Friday, October 25, 2013

Four babies in one week! (or Doula 101: how to be nice to nurses)

I have semi-retired from full-time doula-ing. I write every day now, so I only take 4 or 5 referrals from our ‘head doula’ (Reverend Mother Doula? Doula Supervisor? Doula President? In-Charge Doula? Debbie, what are you, anyway?) at Everyday Miracles ( for new mothers-to-be every few months. That way I have been, so far, having about one or two births a month or so. We are required to visit with the mom four times before her due date, attend the birth, and then do a postpartum home visit afterwards on day 1 or 2. Until this week at least, I could write 5 or more hours a day, update or post a new chapter on my blog ( fit in a couple of prenatals a week, and fill in the rest of the time reading, researching new information and visiting refugee families around our neighborhood. Until this week…. And it wasn’t even a full moon. I am not sure what it was, but it was busy!            
An Amharic* translator I had worked with before called me from a hospital in St. Paul, Minnesota to let me know one of ‘my’ ladies was in labor and didn’t I want to be there? I had worked with her before, a gem of a woman. I have been encouraging her to go to medical or midwifery school. She is brilliant, and a ‘natural’ with caring for women. She already has a bachelor’s degree, too. Belem is an observant Muslim, and one of the funniest ladies I know. She laughs at everything! I suggest a warm bath for the laboring woman, set out my little battery-operated candles around the tub and she laughs her head off! (I am not allowed to have real candles in the hospital – a fire hazard. We are also no longer allowed to bring in a heating pad or sock filled with flax to pop in a microwave and use for labor – a burn liability.)
            So I rush over to St. Joseph’s hospital and find out that not only has Keleme not called me, but she has been in labor for over 24 hours already. So we settle in and visit and with her midwife figure out how to help her rest for a bit. I guess that she is just exhausted and hasn’t eaten or had enough to drink during labor and her midwife suggests some IV fluids along with a muscle relaxant so she can sleep for a bit. It works. Three hours later after the drug wears off she has a beautiful little 5-pound boy, her first baby, with only 3 pushes! He is tiny but nurses immediately. He is going to catch up just fine.         
By 2:00 a.m. I am on my way home. I shower and slither into bed – it feels soooo good – and fall asleep, only to wake up to the phone by my bed ringing at, ugh, I can’t even read the time without my glasses. Oh there, 7 a.m.? OK. It is my lady from Laos. Her water broke an hour ago. Should she go into the hospital yet? “Yes” I tell her. “I will meet you there. Remind me, which hospital. Good. Ok, honey. We’re gonna have a birthday party today aren’t we?” Also a first-time mama. I grab her file. Yes, I thought this was early. Only two weeks. Not bad. So I dress in my next clean outfit and call a taxi.            
I have a new driver that I have not met before. I can tell by his accent he not a native “Minn-ah so-‘n” as they say here. I ask where he is from and he hems and haws a bit and then says, “Iran.” I answer, “Oh, that’s great! I am a doula and I am on my way to my second birth in 24 hours.” He is visibly relieved that I am actually happy that he is Iranian. There have been numerous attacks recently on the streets here. Lots of anti-terrorist feelings flying around since the Boston Marathon bombing, and anyone who even looks Arab has been getting harassed by ignorant locals who think all Arabs are horrible people. He actually melts and says what a blessing that is, that I help women have their babies, and proceeds to tell me all about his two kids. I ask for his card and say I will call him next time I need a cab. He drives up to the hospital and before I realize what he is doing he has run around and even opened the door of the taxi and holds it for me!            
As I ride up in the elevator to the Birth Center my phone rings. It is another mom letting me know she just lost her mucus plug. I congratulate her hoping she will be a bit more excited about her second baby than she’s been all along and tell her to keep me informed, day or night, reminding her that she could still wait several more days for labor to kick in.

