The Art of Labor Sitting
Labor sitting is the process of being present with a mother when she is laboring and does not require your direct attention, but needs your attentiveness. In other words, labor is going well but there really is nothing for the doula to do but step to the outer circle and wait. Common situations for labor sitting are early labor, the first few hours of an induction, when mother is resting with an epidural, or taking turns with another member of the birth team.
Good labor sitting means that the doula seems occupied but interruptable. The mother does not feel pressured by your presence to be further along in labor or to be doing anything different than what she is doing. At the same time she can feel your presence, knowing you are available if she should need you. Often, labor sitting takes place in the same room with the mother. Effective labor sitting is an active, not passive process. It may seem we are sitting on the couch working on a little project. But a good doula is much more aware of what is going on than it seems!
So how do you strike this balance? Over the years, through trial and error – doing it wrong and by accident doing it right and then repeating it – I have found my way to effective labor sitting. I do needlepoint. If I am reading a book or looking at the screen on my phone, I seem occupied by what I’m doing. My attention is focused on the book or my phone. Someone might feel they were interrupting me if they spoke to me. If I am just sitting there, people may feel bad because I’m just sitting in the chair not doing anything. They might feel badly or pressured because my skills weren’t being used yet. If I am sitting on the couch doing needlepoint*, my mind is in the room with them, yet I am happily occupied.
One time a father called me saying he and his wife were getting ready to go to the hospital. They weren’t packed yet so he was rushing around the house. Her contractions were 4-5 minutes apart with no bloody show. Mom was relaxing in the bathtub and coping well. Through our conversation I got the idea that Dad was anxious. I surmised he wanted to go to the hospital because it would relieve his anxiety. As we’ve all learned from TV when you go to the hospital the baby comes out. While this is an irrational belief, it is the way our culture has trained us.
I offered to come over and help. When I arrived, Mom had just gotten out of the tub and gave me a big smile. My doula assessment of the labor was that it was not time to go to the hospital. I asked her preference and she said she wasn’t ready to go (she is the decider, not me). We talked a bit and I went to sit on the couch and got out my needlepoint. I didn’t say anything but after a while Dad seemed to calm down. We chatted and his furious pace of grabbing household items and putting them in the pile slowed down. He began to pay more attention to Mom. The message he got from my behavior was: “Amy’s calm so there must not be any rush.” When mom had a contraction I would stop and breathe with her, looking at her from across the room. This visual regard is also a part of effective labor support – if she were to look at me she would see that I was watchful and available. In due time we went to the hospital; they were both calm and made the decision they were ready.
Another time labor sitting skills come in handy is at the beginning of an induction. There are many anxieties to soothe and many decisions that are made in those first few hours that have repercussions later. If I am present I am able to remind them of their choices, make sure their questions are answered, and calm them down. I create an atmosphere in the room to make it their space. I can increase the level of connection between my client and the nurse, resident physician, and attending physician. If I am not there, those things often do not happen. This is another time to discuss methods of induction and parent’s concerns. It is often easier to advocate for using the shower or tub, or having a slower, gradual Pitocin drip before any interventions are administered. Parents may be able to get approval for a plan to go home under certain conditions. What I have found most often is that a mother may bring up these things and then the medical care providers (MCP) explain to her why they won’t do it that way. But in the long run, my client has explored her options to the extent she wanted to. Plus, the MCP and my client have talked and understand each other’s concerns and preferences. The nurse has heard the mother and she may make more suitable labor support or intervention suggestions.
Of course a discussion about options is fifteen minutes out of three hours of labor sitting. Even if none of these discussions happen, there are still other fears and plans that are on their minds and choices to be made. I have never found NOT being there at the beginning of an induction to gain my clients or me anything. Sometimes with a Pitocin induction, parents want me to leave for a while. That’s fine and we agree to check in verbally – not with a text – every hour or two. If they want privacy with a misoprostol induction, I stay immediately outside the room or return every 15-20 minutes. Those intense contractions can hit without warning and the partner or nurse may not be able to contact me.
Labor sitting is a creative art. It requires an understanding of the people involved, a perception of possible futures, and an empathetic, compassionate presence. It is not a passive process – you are not waiting for something to happen and then responding to it. Instead, you are influencing the present moment. You are there, caring, mindful, and available. People take their cues from your behavior and from your presence. Because of active compassionate labor sitting, labor often unfolds differently.
*Some doulas embroider or crochet something for the baby or make a lace cap out of a handkerchief. Knitting needles may click which bothers some mothers.