Sunday, March 23, 2014

Welcome to the World of Doula!

How would I describe them? Not shiftless, just idealists. Anarchist perhaps. Communists? No, but maybe Socialists. Hippies … I think that could fit too. They were living in a community of sorts; four houses on one street, vegetable gardens and chicken coops in between the houses. Yes, in the city. Faded jeans and unbleached diapers always hung on the lines above the chicken coops. There were usually kids playing some game of tag, running past you at the speed of lightning.
We had gone to a few of their neighborhood cookouts and a potluck wedding once. The square block of bicycle parts that had formerly littered the drive were miraculously all put away before the wedding. I can’t crack on that wedding. It sure beats taking out a loan just to get married in a dress you’ll only wear once (like I did) and to pay for a caterer when you could have cooked much tastier food yourselves. There is something to be said for living simply: no debt, no car, no insurance, no phone bills; just hang out and find a job you like. Go dumpster diving behind all the co-ops and bakeries and grocery chains and harvest all you need for a whole week’s worth of food. Sure, the luxuries of life will be gone, but you’ll find treasures hidden in Nature and other people instead. They had a point there.

But when it came to babies, I would have drawn the line. Sure, I had mine at home, some with midwives and 2 in such a hurry three years apart that no one made it to those. But if something had gone wrong we would not have hesitated to transfer to a hospital. That’s what they are there for. And there are countries all over the world where babies and mothers die every day because they don’t have the facilities that we have. But to boycott all hospitals under all circumstances because they are part of a materialistic, consumer-based conglomerate and perpetuate our capitalistic policies, and they only enable the rich and don’t serve the poor equally, does not mean we should never, in any unforeseen eventuality set foot inside their marble halls. Except this is exactly what they had decided: to do without ‘the system’ entirely and live in the fringes at the edge of the rest of the population. So when Juliette got pregnant, they looked for specifically and found an unlicensed home birth midwife who shared their world view.

Then they asked me to be their doula. I hesitated. Did they have a plan B should they need to employ one? No. Did the midwife have any backup? No. If she needed it what would she do? “Nothing” was the answer. They were on their own there. They could show up at a hospital, according to her, but she would not come along. Oh boy. I wasn’t sure. It grew on me slowly. They rented a birthing tub for their tiny room. They ate well enough and she was gaining steadily. Then came the last straw: she told me that had high blood pressure and a congenital problem with a kidney. Holy @$#&!
I told them that I couldn’t be their doula unless they had a doctor backing them up. And she would have to do that before her 8th month. If I was going to be their doula and be her primary care provider at her home until we called her midwife, I would need to know that she had been screened and approved for a home birth. And my scope of practice as a doula would not have me doing blood pressure or sugar checks anyway. Then we would have to have a plan B, but the doctor who already knows her would be meeting us at the hospital, should we need to transfer.

I didn’t hear from them for over a week. At this point it was clear that they were obviously battling between themselves over priorities versus idealism. She understood my concern. He did not; he dug in his heels and did not want to budge. This one definitely threw a wrench between them. Their relationship had not been a committed-until-death-do-us-part arrangement and I didn’t want it to get to the point where she could actually be at risk for leaving us all together, as in some fatal complication, which was not entirely far-fetched on my part, knowing of some of the medical issues. I know I didn’t trust enough that Nature knew how to birth this baby, and I had perhaps lost sight of the midwifery model of care favoring instead our allopathic brand, but….

Juliette called me the following week. She had been to a regular ‘establishment’ doctor whom she said cleared her for a home birth. Great! Her blood pressure and sugars were within normal range, so they were delighted with this and wanted to proceed with their original plan, but then as another week unfolded things changed. Drastically. She was sick and not having much luck getting back on track. She went back to the doctor and as she edged nearer her 8th month, was put on several medications and a restricted diet in the hope of stabilizing both the kidney function and blood pressure. In spite of the ominous recent chain of events, her midwife told them it was still the better choice to have their baby at home. Really?

They had scraped together the midwife’s fee by begging and borrowing from family and friends and selling an old car he had fixed up. She was officially hired. I, on the other hand knew that they didn’t have any savings and offered to barter. Pierre, an accomplished carpenter could suggest something he could build for us in exchange for my doula services. Everyone was happy.
About 6 weeks before her guess or due date, Juliette called me saying she was having horrible head aches and feeling really crummy. I insisted she return to the doctor and get it checked out before it got any worse. It could have come from stress, she admitted. Her partner was nowhere ready to have this baby. He wouldn’t pack up his tools or the mountains of junk that covered the floor of their tiny room in the house. The birthing tub had to somehow fit in there. And she had expressed the wish that they move their mattress onto the floor in the main room from its place in the loft where it stood on a platform up on stilts. It was stuffy in there and too high to climb up and down with a baby. But he was not moving to help with any of this. Juliette blamed herself for being so picky and cranky, but they weren’t really as together as she had hoped they would be, especially with a baby on the way. I could only encourage her to keep the lines of communication open with him and that in the end she had to do what was right for her and her little one, even if he didn’t agree.

The report from the doctor was not good. He strongly recommended that she check into the hospital that same day and be induced. Her overall numbers were not good. Her kidneys were being taxed and the blood pressure was too high. He felt that her health could still recover after the delivery, though she was getting into hot water already and waiting would not guarantee that she might not come out of this without some permanent damage, and the baby’s health would only be compromised and at risk if she didn’t deliver soon with these new developments.

Negotiations with their midwife went back and forth all that day. She was willing to help them should they choose to stay at home, but I made it very clear that I could no longer be part of it then, and she countered that her job description didn’t include being with them throughout the whole labor, that was why she had recommended they find a doula, even though they had paid her several thousand dollars. I told them that the hospitals are there precisely for these kinds of situations and that I felt the doctor was on their side, committed to having a healthy baby and a healthy mother in the end. The battle had begun.

So the cards were blatantly stacked against them. Her health might not recover if she didn’t deliver the baby soon and may even become permanently damaged, putting her at grave risk. I pointed out that her baby needed a mom and that although we would like to have control over our health and our births this is not always the case. Welcome to parenthood. I could not tell her what to do, but I could encourage her to think on her own, without Pierre going on and on about corporate greed and disregard for the poor and multi-billion dollar facilities. He just didn’t get it that her life was creeping closer and closer to a point of no return at this rate, her numbers were now that bad. I had never had a mother this sick in my 30 years of midwifery practice, partly because high risk births were screened out through my protocols and I would have been required to transfer care weeks ago in her case.
I told them to call me if I could do anything for them and let go. I had not been this frustrated in a very long time. I said a prayer and made supper. Later that evening she called to tell me that she had decided to go to the hospital and asked if I would be able to meet them there. I said I would be glad to.
I explained what induction meant and how that might be attempted 5 weeks before a due date. She had written a birth plan and we had talked about the numerous options that she had for a home birth, but then tailored that for a hospital birth. Now we had to add induction and what she could agree with and what she did not want to try. Her choice was to have her baby as naturally as possible with as little intervention as possible. I outlined the various options the doctor has for induction, explaining that some were more invasive than other interventions and that she would have time to ask questions and could ask for privacy to decide what she wanted to do. Once she was settled in her room the doctor suggested a plan to start up labor by using a ripening agent placed at the cervix that would help get things started. Then they could start a small amount of Pitocin by morning and get her into active labor. Sometimes these will work quite well but occasionally they don’t do much at all and then the doctor will suggest the next trick up his or her sleeve. So the couple asked for some time to discuss this privately. We all left and I went down to the coffee shop to get a drink.

