Doulas, how do you handle marathon births? - Mothering Forums

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Old 01-29-2011, 04:22 PM - Thread Starter
 
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I was at a birth recently where I was with the couple for 25.5 hours straight. But I was actually up for more like 48 hours....I got an initial labor call from her the night before, was up waiting for the "I'm ready" call but then her labor petered out and picked up again the next night after I'd slept for about 2 hours. She needed constant support from both me and her husband the whole time she was in labor. I took two maybe 15 minute breaks to eat. I managed, but by the end I really felt like I didn't have as much to give as I would have liked. I was just so tired, physically and emotionally- very difficult birth in so many ways.

 

SO...it got me thinking how I might handle this next time. I was thinking I might build something into my contract that if the labor lasts more than 12 hours, I may opt to bring in my backup to cover for me. I'd leave it open-ended so that the couple and I could make some decisions together if/when the time comes, but I'd just put the idea in there that this is a possibility. I figure if I'd been with her for 12 hours and she was at 8 or 9, no problem, I'd just stay. But (as was true here) if she was at 4 after 12 hours of intense support from me (counterpressure for every contraction etc.), I might have the backup come for 2 or 3 hours so I could sleep. That way the mom gets continuous support, she still gets me there for the really tough part at the very end, and my energy is conserved.

 

Thoughts? How have y'all handled this situation? A first for me.


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Old 01-29-2011, 04:25 PM - Thread Starter
 
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Oh and another idea I had, of course after the fact, is that I could have called my backup for this birth and had us BOTH support the woman. That way I get some help, but she still has my continuous presence. I thought about calling in my backup to take over for me but I couldn't leave her during such a difficult birth, and it only occurred to me later that I could have tried to have two of us there at once.


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Old 01-29-2011, 07:31 PM
 
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I would think calling a backup in to at least give you an hour to take a nap would probably be the best idea. I dont think that it is a bad thing to do, because if you are rested you can give better support.


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Old 01-29-2011, 09:41 PM
 
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My contract says that if I am with them for more than 24 hours, I reserve the option to call in a back-up doula to relieve me.

 

However, I've never done this. It is just too hard to leave a laboring mama when I am so invested in her journey.

 

I get about 5-6 births a year that require 24 hours or more of doula support. If the mama is in a good zone and dozing in between contractions, I will put my head down next to her and close my own eyes in between. "Five Hour Energy" drink does wonders for me, as I don't normally drink any caffeine. If dad is doing well (and comfortable in the primary support role), I have occasionally traded with him for 20 minutes of sleep. Well, I give him more than 20 minutes, but that's how long I take! It is amazing what 20 min can do for you. At one birth, the awesome nurse offered to take over with counterpressure for 20 minutes while I sat in the chair with my feet up on the birth ball, dozing. That really helped too, and it was so sweet of her (the mama loved this nurse too, otherwise I never would have "let" her take over). Home births are the best, so much easier to get in tiny bits of rest as the mama is resting too.

 

I don't think it's feasible to call in a backup after 12 hours, nor fair to your clients... Heck, if I'm in-and-out in 12 hours with a first-time mom, I consider that very fast! 12-18 hours of doula support is pretty average for me with primips, and up to 24 (or more) is not unusual.

 

Sounds like you might be a newer doula if you were up most of the night before waiting for "the call"... I have found that over the years I've gotten MUCH better at falling asleep when I know a client is close to labor. I have a little mantra I repeat slowly to myself when I close my eyes and my mind starts to race... "Peace... And sleep... Peace... And sleep..." That really helps me shut off all that monkey chatter and adrenaline. These days I can even fall back asleep quickly if she calls in the middle of the night to consult but she doesn't need me yet... And when I was new to this work I could *NEVER* have imagined that! So it does get better with time and experience.

 

Keep experimenting, you'll figure out what works for you.

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Old 01-30-2011, 09:44 PM
 
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I agree with writing in your contract that a back up may come in if labor is more than 12 hours, 15 hours, whatever you are comfortable with. Another thing I try to do is always have everything ready to go and if I get a pre-labor call I go to bed so I'm ready when I'm needed. It is a difficult balance.

