The Husband's Most Important Job During Childbirth
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Husband coached childbirth has many important duties that the husband must fulfill before, during, and after labor, but by far the most important duty is to advocate for your wife. An experience we had during labor illustrates this perfectly.
My wife decided she wanted to do a natural childbirth - no epidural, no Pitocin, not even IV fluids. I want to be clear at the outset of this article that my wife independently decided that she wanted to give birth naturally. At the beginning of pregnancy I was unknowledgeable about the harms that interventions cause in newborns. My wife registered us for a class and learning how unnecessary most of these interventions are for normal births completely changed my views.
I went to many of the prenatal appointments. My wife notified her OBGYN, Dr. Michella Switzer of her intent to give a natural birth at the first appointment in the second trimester (we switched from another office) and Michella seemed supportive. Michella would turn out to be a wolf in sheep's clothing. To make this abundantly clear to medical staff - “natural childbirth” was the first phrase written at the top of her birth plan.
The time came - labor was slow and difficult but mostly without incident. We checked into the hospital the morning after her water broke. My wife's vitals were normal, our child's vitals were normal. Around midnight my wife needed rest. We decided to lay down for a bit - she would try to fall asleep between contractions. I was so sleep deprived I blacked out as soon as I laid down.
“Josh” I heard my wife whimper from across the room. I shot up out of a dead sleep around 1AM to see that my wife was cornered on the other side of the room by Dr. Michella Switzer and three nurses - they had made sure to not wake me and maneuver my wife away from me to have their “discussion”. As I became conscious I heard words like “C-section” and “emergency”. Switzer wanted my wife to take Pitocin - a drug that speeds up and intensifies contractions (and makes them MUCH more painful - usually requiring an epidural) thus increasing cervical dilation. Once I woke up a bit I began to ask some basic questions that let me see what the situation really was - certainly not an emergency. The conversation went something like this:
J: What's wrong with my wife - how are her and the baby's vitals?
M: The baby might go into distress if we don't give her Pitocin.
J: How are her and the baby's vitals?
M: They're both fine for now
J: It's been hours since her last cervical check - what's her dilation at now?
M: The Pitocin will increase her dilation over about 30 minutes
J: What's her dilation now?
M: We haven't checked yet. If you're concerned we could just start her at a very small dose of Pitocin - it would take about 30 minutes to kick in.
My wife only labored for an hour after this, naturally, and pushed for only eight minutes before our beautiful, healthy daughter was born.
I am reminded of a paper I read in The Journal of Perinatal Education while preparing for labor. From the abstract (emphasis mine):
“Maternity care in the United States is intervention intensive. The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy is far from restrictive. These interventions disturb the normal physiology of labor and birth and restrict women's ability to cope with labor. The result is a cascade of interventions that increase risk, including the risk of cesarean surgery, for women and babies.” 
This exchange disgusted me and I get angry just recounting the details. It was rapey and unprofessional. Medical staff should never coerce a woman into any kind of decision when she is vulnerable. I don't know what the incentive is to push these drugs so hard - is it to free up the room sooner? Perhaps to bill more items to the insurance? Maybe the labor and delivery discipline attracts a disproportionate number of people on strange power trips, as police work sometimes can. Maybe it's the aftershock of the COVID pandemic, where medical staff were suddenly elevated to godlike figures (God is indeed dead and there is a power vacuum to fill after all…), and these new gods were blindly trusted to make personal decisions for us about which drugs we should and shouldn't take. My hunch is that it's a combination of all of those reasons.
My point in telling this story and reflections is to emphasize that a husband's most important job is to look out for his wife's best interests. This is likely controversial in our atomic society that views every person as an island - husbands and wives as totally independent entities that cohabitate in order to both work a full time job and participate in capitalism - after all having children is an inconvenient anachronism that limits the amount of travel one can take, stuff one can buy, and most depressingly to the idea's opponents, requires that one grow up and exercise discipline over their passions.
Despite this controversy I believe it is the husband's most important role during the birthing process. Have these discussions beforehand - how hard should you push (not literally…)? If your wife is crying and tells you she wants an unplanned epidural ask her - long before the due date - how she would like you to handle that situation. My wife wanted me to remind her what she planned and why she planned to do it that way. This happened to us but actually in prodromal labor - she had doubt when the contractions began to ramp up in intensity (who wouldn't). I reminded her that we had taken classes and had been practicing techniques to get through this naturally. I also reminded her that I would do everything to protect her and if she truly wanted to go in a different direction, I would get her whatever intervention or care she wanted. She realized that the doubt was just that - doubt. Talking through it reassured her and she continued on unmedicated. When speaking after the birth she thanked me for not letting her immediately change the plan when doubt crept in - she was grateful that I held to her plan but also that I would advocate for anything she needed - in the plan or not.
You are watching your wife's back during labor. Understand - during labor your wife will be in a very altered state of consciousness - her body is doing miraculous things to prepare to push the baby out. She needs to focus. Honor her wishes but weigh wishes in-the-moment vs decisions in the plan, and decide ahead of time when and under what circumstances in-the-moment can trump the plan - for us this was either a repeated asking for a change or mother or baby in distress (a do whatever is necessary situation).
You'll have to find your line - it is tough to see someone you love in so much pain for so long, but it's also intimate. Communicate lots, war-game all scenarios that might happen, and walk in there ready to tell any doctor that is creepy to eat shit - politely of course :)