They called me on my cell phone shortly after that to tell me that they had called their midwife for advice and she had warned them about what not to let the hospital do to her under any circumstance and suggested some alternatives to try. I did not realize she was still in the picture and found this rather bold for her to be making decisions from some undisclosed location. So the night started off with a bang. They agreed instead to a non-medicated approach and opted for a balloon catheter to be placed that would stretch the cervix open and hopefully trigger labor on its own.
By morning it had succeeded in getting the cervix to dilate slightly but not appreciably. The next suggestion was to try Pitocin and then perhaps breaking her water if the baby’s head came down further. Again the couple asked us to leave and talked it over, and as I suspected, again called the midwife who told them not to let them break the water under any circumstance. I had never seen anything like this. I did not understand their trust or devotion toward this woman. I was mystified by it. I knew I was considered a close friend, but somehow by my being a licensed midwife and certified doula, I had gone over somehow to the ‘other side’ and was deemed too medical or too swayed by ‘the system’ to be consulted on how to stay on the natural side of things, is all I can guess.

The nurses soon got the hang of how to approach this couple. Each step would require consultation, then consideration in private, then double checking what I thought (but only after the other midwife was called) and then the nurses and/or doctor could come back in and negotiations would resume. I was beginning to feel like an international conflict-mediation envoy deliberating the politics of civil unrest. Many of the suggestions only met with rejection as being too invasive or they simply felt that things were being unjustly and routinely rushed and asked for a few more hours of walking or sitting on the birth ball to let things work. I took to listing options for them from least to most invasive, knowing they would veto any and all suggestions unless the guru midwife approved of it. The nurses started asking me to ask them thus and such – hoping I had more say because they realized they did not have in fact any at all. My only objection to their midwife was that she was simply calling the shots in a realm that I felt was now outside of her sphere of skill or experience. 

I do not go to a birth at home or in a hospital ready to do battle. I sincerely feel honored to be welcomed onto a birth team and readily defer first to Mom and her wishes and then follow her midwife’s lead. But this tug-of-war went on all night and all the next day. By evening I was called out to the nurses’ station and given an overview of the bigger picture. Baby was still doing remarkably well. Mom was OK, blood pressure and other numbers not off the charts yet. But it was time for baby to be born. I asked what options they would propose next and breaking her water was the least ‘medical’ in their eyes and might speed labor up appreciably. I went back in and sat down, slowly rubbing her feet as I balanced on a birth ball at the foot of her bed. They were not agreed between themselves what to do next. I told them that they were doing great, that baby was sounding really good and that she was actually making progress, which is not the same at an induction as it is in a term birth. I proposed I go home and sleep and that they try to rest, even if it was only dozing between the rushes or contractions. She was able to eat and drink and was doing OK there. She had refused all IVs and meds up until this point. I knew they would continue to call their midwife whether I was there or not, and was frankly at my wits’ end at 48 hours. I hugged them each good bye, assuring them I would be back within 15 minutes if they wanted me.

I walked the short 6 blocks home. I was so tired and drained that I just showered and cried until I got into bed. I did not ‘get’ this. 
I had a call a week earlier from a birthing clinic asking if I could consult on a breastfeeding problem they were seeing. The couple was from the same tribe as my laboring mom and dad were. They were vegans. Fine. I was too during my twin’s pregnancy and birth and since then. That was not the problem. The issue was that he thought she should be able to skip drinking altogether until they could find a 100% pure reverse-osmosis water source and that they could get along just fine with just raw foods they would ‘harvest’ from around the city. It quickly became obvious that he was dictating or controlling everything she put into her mouth! It turned out she had not eaten that day and possibly the day before. She was very thin and very pale, had not taken vitamins and as soon as I started prying a little further, she simply looked at him. He then tried to assure me that he had studied nutrition and that we should respect their choices. Their midwife, who had called me, felt that the baby was getting dehydrated and loosing precious ounces that he should have been gaining by now. The father would not let us visit with her unless he was in the room. We both spoke to them rather firmly, hoping to wake him up a bit. She had already given up any autonomy she may have possessed, though I doubt she ever had any, at least since she met him. When I called the next day to see how they were the phone had been disconnected. The midwife went out to their house and was told by the landlady that they had moved out that morning. They were gone. Vanished.

I slept in and called the hospital once I was awake. The nurse told me that they had just had a healthy 8 pound girl. The midwife came in after she heard I had left, though they were instructed to say she was just a supportive friend. She helped them try different positions that helped baby along, which they were very glad for. Later that evening I called the couple and asked if I could visit. I congratulated them and told them how glad I was that they had been able to have the natural birth they wanted. She was nursing which her baby took to right away. She was still 5 weeks early but was doing really well and did not have to go to the ICU. I was so glad all the drama was over.

I got a call from another woman who was living in their communal house two days later. She explained to me that public health nurse had come by to make sure the baby was doing well. She looked at the baby and voiced some concern about his color and that he seemed to look jaundiced to her and also that his skin appeared dehydrated. They had read all of the natural birth books
and said they had chosen to nurse on demand,meaning only when he awoke or fussed and asked for it. They had thrown out the doctor’s program for preemies in which he insisted upon waking the baby to eat every two to three hours at the most until she reached the due date. He had explained that their baby may act very sleepy and need to be fed to catch up, whether she appeared interested or not. But they thought the doctor was just going into some routine medical jargon and that they thought ‘nursing on demand’ sounded more natural. Never mind that the baby came 5 weeks early! Or that she was sleeping up to 6 hour stretches and did not cry. The nurse took a blood sample and explained that they needed to know what the bilirubin numbers were and she would call back later that same day after she got the results from the clinic. They added her to their list of ‘establishment’ care providers, turned off their cell phones and went back to sleep.

