Last Tuesday I went with Makda (not her
real name*) to her clinic appointment. The midwives had referred her to an obstetrician
because they were concerned that she still had 2 weeks to go until her guess
date (originally called the due date) and her baby already felt rather big. The
other concern they had was that her last baby had gotten stuck during delivery
with a complication called shoulder
dystocia. It was scary enough that the last midwife made sure to attach an
alert to Makda’s chart. So, here she was, due with another big baby and a bunch
of very nervous midwives.
I
was impressed that this doctor didn’t rush into the early induction option,
especially since the weekend was fast approaching. (Most C-sections in the U.S.
happen before 10 p.m. and not on
weekends.) He explained that since this was her 3rd baby that she
should be able to push out another big baby which she did after all last time.
However, he hoped she would go into labor on her own in the next week. He
hesitated and said that he would think about inducing labor after that if
things didn’t start by then. He mentioned that he would be gone over the coming
weekend but that they had a great group and he felt confident that she would be
well cared for in his absence. We thanked him and left.
I
was also going to be out of town the next weekend (which is very rare for me)
so I told her about my backup doulas, reassuring her that she wouldn’t be
laboring alone. Her husband, Semere would be
staying home with the other children when she delivered, which didn’t seem
unusual to them. Men are not usually in attendance at births in traditional
African cultures. It is one reason why our doula group in Minneapolis has
become so popular with the immigrant women. They have aunts, sisters, sometimes
their mother, and girlfriends to go with them when they have their babies, but
the idea of a doula who can help them negotiate the often mind boggling
American medical system, to them is a godsend which they are truly thankful
for. (Hamduli’Allah! – thanks be to
Allah!) In turn, I tell them that I am deeply honored to be invited to be a
part of their most intimate moments and feel so welcomed at their births.
It
is always hard when we have set our sights on our birth going a certain way and
all of a sudden, either before the birth like this one, or during labor
everything changes gears. Makda and I had talked about what her wishes
were, what she liked or didn’t like about her last 2 births and together had written
up a birth plan. She and I had spent some of our prenatal visits watching
YouTube births, especially water births, home births and natural births. I
wanted her to understand that she has many options to explore and unless she
knows about them, she really doesn’t have those options. She was especially
intrigued by water birth, so we talked about that and included that in her plan
too, but now this wrench in the works.
She was
discouraged. I could tell this was worrying her so I suggested that before she
left that day we get the interpreter back and talk about it a bit. I come from
what we call the ‘midwifery model of care’ where we trust that our bodies know
how to birth and that they also know how big to grow this particular baby. The
other model of care is the ‘medical model’ that has crept into our collective
consciousness and the American way of life for over a hundred years now and in
the process undermined much of our instinctual knowledge.
So we have to
find a way as doulas to navigate between the two, letting women know they are
both out there, encouraging them to find that power that we believe is in each
of us, but also stepping back when our sister is on this journey of
self-discovery and may not be ready to be as daring as we would be (or wish her
to be) at the place we find ourselves at this very moment. I have to respect her choices and hesitations
and not show even the least disappointment if she doesn’t choose what I would
have chosen for this birth. A doula has to be there to unconditionally support
whatever a couple feels is best for them. That isn’t always easy for some of us
who are rather radical when it comes to crusading the cause of birthing women.
And while we
crusade for all woman-kind to become empowered, why do women who end up with a
C-section or have chosen to use medications at birth feel that they have
somehow failed? Do they think they failed us? Or themselves? Or their baby? Why
do they think that we as women or as doulas and midwives will judge them? Have
we set some imaginary standard so very high? Or have we made birth into a
contest, a marathon or triathlon for that matter? How can we support each
mother better and be able to say, “I am so very proud of you!” and mean it just as much at a Cesarean
birth as at a natural un-medicated birth? I believe that it is up to us to
change this self-worth, self-image contradiction we are seeing. I also believe
that the para-medical community is partially to blame if women even perceive
that they have somehow failed. We have to explore this further and be able to
affirm each other better if we cannot answer a woman who has had a C-section
with more than, ‘well, better luck next time.’
