Saturday, July 20, 2013

Call The Doula! a diary© ~ July 15th

This may very well be THE DAY! I have been waiting for Alegra* to call for I don’t know how many days now. I am very glad that her midwife isn’t anxious about her approaching week 41. I have seen far too many inductions this year, though there is very little evidence that we are preventing post-dates complications by doing so, and there is less proof that we aren’t actually introducing more possible side effects by inducing at what only might be post-dates baby. Unless a mom was charting basal temperatures and knew exactly the date of conception, the only other predictor would be artificial insemination or in vitro conception, we might very well actually be inducing a premature baby. Too many times I have seen induced babies who still have all the signs of prematurity: ears flat against their head, lots of the creamy vernix skin coating, etc. Truly post term infants have long finger nails and often peeling skin. The placenta may have areas or patches of calcification. We are still waiting for some direction, called “Best Practice” on this one: when, if ever, is it truly warranted to induce a late baby? Opinions still vary widely among obstetricians. I get the feeling that the whole topic is being revisited at this time, and it is certainly time to address this.

For ten days I have not ventured too far from home should THE CALL come, either before the guess date or like now, after. I have planned suppers around what my family could easily assemble should I be gone when they get home. I learned this one the hard way: When turkeys were super cheap after Thanksgiving last year I bought one, thawed it for 2 days in the ‘fridge and stuffed it with homemade dressing. I got it into the oven, set the timer and went to start a load of wash. One hour into baking the phone rings. Of course someone’s baby decided that Today would be a good day to be born. I turned off the oven, made room in the ‘fridge for the giant roaster and quickly scribbled directions how to continue cooking it once someone came home. Since then, I keep a steady supply of salads in the house, often homemade Tabouli, Cous Cous salad, a Freekah dish that can be eaten cold, hummus or pesto and washed raw veggies. Maybe we should write a cookbook of easy-to-store meals for doulas?

I check my doula bag for the umpteenth time: Back massage tools (2), olive oil, lavender and pine scents, my furry Push-me-pull-me,** a can of champagne to set in ice water for counter pressure for back labor (works really well and we can open it to celebrate later!), mint gum, tooth brush, tooth paste, snacks – for me: dates, raw almonds, apples, trail mix, honey sticks – for mom, her paper work and 2 pens, a sweater – hospitals can be really cold at night, my rubber kneeler from a discount garden store (for me to use by the tub or birth ball and for mom to use in the tub if she wants to stay on hands and knees for any length of time. I also carry a book – should she fall asleep for a time, my I.D. badge, a purse with money and I.D. and my “hospital shoes”. I don’t like the idea of street shoes bringing in all their germs so I change into my comfy canvas shoe/slippers. I try to have some handmade baby hats along too, since a group of grandmas are constantly donating them to our office. Nail clipper, battery-operated ‘candles,’ umbrella, phone and charger, socks, my headache medication. I also have a hair band-type party tiara that says ‘Happy Birthday’ in big pink letters. I often wear that into the hospital if I think we might need to lighten up the mood in the room. It works every time. I have been known to tell a partner, “I don’t need to wear this the whole time, but you do” and they usually take me quite seriously, too!

I get a call at 6 p.m., sure it is Alegra, but it isn’t. It is a desperate doula. Could I be with one of her ladies for a couple of hours until she gets out of her college English exam? Sure. No sweat. She is eternally grateful. I ask for her first born son as payment. Not really. A first time mom, nervous about not having any support, FOB (father of the baby) not really in the picture, as of yesterday at least. Mary Running Wolf is sleeping when I arrive. So are about 9 other bodies camped all over the floor, each rolled up in sheets or blankets. It looks like she does have support: sisters, brothers, girlfriends and girlfriends’ boyfriends are all sacked out. Mary is not yet in early labor but they are keeping her because of some concerns with her high blood pressure. They are talking about using Pitocin in the morning. When the nurse comes in to check her blood pressure and temp she wakes up and I introduce myself. I assure her I will stay until Julie, her doula can come. When the nurse leaves Mary tells me that the pile of blankets on the floor next to the bed is her partner and she wants him at the birth. The FOB will not be coming. I tell her that is fine and that she is doing really well. Contractions are weak but they may pick up. I tell her it is great if she can rest now. I get her some juice and a straw and encourage her to drink most of it. I pull a chair up to the bathroom door and open it just enough to read by the light. Less than two hours later Julie comes.

