It was a day of birthdays for the Hope family of Bowie. Sheryl Hope's third child was due any day, so she had planned a quiet 10th birthday celebration for her daughter Carri. That evening, as they celebrated with cake, ice cream and candles, the family also timed Sheryl's contractions.
Then Carri, 8-year-old Christie and father Keith grabbed the stopwatch and helped Sheryl into the car. Less than an hour after they arrived at Washington Adventist Hospital, the whole family witnessed the birth of Erin.
At one time, the participation of siblings in childbirth could only have taken place in the privacy of home. Today, several hospitals in this area and others nationwide are opening their doors to siblings at the request of parents, midwives, nurses and physicians who believe that an uncomplicated childbirth can be a joyful experience shared by the whole family.
Shady Grove and Washington Adventist hospitals are the first in this area to implement formal hospital programs for sibling participation in their birthing room. The programs, both in existence for about two years, were instituted at the request of several physicians and patients after approval by hospital physicians. Other hospitals allow siblings to participate during childbirth on an individual basis; some hospitals, according to nurses, "sneak in" an occasional sibling.
The notion of childbirth as a family activity is not common. Many view childbirth as an intimate act that should be shared only by the mother and father. Obstetricians and nurses are concerned that the presence of her other children may distract a laboring mother or make her nervous. Mental health counselors are concerned about the fright and anxiety that children may feel as they see their mother in pain, they raise questions about how the child's developing sexual self is affected by seeing the mother give birth, and they wonder if parents' strong desires to have their family at childbirth override the best interests of the child.
For many of these reasons, the number of parents who choose this option is very small. These parents typically are professionally involved in childbirth as educators, midwives, nurses or physicians, and many of them have large families. Their desire to include their sons and daughters reflects a particular approach to pregnancy, nudity and sexuality, and a belief that childbirth is a social and emotional, rather than a medical, event. Such families believe that not only can children benefit educationally from witnessing a birth, but also that children can share their parents' joy. For some, the presence of their children during labor and delivery is the "ultimate experience," as one mother said.
Joyce Daniels' six children, along with her husband, father-in-law and a few close friends, were present for the home birth of her seventh child. "For me, birth is a part of living in this family," said Daniels, who is a midwife for Family Birth Associates in Alexandria. "If we have that opportunity to share, then we should take advantage of it." Her husband, Royal Daniels, agreed. "It never really occurred to me they the children wouldn't be there," he said.
"Childbirth is a normal, healthy experience, and our children need to know that," said Amanda Weiss, a childbirth educator in Arlington, whose 18-month-old son, Aaron, was at the birth of son Zachary at home. "I wanted him to share a very special moment with us. He came in and out of the room while I was in labor, just to check to see if I was okay, and then he climbed right up on the bed after Zachary was born and said, 'I'm a big brother now.' "
Others are less enthusiastic. "I think childbirth is a very traumatic thing to watch, an overwhelming thing to witness," said Dr. Michael DeWitt, a child psychiatry fellow at Children's Hospital National Medical Center. "Even if the parents have the best intentions in involving their children in the childbirth, you can't take into account the way a child's mind works."
Dr. Jerry Weiner, chairman of the department of psychiatry at the George Washington University Medical School, said: "I'm not sure it's of great value, and I see it as a frightening and anxious experience for the child. The child is a participant in the mother's sexuality -- I can't imagine anyone thinking this would be appropriate."
"I would have reservations about counseling a parent to let their children see their mother giving birth," said Robert Kayton, a psychologist with offices in Bethesda and Dupont Circle who sees a large number of children. "There's blood. There's moaning and groaning. What kind of repercussions this might have on the child is unknown. How will this affect the child's attitude toward his new brother and sister? Or his view of doctors or body image?"
One couple, Sandra and Ricky Takai of Gaithersburg, had perpared their 4-year-old son, Ben, to attend the birth of their second child, which occurred last Wednesday at Shady Grove. But because she went into labor at 4 a.m., he slept through it. In retrospect, Sandra Takai says, it might be best that he missed the birth.
"I think he would have been terrified there at the end when I was yelling," said Takai, who used no anesthesia for the birth.
As it turned out, Ben was able to hold his new sister about an hour after she was born, and the orientation he went to at the hospital dispelled his fears that his mother would never return, Takai said.
Families and health care providers who allow sibling participation during childbirth believe that the ultimate joy of the birth overrides a child's fears. Many parents also believe that the children involved have a more immediate and deeper bond with their new sister or brother, and have no ambiguous feelings or bizarre concepts about "Where do babies come from?" Finally, children in these situations take their cues from the adults: if the adults are positive about the experience, the children also will have a good experience.
"We have the most beautiful pictures of the kids with smiles from ear to ear," said Nancy Granados, who gave birth to Brain James at Washington Adventist with 9-year-old Becky, 6-year-old Carlos and husband Ray looking on. "They held the baby before mommy did, and the photos show their excitement and delight."
At Washington Adventist Hospital, children who are allowed to be present during labor and delivery must be over three years old, and must participate in an educational program developed by the nursing staff. An adult other than the spouse must be present specifically to look after the child. The family must get permission from the obstetrician, and a release must be signed that says the birth will have no effect on the child. The child must have up-to-date immunizations.
At Shady Grove, children must be over the age of 6 and must participate in the hospital's orientation, which includes a tour of the maternity ward, a film called "Nicholas and the Baby" and a slide presentation that discusses childbirth.
Health care providers stress that children should be allowed to make their own decisions about whether they want to watch childbirth -- and they should know that the parents will not be upset if the child changes his or her mind and chooses to leave the room at some point during the labor and delivery.
"I know it's not for everyone," said Granados, a childbirth educator in Bowie. "It's not a trend, it's something you have to discuss beforehand. My children knew they had the option that they could leave at any time. My son was a little hesitant at first. But his biggest complaint was that we ran out of candy bars.
Although children are happy to see their brother or sister at birth, their expectations often are very different from those of their parents. For instance, some children say they want to see their mother give birth because they want to find out if it is a boy or a girl. And if the hoped-for sister or brother does not emerge, a cloud descends over the experience.
"When the baby came out, I thought it was a boy," said one 10-year-old who saw the birth of her sister at home last summer. "I was kind of mad because there's only one boy in the family, and everyone thought it was going to be a boy."
Other recurrent themes among the children: they thought childbirth was going to be "exciting," or they were "curious" about what happened when a baby was born. Many of them said they thought the birth was "neat" or "weird," and they all said that they were very happy when the baby was born.
"I thought it would be interesting," said 9-year-old Becky Granados. "I thought it would be good to know what happened, so that when I grow up I'll know what it's like to have a baby."
One mother said that her three daughters marched into her room after the birth and demanded to know if there wasn't another way that babies could be born. "We proceeded to have a conversation about all the places a baby could come out," she laughed. "To them, the idea is disgusting because they think of bathroom things. They just couldn't understand why it had to be that way."
Most of the children said they were not concerned about their mother being in pain. "I knew she was in pain," said Carrie Hope, "but my mom said it didn't hurt that much. She said it was just the work she had to do to get the baby out."
A story midwife Joyce Daniels tells underscores the priorities in preschoolers' lives -- even when they're about to witness the birth of a child. Daniels recalled that at a birth in which an 18-month-old was present, the toddler suddenly heard the trash truck pull up to the front of the house. As the toddler's new brother came into view, the toddler rushed to the window to wave at the trash truck. "This child had been prepared assiduously for that birth," said Daniels, "and he missed the whole thing."