Their baby did have seriously high readings for jaundice and she was in the danger zone for being dehydrated. When the nurse called both numbers over and over and they didn’t answer she did what she felt she had to do. She called Child Protection and explained her concerns which were bordering on dire at this point. They had to re-hydrate this baby now and get her under lights right away.
So a police car and an ambulance pulled up in front of the commune and I get a call explaining all this. I had told them I was a lactation consultant/educator and would gladly give them any help they needed 24-7 and they knew I wasn’t charging them, so why didn’t they even ask? Later that night I went to the hospital and sat with Juliette for a while. She was nursing her baby and had moved into the NICU. The hospital gave her a room with a real bed so she could stay right there. She told me that they just assumed newborns sleep a lot. They thought she would let them know if she was hungry. I explained again that she is premature, that the rules all change at this point. She said, sounding surprised, “Oh. That is what the doctor keeps telling us, too!” She was still pretty shaken up by the whole experience. It didn’t help that she had not slept since labor started, going on day 4 now. She also told me she had decided to stay in the hospital this time until everything was taken care of and they understood what they needed to do, even if her partner didn’t agree with this. 

I still see them from time to time. Luna looks too big for her little mama to be carrying her around anymore. She is very sturdy and has gained beautifully. Juliette is feeling well and taking care of herself. It was another example I could chock up to education. I don’t know what I could have done differently. I am just very, very grateful everyone is OK now.

As a doula I think back to experiences like this one and wonder if I could have done anything differently. I think not. I wanted to respect them even when our values differed and I wanted to advocate as much as possible for what her wishes were. I did not feel at any time that it was my place to act as marriage counsellor either. These were two adults whose ideas were different from mine, which did not make mine better or more valid. I come away from experiences like these convinced we must above all respect each woman we work with and allow that their point of view may not be our own. But I have also learned that I must have my own boundaries and equally respect those. Welcome to the world of doula!

STAY TUNED! This and other stories will be appearing soon in the book Call The Doula! a diary© - by Stephanie Sorensen

Monday, February 10, 2014

China: Can I keep her forever and always?