If we are to heal the planet, we must begin by healing birthing.
~ Agnes Sallet Von Tannenberg
I talked with Makda and told her that there were also a few
other things that might be able to help avoid having to be induced, if this
baby was indeed ready. I suggested walking -- a lot, and that sex can actually
trigger labor. Then I told her about Jeannie (who I wrote about earlier in
March at this blog) who had been told that she needed a C-section the next day.
I had told Jeannie back then that she could also talk to her baby and connect
and perhaps find a way through the problem together. It had worked and she had
a vaginal birth without complications just in time. I wished Makda a good night
and hugged her goodbye.
At 6 a.m. sharp
two days later Makda called. She was feeling sick and not sure what to do. She
had the chills, her stomach was upset, she couldn’t eat and had cramps but not
contractions. She complained that her back hurt, too. I am not going to even
try to figure out what is going on. As a doula it is my job at this point to
direct her back to her midwife or doctor and let them decide what to do. It
sounded like either early labor or a urinary tract infection, but I told her to
call the clinic and let me know what they think she should do. She called me
back and told me that they wanted to see her at the hospital, but she didn’t
want to bring in the kids too, so she wanted to know if I would meet here there
so Semere could stay home and watch their girls. She asked me to call the taxi
which I did and soon met her at the hospital. Of course they had her on a
monitor to track the baby’s heart beat and another monitor to pick up any
contractions. There were both. She didn’t feel the contractions at all, and her
water hadn’t broken. They ruled out anything else that might be causing her
discomfort and decided to watch for an hour and see if anything changed. She
was only 1 centimeter dilated.
So I visited with
her and figured we’d be sent home in the end. An hour later she was actually
dilating and the contractions were picking up. We weren’t going anywhere – yet.
I ordered some lunch for her and snacked on what I had brought, though I didn’t
have my big doula carpet bag. I just didn’t think we’d be staying. I was wrong.
Hour by hour she
continued to open up though it was slow, but definitely progress. At one point
the contractions picked up a bit and she started to feel them, but then they
stopped all together. We walked for a while, glad to be able to move around
finally. Her doctor came by later in the afternoon mostly just to encourage
her. This was her third baby, but he was not in a big hurry. I kept her
drinking plenty of juices which I think got rid of the chills or whatever fever
was threatening to show up. Dehydration alone can cause symptoms like Makda was
having. By evening things had pretty much stopped. The nurse called the doctor
who suggested she just sleep and talk again in the morning and see where we
were at then. I was glad they didn’t want to hurry things along with
interventions. I was very impressed with this doctor’s level of restraint!
I went home at
this point but assured Makda that I would come right back if she needed me. I
made sure she had my number handy and tucked her in. She had a good night, and
so did I. The next morning the doctor suggested a very low dose of Pitocin to
get the occasional contractions a little closer together. They were still
there, but not at all effective. That did work quite well. Finally we entered
that point-of-no-return called “Active Labor”. With my own five births, I
remember this is as THE moment when you ask yourself each and every time, “what
could I ever possibly have been
thinking to want to be back at this point again in a million years?!” It is the
moment when you think, and some say it out loud, “Let’s all just go home now
and come back and do this tomorrow instead.”
