many people in our lives that were already kind stepped up and helped us with the load so much. We just moved in January to a new city. We're naturally social and love throwing parties but regardless it's hard to meet new friends in your late 20s early 30s like us. Here's how our support network grew over the pregnancy.

The list of people that saved our ass during this process is too long to type so I'll post some highlights.

Birthing Class Friends

We took a Bradley method class and not only met some really nice friends there but also had contact with the doula who taught it. When our AC went out and we were spending our last night in the hospital, our birthing class friends met me at the house, brought over their portable AC, AND even set it up for us. Their due date is a couple of months from now and we're looking forward to helping them however we can during the process.

We were also in touch with the doula who taught the class. She was a pro and was nice enough to text and call us during the process. I remember at one point during labor, the doctor told us something really concerning. I played it off to my wife like it was no big deal, then excused myself to go outside while I called the doula to see how big of a deal it was (spoiler alert - no big deal at all).

Peanut App

We met some nice friends through the Peanut app too! It might even be useful to meet friends postpartum. It's basically friend-Tinder for moms. The friends we barely met through the app (due date a bit later on yet) brought us a care package the first day we came back from the hospital with some fruit, drinks, and homemade goodies. It really lifted our spirits after a few very sleepless nights and took some of the food-prep load off of me.

Neighbors

YMMV depending on where you live but we have a lot of neighbors with kids. This is new for us, we historically haven't had very social neighbors. They were instrumental for bringing packages inside for us, letting the dog out, and letting the AC repair people in and out of the house. They are cooking us a homemade meal for dinner tomorrow. If you have neighbors you're close with they can help in a big way, especially if the hospital is a long drive away like it was for us.

Other Friends

I'm close with two dads who each have young kids but I don't live near them. I was able to text them questions to sanity check and one of them even Facetimed me twice to talk me off the ledge. That same friend sent me a text deep into the night that said “Wherever you're at, you got this.” It's one of the nicest texts I've ever received. Conclusion - your support network can be partially virtual - it all helps.

Family

My wife's mom and sister came into town to assist. They handled a lot of administrative stuff for us which was a huge load off! When we needed a hotel booked once I realized the AC was dying and we had to leave the house, her sister was on it. When I was hungry but couldn't leave the hospital, they brought food. When my arms started giving out from doing counter pressure, we rotated out.

Risk Management - Hospital v. Birthing Center

You should be very careful about where to choose to do your birth. Please read my cautionary tale of our hospital experience. Talk with staff, ask around if you know a doula to see what the reputation is for various places. I think we would opt for a birthing center next time - the hospital felt very…hospital-y. I didn't think “vibe” would be so important, but it really is when you're doing something so intimate - birth is not some austere medical procedure.

D-Day (Delivery Day)

Here are some rapid-fire tips on delivery day

  • I can't advise you when to go to the hospital because I'm bad at it - we went two times before being admitted and the first visit was at 1cm dilation 😅

  • Uber Eats on a normal day is complete trash. Someone should make a startup that delivers hot food, on time to your door - it would put UE out of business in a week. Uber Eats at the hospital = cold food and delivery drivers who can't follow simple driving directions = you and wife stressed and/or eating cold greasy food. Have a dedicated food getter. Next level tip - let them know what kind of food you and your wife like so you don't have to make your own decisions on what to eat.

  • Have a dedicated dog-walker. My sister-in-law handled this for us without me even having to ask, that alone took so much stress away.

  • The Bag. My wife wanted to bring half the house. Here are what we ended up using the most:

    • eye mask

    • hair tie

    • TENS Unit (must have!!!)

    • NUUN tabs - two perks here, it will be hard to get her to drink water after a certain point, also she'll probably be sweating and need to replenish electrolytes (can prevent muscle cramping too).

    • Sweater - her temperature fluctuated constantly. As per a tip I got from our childbirth class teacher - keep the room slightly cool and adjust her temperature by adding or removing layers, otherwise you'll be moving the thermostat constantly.

    • Snacks - I packed snacks for both of us but she couldn't eat throughout most of labor. Due to a snafu with having to live out of a hotel during labor, I forgot my snacks at the hotel room when repacking bags. I would have felt much better if I had some snacks.

    • Phone chargers - all of them, long cable or extension cord. I had a really short one and it was a hassle.

    • iPad and AirPods - when she's in hard labor and doesn't want counter pressure, pace yourself. Take some breaks and read the news or watch a TV show without disturbing her (my wife hated having the TV on in the room). I thought I'd read but I didn't have the mental strength to focus enough, TV was about the level of focus I could manage.

    • DSLR - ymmv, I'm a photo enthusiast, my wife is a professional photographer so I knew we'd want to get better-than-smartphone-quality photos. If your camera supports electronic shutter use that so the camera doesn't make an audible “click”

    • Extra clothing - like, more than you think you need. Our situation ended up being a bit unusual but you never know how long you'll be at the hospital. Bring a few changes of clothing for both of you

    • Her own hospital gown - I think this is psychological, when you put on the shared hospital gowns with gross 90's patterns on them you feel ill. My wife bought a cute gown that looked kind of like a dress. I think that helped keep her spirits up a bit.

    • Copies of the birth plan. I brought five - whenever a nurse went to go print a copy I just handed her one of my fresh ones. Keep one on your phone so you remember what you planned for various situations.

    Be There When It's Happening

Try your best to be present during the process. Supporting and shepheding your wife through the process is extremely intimate. I found it to be very anxiety producing but also one of the most incredible experiences I've had in my life.

I take everything in my life too seriously. Maybe I took this process too seriously - the length of this blog seems to suggest so. Treat this text like a buffet - just picking out the stuff that looks good to you, that's probably what your need. Just remember to breathe, enjoy the process, and remember, “wherever you're at, you got this”.