As birth left the home and families were divided by the experience of birth, birth ceased to be a family event. Birth became dehumanized. With the return to the home and with consumer demands for more “homey” settings in institutions, the concept of children at birth has become a “problem” that needs special preparation, classes, and “expert” advice. I have a very strong prejudice regarding the presence of children at birth: if the mother and father want their children to be present at the birth and if the children want to be there, then that family must have their birth. This is your family. To quote Marjie Hathaway, the family is “a necessary and sacred institution.” A midwife’s job is to support and empower families. 1, 2
Why should children be present?
*bonding *positive sex education *an appreciation of fear and pain *witnessing a miracle *being helpful and encouraging *being part of the whole family *maybe lessening sibling jealousy Why shouldn’t children be around ? *negative feelings about sex, birth *fear of the unknown *lack of modesty by the mother *shock at seeing “forbidden body parts” *pain can scare the child *possibility of nightmares 3, 4
How some parents decide
Some families are very comfortable being with their children in various stages of dressing or undressing, occasionally sharing their bed with a child, and can easily discuss any issue that comes up with their children. Other families are very modest and avoid discussions about body parts or gender. There is no one right way, but for a family contemplating a birth with children present, a certain amount of information will need to be shared. In a family that is extremely modest, parents need to discuss their comfort level with their children seeing the mother somewhat nude. If the mother is not comfortable with this idea, then it may be better to plan for the children to be there but not in the room where the birth will take place. Of course, other concerns like the involuntary passage of feces, amniotic fluid, and blood can be embarrassing for some mothers (or fathers) who would rather their older children not be present. Sometimes women make noise while working and pushing. A mother must be sure that she is comfortable making those necessary sounds with her children present. At some point during the birth, her mother will undress to deliver the baby and nurse the newborn. If children are going to be able to witness the birth, they need to know where the baby is going to come out and a little bit about how the process works. The level of detail in these explanations will depend on the age and curiosity of the child or children.
parent preparation
Probably the best preparation is good communication between parents. For parents who feel they need more knowledge, a consumer-oriented job course can be time well spent. Many of these courses include discussions of children at birth. Some even have a dedicated sibling class to help parents prepare for their new brother or sister. Those who plan to have a natural childbirth without medication should take good care of themselves. Good nutrition is the cornerstone of a healthy pregnancy and goes hand in hand with a lifestyle that includes adequate exercise and avoids smoking, alcohol and drugs. A healthy woman has a good chance of giving birth to a healthy baby. The place of birth should be pleasant for the mother and, hopefully, for the father as well. 6
Advantage
There are numerous positive aspects of having children present at the birth of their siblings. The family is together for a family event, they feel part of it. Psychologically, they are not excluded from a family experience. Home birth also helps in this regard because the mother and baby are always there, whereas if the mother disappears and shows up days later with the baby, the children left behind can feel abandoned and jealous of the new baby. 2, 8
Issues
With younger children, fear is often a problem that comes up, especially if the mother makes noises, works hard, or has a wince on her face. Having someone at birth whose sole role is to care for the children can alleviate this problem. Sometimes young children get bored with work and that person may take them for a walk or play with them. 8 Child Preparedness 1) discuss with children what will happen a) pregnancy, labor and delivery b) read books about childbirth c) watch videos about childbirth d) answer questions in an age-appropriate way 2 ) keep labor conversations positive 3) take the children with you to prenatal so they become familiar with your birth attendant and some of the routines (blood pressure, pulse, palpation, etc.) 4) assign each child a job to do during labor or birth or after a) giving a massage b) getting drinks for mom c) making meals d) cutting the cord e) dressing the baby, etc. 5) have a caregiver present for children who need someone 6) have a baby shower after birth for siblings 4, 7
Guidelines for children at birth
*children should be able to come and go as needed *caregiver will attend to the needs of younger children *children will remain in their own home before, during or after birth *only one familiar person will wake a young child who sleep * reassure children that all is well * let children get to know each other in a planned (give a gift) and unplanned way 2
Experiences