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Old 01-30-2011, 11:01 PM
 
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OH dear, I was one of those clients of which you speak!! My amazing doula was with me 30+ hours of a 42-hour labor that ended in c-section. DH and I were totally needing her support to get through it. The majority of the labor was a very physical one to encourage baby to descend (who did not budge one single station) which meant she was there doing deep squats with me, counterpressure, helping with different positions, massage, etc. Very physical for her for sure. I even threw up on her once and was totally and absolutely mortified. One of the nights we all did try to sleep, we bought her food and drinks, and got her a massage thank you package after the whole ordeal was over. Another timeframe I did end up with an epi and we all tried to nap for a few hours. I was so conscious of the fact that it was an entire work week basically. 

 

I did call her early in the labor just to say hey, I am in labor, and we didn't need her for a few hours after that. She was able to shower, get her dogs taken care of, finalize some things in her bag, etc. I tried to wait to call her until I really couldn't talk through contractions and DH needed her there too. 


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Old 01-31-2011, 01:29 AM
 
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 I try not to beat myself up for getting tired. The laboring mom has an energy and adrenaline no one else in the room has.  I relate to your frustration though.  I had a recent doula experience where I was so tired during a very long labor -- the mom was hitting a wall. I was being more of a watchful, vigilant doula and pretty hands off and super quiet and just watchful as this is what she wanted. But in a way I find this type labor support really exhausting in its own way b/c it is  being vigilant without doing a lot. Like,  I don't want to not be aware and watchful on the odd moment she actually does need/ask for something. So...

 

anyway, she looked to me and said she needed to hear her options for pain control -- I was so tired I mentioned (among other things)  that she could have her waters broke to get things moving faster -- completely forgetting her waters had broken themselves about six hours prior!  Ugh I felt so stupid, inattentive "they're gonna think I'm not paying attention" , and everything else. 

I felt also annoyed at myself for having stayed up til 4am the night before, only getting 3 hours sleep -- it was another reminder to not be careless about my sleep (when I can help it) when I have a client 37 weeks or beyond.

 

I have and do totally ask for half an hour, 45 minutes and even an hour away (to eat something and sleep).  15 mins. isn't enough for me. Around 18-20 hours I get tired. I need a proper break. 15 mins. is practically only a  bathroom break. If I can sleep 20-40 mins., personally for me I feel really reinvigorated.

 

As long as there is a partner, friend, nurse, or mom or some one there I can see is capable of decent support and the client is in a  good groove, I feel totally ok doing this. And if an epidural is received, usually the mom tries to rest anyway.

 

Re calling back up-- I wouldn't want to be another stressor on a fellow doula's time by asking for break relief -- unless there is truly no good support for the woman but me. In that case -- I might consider it.

 

 

 

 

 

 

 

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Old 01-31-2011, 01:39 PM
 
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Personally I think 12 hours is rather short since the average first time labor is 12-16 hours.  Maybe 24 hours, but if you put 12 hours in there the mother might feel rushed or feel like a failure if her doula is leaving.  I think another way to think about this is that the mother is up all that time so why shouldn't her doula be as well?  I can see in really, really long births if you really feel like you can't give anymore then yes call in another doula, but 12 hours - just not long enough.  Heck my 9th baby was a 15 hour labor - had my doula opted to leave at the 12 hour mark I would have really, really felt defeated and upset.  


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Old 01-31-2011, 04:08 PM - Thread Starter
 
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Just to clarify, I'm not worried about a 12 hour birth, or an 18- I'm just thinking about what to do if we hit that 12 hour mark and it's clear that we have a LONG way to go.

 

I definitely wouldn't want to make the mom feel rushed, or like she's done something wrong by having a longer labor. I just want to make sure I can get the rest I need to support her optimally, and I don't want to surprise her with a long break. She may read "continuous support" as part of the doula's job and feel upset at being left so I can rest, you know? But it's definitely important to me to be there for the mom regardless of the length of her labor. To me, that's an essential part of the doula role. I just want to find a way to do that the best way possible when a labor goes 24+ hours. For me, I think I need the break after 12-18- by the time we get to 24 I'm already less of a help than I'd like to be, PLUS we might be at pushing stage at that point and I really can't leave.

 

One PP made the very good suggestion to get everything extra-ready when a client is a term- thank you! I think from now on I'll have everything ready- clothes in a pile on top of my labor bag, snacks in the fridge ready to go, etc- so that if I get that 2:30 am call I can go back to sleep and get up when I'm really needed.