The rushes (contractions) have started by the time I enter the room. I scrub up at the sink and go over to the bed to hug her. Der is as stiff as a board, obviously very nervous. The monitor is blaring away and something else is beeping in the room. I hit the nurse button and ask if someone can come down and turn off all the noise. That done, I massage her hands while we chat about what to expect next. Her midwife has prepared her well. Der insists she can do this without drugs. She knows even a small amount could affect the baby. I don’t try to steer moms into having all natural births, but if they are at all interested, I am 100% behind them. Some people just aren’t there yet, and as a doula I need to respect that.             
We walk around after a while, sit on a birth ball, drink juice and munch on snacks and walk around some more. The nurse checks her and announces “Five centimeters! Great” and leaves us alone again. Less than ten minutes later during a rush Der suddenly holds her breath and pushes for all she’s worth. I know that, in spite of being told she was only 5 cm. that she knows what she is doing, in spite of this being her first baby, so I hit the nurse button again and try to calmly say, “we are feeling a bit pushy down here and I think you ought to come. NOW!” Nurses rush around setting up the room; an instrument cart and baby warmer come in from the hallway where they have been on stand-by draped with sterile sheets, chairs go out the door and the bottom half of the bed is removed. Stirrups pop up, though I show Der how to sit up and hold behind her knees with her hands and we don’t use the stirrups at all. (I avoid them if at all possible.) Another push and we can see baby’s black curly LONG hair! I help her rest and slow her breathing after the rush and she appears to instantly go to sleep. When she wakes up as the next rush builds she pushes the little head out. It is perfectly round, hardly cone shaped at all. The rest of the baby slides out and Der reaches for her baby. She immediately starts talking to her little girl in Lao. I have never heard her speak it since her English is so good. I ask what she said to her little girl and she laughs and says, “Oh I just said ‘hi, I’m your mommy and this is your daddy.’” We are able to keep baby on her mother’s chest skin-to-skin for a couple of hours, both covered with pre-warmed blankets. A wonderful birth.         
I get home, shower, warm up some leftovers and catch up on paperwork. I won’t remember when what baby was born or dates or weights if I don’t write it down. Finally I decide I need a nap before my husband gets home. I have hardly seen him this week. It’ll be nice to have supper together. 
            The lady who had called me while I was in the elevator going to the last birth calls back as we are getting ready for bed. It is midnight. She is having contractions but they aren’t regular and they have been coming and going for 2 days and she is done doing this and lets me know she is going to the hospital right now and insisting on being induced and wants me there, too. She will start week 39 in two days. Yes, she is not even due yet. She has already hired and fired two doulas before me. She had numerous issues with them but for some mysterious reason decides I am OK. I find out her mother died two years ago this week and she is angry that her mom couldn’t hang around long enough to help her with her kids. I met her in a clinic I had never been to in town just a week ago. The entire area reminded me of Harlem in the 1960s. I had no idea we even had such pockets of poverty in Minnesota. She was in the waiting room with her partner and their 3 year old the day I came to meet her for one of her prenatal appointments. The little boy was snarfing down a whole bag of mini Milky Way bars and the mom was munching on Cheetos. After 10 minutes she says to the little guy, “OK baby, let’s trade” and they exchange bags and continue noshing. This is lunch. Yes, really. No, I don’t do my nutrition schpeil. I am sure her doctor has had this conversation already, many times.             
I talk to her awhile on the phone and she calms down. I remind her that this is still 2 or could be even three weeks early and I really don’t want to see her deliver prematurely and not be able to bring her baby home from the hospital with her if he ends up in the NICU. She finally agrees and asks what she can do to hang on a little longer. I try to encourage her and tell her again to feel free to call me any time. I remind her that we’ve all been through this and acknowledge that it is hard to wait when you are so uncomfortable but she’ll be OK and will soon see baby boy #2.