This is a love story.
I never thought we would ‘click’ at all. Everything was wrong from our first appointment. China complained about how awful pregnancy was. (I would give anything to have just one more baby. I loved being pregnant!) She accused her baby of hating her -- why else would he kick her so much? She told me she was having this baby with the wrong man. She confided that he was a loser and she hated him, he couldn’t even find them decent housing. They were homeless and camping out at his sister’s house. Then after the tour that OB patients were offered she called to tell me that the hospital was all wrong. She could not, would not bring her baby into the world in such a depressing place. I had to find her a better hospital. Why, they didn’t even have pictures in the rooms! I thought to myself, ‘sweetheart you’re not gonna care what is on the walls when the time comes.’ If she blames her baby for her discomfort now, what will labor look like? And she says she wants a natural birth.
I called my supervisor at this point asking for some wisdom. Was I the right doula for this client? Would she be happier with someone younger? Debby told me she wouldn’t choose United Hospital either. It is depressing. OK. I’ll keep her.
I started going to her prenatal visits with China. I needed to get to know her better. I gave her the phone numbers for some of the birthing centers throughout the city. She visited one that is absolutely gorgeous, but they were not a non-profit and subsidized their medical assistance payments from low income families by charging an additional $300. in cash up front. She is homeless, for goodness sake! How can they do that? Is that even legal? I told her I would find a place for her.
So I called some of the other birth centers and found out that most did not take transfer clients after their 34th week. I knew I could probably get her into the midwife program at the local public hospital, but imagined she would be turned off by their ‘public’ image. It is often seriously over crowded, usually very loud, with standing room only in the emergency waiting room no matter what time of day or night it is. I called them and asked for the labor and delivery charge nurse. I explained who I was and what I was hoping to do for China. She explained that it was too late to transfer, but she actually knew who I was from some of the births I had been to there, and asked me if I would hold while she checked with the floor supervisor. She came back on the line and told me that if I could get her to the clinic the next day they would take her. I asked if I could also tour labor and delivery with her and silently hoped that their ‘better’ rooms would be unoccupied so she could see them.
The next hurdle was getting her there. Medical assistance will provide a taxi for medical appointments but only if you schedule it two days in advance. I don’t drive so I was trying to figure out how to get her there in the morning. Her boyfriend’s sister’s where they were staying was out in the suburbs, where the buses only run once an hour. It has been below zero here all week, with the wind chill factors down in the minus 30s. Really! Buses were out. So I called medical assistance’s transportation number and told them that one of my clients had to get special emergency clearance to get next-day rides from here on out until she delivers. They actually approved her if I would arrange the rides for her. Great! It worked!
The next day we were called and roomed in a tiny cubicle to wait for the midwife. China must have gotten out on the wrong side of the bed that morning because the first thing she did when the midwife came in was demand that she be induced! She said she was sick of being pregnant and miserable, can’t eat, can’t sleep, her baby hates her and kicks her on purpose, and that she will only stay if they will get this delivery rolling. Like today! The midwife listened and skirting the issue completely asked if she would kindly jump up on the table so we can hear her baby. The midwife and I both gushed about how wonderfully strong her baby’s heartbeat was when the Doppler was turned on. China just kept griping. I had had enough so I said to her, “you know, I have had ladies in the past year whose babies couldn’t move like yours can. I even had one baby who was born with half a heart! (See the story Emma Hope.) You have a really healthy baby, and I am really looking forward to seeing him, too!” The midwife was nodding her agreement the whole time.
We finished with the appointment and the midwife explained that it was not their policy to induce labor without a good medical reason, like when the mother has pre-eclampsia or diabetes. China grouched a bit more but realized the two of us were not going to be moved on this one.
We went on a walk through the midwives’ labor and delivery side of the hospital wing then, starting with a huge open room, almost a suite, with birthing tub, private bathroom, little refrigerator and yes – there were even pictures on the walls. We saw two more rooms, decorated sparsely but pretty. They passed her royal highness’ inspection. Whew! I thanked the midwife profusely and we went down to the front of the hospital to wait for the return taxi.
Talk about an attitude! Maybe she was feeling so very helpless being homeless and without support that she had decided to demand her rights in the littlest things that perhaps she could have control over. She was 23 but it was like she was going on 12! Then it dawned on me, I would gain her confidence with love. The expression, ‘Kill them with kindness’ came to mind. I would lay it on so thick she wouldn’t know what had hit her. I would smother her with kindness. I couldn’t image how else we would be able to work together through this birth. I knew that she didn’t have a clue how hard it was going to be. And I didn’t want to see her fall apart before she even got into active labor and had to actually work to birth her baby.
My supervisor had suggested I bring China a book from our library called, “Bonding With Your Baby Prenatally” which I had brought along. I gave it to her as I hugged her goodbye that morning. It was almost Christmas.
The following week I collected all sorts of baby clothes and wrapped up a beautiful scarf a friend had just gifted me with. I already had 4 others so I thought it was just the right thing to give her. My old heroine Dorothy Day said that “the extra coat hanging in your closet actually belongs to the poor.” I decided this must apply to scarves too.
(See: http://www.catholicworker.org/dorothyday/daytext.cfm?TextID=150) I have never been very good at hanging onto things that people have given me. My own mother had become furious with me years ago and finally asked me before my birthday one year, “If I give you a gift, will you give it away because I will never buy anything for you again if you do.” I confessed that I could not promise her that.
The next week I was given some donations to give to some of my mothers, so I started another ‘care package’ for China. She was charmed, to say the least. And we even got along well enough to talk about a birth plan and her wishes. This was better, but when I asked at this point if she wanted the boyfriend in the room at all, or what was she thinking she said, “He is gonna be there the whole time and see what he did to me!” Oh dear, not a good reason to add him to the birth plan.
Another week and she called me and we were back to her demanding induction. I very calmly explained that she was only at 36 weeks and that I would find it really sad if her baby couldn’t go home with her after she had him and had to stay in an NICU. I told her all that happens in the next couple of weeks to ensure that he is really healthy, and that his lungs might need extra help at this point should he come out now. She backed down. I told her to call me anytime and stay in touch.
A Korean graduate student in my apartment building was moving out about this time and asked if I could find takers if she gave me any nice but used clothes. China was just as petite as Song. I looked in the box when I got it back to my place. I never would have been able to afford the cute sweaters and dresses, even designer lingerie! It was a huge success. I had found China’s weak spot! And we were buddies – at last.
One evening in her 38th week she called to ask if she might have lost her mucus plug and described what she was seeing. I agreed that it sounded like it and congratulated her! It brought back memories from when my own kids first pooped on the toilet and I would clap and enthusiastically praise them for their accomplishments. I cautioned her that though her body
knew exactly what to do and would certainly kick into gear on his exact birthday (that of course only he knows), that this could still be several more days and that she should just keep doing whatever she had been doing, resting, eating, watching movies and walking.