Another call comes just as I am opening the door to my apartment. I am hoping it might be Alegra. A mom who isn’t due for another month is asking what she should do: she has pelvic pain, a fever, chills and feels really crummy. I ask her to call her midwife and let me know if they want to see her at the hospital. It may be a urinary tract infection, but as a doula I am not about to diagnose what it might be. She calls back to tell me she is going to be seen in the emergency room and asks if I can come. She is a single mom. I tell her I will meet her there.

7:30 p.m. They are just hooking up the monitors and have her in the maternity triage area. A woman is screaming in the next room and nurses are running every which way. It looks like they aren’t going to get her up to Labor and Delivery in time. Our nurse’s pager goes off and she too leaves. Carmen and I visit until she comes back, but not before we hear a very healthy baby crying! The nurse explains that they will monitor Carmen for about half an hour and then call the doctor to come and assess what is going on. They draw some blood and have her give them a urine specimen. We haven’t had time to visit like this in two weeks, so it is nice to catch up. I just wish she was feeling better.

Everything comes back normal but there are indications that she is quite dehydrated. They suggest she stays long enough to have an IV and she agrees. She feels 100% better after that and promises to drink lots more water than she had been drinking. I am glad that it isn’t early labor. Her baby needs to gain more weight before she arrives. I wait for her taxi home and hug her goodbye when it comes.

Back home I climb into bed after checking that I have set a clean set of clothes on a chair should The Call come. Which it does at 12:15 a.m. At last! It is Alegra! Contractions are 5 minutes apart and she has called her midwife who agrees it is time to come in. I have not had a mom this prepared in a long time. She has done her homework too, even presenting me with her birth plan at our first appointment.

We are settled in a large room and the midwife meets us there. I suggest hanging out in the tub in the bathroom while the birth tub is set up and filled, which will take a while. The room doesn’t have a built-in tub but the midwife and nurse haul in a huge assemble-your-own-tub-kit which is rather nifty, with a liner which is disposable. I bring in my battery-operated ‘candles’ placing them around the edges of the tub, turn off the overhead light, get Alegra’s jug of juice and settle in for however long we’ll be here. Her partner, Fernando isn’t here yet. He will get off of work in an hour and Alegra has assured him she will wait at least that long.
After the tub is ready we move back into the room. Alegra is so relaxed that I am surprised when her midwife checks her and says she is already 8 centimeters. Fernando arrives and is excited as well. Alegra is very quiet at this point, slowly breathing and not answering his questions. After the contraction she tries to tell him that it is getting too intense to talk. He doesn’t exactly ‘get it’ and tries to bring up the subject of the baby’s name which they are still not in agreement with. He playful tries to smooth back some of her hair and she smacks him square in the chest. He gets the message this time. I suggest he takes my place by the edge of the pool and just holds her hands. We switch places and they get into an easy rhythm, breathing, resting, breathing, resting…. He moves over and Alegra grabs his belt with both hands. He tries to pry her fingers off the belt and hold her hands but she has decided that this is what she needs to do in this moment. His jeans are creeping earth-ward, but he is the only one at this point who is concerned.


I tell her how well she is doing, that it won’t get harder than this, that she is really doing great. All of a sudden, with the next rush I hear the Universal Grrrrrrrrr! Midwives and doulas the world over recognize this sound, at least wherever women are allowed to birth naturally, instinctually, and are not rushed into the second stage and pushing. I whisper, “uh huh” to confirm that this is it, that she is doing it right. After the next couple of rushes I think I see the head crowning, though with Alegra in a squatting position, I am not positive. I silently slide over and whisper to her midwife, “I think you want to be here.” She takes the cue as the baby’s head becomes visible and tells Alegra to pick up her baby. This moment is the most magical span of time in the entire cosmos; I watch in slow motion: Alegra reaches for her baby as the rest of him slides out, face down. She brings him out of the water and up to her chest, dripping water the only sound. I can tell Fernando is totally blown away by this. It is the most amazing thing happening in the whole world and we are allowed to witness it. Little Xavier starts crying on his own which wakes his daddy up, who starts crying, too. Alegra is still in shock. She says that she kept waiting for it to get worse, to hurt more. She was prepared for labor to be harder to navigate, but perhaps because she expected it to be harder, she was able to integrate each stage as well as she did. We congratulate her and help her to the bed when she is ready. We don’t have to do anything for Xavier. He is pink and breathing and thinking about rooting already, lifting his head to look around. She thanks the midwife and me, though I tell her simply it was she who did all the work. We didn’t do anything, really. I tell her she could write the book on how to birth babies.
Here is Alegra’s story of her birth. I love seeing it once again through a mother’s eyes:

