As birth moved out of the home, and families were splintered by the birth experience, birth no longer was a family event. Birth became dehumanized. With the return to home and with the consumer demands for more "home-like" settings in institutions, the concept of children at birth has became a "problem" that needs special preparation, classes and advice from "experts". I have a very strong prejudice regarding children's presence at birth -- if the mother and father want their children present at the birth and if the children want to be there, then that is how that family should have their birth. This is their family. To quote Marjie Hathaway, the family is "a necessary and holy 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 *to witness a miracle *be helpful and encouraging *be a part of the whole family *maybe diminish sibling jealosy Why should children not be present? *negative feelings about sex, birth *fear of the unknown *lost modesty for mother *shock at seeing "forbidden body parts" *pain might frighten child *potential for nightmares 3, 4

How some parents decide

     Some families are very comfortable being with their children in various stages of dress or undress, occasionally share their bed with a child and are easily able to discuss any topic that arises with their children. Other families are very modest and avoid discussions about body parts or sex. There is no 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, the parents need to discuss their level of comfort with having their children see the mother somewhat naked. If 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 be taking place. Of course, other concerns such as passing involuntary feces, amniotic fluid and blood may be embarrassing to some mothers (or fathers) who would prefer to not have their older children present. Sometimes women make noises while they labor and push. A mother must be sure that she is comfortable making those necessary sounds with her children present. At some point during the birth, their mother will be unclothed in order to birth the baby and nurse the newborn. If the children will 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. How detailed these explanations become will depend on the age and curiousity 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 childbirth course may be time well-spent. Many of these courses include discussions of children at birth. Some even have a class devoted to the siblings, to help the parents prepare them for their new brother or sister. Those who are planning to have an unmedicated, natural birth need to 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 stands a very good chance of giving birth to a healthy baby. The place of birth must be agreeable to the mother and hopefully the father, too. 6

Advantages

     There are numerous positive aspects to having children present at their sibling's birth. The family is together for a family event, they feel a part of it. Psychologically, they are not locked out of a family experience. Home birth helps with this regard also because mother and baby are always there, whereas if mom disappears and shows up days later with the baby, the children left behind may feel they were abandoned and are jealous of the new baby. 2, 8

Problems

     With younger children, fear is often an issue that arises, especially if the mother is making noises, working hard, or has her face grimaced in pain. Having someone at the birth whose sole function is to take care of the children can ease this problem. Sometimes little children become bored by the labor and that person can take them for a walk or play with them. 8 Child preparation 1) discuss with children what will happen a) pregnancy, labor and birth b) read books about birth c) watch birth videos d) answer questions in an age-appropriate way 2) keep conversations about birth positive 3) take children with you to prenatals so they become familiar with your birth attendant and some of the routines (BP, pulse, palpation, etc.) 4) give each child a job to do during labor or birth or after a) give massage b) get drinks for mom c) make meals d) cut cord e) dress baby, etc. 5) have caretaker present for children who need someone 6) have a party for new baby after the birth for siblings 4, 7

Guidelines for Children at Birth

     *children must be able to come and go as they need *caregiver will take care of smaller chilren's needs *children will stay in their own home either before, during or after the birth *only a familiar person will wake up a young sleeping child *reassure children that everything is alright *let the children get to know each other in both planned (give a gift) and unplanned ways 2