Two days later she called screaming that she couldn’t sleep all night and she couldn’t do this anymore, and that her back was killing her and she was nauseated, etc., etc. I was quite excited that this might be early labor. I was really looking forward to meeting this baby. I told her to eat and rest and call me if things changed or she gets regular contractions. I also told her to call the hospital and let the midwives know and that they might want her to come in to check her. I hung up and went back to our supper. By the time we were washing up the dishes a very hysterical China called to say she had been on the phone with her grandma when her water broke. What should she do? I suggested she call the hospital and let me know what they say. I knew they would want her to come in, but that isn’t my call as a doula. I made her promise
to let me know. YA-HOO! We were going to have a baby! I realized then how much I really cared about China. She was the same age as my own daughter. I really wanted to see her succeed, to be a good mom and get her life back on track. It wasn’t until I stopped judging her and started listening that I realized how very hard she really had it: parents on drugs, foster homes, you name it. I had to hand it to her though. She told you what was on her mind and she wasn’t bashful about letting you know how she felt that day. There was no guesswork at all, you got the whole story whether you wanted it or not.
“However much we know about birth in general, we know nothing about a particular birth. We must let it unfold with its own uniqueness.” ~ Elizabeth Nobel
Almost 2 centimeters, 95% effaced, contractions picking up. This was it. The midwife confirmed that her water had broken. China wanted to rest for a bit so she lay down and closed her eyes. All of a sudden she rang the nurse’s button and sat up. The nurse came in and China announced that this wasn’t the room she had seen on the tour of the unit the week before. That room was pink. This one was an ugly tan. I tried to ignore this comment, but she wasn’t going to let it go. She dug in her heels. She threw on a robe and said she wanted to check out all the other available rooms. The midwife took a deep breath (and I think she hinted by the look she threw my way, ‘what have you dumped on us?’) and said, “OK” and led the way.
We walked into each of the other 6 rooms on the hallway and then back tracked through each
one of them once again, China leading the way and all of us in tow. She settled on a pink room and ordered us all to go get all her stuff and bring it in. The rest of the afternoon and evening was uneventful. She was dilating at about 1 centimeter every 2 hours and baby sounded great. It was slow, but not unusual for a first baby. By 4 centimeters China asked the nurse about getting something for pain. The nurse reviewed all of her options and China chose a low dose of an IV drug to take the edge off but not make it impossible to get up or get into the tub. In the end it hardly worked at all and wore off before an hour was up. It also affected the baby and his heart rate flattened out to a low 100 to 110 beats per minute, which isn’t all that great. When
China asked for more, the nurse suggested an epidural, but she really didn’t want that if she could possibly avoid it. I backed her up and pointed out that the baby didn’t do too well with the first drug and that I wasn’t encouraging her to get more. I suggested she try the tub at this point, got her a cup cranberry juice and filled the tub. She really liked that. I had been telling her that being flat in bed was not the best position to labor in. She found a real rhythm then on her own. I was actually surprised and told her how well she was tuning into her body all of a sudden and finding a way with each rush as they rolled in on her. Penny Simkin, eminent author and doula talks about the 3 Rs: relaxation, rhythm and ritual during labor but I had never seen someone find that on her own in exactly this way. It happened when I was breathing with her during a rush and her head bent down and leaned forward and rested on my knees and I automatically ran my fingers through her hair from the back of her neck and then gently pulled her hair back toward me. We did it a few more times and I asked if that helped at one point and she just purred, ‘uh huhhhhh.’ So we kept doing it. She changed position after a while and with each rush ran her own hands down her neck, and rocked gently forward until it passed. For the rest of the labor she found some rhythm to add to the breathing which I found fascinating. She had tuned into some inner strength that I had not seen before and just went with it. Penny explains (See http://www.youtube.com/watch?v=Mo4VmgpHmxs) that from observing hundreds of women in labor she learned that those who were able to cope best found these 3 Rs and used them in their own ways. 
Then, in walks the grand matriarch of the clan: Grandmama! … in flowing black and purple layers of some kind of robe and antique silver earrings, spotted leopard hat to top it all off. Regal is a modest description. She blew me away! (Sorry, but I could not find a picture befitting this lady!) As she glided into the room she set out bags of goodies for all of us. She had thought of everything: granola bars, bottled spring water, snacks, and cookies. Then she looked over at China and beamed, “You are so beautiful! You are a goddess! You are doing this sooooo well!” She proceeded to unpack a huge bag and laid out baby blankets, baby clothes, baby socks, baby shoes, all brand new and all blue! Then she turned once again to China and said, “You can’t have any more kids ‘cause this all broke the bank!”
With the next contraction the Dowager Empress stood by the bed and breathed with China. Then she brushed her hair and massaged her neck. I was still sitting there in awe. And all this loving on China really got things going. Soon she was saying she couldn’t do it anymore and needed an epidural NOW! and I knew we were at least 9 if not at 10 centimeters. I explained that this is transition and it is the end of the very longest part of labor, that she was doing so so SOOO well and that we will help her with each rush until she can push. I said she should rest now in the few minutes in between which she did. She trusted me by now and we were a finally a really great team. I let Grandmama coach her all she wanted and hung back a bit. This lady was truly stellar!
China tried a hands and knees position and then went back to sitting up cross legged. I asked the midwife if they had a squatting bar, thinking that it might be just the right thing, and it was. China leaned into it, threw off her hospital nightgown and pushed! Two more pushes and she screamed. The midwife assured her she was doing it perfectly and was feeling the baby’s head at this point. I tried to help her reach down to feel the baby’s head crowning but she shook my hand away, grabbed the bar once again and pushed her baby out onto the bed. Still squatting she picked him up and held him to her chest. He gurggled a tiny cry and then let loose! He was tiny -- perhaps all of 6 pounds but sure had a huge set of lungs. We helped her back down to the bed where she could lay back on the pillows as I piled them up behind her. She studied her beautiful little baby as he blinked back at her and then said, “I love you so much!”
We let him do the breast crawl and latch on his own when he was ready. He was on within 20 minutes! (See: https://www.youtube.com/watch?v=pjDQN9keKQk)
The next day I visited China one last time. After this I had no reason to visit with her as a doula. I have paperwork to turn in and can then ask for more client referrals.
One of the forms we have is a survey for the moms to fill out rating the usefulness of the doula program from their point of view. There are questions like, ‘Were the techniques suggested by the doula helpful to the mother in handling the physical aspects of her labor?’
So the next day at my last visit, I sat and held little Baby Boy (who didn’t have a name yet) while China filled out the evaluation form for me. When she was finished I took it and stuffed it right away in with the other papers in my bag and hugged her goodbye. I whispered in her ear, “You know, my love, now you can do anything!” She looked me straight in the eye and answered “Yeah, I can do anything!”
When I got home I had supper and pulled out the paperwork so I could finish it up and send it in the mail the next day. As I was stapling the papers, I read the evaluation page. I noticed that China had written a number 10 after the 5 and circled it for her answer to #4. Then I read her comment at the end of the form. She had written, “I love my doula. Can I keep her forever and always?” I cried.