            I sleep like a log. I needed that. When I got up I called my single mom who was due the day before to check in. She tells me she had been contracting all night but the rushes aren’t yet 5 minutes apart. Her water hasn’t broken, so I offer to come to her house or meet her when she decides to go to the hospital. She is doing well, has girl friends over and says she will stay in touch. Within an hour she calls back to tell me she can’t handle this at home anymore and asks me to meet her at the hospital. She gets there before I do and lets me know she is already 3 centimeters as I walk in with my pink Happy Birthday tiara on. It always makes people laugh, so I bring it when I think we will need a bit of light humor. She puts it on as she gets in the tub. I turn on the jets – this one is a real Jacuzzi! – and she sighs with pleasure as she relaxes into it. No, sorry but I don’t have a picture of this. So cute!            
One of her friends is a mom herself, studying infant massage. I noticed when I came in that this friend was guiding Stacy through the rushes so beautifully. I held back a bit and just watched how she was able to calm Stacy and saw that they were really a great team. I brought in a stool and put it by the tub and invited her to just be there for her. I left them alone and busied myself cleaning up the room a bit. I walked down to the nurses’ station and asked our nurse if we could order breakfast which she agrees to right away. I knock and go into the bathroom and offer to call in her order. This hospital has 24-hour cafeteria service and will deliver a tray to the room ½ hour after you place your order. You can even get breakfast 24 hours a day!            
As her doula, I could have just ordered her breakfast and not asked her nurse’s permission. I could also have just turned off the beeping machines at the last birth, too. I don’t have to get the official OK either just to unplug monitors to take my client to the bathroom. But I have discovered that by setting the tone with these completely benign protocols, I can get an awful lot of mileage with the birth team. I often try to find one or two ways of deferring to them early on in labor. It is a kind of body language that almost suggests subliminally that we can work together just fine and that I am not there as a raving advocate for my lady ready to do battle on her turf. Somewhere along the line doulas, and midwives too for that matter, have become known as radical militants in our own rite, and many health care professionals are not happy to see us. I am trying to change that image by looking for ways to work together and earn some respect for our profession. So far it has worked very well. They can tell right off that I have a relationship with the mom that they I don’t have, especially if the mom asks me what I think about a suggestion the nurse may have posed and the mom wants my opinion on it. That could set me up for becoming a referee, which is not who I am. I just know that the nurse will go right back to the nurses’ station and inform all of the other nurses to ‘look out for that doula back there.'            
Last year I was at a birth with a first time mom and the baby was definitely not tolerating labor well. His heart rate would decelerate with each rush and take a whole 2 minutes to recover before the next rush. Finally, they stopped going back up all together. Her doctor was worried and asked her to consider a C-section since she wasn’t even dilated to 6 centimeters yet. She did not want a C-section and had visions of a natural birth which we had talked about all along. So she turns to me, with the whole birth team looking on, and says, “Stephanie, tell me what to do!” Oh gosh! I wish I was a doctor at these times, or had more confidence in this baby, but I told her, “Dear Felicity, I wish I knew what to do, but if this was my birth, my baby, I would go for it, I would have a Cesarean right now.” She couldn’t see the doctor’s face from where she was lying but I could. He was shocked that I would be on their ‘side’ which, while I had never considered ‘sides’ assumed we all wanted the very best for this sweet lady and her baby, though he had assumed otherwise. And in the operating room, after her baby was born and cried and she burst into tears, I whispered in her ear, “Honey, I am so very proud of you! You did it!” and she answered through her tears, “Yeah, I did it!”       
In an article recently posted by DONA, International called, Commentary: Nurses, Doulas, and Childbirth Educators - Working Together for Common Goals by Amy L. Gilliland, BA, CCA, CCE at she writes, “I can't speak for all of Eastern Canada, but I know here in St. John's, one of the biggest challenges our doulas have experienced is trying to build relationships with hospital staff and forge a place for ourselves in the case room and on the birth support team.” The article goes on to so eloquently state, "birth is an experience parents and especially mothers will remember forever. The behavior and acceptance of the hospital staff coupled with the interactions they have with birth doulas will make the difference for each women and her childbirth experience. This can result in a safe, women-centered and empowering birthing experience or one filled with tension, resentment and disempowerment...the choice is yours."