One of the
resident doctors came to introduce himself to us and asked permission to
observe this birth. Makda didn’t understand what this was all about, so I
explained to her that he would like to stand in the corner and just watch and
learn from this birth, that he was a student doctor and that this how they learn –
and how we can contribute (hopefully) to their education including natural
birth. That is how I learned, by watching midwives and doctors when I was in
school. I explained that she had every right to say no, that there were enough
people already involved, but she said it was perfectly OK and even put her hand
out to welcome him. He read the chart and asked the senior doctor if, in light
of the last shoulder dystocia, he was considering using the Gaskin Maneuver? I was floored! This was
the first time ever that I have
encountered a doctor who not only knew about Ina May Gaskin and the successful management
of shoulder dystocia that was named after her, but was actually hoping to see
it in action! The OB who was overseeing Makda’s labor at this point said, yes,
it might help and he was familiar with it, but then added that a small vacuum
might also help. I assumed he was more familiar with the latter intervention by
the way he was explaining it. I couldn’t resist putting in my own two cents at
this point and said, just as an aside, “Ina May Gaskin was at my twins’ birth
on the Farm in 1982.” (See “Twin Birth on the Farm”© story on pg. 130 from Spiritual Midwifery 2nd ed. by Ina May Gaskin at
this blog. Also see “Twin Vertex Birth”, a DVD from the Farm Video at http://www.inamay.com/natural-delivery-vertex-twins-dvd)
The resident practically
hopped up and down and said, “ REALLY? I just saw that video! That was YOU?”
Well, wonders never cease! I said, yes, that was us. Later that night he came
by with another young intern to meet me. I was able to give them my card with
the blog address and upcoming book information. When did medical school ever
look like this? I still find it mind boggling!
So we walked, and
labored, and breathed, and thought about giving up, and walked some more and
took a long bath, the only sound water slowly trickling over her belly in a
dark quiet bathroom and then our breathing together in unison, trying to slow
down, and then blowing that rush away forever. Finally fully dilated we tried
different positions for pushing. Hands and knees worked well, and the doctor
was in agreement with staying there, especially if it would help with big
shoulders, but Makda wasn’t sure this was working. The nurse checked and the
baby hadn’t come any further down even with some really good pushes. Then the
doctor checked and became concerned that he couldn’t feel the lines in the
baby’s head. He wondered if he had turned somehow and could even be breech, so
they rolled in an ultrasound machine to check. No, the head was still down, but
looked posterior. That would explain the back labor, but not that he wasn’t
budging. The doctor was fine with her pushing as she had the urge, but it
didn’t look like she was getting him to move. At this point he ruptured the bag
of water, hoping that would help with some progress, but what happened next was
a surprise. Until then the baby had sounded great with nice variable heart
tones. But the water was full of meconium. Baby wasn’t happy.
The heart tones
continued to look good, but all of the pushing wasn’t doing much good. Finally
the doctor suggested trying a small vacuum that might help the baby’s head to
move which he was sure by now was acyclic, or turned to one side and aiming
down the birth canal at an awkward angle, which Makda agreed to right away. We
all just wanted to see this baby out at this point. So that was tried and after
three attempts, the doctor gave up on that too. Baby didn’t move. We had tried different
positions and just about every trick in the book by then. All of a sudden I
looked over at the monitor at the same moment that one of the nurses announced
as calmly as possible, “fetal heart tone 50… 60… 50…” which meant that our baby
was in trouble.
Back to hands and
knees and monitors. I was the closest one to the oxygen port in the wall and unraveled
the tubing, plugged it in and turned it up to 10 liters at the nurse’s
direction as I passed the mask to her who had Makda breathe the oxygen and help out her baby. We tried having her on
her side, then the other side, then upright. Nothing helped for long. After
every contraction the baby’s heart rate fell dangerously low. The doctor
wondered out loud if the cord was being pressed somewhere next to the baby’s
head both preventing further descent and causing the low heart rates. He
explained all of this to Makda and asked if she would be OK with an emergency
C-section because the baby wasn’t doing well and we didn’t want to wait
further. She agreed. She had been begging for a C-section around 8 centimeters but
I had explained then that they would not even consider that for a healthy baby
and mom. Little did we know that he would be in trouble so soon.
At the moment she
consented, the staff went into high gear. She was asked to sign a consent form.
Compression bags were put on her legs and a sterile cap covered her hair. The
IVs were all detached at the pole and monitors were shut off. A catheter was put
in and a fetal scalp monitor to listen to the baby directly. Every minute
counted. He still sounded OK which I was glad I could tell her, and I helped
Makda pant through the contractions and take deep breaths as they passed. I
tried to sound calm and quiet, hoping to diffuse the sense of panic around us.
