Friday, November 29, 2013

Nature Makes No Mistakes… or does she?

My mantra has always been “Nature makes no mistakes” so how do I understand this birth? Perhaps we are not meant to know all of her secrets in this life (Nature’s.) Maybe it will be given in the next. I can’t explain what we witnessed. I can only wonder…. Leslie and Fred’s first baby died at 5 months’ gestation. It was a nightmare, finding out first that their baby was no longer living, and then having to say goodbye plus still deliver him. You never forget; you never completely make peace with such tragedies in this life. I think it just doesn’t hurt quite so much as time goes by. Time does not heal. It numbs.

There was little explanation as to why it happened. It just did. But in the process of sorting out what little they did know, several chronic medical concerns with Leslie’s health did come to light and those are the things that she could focus on and improve. Thus began their journey into holistic and alternative medicine which was able to give Leslie her health back. It has been a huge learning curve, but a much needed one. Physically she was now in a better place than she had ever been, now that she was caring for herself and addressing issues she had tried to ignore for decades. But she was still not pregnant even five years after the stillbirth. They figured that they were not meant to have their own children in the usual way but were very resigned to adoption. Surely there were babies out there who were waiting for a family, their family. They had also put in their time at a university fertility clinic. Tests, scopes, dyes, charting, sex-on-schedule, everything medicine could and has thought up. My husband and I had also been through years of infertility testing. I was even told once that it would help the sperm along if I stood on my head after sex so they didn’t have to swim upstream. Right!
And then she was pregnant. The biggest hurdle was to hope without setting themselves up for that raw disappointment again. This was inevitable. Of course they would hold their breaths every day, every hour until they got past the 6th month mark this time. They tried not to put too much stock in hoping for a successful pregnancy, but at the same time, anyone in this situation is going to hope, and should it not work out, you would still be crushed and devastated, no matter how realistic you tried to be.
     But as her belly grew and the days moved into months…. six… then seven… and eight… they hesitantly allowed themselves to become excited. The ‘what ifs’ never went away completely, but it seemed that Someone had indeed smiled down upon them and this baby was meant to be with them. They knew it was a boy and promptly named him. They found a doctor whom they felt they could trust and would work with them on their terms. And they decided to hire a doula.
     I received an email one morning asking if I was available that week to interview with them. I said I was very interested and sent along the link to my blog so they could get to know me a bit before we met. Leslie, Fred and her mother actually did look me up and read several of the stories I had posted on the blog, many of which have now become the 2 books, my first one, Stone Age Babies in a Space Age World; Babies and Bonding in the 21st Century and this one, Call The Doula! a diary. 

