Wednesday, March 13, 2013

Call the Doula!

Doula, pronounced DOO-la, originated from the Ancient Greek word meaning servant to women; a non-medical person who assists a woman, her partner and/or family before, during, or after childbirth providing information and physical and emotional support. Continuous support during labor by doulas is associated with improved maternal and fetal outcomes and other benefits. 
         
It was a circus; hardly a birth. Bah is 14. I put this into context this way: her parents were married at 15; life expectancy in their experience is about 45. They’ve been in the U.S. a couple of years. There are over 50,000 Southeast Asia immigrants in Minneapolis. FOB, as us doulas call him (Father Of the Baby) is too young to drive himself to the hospital. The family sleeps on homemade platforms at home, squatting on the floor to play cards, like in the old country; gold papers stuck to the walls to placate any bad spirits that might be lingering there.
            Bah (not her real name) called me on a Friday at 11 p.m. to tell me that she was having contractions, wondering if it was time to go to the hospital. I offered to go her home and hang out with her until it was time to go. I went.
            The contractions weren’t very strong and by 4 a.m., now Saturday, petered out. They stopped altogether after breakfast: whole fried fish, eggplant soup and steaming piles of rice. I went home after breakfast suggesting they rest and call me when the contractions are 3 – 5 minutes apart for a whole hour or her water breaks -- whichever comes first. Later that day I had supper with my husband. No calls yet. We went to bed at 11 p.m. Then the call came at 11:15 (of course). She wanted me to come.
            Bah’s mom had 9 full term babies; 3 died simply because no one knew how to resuscitate them at birth. Her last baby was born shortly after they arrived in the U.S. She was terrified, labor stalled and she ended up needing interventions she didn’t understand; a very traumatic birth. In the end she jumped off the bed -- IVs and all -- and had the baby squatting in a corner, everyone yelling at her. Now Grandma tells me no one is to touch her daughter, no internal exams, IVs, Pitocin, medications, C-section, no men including doctors. I told her we’ll try to labor at home as long as we can though I can’t promise what she is asking. Whoa!
            Bah speaks English, having been attending a high school for pregnant teens. Her mom speaks none. I had learned a bit of their dialect over the past 30 years which helped a lot.
            Understandably she was projecting her fears onto the girl. I explained to Bah that her labor was going really well and she and her baby were healthy. We were at home until things picked up at about 2 a.m., now the third day. I asked her who was going to take us to the hospital. She said, “My parents don’t drive, just call the ambulance.” I said, “No, we won’t and anyway, how would your mom and I get there?” I called a taxi and I jumped in saying, “You know where St. Joseph’s is?” And he says, “Yeah, but is someone having a heart attack?” I said, “No, a baby actually.” The guy turned white (no, he wasn't my regular Somali taxi driver) and said, “You’re kidding me, right?” I said, “No, I’m not, but I don’t think it’s imminent and I will tell you if we need to pull over.” Literally shaking he says, “Really, you’ll know WHEN?” I said, “Yes, start the car and just drive. I am calling the shots, don’t worry.”
            I settled them in their room and went out to brief the nurses. The head nurse wanted to know why the mother hadn’t been able to resolve some of her issues in counseling. I told her that she is from another world where you don’t talk about these things, much less with strangers. The staff left us pretty much alone. After a while the nurse asked if she could check Bah’s dilation. I told the mom that very simply the doctor won’t come to deliver the baby if she won’t allow a check. She said OK, but only one finger, and very gently. We agreed. (Normally a vaginal bimanual or two finger exam is done to track the progress of the cervix’s dilation from 0 to 10 cm. which is how we measure each stage of labor.)
            8 cm. Great news! Bah surprised me how well she was doing with the pain though pretty worn out having now been up 2 days and 2 nights -- slow but not unusual for a first baby.
            An hour later an aunt showed up with some herbal potion that would speed things up. The doctor didn’t want to speed things up, especially since waiting can allow the baby’s head to mold well and stretches the mother naturally, but they insisted. So she drank the brew and it starts coming back up. I get to hold the bag. Just as she is getting cleaned up another aunt comes and proclaims that the reason her baby isn’t coming is because she ate sweets and made her baby too fat!  I whispered to her between contractions as soon as I could that her baby was just the right size for her and he isn’t 8 or 9 pounds; we still think her labor is going really well and I am very proud of her.
            Great Aunt shows up next and tells her that her baby won’t be born unless she apologizes to her parents for the times she talked back to them. She does. They give her more brew.
            Then -- and I swear this is all true! -- FOB’s clan sends three chubby middle aged tribal pastors to come pray over her. They walked in the door without knocking looking like the Three Stooges in pin striped suits that are too big for them. I asked Bah if I should send them away. She said they could come in for just a minute. They trooped in, laid their hands on her head and prayed -- on and on, through at least 2 contractions with Bah trying to hold still. Finally I said, AMEN and ushered them out thanking them profusely. I got a door sign directing all visitors to check at the desk first and closed the door.
            Finally Bah was 10cm. and could push. It took another hour but then her little boy was born, crying right away. Grandma told us she would hold him first because the placenta wouldn’t come out if Bah held him, so we wrapped him in warm blankets and she held him after she cut the cord. I tried to involve her as much as possible, hoping this birth might help heal some of her memories. She cried when she cut the cord and thanked us. We had her in charge of the cool cloths for sponging her daughter’s face and neck during labor. I kept telling her what a great doula she was, such a good mom.
            So, Grandma was holding the little guy who won’t be officially named for a couple of weeks (the bad spirits might hear his name or someone say how cute he is and ‘they’ could take him away) and Bah starts bleeding a bit too much and promptly faints. They start an IV, massage her uterus and Grandma has a total melt down, throws the baby on the lounge chair, and starts shrieking not to touch her. The doctor has me explain hemorrhage and what they have to do but Grandma is beyond reasoning, calling the clan elders on her cellphone to hold a palaver and take her side. In no uncertain terms I say that there are mothers dying in China after birth everyday because they don’t know how to do this (at this point the doctor and the nurses are all vigorously nodding all together) and finally we get her to stop yelling. Finally I help Bah get baby latched on properly (which helps the uterus clamp down and reduces bleeding) and he starts nursing and things settle down.
            8 P.M. My husband picked me up. Out for supper and then SLEEP! Back to the hospital this afternoon to figure out the next step. In their tradition a mother can’t come back to her family after birth, she is unclean for 30 days. We wouldn’t want to incur the wrath of the bad spirits, but she can’t go to her boyfriend’s family either, because Child Protection is involved and won’t allow that. FOB is going to a hearing this month to be tried for statutory rape: she is under 15, which is the cutoff for a ‘consensual relationship’; she’s a ‘vulnerable minor’ instead. In the past another family in the same predicament built a hut in the backyard for the mom and baby in the middle of a Midwestern winter and of course the courts got involved. The doctor won’t discharge Bah unless she is OK with whatever arrangement we can get the family to agree to. Mother Teresa’s nuns at the Missionaries of Charity Shelter where I volunteer have agreed to take her.
            My next birth is with a family from Liberia, but that is another story.



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