 

Thanks y'all!


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Old 01-31-2011, 07:14 PM
 
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Just to clarify, I'm not worried about a 12 hour birth, or an 18- I'm just thinking about what to do if we hit that 12 hour mark and it's clear that we have a LONG way to go.

 

 


But how do you know it will be a long birth?  I guess I am not following you on this one because I have seen moms labor for hours and hours and hours and suddenly take off and go to complete in an hour.  You simply cannot predict how long a labor and/or birth will take.  I had one mother that zoomed to 9 cms with a lip and then she sat there for more hours then I would care to think about (I think it was like 8 hours or something nuts like that).  We all thought for sure she was heading to a cesarean and then suddenly it was gone and she pushed her baby out.  

 

I just don't think you can predict how long a birth will go no matter what is happening.  

 

I think most mothers would understand at the 24 hour mark if a doula needed to be relieved, but I just can't see that happening before then.  Just my two cents.


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Old 01-31-2011, 07:53 PM
 
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I agree with momto9. I can't see asking for a break at the 12 hour mark. If you've been there for 24 hours and she doesn't seem to be close to delivering, I think that the parents would understand if you need a nap.

 


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Old 01-31-2011, 08:36 PM
 
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I was just dealing with this same question a few nights ago.  When we hit the 24 hour mark and I was totally worn out and she was just starting to really need support...I was not sure I could give more if it lasted a whole lot.  I think I might ask my back up to come for a few hours for me next time - just to give me an hour or two break.  Still haven't decided for sure.  BUT I am sure I'm not paid enough for long labors like that.


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Old 02-01-2011, 12:29 AM
 
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One option that hasn't been explicitly mentioned is what my backup and I have talked about doing (I am currently pg, and she is planning on TTC in the near future). What we've talked about doing is having it in our contracts that we work together, both see clients for prenatals so we both have an established rapport before the birth, and then after x hours (we were thinking 12-18) we tag-team. So whichever doula is at the birth from the start would trade off with the fresh one at that point, to ensure that the mother is always getting the best support possible. Then if (G-d forbid) labor lasted another 12-18 hours, we'd trade again. Also, after we both have our babies, we'd be able to trade off for long enough to breastfeed or pump.

We know at least one other doula "team" locally who practices this way, I think they have it written into their contracts that they trade at 12 hours. They seem to get quite a few clients, so it doesn't seem to be a problem with the moms or their partners...


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Old 02-02-2011, 01:39 PM
 
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I'm a fairly new doula too, but it seems that most of the first births I attended were quite long--two around the 40 hour mark, another couple around 20 to 24. I've found that adrenaline gets me through quite a bit if the mom is needing my help, as well as snacking, and closing my eyes in between contractions if the mom is also dozing. One of those long births was a home birth and I was one of two doulas, so we spelled eachother for naps and food. The other was in the hospital and she got an epi around the 30 hour mark so all three of us (mom, partner and I) slept for awhile. I'm not sure what I would have done otherwise because I was definitely feeling the strain and a lack of mental agility.

 

Having the bag packed and everything ready to go is definitely helpful, and paying attention to my own sleep needs and health when on-call. Out of curiosity, how much does a doula team charge and how do they work out compensation between the two?

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Old 02-03-2011, 04:45 AM
 
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Quote:
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Just to clarify, I'm not worried about a 12 hour birth, or an 18- I'm just thinking about what to do if we hit that 12 hour mark and it's clear that we have a LONG way to go.

 

 


But how do you know it will be a long birth?  I guess I am not following you on this one because I have seen moms labor for hours and hours and hours and suddenly take off and go to complete in an hour.  You simply cannot predict how long a labor and/or birth will take.  I had one mother that zoomed to 9 cms with a lip and then she sat there for more hours then I would care to think about (I think it was like 8 hours or something nuts like that).  We all thought for sure she was heading to a cesarean and then suddenly it was gone and she pushed her baby out.  

 

I just don't think you can predict how long a birth will go no matter what is happening.  

 

I think most mothers would understand at the 24 hour mark if a doula needed to be relieved, but I just can't see that happening before then.  Just my two cents.