Experiences

Family after family documented their births with older siblings present in Children at Birth. Nearly all the children who were interviewed were very pleased to have been at the birth and were not frightened by the actual birth. One story near the end highlighted the reason a caregiver is needed for the children. This little girl was firghtened by the mother's efforts to pucsh the baby out and left the room, refusing to re-enter. Then someone noticed she was upset and talked with her about her fear, got the mother to smile, and the little girl joined her family for the birth. 8 The Thompson family had a number of children born at home and all of them remember the events as being very exciting and filled with joy. The husband of one of the daughters comments, "At one time, I believed having a baby was just the same as having your appendix removed. It always seemed like it was a matter of life and death..." After the homebirth of his niece, whom he saw within 5 minutes of her birth, he said, "I can't believe that something so complex could be so simple and beautiful." Although he was an adult, his impression expresses what so many children feel but are unable to articulate. 9 Sue Hathaway, 15, spoke at a NAPSAC conference about her experience watchilng her youngest sibling be born. Her concluding comment was "If you are not going to learn from your parents about having babies, who is going to teach you?" Jonathan Stewart also spoke at that NAPSAC conference. His recollections of the births of his 4 siblings were of wonder, "pleasant memories", and he remembers very little blood. Younger brother Keith, upon seeing his newest brother just be born, blurted out, "Look, Mom, he is naked." Ten-year-old Lora in remembering the her brother's birth says "I felt love in my heart. . . I felt close to him." 10 Shiela Kitzinger interviewed a couple of women whose older child slept until the baby was just born and then awaoke and joined the family on the birth bed. Said one, "Julie woke up to find a sister had been born during the night just as we had told her it would happen. We were the happiest little family in the world." 11 Sandra Anderson had her son Josiah in a hospital with many interventions. When she became pregnant with her second child, she was determined to have a natural birth and to include Josiah in this very family-centered event. He was 2 1/2 years old. Her perspective of his experience was that he was comfortable with the whole situation. An added benefit for her, was that he reminded her that she would not be in labor forever, as he asked, "Where are my tinkertoys" and "I want a peanut butter sandwich." She felt Josiah added a "wonderful spirit of spontaneity to the birth." 12 Children have a different perspective on birth and do not necessarily "see" it as adults do. One woman remembered how after the birth of her fifth child, her fou-year-old came into the room and noticed the furniture had been rearranged. This so interested her that she went and got her other siblings to see the room. One family felt that having the children included from the start of the pregnancy through the birth was very important and wrote, "The midwife asked us every day how the baby was, and the children delighted in telling her all that had happened since her last visit. These may appear to be trivial details. But when I read of the break-up of families perhaps they are not so trivial, but vitally importnat factors instead." 11

Studies

     A number of studies have been conducted over the years looking at various aspects of birth and the effect on children and families. A few studies have found that one of the reasons parents choose a home birth is specifically for the opportunity for all family members to have a positive experience. Lewis Mehl noted that the children he studied had accurate information about birth and saw the event as a good experience. Another researcher, Chase, found that mothers noted less sibling rivalry between sibllings who were present at the birth. Curry comments that children blame the new baby when mother disappears to go to the hospital, but when children are included in the birth, they see the new baby as a "gift." When children were allowed at births, their view of birth became a real experience and not the mysterous, scarey, life-or-death event portrayed in the media. They were not separated from their mother or father and so by-passed the separation anxiety that many children suffer when their siblings are born in a hospital that does not permit their presence. It is felt that the presence of children at birth also affects how well the siblings bond, sinimlar to the mother-infant bonding that occurs immediately after birth. 2 While not a truly scientific study, Dr. Michelle Harrison's informal study of children over a two hour time during which they were actively speaking about birth and related issues, makes a couple of points. She notes that the conversations about birth seemed so serious, where as when the children were discussing animal births, they were livlier. Her interpretation includes the insight that they may perceive talk about birth as being more for adults. Some children did talk about bad outcomes and Dr. Harrison writes that this affirms the idea that birthing babies is serious business. One topic that was somewhat surprising was a discussion about talking about birth at school. They tended to feel that it was not ok to talk about their birth experience at school or with with their teachers or peers because the experience was not a familiar one. 4 1

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, pages 31-34. 6. Hathaway, pages 41-58. 7. Hathaway, pages 105-106. 8. Hathaway, pages 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, pages101-111. 12. NAPSAC, Chapter 66, pages 865-867.

-Yvonne Lapp Cryns