Birth attendants often claim that their high cesarean rate is due to their clientele - that
they provide care for a lot of high-risk clients. This analysis shows that:
Among lower risk women, likelihood of cesarean delivery varied between 8
and 32 percent across hospitals.
Among higher risk women, likelihood of cesarean delivery varied between 56
and 92 percent across hospitals.
Hospital variability did not decrease after adjusting for patient diagnoses,
socio-demographics, and hospital characteristics.
This shows that practice variation in cesarean rates is real, substantive, and not just a
reflection of the mother’s risk level.
I thought it would be good to include in the magazine an article on
having older siblings at a homebirth, especially as with the homebirth
option many parents today are considering or planning this, but I was unable
to find a specific article, just a lot of references, so I decided I’d
have just have to put them all together and write one myself.....
Things to consider: Firstly the most important thing to consider is
the willingness / desire of the child to attend. It is also very
important to acknowledge the child's rights to decide at any time that
they don’t want to see the birth. Some children are very excited about
it beforehand, and change their mind at the time, and vice versa. It could
be traumatic to make a child watch a birth that they don't want to.
Secondly how do you feel about having your children there?
It’s important that this is your decision and others do not convince you
that this would be a good idea. Some women just can’t imagine not having
them there to share such a special event, whereas others do not want the
distraction of having them (or anyone else) present. Be prepared
to play it by ear and be open to changing your mind.
Some advantages are that watching the birth of a sibling is a great
bonding experience for siblings and can help reduce rivalry - and its wonderful
early sex education for kids, hard evidence that birth happens or should
happen in the context of a loving family. Many women find that having
children there “grounds them” and gives them something else to thing about
Some other points to consider are:
If labour begins at night do you want to wake them? With younger
children it may be best to not wake them until well into labour.
If a transfer to hospital becomes necessary, do you want the kids to
accompany you? Some children may be frightened by the change of location,
huge weird beeping machines, procedures (eg episiotomy), unfamiliar hospital
staffs and the concern they can sense. Make sure they are prepared
for this, or if they are not going to come, make sure there is someone
to stay with them and answer any concerns they have and to make sure they
do not feel deserted.
Once the decision has been made to include them the next step is to make
sure they are fully prepared. Here is a list of ideas:
start with Mum & Dad talking a lot about "when the baby comes out",
read age appropriate books with parents and be open about any questions
look at birth photos and talk about the process
watch birth videos
practise making "labour noises". Strange noises seem to be one of
the biggies that bother’s kids - even the bigger ones! It can be
done in a fun and humorous way so when the time comes the noises are not
draw pictures of mummy pregnant and of the baby being born
get into a pushing position and make "pushing noises" together -
explain that mum will be doing hard work and it might sound like she's
in pain (and will be in pain) but it's a '”good pain”
talk about the "good blood" that they will see
movie’s or even real life experiences of people working really hard at
something are invaluable for kids as they prepare for birth eg Olympic
competition, marathons, weight lifting, etc. showing people who are working
hard, red in the face sweating, grunting or yelling with exertion and happy
to be doing it!
involve them in antenatal appointments - let them build up a trusting relationship
with your midwife and ask the midwife to let them listen to the babies
heart, show them the different "baby parts" by feeling your belly, allowing
them to touch and see all the items in her birth bag etc.
play with someone else's newborn so they are expecting a baby not an instant
try role playing eg imagine pushing a refrigerator across the kitchen -
what does your face look like? what sounds do you make? – this is letting
them know that mum's pushing noises are just the sound of hard work.
use age appropriate terms eg something like “Mummy might moan '”to call
the baby to come out”
explain that mum won't be able to help anyone else, and Grandma (or whomever)
will be there just for the child.
remember young children interpret events they observe according to the
interpretations of the other people around them. If other people are very
calm, they'll assume that this is a safe, calm event. Most young children
are not "grossed out" by mud, poop or blood.
Remember the senses:
Sight: what birth looks like, what the baby will look like, what the placenta
looks like, what white vernix is etc.
Sound: the loud sounds that mummy might make, the crying of the newborn
Smell: remembering mummy might not like a particular food smell while in
labour, the smell of amniotic fluid, baby etc
Touch: practise comforting touches, massage etc or maybe Mummy won’t want
to be touched at all etc. * Taste: what Mum might like to eat or drink
while in labour etc.