Sometimes the only thing that makes a woman’s pregnancy high risk is her choice of a care provider.
They are still in the tub room. I read some articles I have printed out and have stuck in my file marked, “TO READ” which is sorely outdated already, until Stacy gets out of the tub and decides to walk around for a while. At this point I asked her friend, Becky if she had ever considered becoming a doula. I assure her she’s got what it takes. I add that she is really good too. She appears very surprised but I insist she is really very intuitive and would be a great doula. I give her my card and tell her to call me and we’ll talk more about it.
            Finally baby is ready to come. After some serious pushing he arrives, a perfect beautiful little guy. I let Becky stay by Stacy’s head to coach the pushing stage. I helped by holding her leg and massaging it when it started cramping. I pitch in to help the nurses clean her up and change the bedding, her little boy on her chest the whole time. I hug her before I leave and tell her, “you know, sweetheart, you can do anything now!” and she repeats in complete awe, “Yeah, I can do anything now!”
            I go home and sleep and eat and nap again and try to get back to feeling normal. Yes, I can still remember the feeling. I do the laundry – no one else can go into labor until I have clean clothes hanging and ready to go! The house is a wreck and the dining room table is covered with charts to update and turn in.        

The next morning the chocolate bars and Cheetos lady calls to tell me that her water broke. I shout my congratulations into the phone and tell her I will meet her soon. There are no contractions yet. Her first birth was induced, medicated and basically a blur, so all of this is new to her. My personal Iranian taxi driver shows up just in time, bubbling about blessings and new babies, as excited as I am! He even forgets to ask for his fare when we get to the hospital. I repeat, “How much?” until he settles down and sheepishly looks at his meter that he forgot to even turn on. I offer his a $20 bill, which is what the usual fare has been, and he is ecstatic.
            We walk the halls, and dance, and do circular exercises on the birth ball until she gets discouraged and asks for an epidural. She agrees to try the tub first which she really likes. Then we go back to bed and she explores the range of available meds with her nurse. She is able to rest now and continues to dilate. It is getting close. The meds are wearing off and she asks for more but before the next dose arrives she shrieks: “I gotta SHIT!” I laugh and hug her and say, “Honey, that’s your baby coming!” She insists, “NOITAIN’T!” and starts pushing really well. I help her sit up so she can push more effectively and help her rest between the rushes. After one she looks over at me and tells me, “Today is the day my momma died.” I hug her again and tell her that I am sure her momma can see her now and will always be watching over her. She names her chubby baby girl after her mother. Her 3 year old has slept through the entire thing rolled up in a lounge chair in the corner of the room, his tiny teddy tucked under his chin. He will have quite a surprise when he wakes up.            
The next day is Monday and I will be seeing my lady who is at 37 weeks now. She lost her first baby at 5 months along 6 years ago. No one could explain exactly what went wrong, but it was a wake-up call for Katherine and her husband who both felt that they needed to clean up their lives. Her health had never been great but in the next few years they researched and explored and learned all they could and all of a sudden she became pregnant again. She looks and feels great and although she was pretty apprehensive as she neared and then passed the 5 month mark in this pregnancy she continues to do well. They are both older than most of the moms I see and very excited about seeing their little boy soon. That will be another story, I am sure.             
I’ve been collecting diapers and baby clothes for my mom with baby #2 (I can’t go on thinking of her as the ‘Cheetos Mom,’ – that’s awful!) and will visit her later this evening. It is kind of sad, the last time I say goodbye to my moms. We have been through so much together. In a way we have bonded and become closer sometimes than they have ever been able to with other women. I wonder if I will miss them more than they will miss me. I think so, mostly because they are now very busy, sleep-deprived mamas, entertaining friends and family who will come to visit the newest member of the tribe and many will also shortly return to school or work. I am sure that they will never forget the memory of their births though. I am convinced of that. And if they look back and think of those times as wonderful, powerful and sacred and holy or blessed, and I am just a fleeting shadow in that picture, I have done my job well.

*Amharic is spoken in much of Ethiopia. We have over 70,000 African immigrants living in Minnesota at this time.

Stay tuned! This and lots of other stories will be in the book, Call The Doula! a diary© pending, Stephanie Sorensen

Tuesday, October 8, 2013

Breastfeeding 101: the beginner's guide...