“The story of Xavier’s birth began Saturday morning, September 1, two days after his due date of Thursday, August 30th. On Saturday morning at 5 a.m. I woke up with some spotting. Nothing big and nothing happened after that, except that I couldn’t really get back to sleep again. Mom and I went out shopping ALL afternoon. Around 3:45 p.m., I noticed that it seemed like I had some pressure that came and went, nothing serious. When we got home, it was Saturday night and dinner was spaghetti – our family Saturday night tradition. We must have gotten home a bit later, because we didn’t eat until almost 8 p.m. Around 9:25 I called the midwives through my nurse helpline to leave a message. After a midwife called me back, I called my doula, and told her what the midwife had said. I told her I’d take a bath and then let her know how I was doing. So I made a warm bath and hopped in, and it was so relaxing and wonderful, the contractions (which by now I had figured out that’s what they were, even though there still was no “whole-belly-squeeze”!) dissipated and I figured my labor was slowing down again. “It’ll be another day,” I thought.

“But, when I got out of the bath around 10:45 p.m., wham! The contractions started up again and coming quickly – every 3-4 minutes. Actually that was with the minute-long contractions, so it felt like every 2-3 minutes. After a while I called my doula and she said it sounded like it was about time that I went in and that she would meet me there on the maternity floor. By this time, though, I had to pause so frequently that it took us a while to get out of the house with my hospital bags. “What department?” the security guard asked. I would have laughed if I hadn’t been in the middle of a contraction. “Maternity!!” “Oh, do you want transportation?” (Did I look like I needed a bus? Then it registered…a wheel chair.) Of course I chose to walk, which took more time. We had to buzz in through the secured doors of the maternity unit, and as they slowly opened, I saw my doula at the end of the hall in front of the check-in desk, waiting for me. Relief! She had gotten there first because it took me so long to get out of the house and then through the hospital once the contractions were coming more frequently. Heather, my midwife checked my dilation and said, “Good news! You’re already at a 6." They filled a warm bathtub for me to sit in until the big water birth tub was ready. I kept waiting for Fernando to arrive, but he was at work and didn’t come until after 2 a.m. When he did, I relaxed more and with a couple of heaves, revisited my spaghetti dinner. Actually, even though things were getting more intense, I remember almost laughing that the first thing I do is practically vomit all over him. I said something like, “You came just at the right time!” but Stephanie was encouraging: “You know what Ina May says, ‘every time you throw up, you dilate another centimeter!’” And even though I hadn’t been nauseous, throwing up actually did feel a lot better. 

“Not long after Fernando arrived (later I learned it was between 2:30 and 3 a.m.) the birth tub was ready, and it was time to move in there. By then the midwife told me I was at 10 cm. but the water bag was still intact. She asked if she could break it. I said yes, and after that, the pressure got a lot stronger. The lights were still low, except for a light over the bed by the monitor where the nurse was charting. The best part was that I was so grateful for everyone’s help, yet even though I had no emotional energy to tell them, or even to say thank you, they were very present and continued pouring it out.

“After it seemed like the pushing contractions were slowing down, finally with a change of position, the intensity of the pressure got heavier and heavier. At some point I remember thinking, "THIS is why women ask for epidurals," but it was a passing thought, especially with Stephanie and Heather's encouragement. I didn't realize I was tensing up instead of relaxing. Then I started making real progress (or rather, the baby did) and with each contraction, I felt a strong and repeated urge to push. Along with the pushing, I was grunting from deep down, primal sounds. I had a fleeting thought – my vocal cords are gonna hurt (and later they did) – but in the moment I didn’t feel anything except the pressure down under. Then Heather reached down and said, “You can feel the baby’s head. Reach down and feel it.” And I did – it was unbelievable. It was at that point that labor actually began to feel like pain – I felt the “ring of fire” – the stretching around the baby’s head, and I started panicking and felt myself closing up and was afraid that his head was going to go back up inside. Stephanie and Heather kept pouring out encouraging words for me to relax and not panic. Later I realized it hurt so much at that very end because I had both first and second degree tears. But I also reflected on the fact that I didn’t register actual pain until the last 15 minutes or so. Everything before that was increasingly intense, but not painful.