Don't miss the movie, Gimme Shelter  See: http://www.youtube.com/watch?v=tjyi_dMhyIs

Stay tuned! This and other stories will be included in the forthcoming book, Call The Doula! a diary© 2014 by Stephanie Sorensen.



Friday, January 3, 2014

Doulas and Dads - the first post of 2014

Last night I watched the British PBS TV series’ 2013 Holiday Special “Call The Midwife!”* At one point we see the drama being played out between one young couple as the mother goes into labor while our dad-to-be is suffering symptoms of what was referred to back then as ‘shell-shock’ which we now recognize as PTSD after his stint in the Korean War. As soon as their baby girl is born, the wise midwife hands the baby not to the mother, but to the father. He sees blood, one of the ‘triggers’ that has been setting him off since the war, but this time it is “good blood” as the midwife tells him. He is healed as he holds his tiny miracle. His wife has been through the worst with him and now he is no longer the victim and not only supports her but shares this amazing gift of life with her. It is a very moving moment. (Below: your doula says, "Please remove your shirt, your Highness")
It struck me as quite a coincidence as I watched it since I had been thinking very much about two recent births I had attended as a doula in the past 3 weeks. Under two very different circumstances both mothers were not able to hold their newborns immediately after birth and their babies, in both cases had been brought and left alone on warmers at the other end of the room. Only a month ago I had the privilege of meeting and spending time with Dr. Nils Bergman, a researcher from South Africa, at a summit in Minneapolis. He speaks all over the world about his findings concerning skin-to-skin contact, especially the benefits to premature infants. He goes so far as to say that preemies will actually do better if ‘kangaroo care’ is introduced immediately at birth and we do away with incubators all together. My own research into bonding or maternal-infant-maternal** attachment (see my book Stone Age Babies in a Space Age World: Babies and Bonding in the 21st Century© – publication pending) also points to Zero Separation at all births and is now being scientifically confirmed by Dr. Bergman’s studies and others.***
In the first of these two births a couple from Spain who are living in Minneapolis asked me to be there doula toward the end of their pregnancy. We were able to squeeze in two visits before her labor began. It was their first birth. The mom had been dealing with multiple chronic health issues and was quite successful in controlling many of them with natural methods. They had really done their homework and were determined to have a natural birth. We put together a birth plan listing all of their wishes and all of the things they hoped to avoid, though they were very realistic about the possibility of interventions in their case in particular.
They called in the middle of a snowstorm a week later. I met them at the hospital as the nurse was hooking up a monitor on her belly. Baby sounded fine. We had been put into a triage room. This particular hospital felt that so very many couples were coming to the hospital far too early and were being sent home to labor until contractions were closer to 5 minutes apart which would ensure that they were indeed in active labor. This way only the exam rooms would need to be ‘broken down’ and sanitized and not an entire birthing suite had they been immediately roomed there. So her midwife was called and luckily she was in the hospital and walked right over to check the mom’s dilation. We were breathing through each contraction which were very regular. I thought Conchetta was handling this stage very well and expected to hear she was two, or maybe 3 or 4 centimeters along at this point, being a first baby. When the midwife announced that she was 8 already and, all in one breath indicated that we were moving into a regular room, like IMMEDIATELY, I was surprised. This lady should have written the book about dealing with first stage labor!
With a flock of nurses now setting up the room and the midwife gowning up I continued to breathe with Conchetta. With the next contraction she instinctively pushed for all she was worth. I knew she didn’t need to be checked again, but the midwife wanted to be sure she was fully dilated, which of course she was. Two more mega pushes and the head was born. Another contraction and their beautiful baby girl slid out followed by a rather impressive river of blood. It looked like a lot to me, so I waited to see how I should help and back up the midwife’s next move. The nurses also saw that there would be something other than the regular plop-baby-on-mom’s-tummy program happening next and brought the baby to the warmer after hastily clamping the mother’s end of the cord and cutting baby loose.
The dad had never seen a birth so he thought this was all very normal and routine. He would be OK for a few minutes I figured, so I went over to the warmer. Their baby was doing beautifully with a #10 Apgar score and the midwife was talking to Conchetta while the nurses were hooking up an IV with Pitocin and fluids. I was mainly concerned that baby not be left alone. Especially after my own work on bonding and the summit by Dr. Bergman I was completely convinced that babies are born fully expecting a continuum of contact and that there should be Zero Separation from now on. Not only are human babies fully hard-wired with this expectation, but they will not thrive unless this is provided. We are the only mammals that consciously defy Nature and dress and take our baby mammals away from their maternal environment at birth. The consequences are dire. Researchers are now even going so far as to suggest that many if not all of the multitude of developmental disorders that are mysteriously proliferating in our century in spite of all our advanced science and medical knowledge may very well be caused by this unnecessary separation. And I would posit even further that we are looking at what is called iotrogenic disease which is now resulting in a doctor-induced diseased generation.   
I thought now, “What do we do with baby?” No one was paying much attention to her at this point. All of the drama was across the room while everyone was trying to figure out where this hemorrhage was coming from. So I loosely wrapped up baby, replacing her soggy little hat with a dry one while I talked to her. I held her close and went and got her Dad where he was still standing at the head of the bed by his wife. The midwife was trying to sound calm and reassuring as she explained to them that she was poking around down there trying to find the source of this bleeding. I walked back to the other side of the room with Dad and motioned for him to sit down in the rocking chair by the warmer. I suggested he take his shirt off and keep his baby nice and warm and skin-to-skin until Conchetta could get her back. He did what I asked immediately. I find that dads are especially compliant at this stage and will do absolutely anything I ask them to. I could have just said, “strip” and he would have, I am sure! 
His baby girl had already started blowing bubbles and rooting around while I picked her up. I told him she already knew him and his voice and was smelling him as she got to know him. The look on his face said it all. He was smitten. As she cuddled into his chest I could tell he had probably never held an infant. Then she started throwing her head back and wiggling. I told him just to hold her as I wrapped them both in blankets. When she reached the point where her head was cradled in the crook of his arm and her cheek was touching his furry chest, she stuck out her tongue and started licking his nipple! I giggled, but Dad looked up at me with tears in his eyes. He completely melted. I just repeated to him that she knows him and needs to stay with her parents. In the meantime, the room had now filled up with a couple of OB doctors and additional nurses. 
They had found the source of the bleed. Its apex was behind the cervix in the posterior or back vaginal wall that rides above the rectum. One of the medical issues that Conchetta had been dealing with was a problem with the clotting factor in her blood. Because her baby had descended down the birth canal so very quickly, where most women would have stretched slowly as the baby’s head molded, her ‘friable’ tissues had simply parted and broke open. This was about the worst 4th degree tear I had ever seen. They were tying off the bleeding veins and soon had the situation under control.
Time passes outside of our usual frame of reference during emergencies. It had only been 20 minutes or so but felt like hours from my corner of the room. Dad did not really have an inkling of what was going on and I was glad I could reassure him and get him and baby away from the electric vibes on the other side of the room and actually create a safe or sacred space for his baby during this time. I kept wondering what my friend Nils Bergman or his ‘kangaroola’ wife Jill would have done in my place.
Within an hour we were able to get baby onto her mother’s chest where she immediately raised her head and latched on the first try without any direction from us. I visited this couple the next day in the hospital and the day after that at home and both times found the Enrik√© still holding his baby with his shirt off. I doubt very much he had put her down at all in the interim. I marveled that this was indeed continuum bonding as I had rarely seen it since becoming a doula. How could I do this more? How could this affect father-baby bonding especially? I did not have long to wait to find out.
A week later I was at a birth at a different hospital with a couple who were living in one of the highest crime-ridden neighborhoods in the city. You can automatically add on social and economic poverty to the list of things this family was dealing with. It was this mom’s third baby, though it was his first. He was clueless. But it was his baby and he was going to give it a shot. Unfortunately, the African American community continues to struggle with the highest rates of absentee fathers in the nation. According to 2011 U.S. Census Bureau data over 24 million children live apart from their biological fathers. That is 1 out of every 3 (33%) children in America. Nearly 2 in 3 (64%) African American children live in father-absent homes. One in three (34%) Hispanic children, and 1 in 4 (25%) white children live in father-absent homes. In 1960, only 11% of children lived in father-absent homes.
Children who live absent their biological fathers are, on average, at least two to three times more likely to be poor, to use drugs, to experience educational, health, emotional and behavioral problems, to be victims of child abuse, and to engage in criminal behavior than their peers who live with their married, biological (or adoptive) parents.
I knew all this already, but wondered if there wasn’t a possibility of perhaps connecting some of the dots here by finding a way for dads, especially ones who didn’t have a mutual agreement of commitment yet in place, as in being married to the mother of their child, and if by better, earlier bonding these statistics might be reversed. While I was busy pondering this, I was referred to this particular family.
I was able to meet with Sh’neice four times in the weeks before her guess date, (formerly called the due date.) I collected baby clothes from friends for her and made sure she was connected to WIC and any other services that they could use. She was taking very good care of herself and her other kids and we had enjoyed getting to know each other. 
I went to her last prenatal clinic visit with her at her request. She had hoped to have a chance to have a VBAC but her OB wasn’t budging. In the end the doctor convinced her that after 2 C-sections already, this was the best choice for her. At this point as a doula this is not my call. As much as I would love to support her having a VBAC, it would only undermine her physician’s relationship with her, and also be outside of my current scope of practice. I bit my tongue. Hard.
I met her at the hospital on the appointed day at 7 a.m. When she was finally wheeled down to the OR at 11:00 her boyfriend and I put on our scrubs that the nurse had handed us. They wanted us to wait while they did the epidural and prepped her for surgery. Then someone would come and get us. He looked at himself in the mirror and I could just barely hear under his breath, “I will not faint… I will not faint.…” I then realized that this was his first-ever birth. Was there any way I could involve him and have him feel intimately a part of this birth? It was easy when a dad is at an all-night birth and I can have him rubbing her back, fetching juices, wiping her face with cold rags and walking the halls for hours on end, but this was all going according to protocol and I didn’t know what I could do to fit him into this picture. I did all the usual things I did at C-sections like having him take pictures as his baby is brought to the warmer and hold his baby’s hand or foot as they assess her. I also direct him when he is finally holding his baby back to mom and help her also hold her baby. Sh’neice was still quite uncomfortable and the doctors had a lot to do to repair not only this incision but also deal with extensive scar tissue from 2 previous Cesareans, so she was not ready to hold her baby when he did return. 
Dad was happy to just sit there holding his fat bundle where she could see him. I checked in with him periodically to make sure he was OK. He did really well, which I made sure to let him know I thought. It was finally time to move into the recovery room so we all followed the bed out of the OR and down the hall, Dad proudly carrying his very own baby now. As soon as we got there Sh’neice began vomiting, which is not all that unusual after surgery. She still was not ready to hold her baby and I didn’t think I should push her at this point but rather thought to let her take her time to recover.
I looked over at Dad standing aside nearby rocking from side to side with his little bundle in his arms. He was oblivious to the rest of the world. “Good” I thought. But then it occurred to me that we could even improve on this. I pushed over a glider-rocker that was in the room and offering to take baby suggested he take off his shirt and hold her skin to skin to keep her warm. Of course I have him under my spell by now, and he will gladly do whatever I request! As he sat down I handed him his baby and helped him unwrap her, too. I wrapped them both back up then with a warm flannel blanket. The next time Sh’neice looked over to see where they were, she saw him talking to his baby who was now looking up into his eyes. She had not tried to open them in the OR with all the bright lights in there. I thought to myself, “This is right. Only this baby can change this big dude with all his huge tight abs and fly swagger. Only this baby can turn him into a real father.”
I am definitely going to keep this in mind for my next births. I think we are on to something very significant here. Stay tuned!
This and other stories will be appearing in my forthcoming book, Call The Doula! a diary© pending publication.