As she was being wheeled out of the room the interpreter and I were each tossed
a set of scrubs, hats, booties and masks which we caught mid-air. We ran into
the bathroom in the room and wiggled out of our clothes and into the scrubs as
fast as possible without even closing the door and then ran down the hall to
catch up to Makda.
While she was prepped for surgery I was able to hold her
forehead and tell her what was happening. The IVs were all reattached, the
epidural line was being transferred to the O.R. (operating room) equipment in the room, her belly
was being scrubbed and then covered with a sterile sheet that would stick and
stay in place during the surgery. Within 10 minutes or less the doctor was
starting the first incision. I explained that she would feel pulling as they
held back each layer of skin and muscle and then they’d be ready to lift out
her baby. I told her he still sounded good – better even since we left the
room. Within minutes I told her to expect some tugging and pressure…then I told
her I could see lots of curly hair and before I could say more he let out a
huge cry as they lifted him up. He looked pink and didn’t even need to be
suctioned. Because of the earlier meconium the resuscitation team was on hand
but he did better than anyone expected. He was in the warmer now and I lifted
up the sheet to Makda’s left so she could see him as they cleaned him up and
checked his breathing. He was doing great. I whispered in her ear that he was
beautiful, and that we were all so very, very proud of her. As soon as it
looked like the nurses were starting to wrap him up I asked if she could hold
him now. They brought him over and I held him next to her so she could see and
kiss him while they freed up her hands so she could hold him. He was blinking
and trying to see her, too.
Finally she was
brought back to her room – this little hospital didn’t have a recovery room, so
we settled back in where we had started. I was glad to see that for the trip
back to the room they didn’t put the baby into a crib to wheel him down or send
him to the nursery, but plopped him right next to his mom and covered them both
with a heated blanket. The interpreter called Semere and explained that his son
was finally here and he should come when he could find someone to watch the
little girls. Makda instructed the interpreter not to tell him that she had a
C-section because she was afraid that he would race to the hospital and get in
an accident. She asked me to explain to him what happened and why when he
arrived.
About an hour
later he came with the 2 little girls.They were dressed alike, and their daddy had
even fixed their hair. One was holding a huge bunch of flowers and the other
one had two balloons on strings for their new baby. An aunt was also along to
watch the girls so Semere would be free to visit with his wife. Baby was left
in the room when we explained that she wished to room-in and that her husband
would be caring for the baby during the night. I explained to him briefly that
the doctor was concerned about the baby and after trying several interventions,
decided to do the C-section. I gave him a very brief outline and told him we
would talk more when I came back the next day. I did say that I was very glad
for the doctor we got and that the whole staff had been great, actually very
caring and competent. I told him we had been very lucky. I told him, too, that
he had a very brave wife and he should be very proud of her. I hugged them both
goodbye and went home.
When I came the
next day Makda was up and walking around the room taking care of her baby. He
was nursing well and she looked exceptionally well and happy. She had a few
questions as she was trying to process the rushed chain of events before his
birth. We talked about it all again, and also I told her that we were all very
grateful for how supported she was and the great team she had.
The midwife part
of me still tries to analyze alternative possible scenarios, and what we could
have done differently. The doula part of me knows I was there every minute to
try to bring a calm and balance to her birth that she would remember always. I wanted
her to feel that she had done a good job in spite of the problems and that she
was still a strong, beautiful woman who was on an incredible journey of
motherhood.
We
visited over lunch in her room, just so very grateful that little Azmera was here. She marveled
that he was so peaceful and nursed so well. I reminded her what a good mama she
was and that the older we get, the more laid back we often are, which babies
can pick up on, too.
"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
*all names, ages and identifying characteristics have been
changed.
STAY TUNED: this and other stories will be appearing in the book, Call The Doula!: a diary© pending by Stephanie Sorensen
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