Saturday, April 6, 2013

Above and Beyond the Call of Doula: Shavonne’s* Birth

"I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel." 
~ Maya Angelou 

She walked into the lobby where we had agreed to meet for our first prenatal appointment. My first thought was, “She’s BEAUTIFUL!” And it wasn’t just her pregnant belly. I have this thing about tummies. I have been a midwife for over 30 years and work as a doula now, when I am not an author or a Grandma or Mom to my own 6 kids. They are all grown up but you always call them ‘the kids’.
            I had been given her referral a few days earlier. It painted a grim picture: homeless, FOB (father of the baby) involved, 1 living child, 1 stillborn, due in September, single birth. This would be my third homeless mom in 4 months. As a doula my job is to accompany and support low income women during their pregnancy, birth and postpartum time with education about birth, labor, delivery, breastfeeding and newborn care, and emotional and physical support. This often spills over to include helping them find services in their community like free clothes, food shelves, employment agencies, social services, subsidized housing, counseling and treatment facilities, etc. 
Some facts about homelessness in Minneapolis:
            The shelter where Shavonne was staying is the largest shelter in Minnesota. They served 1,187 homeless families in 2011. 59% of guests were children and 34% are under the age of five years old. The average age of a child there is 6 years old. The number of families rose 18% in 2011, with an average of 347 guests per day. 37 days was the average length of stay for a family in 2011. 250,398 meals were served at this facility in 2011. 24 hour front desk service supplies diapers, formula, warm clothing and other basic needs. And a bit of trivia about homelessness in Minnesota: During the winter of 2002 - 2003, 70 homeless people died of exposure. That same winter, the Twin Cities Winter Carnival spent $5 million that was privately raised on the Ice Castle, an extravaganza built out of huge blocks of solid ice complete with light show, turrets and a drawbridge, but roped off and patrolled all night by local police so that no one would go inside of it, much less attempt to sleep there, the reason being that they didn’t know if during a thaw before it was disassembled it might create a hazard and someone could get hurt. The Dorothy Day Center across the street from the Ice Castle didn’t have enough beds to accommodate all the homeless. Each night they would have a lottery: take a ticket and wait in line and at 8 P.M. sharp they would call out numbers, like at a Bingo game. Some got in, some didn’t. I wanted to know why the city couldn’t put some of that $5 million toward adding another floor for a dorm above the one story Dorothy Day Center? I even held a one-woman silent vigil there for several nights that winter in protest.
            The lobby was alive with kids that morning: kids with knapsacks waiting for school buses, kids crawling under the bench I was sitting on, kids running in circles around a mom or dad who was waiting in line at one of the numerous desks lined up against one wall where staff were issuing free bus passes or other services for that day. The noise level was up there with my memory of the last rock concert I attended about 30+ years ago. I looked at Shavonne and asked if she could leave with me for a couple of hours. She signed out and we took off.
            We found a nice coffee shop nearby. I asked her if she had had any breakfast. She hadn’t. She had missed the half hour time slot to go down and get cold cereal and milk and couldn’t take anything back to her room. So we ordered breakfast. She kept telling me how good it all was as she was eating. I wondered at the quality of the food at a huge shelter like hers. Fresh fruit? Vegetables? Or government surplus institutional food -- sodium, sugar and MSG contents would be just right for a pregnant woman, right?
            Over the next two months we met every Monday at the coffee shop. I often brought my laptop and we would watch YouTube videos on everything from water birth to natural birth in Russian tidal pools at the ocean, twin home births, animal births (a great way to see how Nature intended birth to be),** and the latest out on breastfeeding (see UNICEF Breast Crawl on YouTube.) Most of this midwifery or natural model of care was new to Shavonne. Our meetings became an oasis in the midst of a very stressful period for her: a tentative relationship with the current boyfriend, her homeless situation, a fragile relationship with her family, a job she was struggling to keep right up to the time she would birth this baby and the chaos of the shelter with its own dynamics of unstable, often mentally ill roommates, and rampant theft. She was in a dorm room that housed 6 pregnant women. Talk about drama!
            Her first birth had been a C-section after her baby began showing serious signs of distress during labor. He is 5 and living with his dad in another city. Her next baby was carried to term and unexpectedly died only days before his due date. With this history, her present doctor was reluctant to let this pregnancy go to term or attempt a VBAC or TOLAC, Vaginal Birth After Cesarean or Trial Of Labor After Cesarean. Neither precaution he suggested has been proven as best practice or been able to avoid a poor outcome, much less without carrying their own multiple risk factors.
            One fun thing we did together was to make a belly cast just weeks before her due date. (See Belly Casts, Babies and Negasi’s Birth at this same blogsite due April, 2013.) Shavonne had planned to bring it to her baby shower that a friend was hosting for her and have everyone write blessings and messages on it. Unfortunately, she had stored it in a plastic bag under her cot at the shelter. When she opened it later, it was covered with mold; it had not had enough time to completely dry.