Agreed 100%! Honestly, I think if we're in this work, we have to be prepared for the long hauls. I think many of my clients would be worried by a provision that I might leave/trade off after 12 hours. They do want continuous support. Even when I'm exhausted, I get a nice adrenaline boost when the mom starts pushing and I've always been able to provide any extra support she needs at this time. Long births come with the doula territory -- we get through them, catch up, and hope the next one might be a sprint rather than a marathon.

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Old 02-03-2011, 11:54 AM
 
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Originally Posted by Keileen View Post

I'm a fairly new doula too, but it seems that most of the first births I attended were quite long--two around the 40 hour mark, another couple around 20 to 24. I've found that adrenaline gets me through quite a bit if the mom is needing my help, as well as snacking, and closing my eyes in between contractions if the mom is also dozing. One of those long births was a home birth and I was one of two doulas, so we spelled eachother for naps and food. The other was in the hospital and she got an epi around the 30 hour mark so all three of us (mom, partner and I) slept for awhile. I'm not sure what I would have done otherwise because I was definitely feeling the strain and a lack of mental agility.

 

Having the bag packed and everything ready to go is definitely helpful, and paying attention to my own sleep needs and health when on-call. Out of curiosity, how much does a doula team charge and how do they work out compensation between the two?



I'm not sure how much they charge (I know they charge more than I do, but they get a lot of the local births), but I think they handle compensation based on a percentage system, and the percentages are based on the amount of time spent with the laboring mother. My backup and I haven't discussed in detail yet how we want to handle it, but we probably will fairly soon, since being a pregnant mama myself, I'm just not sure I can physically handle a marathon birth right now.


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Old 02-04-2011, 09:43 AM
 
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I used to live off the adrienaline too...but I don't get that much of a high now till things are really getting strong and active.  If it is a slower labor I am just me - no super powers.  :(  But, I'm always very energized when it is really needed.


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Old 02-04-2011, 01:31 PM
 
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Here are my strategies:

1. Eat a decent dinner and maintain a 10 p.m. bedtime is a prudent rule if you are on call.

 

2. Don't go to mom too early. Really encourage her and her husband to take that first part of labor to be alone and savor their last moments as a couple (with first births). Encourage them to labor at home as long as possible, do phone check-ins periodically, and look at the doula as something for when you are feeling that you cannot handle the contractions on your own. I have one friend who I think tries hard to get couples to call her in only when they are going to the hospital so that she conserves her energies for when they will need her the most, and 'going to the hospital' is a good proxy for 'things are getting serious.' I also ALWAYS tell moms who are getting some regular contraction activity after 9 p.m. to try having a dose of benadryl or glass of wine and take a warm bath to see if they can catch another few hours of sleep so they don't go into their labor without any rest, and then I drop what I am doing and go to bed immediately knowing I might be called back in an hour or two or four.

 

3. Make sure you are eating/drinking enough to stay energized and hydrated. If mom is drinking 8 oz. of water per hour, you should be too. Eat complex carbs and proteins, not just a candy bar or a handful of raisins.

 

4. Nap when mom naps. Or, if the couple is in a good spot (mom is laboring well in the tub, for example), tell them that you are going to give them some privacy but that you'll be right there in the room if they need you, and take a cat-nap then. I never sleep soundly, but a 20 min. power nap can give you a big boost.

 

5. Don't stand when you can sit, and wear shoes with good arch support and padding - hospital floors are hard.

 

6. Remember ergonomics - practice good lifting; don't stretch or contort yourself into crazy positions to massage the mother. Move things around or move yourself if you need better access to her.

 

7. I also carry a toothbrush, very minty toothpaste, and a clean pair of socks in my doula bag. Take a moment to freshen up - go wash your face, brush and floss, and change what clothing you can. It's amazing how good fresh socks can feel if you've been awake for 36 hours.

 

8. Call in back-up if you are at the point where you can't complete a sentence or think straight. I tell clients that one of the reasons I have back-up is that if their labor goes long, they will want a fresh horse. I haven't ever had one go so long that I had to call a back-up in, but you just never know.


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Old 02-04-2011, 03:34 PM
 
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I recently wrote it in that 18 hours is the point that I will consider backup if I feel it is needed, but for 2 recent births- 26 hours, 25 hours I didn't, although I took nursing breaks nad had a nap at both, so that makes up for backup imo. I am a mom of a 1 yr old, so marathon births... 52 hrs is my longest! Won't work for me, or my clients.


