Getting the Family Involved

by Mark D. Freedman, MD

Having a baby is an event which changes a whole family. Although the newborn’s mother is the first and most important person a baby gets to know (starting even before birth), the mother’s relatives and companions will all come to know the new child and play important roles in his or her development. In addition, an adult woman’s status within her family changes as she goes through pregnancy, delivery and post-partum recovery, and takes on new responsibilities of motherhood. She and everyone else in her family learn to adjust to her needs and the new person in their lives.

Smooth adjustments take time, effort, and planning. Since pregancy takes most of a year, not just the mother, but also the father, grandparents, siblings, and close friends have an opportunity to involve themselves in the upcoming event. The loving support of a pregnant woman’s family and the connection they develop to the newborn from the first moment of life can have a huge impact in ensuring successful childbirth and child-rearing.

In recent years, the health care system in this country has become aware of the importance of family support for obstetric patients, and most hospitals and obstetric providers have moved away from the model of separating a pregnant woman from her spouse, family, and friends until the baby is out, bathed, swaddled and behind a glass window. Hospital labor-delivery-recovery rooms are usually equipped to accommodate fathers and sometimes one or two other family members for visiting. Improvements in the technology of IV drug delivery, fetal monitoring, and epidural anesthesia allow women in the midst of even complicated labor to interact with her family members and receive the support they can provide. Physician and nursing staff welcome the opportunity to provide education and information to the extended family of the mother and child, to answer their concerns and include them in the therapeutic "team."

How exactly does the family participate in a woman’s pregnancy, delivery, and recovery? When should the process begin? Which family members are most important? What can family members expect from the medical clinic and hospital staff? There may be as many answers as there are different types of families, but the guidelines listed below will generally apply to almost every situation:

1. Begin early. As soon as pregnancy is established, identify the family members who will accompany the expectant mother throughout the process. Usually this is the expectant father, but may be the mother’s own mother, sister, a close friend—even an older child. This person must be committed to tagging along for prenatal exams, testing, prenatal classes, and, ultimately, labor and delivery. Schedule clinic visits so that the support member of the family can attend; male companions should not be shy about going with their partners to a gynecologist’s or midwife’s office. If possible, designate one or two alternative family members to serve when the primary companions cannot.

2. Share the "big events." There is no substitute for being there when the first fetal hearbeat is detected or the first ultrasound comes on the screen, when fetal movements can be felt or seen on real-time ultrasound, when the baby’s head starts to emerge during delivery, and when the baby is first examined after being born. These are critical moments which create an attachment by family members to the unborn and newly-born infant. Even expectant siblings as young as two or three years old can appreciate the magic of these prenatal events in a way that cannot be conveyed verbally or by reading a book. And with her loved ones to share it, each moment becomes more memorable for the expectant mom, just as each anxiety becomes less of a burden.

3. Participate — don’t just observe. A woman may want only a little help, but no woman wants to be merely a spectacle. Family support members need to learn as much as the expectant mother about pregnancy, labor/delivery, and infant care. Family members need to be familiar with the doctors, nurses, hospitals — even the health insurance benefits — long before labor ensues. Rehearse emergency and even routine plans. Schedule a tour of the hospital and find out specifically what policies apply to visiting family members (there are differences in facilities). And certainly, provide real physical help to the pregnant woman or new mother who just "isn’t up to it yet."

Ideally, the expectant mother should have one or two family members to go with her to every prenatal visit, every prenatal class, be there for the big moments and connect to the new baby at the earliest possible time, and lend a much-needed helping hand.

Providers of obstetric care should do everything possible to encourage the participation of family members. The patterns of care, attachment, and action that emerge from family support during pregnancy will serve as a foundation for security and growth of the new baby and fulfillment of the mother.

Editorial by Mark D. Freedman, MD at Ravenswood Hospital Medical Center. Dr. Freedman is board-certified in family practice, which includes obstetrics and neonatal/infant care. He is also a clinical instructor for the University of Illinois College of Medicine Department of Family Practice.