Caregiver for the Child:
It is important to have a Caregiver for EACH child so that the birthing
mothers support people are not distracted or involved in caring for the
child’s needs. Choose your support person carefully - they must be
fully supportive of your choice and not easily freaked out - kids will
pick up the moods and negative energy of those around them. If no
one in your family is suitable remember there are many aspiring childbirth
educators, midwives etc who are very eager for the opportunity to observe
ANY homebirth. Also another woman considering the homebirth option
may see this as a wonderful opportunity to see first hand what it ’s all
However the Caregiver must be committed to staying or leaving - whatever
the child expresses a desire to do. So if you think they might try to influence
your child to stay so they can see the birth, choose someone else.
Make sure the children have plenty of time before the birth to become comfortable
with the Caregiver and that the Caregiver knows all of the child’s routines
and preferences and where things in your house are.
Keeping Kids occupied During the Birth:
Especially with smaller children it’s important to have plenty for the
child to do, as they really don't understand why birth takes so long. Here
are some suggestions:
Give the child a disposable camera - in addition to giving them something
to do with their hands, it will give everyone some nice photos, and maybe
their own personal photo album of the birth, which should enhance the bonding
even further! Also, cameras can have the effect of distancing the
photographer from the immediacy of the event, so this would provide them
with a way of remaining present while reducing the intensity if it's getting
to be too much.
Have the child prepare a backpack etc filled with snacks and a cassette
player with headphones, book etc. Have them pack their favourite
pillow and sleeping bag if they want to "camp out"
During labour have them bake and decorated a birthday cake to eat after
the birth or maybe colour some pictures for the baby.
Roles in the Birth:
Allow each child to participate at its own comfort level. Maybe assign
their own special "birth helper" job eg announcing the sex, cutting
the cord, helping weigh and measure the baby, cutting the birthday cake,
announcing the new arrival to everyone who arrives after the birth or making
some announcement phone calls etc.
Some Personal Accounts:
My daughters were 5yrs4mos and 3yrs1mo when their brother was born. My
mother and grandmother were there for the kids. My 5 year old was
totally into it, rubbing my back and breathing with me. After the birth
she said, with wonder in her voice, Oh Mummy, congratulations! That was
so great. My 3 year old mostly remembered that after the baby was born
she got a Popsicle!
My daughter was just turned 5 when she came to the birth of our third daughter.
She was very "experienced" at seeing birth because she had watched ALL
of the birth movies that I previewed during my pregnancy. She told me that
she would not be scared and that if I screamed too loud that she would
just cover her ears! We made sure that Lauren had a lot of things to do
ie. sticker book etc. in case it was a long haul. Well, the baby was born
after only 35min. Right after the baby was born, Lauren exclaimed, "I didn't
even have to cover my ears!" And, to show how normal birth is and the fact
that children recognise this, as they were delivering the placenta, Lauren
rushed over to me exclaiming, "Mum, LOOK! Look at my STICKER BOOK!!!!"
Lauren is soon to be six now and still is talking fondly about "being there"
when her sister was born. In fact she will still give anyone a play by
play account of the birth if they give her a chance!
A friend of mine told me about a birth where young siblings were present
and the Mum made very, very loud noises during the labour. Afterwards,
the Dad asked the 2-year-old whether she was frightened during the birth.
The 2-year-old responded that she had never been frightened because the
midwives kept saying, "You're doing great. Everything looks good."
Sometimes we forget how much little ones depend on adults to interpret
their experience for them. There are things that scare adults that won't
scare a two-year-old who feels safe because all the adults are acting calm.
My Own Experience:
I asked Dylan (5yrs) what happened when Celina was born (he was 4 ½
at the time) and this is what he told me:
“Granny made Shaun and me scrambled eggs for dinner. There was
a pool there too but we didn’t get the baby born in it though cause we
didn’t want to that day. Rose helped us to get the baby Celina out
of our tummy. Mummy pushed her out of her tummy so hard and I went outside
with Grandad looking at things and then Grandma came and said Celina is
born so we went inside and saw her and she screamed and screamed and I
had a cuddle with her and that was good and it was a girl and then me and
Shaun went to bed and then the other people had dinner. In the morning
we woke up and I came into my Mum’s room and I said “where is Celina” and
Mummy said she is in her bassinette so I went there very very quietly and
I saw her fast asleep and she was very tiny not like she is now. “
I asked Shaun who was just 2 at the time and he started to tell me about
something that happened yesterday :-)