“I felt so desperate and to the point of no return that I just pushed as hard as I could. I started to feel his head push past the intense pain, then on a second push, his body. Heather’s hands were there to help adjust his body as he came out, and then she held his head down in the water as he slid out. She kept him there for a second, then without thinking I reached down and drew him up out of the water and immediately he turned bright red and started screaming. His lungs were clearly working. I was in shock. I had expected to cry. Once again, I was surprised by my own reaction. I had no urge to cry at all. I just stared gaping at the screaming creature in my hands. Later I learned he got an Apgar score of 10 both at 1 and at 5 minutes. Yay for Xavier! 

“The nurses and Stephanie and maybe Fernando (I was so NOT focused on them at that moment) helped me out of the birthing tub onto the hospital bed, where the baby was still attached by the umbilical cord. I was holding my baby, they were holding me. We didn’t cut the cord for at least 10 minutes, and then Fernando cut the cord after it turned white (“like cutting chicken” the nurse said) and the nurse clamped it. The nurse and Stephanie encouraged me to place him on my chest and allow him to spontaneously breastfeed, which he did – from the middle of my chest he wiggled to the right spot and started to latch on. Amazing!

“Heather and Stephanie both examined the placenta and Heather explained what she was looking for – how to gauge its age, the attachment of the cord to the placenta, and how to know it was all there. She even remarked that it was asymmetrical and that the cord was bifurcated – meaning that it split at the base as it connected to the placenta. The fact that I remember that is incredible, since I had been up since 5 a.m. Saturday morning and it was by then at least 5 a.m. Sunday morning, but I was wide awake. Tired for sure, but on an adrenaline high. It was still dark outside and the room was peaceful.

“A little while after I was stitched up, Stephanie told me it was time for her to go. She had only been up all night. I was so grateful for her calming presence the entire time. My mom came back in from the waiting room, and she got to meet her grandson for the first time. I rested as they weighed and measured him, and my mom took the first pictures of him in my arms. Then a nurse came in and as the first rays of morning light came up, I signed my admittance papers. Heather was going off-shift, but I was so grateful to her, my doula, the nurse, and Fernando for an amazing birth experience. Most of all, I was so thankful that I had had a natural birth in which I was free to move about freely and comfortably. I loved the calming and warming feeling of the water. I am sure this helped me to not have pain and to really appreciate and embrace Xavier’s peaceful entrance into the world.”

Stephanie: two weeks later I got a call early one morning from Fernando. He wants to pick me up at noon to go to a Salvadorian restaurant. I have never had their food and I tell him I would be delighted. I don’t have any appointments and I am free, so I am ready at twelve sharp. Lunch was amazing, but it was just as much fun to see how big Xavier had grown. Alegra is also a pro at breastfeeding. Then Fernando’s ulterior motive is revealed: he wants my opinion whether I think she has enough milk and if their baby was growing fast enough. I assured him that she was doing better than 99% of the moms I see and that his baby is perfect. Their doctor had told them as much, but he just wanted another opinion and wanted to be sure. I told him that he was such a good daddy for being concerned, and that he should continue to have skin-to-skin time with his son.
I add Xavier's picture to my collection of baby photos when they send one. I now have one more baby. I stopped counting years ago after baby number 200. He is probably my first Salvadorian baby. There are Mexican babies, Hmong, Kenyan, Nigerian, a Native of the Cameroons (Cameroonian?), Vietnamese, Lao, Togolese, Native American, African American, Liberian, Cambodian and melting-pot American babies.
And I love each one. I worry about some. I pray for all of them. Each one has blessed me. Each a perfectly unique little soul.

"You are … assisting at someone else’s birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say: 'We did it ourselves!'”  ~  From The Tao Te Ching

*all names and characteristics have been changed to protect privacy unless permission has been given to use the original names.
**See: http://ahandspunhome.com under ‘baby’ and order through: info@enlightenedmama.com

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,© or Call The Doula! ~ a diary©, both pending by Stephanie Sorensen

§This phrase was first coined by Dr. James McKenna, used here with permission and gratitude for his work. A world-renowned expert on infant sleep – in particular the practice of bed sharing, he is studying SIDS and co-sleeping at his mother-infant sleep lab at Notre Dame University. He is the author of “Sleeping With Baby: A Parent’s Guide to Co-sleeping,” 2007, Platypus Media, Washington, D.C.

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