          We continued meeting for our Monday breakfasts until she called one morning after a prenatal visit. The doctor had scheduled her C-section for the following week. She was not happy with this option at all, but her family insisted that it was for the best. It is not my place to referee these events, nor am I being asked to override a physician’s position. Shavonne knew by now how I felt about natural birth and believed she could do that, but her last baby’s birth was still painful enough to make her doubt her own reserves of strength. I also let her know I would be there to support her no matter what she decided to do.
This may be the hardest part of being a doula. You have found that inner power and have seen it work a hundred or more times, but you cannot make that journey happen for another woman, no matter how much you love her.
            We reworked our birth plan to include baby-led breastfeeding in the operating room or in recovery as soon as possible. We made it clear that baby would be rooming-in and that he should not be given water, formula or pacifiers. Shavonne also wanted her partner and doula there. So we went to the hospital on the appointed day ready to meet little Ra’shon. I asked the nursing staff if I would be able to join her in the O.R. before the epidural was started and was able to talk her through that. I was given one square foot to the right of her head by the table where I could hold her hand and talk to her without getting in the way of the anesthesiologist and her assistant. I felt like if I moved an inch I would be sitting in one or the other’s lap! It was a tight squeeze, but they were all very nice about it. Her partner was positioned on a chair to her left. A large sterile curtain cuts off the surgical site from all of us at her head and shoulders side of it. Within 10 minutes the surgery was begun. I was able to tell her what was happening each moment and warn her when there would be pressure and tugging. I could see when they were ready to lift her baby up and as I was telling her about all of his black curls he let out a huge squall. At that moment she started crying, big tears running down her face into her ears. Her arms were full of IV lines but I had a tissue handy and wiped her eyes while we listened to her baby who was finally here sounding very healthy and strong. I whispered in her ear, “You did it! I am so proud of you, sweetheart!” More tears.
            Within minutes little Ra’shon was wrapped up and in his daddy’s arms. He brought him back to where Shavonne could see and kiss him. It was so beautiful. Only this perfect little baby could make her whole world worth living in again. Shavonne was overwhelmed with relief and joy that he was finally here and healthy. All she had to do now was get stronger and hopefully the rest would fall into place – a better place than it had been for the last several months.
            Shavonne asked a friend if she could bring the baby home to her house when she was able to leave the hospital. That seemed like a better option than going back to the shelter, so it was arranged for the following week. Within two days she called me back. The ‘friend’ was an alcoholic and the situation was impossible. In the meantime, the housing advocate at the shelter had found Shavonne an apartment. When she went to see it, she found it more than filthy: it was overrun with cockroaches. She told the worker that there was no way she would bring her baby there. The worker returned to the shelter and filed a report that Shavonne was not cooperating with the shelter staff and refused the apartment. The next thing she knew, Shavonne received a notice that she could not return to the shelter for refusing to cooperate within the program. She was homeless. And now the shelter closed its doors, too.
            I often volunteer at another shelter for homeless pregnant women run by Mother Teresa’s Missionaries of Charity in Minnesota. I fill in as ‘house mother’ when the sisters are invited out. I often make breakfast and lunch and hang out with the women for the day. It is housed in a beautiful renovated building, bright and immaculately clean. There was room there, so a friend and I picked up Shavonne and little Ra’shon and brought them to their next home. Shavonne couldn’t believe it when we walked into the new house. It was very different from the last shelter she had been in before the birth. She had her own room with a crib and the nuns made hot meals, too. A bowl of fresh fruit was frequently refilled and sat on the kitchen table.
            So Shavonne settled in and spent the next few weeks trying to access the county services and arrange a more permanent arrangement. She could not stay with the sisters indefinitely. Finally her time there was up, too. Friends outside of the city had a room in their house and offered her that space. Her former employer let her know he was holding her job open for her. Now she was just waiting for the county worker to sign a voucher that would cover childcare so she could return to work. Finally things were coming together.
            That was the last time I heard from Shavonne. I don’t know if her phone is still working or if she simply could not pay for the next month’s minutes. I think of her often, another young woman whom I grew to love and had to let go. I never forget them. I pray for all of them. I think that must be part of my job as a doula.

*all names and identifying characteristics have been changed to honor privacy.
**See The Dramatic Struggle for Life – Bali, and Chimp Birth Attica Zoo at YouTube.
STAY TUNED... this and other stories will be appearing in the book, Stone Age Babies in a Space Age World: Babies and Bonding in the 21st Century© pending by Stephanie Sorensen

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