I could write a book on breastfeeding but, for one, there are many excellent ones out there already. I have listed my favorites at the end of my book in the Resources section. And secondly, if you are expecting your first baby, or if you are expecting another baby and had difficulties breastfeeding the first, I would strongly urge you to read all you can and also sign up with your partner for a breastfeeding class. Mothers who are most successful usually have the support of their partner. Without that support it would be a constant struggle, and worry and fatigue are the two prime culprits that undermine successful breastfeeding and milk production.
           I also didn’t have all of the wonderful information, DVDs, YouTube videos or books that are available now when we were having our babies. I knew it would be difficult for the first 2 – 3 weeks but I was determined to do it. Yes, I had cracked bleeding nipples and chronic neck pain from leaning into my babies (whom I would lay flat on their backs on my lap) instead of bringing them to my breast. I also didn’t have a clue in 1980 that babies could latch on their own and actually do better if we let them lead this mother-baby dance. We didn’t have Boppy pillows, either. All of these things would have made it oh-so-much better, but we trusted that Nature had this thing all figured out, and we were gonna get the hang of it even if it killed us. Which it didn’t. I was lucky that the La Leche League was going full tilt by then, having started back in 1969, so I had a ready resource to call when I had questions or problems. They were wonderful and are still available today.
           In my breastfeeding classes I start out by saying that 1. I never owned a breast pump and 2. I never bought a nursing bra. I was able to nurse twins until they were past 2 and nursed 5 children in all, using exclusive breastfeeding to naturally space our children and as birth control. (See: Breastfeeding and Natural Child Spacing by Sheila Kippley.)
            What is important is that breastfeeding, whether you do it for 3 months or two years or more, creates the conditions necessary for bonding. Some moms cannot nurse at all, but what is critical is the skin-to-skin contact. Nature ensures that babies and mothers have that bonding time regularly throughout the day and night, every day until babies are mature enough to eat solids and venture off exploring further and further from mom, which both occur at about the same time, somewhere after 6 months or so. It is vital that whether you are holding a bottle or nursing that you are holding your baby close: Tummy to tummy, chest to chest, the nose and chin should touch the breast. Partners should also have regular skin to skin time every day with baby, too. And please never prop a bottle up and leave your baby in a crib to finish his feed on his own, especially during his feeding time. He cannot ‘talk’ to you while he is sucking, but he will be looking for your eyes to meet his which is just as important a bonding factor as cooing and getting a response from you. He cannot smell you, which is also a point of connection if he is drinking his bottle off somewhere else without you.

So, stop reading this right now, pull up a new tab, go into YOUTUBE and drop this in:  It is THE BEST breastfeeding ad yet!
I would add here too, that as tempting as it is to use your nursing time to catch up on the phone or to read a book, that you will actually miss the cues that your baby is sending out
            Again, there is a threshold somewhere between what is just enough of all the levels of all the factors of bonding needed for healthy development and what is simply too little and results in irreparable damage to the psyche and can never be repaired or fixed once it has passed that point below that limit. The ramifications may very well be the innumerable problems we see in our babies and young children today. 
            The cycle of life of animals in the wild can teach us that this sequence of events is required for successful survival to adulthood. The various facets of life must all fall into their proper place for growth and maturity. Without one or the other bonding factor as Nature intended and has flawlessly built in to all species of animals, yes, even us human animals, there is a disconnect that occurs, throwing the entire exquisitely designed system into chaos. We must trust this
sequence of events and allow them to be fully expressed at each stage of development as our children grow if we want them to ever reach their ultimate potential of wellness and happiness.
            Human and mammal babies alike use their breast time also for learning as they play. The touching and stroking that a baby does as he reaches out to his mother are not meaningless acts. He is learning that other people also feel and not only him. He learns here first that he can give pleasurable touch and not only receive it. Children who do not experience these early lessons often go through life without the empathy required that we should bring to all our relationships in life. They may even develop a conscience devoid of compassion as is being researched now in criminal minds. The disconnect could possibly be traced this far back into infancy.
            My own babies used nursing time to learn about other’s (mine) feelings of joy and pain. My baby boy twin bit me once and definitely registered that I reacted quite violently. The next time he tried it, he did so quite thoughtfully, maybe to visibly test my reaction. He slowly clamped his teeth on my nipple while looking directly into my eyes. It was definitely a learning moment. Of course I again quickly broke his suction and pulled him off my breast, voicing an unequivocal “NO!” He was actually smart enough by 7 months to learn what this meant. He had set up the experiment quite consciously (not with any malicious intent but just curiosity) and learned from it. I also found it curious that from about that same time he always got a foot up onto my other breast as if to ‘guard’ it from intruders whenever he nursed. He was protecting not only his milk supply but his access to me, or rather my undivided attention for him, literally perhaps because there were two of them and my attention was divided that they needed more cuddling and listening than my other three children seemed to need, both during their 3rd and 4th years especially. I could actually fend off squabbles and even tantrums by stopping what I was doing and literally sit down cross-legged on the kitchen floor taking one or the other onto my lap and wrap my arms around them, even if it was only for a couple of minutes, to listen to what they needed to tell me. His twin sister devised a repetitious kind of touching when she nursed. One little hand fit into my arm pit while her other hand stroked my upper lip under my nose. She would also watch my face and object if I became busy with one of the other kids and looked away from her.         
I observed that my babies could not multi-task when nursing. Either they could suck or listen to what I was saying or singing but usually not both at the same time. They did stop sucking when they wanted to concentrate on what I was saying and occasionally tried to repeat what I said, whether they had a mouth full of breast or not. I also want to mention that most parents worry if their baby was born prematurely or needed interventions at birth and were not allowed to bond immediately at birth and instead spent time in a NICU. Many children’s hospitals and neonatal intensive care units are doing very well nowadays in encouraging bonding.