More pictures of daddies with newborns at Google Images.

*a true story re-enactment of a diary written by a novice midwife sent to the notorious East End of London to practice in the 1950s.
**I now insist on using the term ‘maternal-infant-maternal’ attachment, instead of the former, ‘maternal-infant attachment’ to exemplify the fact that the infant is also displaying cues and instincts that he expects will be reciprocated, despite the persistent thinking by some doctors even into the 21st Century that bonding is only ‘one-way’ or that the majority of bonding is from mother to baby if not exclusively initiated by her. Dr. Bergman and many other researchers are now proving unequivocally it is indeed otherwise.
***See: http://www.skintoskincontact.com/dr-bergman.aspx for Dr. Bergman’s mission statement.



Friday, November 29, 2013

Nature Makes No Mistakes… or does she?

My mantra has always been “Nature makes no mistakes” so how do I understand this birth? Perhaps we are not meant to know all of her secrets in this life (Nature’s.) Maybe it will be given in the next. I can’t explain what we witnessed. I can only wonder…. Leslie and Fred’s first baby died at 5 months’ gestation. It was a nightmare, finding out first that their baby was no longer living, and then having to say goodbye plus still deliver him. You never forget; you never completely make peace with such tragedies in this life. I think it just doesn’t hurt quite so much as time goes by. Time does not heal. It numbs.

There was little explanation as to why it happened. It just did. But in the process of sorting out what little they did know, several chronic medical concerns with Leslie’s health did come to light and those are the things that she could focus on and improve. Thus began their journey into holistic and alternative medicine which was able to give Leslie her health back. It has been a huge learning curve, but a much needed one. Physically she was now in a better place than she had ever been, now that she was caring for herself and addressing issues she had tried to ignore for decades. But she was still not pregnant even five years after the stillbirth. They figured that they were not meant to have their own children in the usual way but were very resigned to adoption. Surely there were babies out there who were waiting for a family, their family. They had also put in their time at a university fertility clinic. Tests, scopes, dyes, charting, sex-on-schedule, everything medicine could and has thought up. My husband and I had also been through years of infertility testing. I was even told once that it would help the sperm along if I stood on my head after sex so they didn’t have to swim upstream. Right!
And then she was pregnant. The biggest hurdle was to hope without setting themselves up for that raw disappointment again. This was inevitable. Of course they would hold their breaths every day, every hour until they got past the 6th month mark this time. They tried not to put too much stock in hoping for a successful pregnancy, but at the same time, anyone in this situation is going to hope, and should it not work out, you would still be crushed and devastated, no matter how realistic you tried to be.
     But as her belly grew and the days moved into months…. six… then seven… and eight… they hesitantly allowed themselves to become excited. The ‘what ifs’ never went away completely, but it seemed that Someone had indeed smiled down upon them and this baby was meant to be with them. They knew it was a boy and promptly named him. They found a doctor whom they felt they could trust and would work with them on their terms. And they decided to hire a doula.
     I received an email one morning asking if I was available that week to interview with them. I said I was very interested and sent along the link to my blog so they could get to know me a bit before we met. Leslie, Fred and her mother actually did look me up and read several of the stories I had posted on the blog, many of which have now become the 2 books, my first one, Stone Age Babies in a Space Age World; Babies and Bonding in the 21st Century and this one, Call The Doula! a diary. 