Family after family documented their births with older siblings present at Children at Birth. Almost all the children who were interviewed were very happy to have attended the birth and were not frightened by the actual birth. A story near the end highlighted the reason why a caretaker is needed for the children. This child was startled by her mother’s efforts to push the baby away and left the room, refusing to go back in. Then someone noticed that she was upset and talked to her about her fear, made her mother smile at her and the girl joined her family for her delivery. 8 The Thompson family had several children born at home and all of them remember the events as very exciting and full of joy. The husband of one of the daughters comments: “At one point, I thought that having a baby was the same as removing your appendix. It always seemed to me that it was a matter of life and death…” After the birth at home of her niece, whom she saw 5 minutes after her birth, said, “I can’t believe something so complex can be so simple and beautiful.” Although he was an adult, her impression expresses what so many children feel but cannot articulate. 9 Sue Hathaway, 15, spoke at a NAPSAC conference about her experience seeing her younger brother born. Her final comment was, “If you’re not going to learn about having babies from your parents, who’s going to teach you?” Jonathan Stewart also spoke at that NAPSAC conference. Her memories of the births of her 4 siblings were wonderful, “pleasant memories”, and he remembers very little blood. The youngest brother, Keith, seeing the birth of his newest brother, blurted out: “Look, mom, he’s naked.” Lora, ten years old, remembering the birth of her brother says: “I felt love in my heart… I felt close to him.” 10 Shiela Kitzinger interviewed a couple of women whose oldest child slept until the baby was born and then woke up to join the family in the delivery bed. One said: “Julie woke up to find that a sister had been born overnight just as we told her it would. We were the happiest family in the world.” 11 Sandra Anderson gave birth to her son Josiah in a hospital with many surgeries. When she became pregnant with her second child, she was determined to have a natural birth and include Josiah in this family-focused event. He was 2 1/2 years old. Her perspective of her experience was that she was comfortable with the whole situation. An added bonus for her was that he reminded her that she wouldn’t be in labor forever, when he asked, “Where are my playthings?” and “I want a peanut butter sandwich.” She felt that Josiah added a “wonderful spirit of spontaneity to the birth”. 12 Children have a different perspective on birth and do not necessarily “see” it the way adults do. One woman recalled how after the birth of her fifth child, her four-year-old son walked into the room and noticed that the furniture had been rearranged. This interested her so much that she went to get her other siblings to see the room. One family felt that having the children included from early pregnancy to birth was very important, writing: “The midwife asked us every day how the baby was doing and the children were delighted to tell her everything that had happened since their last birth. visit”. These may seem like trivial details. But when I read about the breakdown of families, maybe they are not so trivial, but vitally important factors.”11
Studies
Over the years there have been several studies looking at various aspects of birth and the effect on children and families. Some studies have found that one of the reasons parents choose a home birth is specifically because of the opportunity for all family members to have a positive experience. Lewis Mehl noted that the children he studied had accurate information about the birth and viewed the event as a good experience. Another researcher, Chase, found that mothers noted less rivalry between siblings who were present at the birth. Curry comments that the children blame the new baby when the mother disappears to go to the hospital, but when the children are included in the birth, they see the new baby as a “gift”. When childbirth was allowed, their view of birth became a real experience and not the mysterious, terrifying, life-or-death event portrayed in the media. They were not separated from their mother or father and thus overcame the separation anxiety that many children suffer when their siblings are born in a hospital that does not allow their presence. The presence of children at birth is also thought to affect how well siblings bond, similar to the mother-infant bond that occurs immediately after birth. 2 While not a truly scientific study, Dr. Michelle Harrison’s informal study of children over a two-hour period during which they actively discussed birth and related issues does highlight a couple of points. She notes that the conversations about birth seemed very serious, whereas when the children discussed animal births, they were more animated. Her interpretation includes the idea that they may perceive that talking about birth is more for adults. Some children spoke of poor outcomes, and Dr. Harrison writes that this affirms the idea that giving birth is serious business. One topic that was somewhat surprising was a discussion of how to talk about birth in school. They used to feel that it was not okay to talk about their birth experience at school or with their teachers or peers because the experience was unfamiliar.
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Hathaway, Marjie, and Jay, Children at Birth, 1978, page 1. 2. NAPSAC, Chapter 68, pages 877-895. 3. Hathaway, pages 11-21. 4. NAPSAC, Chapter 67, pages 869-876. 5. Hathaway, pp. 31-34. 6. Hathaway, pp. 41-58. 7. Hathaway, pp. 105-106. 8. Hathaway, pp. 131-174. 9. Thompson family, 21st Century Obstetrics Now!, vol. 1, Chapter 18, pages 239-253. 10. NAPSAC, 21ST Century Obstetrics Now!, Vol 3, Chapter 65, pages 857-863. 11. Kitzinger, Sheila, Birth at Home, 1981, pages 101-111. 12. NAPSAC, Chapter 66, pages 865-867.