Kangaroo time, when Mom or Dad have skin-to-skin time with their newborn is an important element in the newborn care plan. Singing, talking to and stroking premature babies is just as important as the antibiotics and surfactant medications given for underdeveloped lungs in newborns. Especially with tiny babies, remember that we are the only mammal that dresses our babies after they are born.  

Ruth, our other twin developed a stutter when she began to talk. I puzzled about this for quite a while. It was only after I began to stop what I was doing – cooking or cleaning usually – and would physically turn to her and look at her when she wanted to tell me something that it finally went away. It had something to do with my not fully engaging with her for enough moments during the day that was the cause.
Stop and consider: this moment at the breast seems to me the most bonding intensive time of any day, for they are not only eating, but their mouths (lips, tongue and cheeks) are completely engaged (tasting and touching) while at the same time they are smelling you without even thinking about it, hearing you, looking at you, and being carried or laying on you somehow. No other single activity intertwines all the factors of bonding. And if this occurs 8 – 12 or more times per day every day in the first 6 months and continues, though progressively less
often over the next 6 months, this appears to meet the threshold requirements needed for adequate bonding. The opposite would look something like this: feedings every 4 hours and not on demand would factor out to only about 6 times per 24-hour period. If the milk is in a bottle, more often than not especially after the newborn stage, the baby will be able to hold his bottle and not necessarily be in contact with a person, thus removing the voice, sight, hearing and touching interaction with a parent. The threshold contact times of each factor then goes from 100% engagement occurring 8 to 12 times per day for the first 6 months, and slowly leveling out over the subsequent months up to a year or more versus less than 5% of each of the 5 factors often not even once per day. Bedtime cuddling alone will not replace the numerous other periods of contact missed. And those cannot be replaced once lost.
A child’s sense of security is learned at the breast. Even baby animals will run and hide under a parent’s wings or body when threatened. Our human babies invariably run back to be enveloped in a parent’s arms when they have fallen or bumped or bruised something or their feelings are hurt. Even when they are older, children will climb into bed with their parents if they’ve had a nightmare or are afraid of a storm. Children whose parent(s) do not allow this are leaving children to somehow soothe or comfort themselves. Insecurities and phobias may well be the result of a fragile or unresolved attachment at this stage. Children will be the first to announce their declaration of independence, and not the other way around. If they have had a secure bond and are allowed to venture away from it at their own speed and not be rushed, and not be told they are now too old for this, they will be far more independent and confident than their peers who were literally pushed away from a protecting figure.

STAY TUNED... This and other stories will be appearing the book, Stone Age Babies in a Space Age World: Babies and Bonding in the 21st Century© pending by Stephanie Sorensen