I agreed to meet Leslie later that week at a nearby coffee shop. We hit it off right away. We asked each other lots of questions and talked and before we knew it two hours had passed. I told her that she could let me know the following week either way and explained that I would email them a contract to go over should they wish to continue with me. We hugged goodbye and she assured me she would be in touch.
     We got together the following week, this time with Fred and her mom Alice also. We talked about what services I could offer and went over what a doula does and does not do. Then we watched the Doula DVD produced by the Childbirth Collective here in Minneapolis, a beautiful movie about our work and a very good glimpse into the doula’s role at home, hospital, water and C-section births.
     Our last prenatal appointment finally arrived. This was it. The next time I would see them would be in the hospital. We were excited, and nervous, and very encouraged that this little guy had made it this far. And he wasn’t tiny, either. The doctor guessed around 8 pounds. He also began to question her ability to birth such a big baby. He ordered a further ultrasound and explained to the couple that she really did have a narrow pelvis. He knew they wanted a water birth, and definitely a natural, un-medicated birth, but now he felt he had to share some of his concerns. He was absolutely willing to let her try a vaginal birth, but wanted to prepare them should they run into cephalopelvic disproportion – a dynamic which tells you that the size of the fetal head is different from the size of the pelvis which signals a lack of the proper relationship between the two factors. CPD occurs when a baby's head or body is too large to fit through the mother's pelvis despite allowing ample time to mold. Her baby had also been breech, or head up and feet first until the last appointment which confirmed he had indeed turned around all on his own. I had told Leslie that I had complete confidence that her body had grown this baby and would now also know how to birth him.
During the next week Leslie was feeling contractions on and off, usually picking up in the evenings, though none progressed into a real labor pattern. We checked in by phone daily and my main job was to remind her that she would not always be pregnant and that most babies do come out, in fact I never knew one not to. I encouraged her to eat and rest and take walks and know he will come… on his birthday. I told her I had no doubt. Then she had another prenatal appointment.
     First it confirmed he was still head down. This was on a Friday. Because of the combination of some of the medical issues they were dealing with, the doctor explained at this point that he was not comfortable waiting for labor to start after the due date. He felt it was time now, in the next few days, citing some very valid studies and recommendations that sometimes the placenta will not do very well given the concerns they were dealing with and he was not willing to wait until problems presented themselves. He scheduled an induction for Wednesday evening. He proposed using a prostaglandin medication to ripen the cervix. It is inserted and left there for 12 hours, preferably while you sleep. Then in the morning Pitocin is used to encourage contractions and labor hopefully kicks in soon thereafter. In rare cases the first medication alone is enough to turn labor on.
     I did not know it at the time, but Leslie has quite a track record for being one of those rare cases. Nothing that came next was ever written in any text book. Her mother and partner were going to stay overnight with her in the hospital and I would come in by 8 a.m., unless of course they wanted me to come earlier. By 3 a.m. she was having some really good contractions about 5 minutes apart. She had been only 1 centimeter dilated when they put in the medicine the night before. They wouldn’t check her again now until they removed it at 8:30 a.m. I arrived shortly after 6:00. We breathed, slowly… in… out… relax your shoulders… relax your jaw… 4 minutes apart now. I was excited too. This was the real thing! We were going to see this little big guy soon! She was doing amazingly well hour after hour. She could write the book about relaxing in labor! 
        At 8:30 the nurse checked her. Still 1 cm. I told her that I wasn’t at all discouraged. This was not a normal labor – yet. It was an induction. All the different parts have to come together in order to progress to the next stage. She needed to eat now, rest, visit the bathroom and walk. I showed her partner how to support her with the next contraction and sway or dance from side to side and help her baby move down. She had been working so hard with the contractions. I was a bit mystified too. The next time the nurse checked her she could not feel the baby’s head. Had he slipped up farther away from the pelvis? She wasn’t sure. She called the doctor who recommended starting some Pitocin to try to strengthen the contractions and hopefully start her dilating and moving into active labor.
     Four hours later the nurse found the cervix to still be at 1 cm. This wasn’t going anywhere. Then Leslie said, “I just heard a pop! My water bag broke!” We continued breathing and trying to relax, one rush… at… a… time…. The nurse returned with an ultrasound machine and proceeded to try to map out where our baby was. She went back and forth and up and then down with the gooey wand. We were all watching, hoping to get a good look at him. She finally gave the wand to another nurse who started scanning higher up this time and as she did, I saw the baby’s head clearly silhouetted there. I blurted out, “He’s breech!” The nurse simply nodded and wheeled the machine out into the hall, the other nurse following close behind her. While I grabbed a towel and wiped off her sticky belly, Leslie started sobbing.
The Pitocin IV was stopped and her doctor was called. When he arrived he said he was as surprised as the rest of us. He was not prepared to offer a vaginal birth now, especially since he was already wondering about the size of the pelvis. He was also surprised that in spite of the water bag having broken, that somewhere in the last few hours it appeared that baby had turned around. Again. Why would he do that? He said that the chances of that happening were less than 5%. Leave it to Leslie to be one of the 5%!
Looking back on this series of events, I can only wonder: did baby at least try to engage his head and finding that not possible decide to attempt to come feet first? Did he have any idea that the first option was simply impossible? Do babies have some kind of innate ability to conform to the particular circumstances? Does Nature adapt? Did she make a mistake this time? Or was this part of some exquisitely intuitive plan?
     Because her membranes had ruptured, we were past the point where the doctor could have tried to turn the baby. He had actually been thinking on the drive to the hospital that he would offer that as an option. He also did not realize until he arrived that the contractions were still continuing to intensify, even with the Pitocin out of the picture. He discussed the options left to the couple and together decided on a Cesarean section. Not the water birth they had so carefully planned. All those hours writing a birth plan, the long weeks of hoping, months of planning, hours watching water births on the Internet -- all culminating in this moment, all control gone out of their hands. We were all crying at his point, Fred, Grandma, Leslie and me. How could we get back to focusing on their precious baby about to be born? I tried to gently tell her she will be holding her little one soon. I assured Leslie that she had done a valiant job and could not have done more. Two nurses returned and swung into action. There was a whole list of protocols now to run through: papers to sign, shaving her lower belly, drinking the antacid cocktail, etc., etc.
I had noticed throughout the day how connected Leslie and her mother were and decided to bring up the subject then about who would go into the operating room with her. The nurse had tossed two sets of scrubs onto the bed stand and I told Fred that we needed to get ready. While the anesthesiologist was talking with Leslie, I took her mother aside and asked if she would like to go in as her doula. She was about to see her first grandchild being born. There very well may never be another chance like this one. She jumped at the idea. I told her if anyone questions her, she should tell them she is a doula in training, besides being her mom. It worked.
     I have always gone into the operating room with my clients should they need a C-section. I have been able to make sure that the baby is brought sooner than later over to his mama to hold or even nurse. If there isn’t a partner with her, I make sure we get some good pictures and let her know how her baby is doing while he is on the warmer until he can be with her. Afterwards it is important to talk about what happened and why. It is hard to process the chain of events sometimes. Often a woman feels like she has somehow failed if she needed a C-section and I want to have this discussion to reinforce the fact that she was a total success and that she did everything in her power to birth her baby but that certain things happened and we had to deal with that as they came up. I remind her that this is now the land of parenthood, where there are curves in the road, and even our best laid plans are apt to be foiled in the blink of an eye. This land is not always very fair, or forgiving, and we cannot see the future here, either. As one wise woman recently said, “Meconium Happens.”
     I used the time that they were in the OR to clean up the room and grab some food. She would be coming back to this same room after only an hour in recovery. I prayed too that it would all be OK. I was anxious to meet this little man who had such an unorthodox way of coming into the world. I had never seen anything quite like this before. After more than 30 years in birth work I thought perhaps I had seen it all. Not quite.

Finally Leslie’s mom came back to the room followed soon after by a nurse wheeling baby in. I took one look. He was beautiful and he was huge! My own last two babies, three years apart, back in the 1980s were over 10 and 11 pounds, respectively. This baby was on the same soccer team. He weighed in at 10 lbs. and 7 ounces. Leslie was soon brought back with the proud Dad. It was over. We hugged all around, crying happy tears this time, so relieved that everyone was here safe and sound. Every time I looked at him I marveled at how this had all played out. Could he have known he would not have fit head first? Could she have somehow unconsciously known too? What would this birth have looked like today in Tanzania or Zimbabwe? Would either of them have survived? Or if he was born in the 1900s here in this country? Fetal macrosomia comes with a whole host of complications including dystocia or a baby getting stuck in the birth canal. Unstable sugar levels after birth are also common problems with larger babies. But he was here now, and healthy and his parents are very relieved and happy. And exhausted. I continued to ponder these things in my mind as I left later that evening. Before going I reminded Fred to protect mother and baby now in the next few days and not let her get overwhelmed with visitors. I told him in no uncertain terms that now this space around her is sacred and it is his job to protect it, and they can have their families descend upon them next week, or better yet, the week after that, but not now. He agreed and gave me a big hug goodbye.


Stay Tuned: This and other stories will be appearing in my upcoming book, Call The Doula! a diary© by Stephanie Sorensen.
The babies pictured in this article are credited to Anne Geddes with many thanks!