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Old 02-05-2011, 12:34 PM
 
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These tips are awesome -- I *am* wondering how you accomplish no 6? It seems impossible to me! After almost every birth, afterward I'm all sore. I usually end up in all kind of funky positions. What about when they are in the tub, especially? (and need hip squeezes?) Or on all 4s?  If they are laboring instinctively I find they get in funky positions?   The best I hope for usually is the woman has a willing and strong partner to help me with the back labor/support.

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Old 02-05-2011, 04:18 PM
 
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Quote:
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These tips are awesome -- I *am* wondering how you accomplish no 6? It seems impossible to me! After almost every birth, afterward I'm all sore. I usually end up in all kind of funky positions. What about when they are in the tub, especially? (and need hip squeezes?) Or on all 4s?  If they are laboring instinctively I find they get in funky positions?   The best I hope for usually is the woman has a willing and strong partner to help me with the back labor/support.


You have the dad do it :o)  I completely agree - I always try to save my body, and I also will not start something that I know I cannot sustain.  For example, I do not do the double hip squeeze.  I know my hands and wrists cannot take it so I won't do it. I will show the birth partner and if there isn't one there then I use something else.  


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Old 02-05-2011, 06:02 PM
 
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You can use a rebozo for hip squeezes if mom sits in a chair and has it wrapped behind/around her hips - you can cross the ends and pull so your left hand pulls the side coming from her left, your right pulls the side coming from her right. You can also press one side while dad presses the other if she's on hand and knees, or switch frequently with the dad. Also, if mom is in the tub, have dad get in with her.


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Old 02-06-2011, 12:05 PM
 
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 I should look into a  rebozo for sure.

I feel bad not doing the pressure a lot b/c it seems to make such a  diff. for so many of them, however when I think about it and read your suggestions/own ways of handling this  -- I do need to figure out a  way to offer relief without killing my body. I do encourage them to get into other positions but sometimes it's just like yeah right and I'm stuck with "PRESSURE PLEASE!!" with mama in some position that's difficult on me (like some dinky little tub or shower stall or low *something* or other --even the bed is often awkward --unless it's at a hospital, for which I am grateful for their adjustable beds).  I should learn ways to verbally encourage positions in such a way I don't feel I am interfering with mama's instincts.

. I also think I do need to start a consistent strength workout, especially upper body!  Thanks for these reminders re preserving the body. Maybe I will try to get in little "back pressure tutorials" for mama's other support people, before the birth...so often it seems like the lady's partner is *not* too effective at hip squeezes (or even simple pressure, like "no honey too hard!/low/high etc etc!" Then partner ends up comforting mom in some other way and I'm doing the pressure. :/

I  get stuck with it a a lot! I think I *will* start these little tutorials before labors.

 

 

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Old 02-07-2011, 10:55 AM
 
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Re: so often it seems like the lady's partner is *not* too effective at hip squeezes (or even simple pressure, like "no honey too hard!/low/high etc etc!"

 

It's funny how often that happens, even with tutorials. I sort of wonder if women have an instinctive connection with other laboring women that men take longer to click in with. I hardly ever have moms correct what I am doing, but they often tell dad to move his hands, use more or less pressure, or even say, "Just let HER do it!" I am still puzzling over why that seems to be the case.


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Old 02-07-2011, 02:25 PM
 
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Originally Posted by kcparker View Post

Re: so often it seems like the lady's partner is *not* too effective at hip squeezes (or even simple pressure, like "no honey too hard!/low/high etc etc!"

 

It's funny how often that happens, even with tutorials. I sort of wonder if women have an instinctive connection with other laboring women that men take longer to click in with. I hardly ever have moms correct what I am doing, but they often tell dad to move his hands, use more or less pressure, or even say, "Just let HER do it!" I am still puzzling over why that seems to be the case.


That was me- I needed a constant double hip squeeze when I was laboring with my daughter, and the nurse showed DH *exactly* how to do it, and he just couldn't do it like she did!

I have found that I can even put the dad's hands right where mine go, and push on his hands like I'd be pushing if I was doing it, and it still doesn't work. I don't know why it is either, but since it happened to me, it's at least a little easier to understand...


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