I agreed to meet Leslie later that week at a nearby coffee shop. We hit it off right away. We asked each other lots of questions and talked and before we knew it two hours had passed. I told her that she could let me know the following week either way and explained that I would email them a contract to go over should they wish to continue with me. We hugged goodbye and she assured me she would be in touch.
     We got together the following week, this time with Fred and her mom Alice also. We talked about what services I could offer and went over what a doula does and does not do. Then we watched the Doula DVD produced by the Childbirth Collective here in Minneapolis, a beautiful movie about our work and a very good glimpse into the doula’s role at home, hospital, water and C-section births.
     Our last prenatal appointment finally arrived. This was it. The next time I would see them would be in the hospital. We were excited, and nervous, and very encouraged that this little guy had made it this far. And he wasn’t tiny, either. The doctor guessed around 8 pounds. He also began to question her ability to birth such a big baby. He ordered a further ultrasound and explained to the couple that she really did have a narrow pelvis. He knew they wanted a water birth, and definitely a natural, un-medicated birth, but now he felt he had to share some of his concerns. He was absolutely willing to let her try a vaginal birth, but wanted to prepare them should they run into cephalopelvic disproportion – a dynamic which tells you that the size of the fetal head is different from the size of the pelvis which signals a lack of the proper relationship between the two factors. CPD occurs when a baby's head or body is too large to fit through the mother's pelvis despite allowing ample time to mold. Her baby had also been breech, or head up and feet first until the last appointment which confirmed he had indeed turned around all on his own. I had told Leslie that I had complete confidence that her body had grown this baby and would now also know how to birth him.
During the next week Leslie was feeling contractions on and off, usually picking up in the evenings, though none progressed into a real labor pattern. We checked in by phone daily and my main job was to remind her that she would not always be pregnant and that most babies do come out, in fact I never knew one not to. I encouraged her to eat and rest and take walks and know he will come… on his birthday. I told her I had no doubt. Then she had another prenatal appointment.
     First it confirmed he was still head down. This was on a Friday. Because of the combination of some of the medical issues they were dealing with, the doctor explained at this point that he was not comfortable waiting for labor to start after the due date. He felt it was time now, in the next few days, citing some very valid studies and recommendations that sometimes the placenta will not do very well given the concerns they were dealing with and he was not willing to wait until problems presented themselves. He scheduled an induction for Wednesday evening. He proposed using a prostaglandin medication to ripen the cervix. It is inserted and left there for 12 hours, preferably while you sleep. Then in the morning Pitocin is used to encourage contractions and labor hopefully kicks in soon thereafter. In rare cases the first medication alone is enough to turn labor on.
     I did not know it at the time, but Leslie has quite a track record for being one of those rare cases. Nothing that came next was ever written in any text book. Her mother and partner were going to stay overnight with her in the hospital and I would come in by 8 a.m., unless of course they wanted me to come earlier. By 3 a.m. she was having some really good contractions about 5 minutes apart. She had been only 1 centimeter dilated when they put in the medicine the night before. They wouldn’t check her again now until they removed it at 8:30 a.m. I arrived shortly after 6:00. We breathed, slowly… in… out… relax your shoulders… relax your jaw… 4 minutes apart now. I was excited too. This was the real thing! We were going to see this little big guy soon! She was doing amazingly well hour after hour. She could write the book about relaxing in labor! 
        At 8:30 the nurse checked her. Still 1 cm. I told her that I wasn’t at all discouraged. This was not a normal labor – yet. It was an induction. All the different parts have to come together in order to progress to the next stage. She needed to eat now, rest, visit the bathroom and walk. I showed her partner how to support her with the next contraction and sway or dance from side to side and help her baby move down. She had been working so hard with the contractions. I was a bit mystified too. The next time the nurse checked her she could not feel the baby’s head. Had he slipped up farther away from the pelvis? She wasn’t sure. She called the doctor who recommended starting some Pitocin to try to strengthen the contractions and hopefully start her dilating and moving into active labor.
     Four hours later the nurse found the cervix to still be at 1 cm. This wasn’t going anywhere. Then Leslie said, “I just heard a pop! My water bag broke!” We continued breathing and trying to relax, one rush… at… a… time…. The nurse returned with an ultrasound machine and proceeded to try to map out where our baby was. She went back and forth and up and then down with the gooey wand. We were all watching, hoping to get a good look at him. She finally gave the wand to another nurse who started scanning higher up this time and as she did, I saw the baby’s head clearly silhouetted there. I blurted out, “He’s breech!” The nurse simply nodded and wheeled the machine out into the hall, the other nurse following close behind her. While I grabbed a towel and wiped off her sticky belly, Leslie started sobbing.
The Pitocin IV was stopped and her doctor was called. When he arrived he said he was as surprised as the rest of us. He was not prepared to offer a vaginal birth now, especially since he was already wondering about the size of the pelvis. He was also surprised that in spite of the water bag having broken, that somewhere in the last few hours it appeared that baby had turned around. Again. Why would he do that? He said that the chances of that happening were less than 5%. Leave it to Leslie to be one of the 5%!
Looking back on this series of events, I can only wonder: did baby at least try to engage his head and finding that not possible decide to attempt to come feet first? Did he have any idea that the first option was simply impossible? Do babies have some kind of innate ability to conform to the particular circumstances? Does Nature adapt? Did she make a mistake this time? Or was this part of some exquisitely intuitive plan?
     Because her membranes had ruptured, we were past the point where the doctor could have tried to turn the baby. He had actually been thinking on the drive to the hospital that he would offer that as an option. He also did not realize until he arrived that the contractions were still continuing to intensify, even with the Pitocin out of the picture. He discussed the options left to the couple and together decided on a Cesarean section. Not the water birth they had so carefully planned. All those hours writing a birth plan, the long weeks of hoping, months of planning, hours watching water births on the Internet -- all culminating in this moment, all control gone out of their hands. We were all crying at his point, Fred, Grandma, Leslie and me. How could we get back to focusing on their precious baby about to be born? I tried to gently tell her she will be holding her little one soon. I assured Leslie that she had done a valiant job and could not have done more. Two nurses returned and swung into action. There was a whole list of protocols now to run through: papers to sign, shaving her lower belly, drinking the antacid cocktail, etc., etc.
I had noticed throughout the day how connected Leslie and her mother were and decided to bring up the subject then about who would go into the operating room with her. The nurse had tossed two sets of scrubs onto the bed stand and I told Fred that we needed to get ready. While the anesthesiologist was talking with Leslie, I took her mother aside and asked if she would like to go in as her doula. She was about to see her first grandchild being born. There very well may never be another chance like this one. She jumped at the idea. I told her if anyone questions her, she should tell them she is a doula in training, besides being her mom. It worked.
     I have always gone into the operating room with my clients should they need a C-section. I have been able to make sure that the baby is brought sooner than later over to his mama to hold or even nurse. If there isn’t a partner with her, I make sure we get some good pictures and let her know how her baby is doing while he is on the warmer until he can be with her. Afterwards it is important to talk about what happened and why. It is hard to process the chain of events sometimes. Often a woman feels like she has somehow failed if she needed a C-section and I want to have this discussion to reinforce the fact that she was a total success and that she did everything in her power to birth her baby but that certain things happened and we had to deal with that as they came up. I remind her that this is now the land of parenthood, where there are curves in the road, and even our best laid plans are apt to be foiled in the blink of an eye. This land is not always very fair, or forgiving, and we cannot see the future here, either. As one wise woman recently said, “Meconium Happens.”
     I used the time that they were in the OR to clean up the room and grab some food. She would be coming back to this same room after only an hour in recovery. I prayed too that it would all be OK. I was anxious to meet this little man who had such an unorthodox way of coming into the world. I had never seen anything quite like this before. After more than 30 years in birth work I thought perhaps I had seen it all. Not quite.

Finally Leslie’s mom came back to the room followed soon after by a nurse wheeling baby in. I took one look. He was beautiful and he was huge! My own last two babies, three years apart, back in the 1980s were over 10 and 11 pounds, respectively. This baby was on the same soccer team. He weighed in at 10 lbs. and 7 ounces. Leslie was soon brought back with the proud Dad. It was over. We hugged all around, crying happy tears this time, so relieved that everyone was here safe and sound. Every time I looked at him I marveled at how this had all played out. Could he have known he would not have fit head first? Could she have somehow unconsciously known too? What would this birth have looked like today in Tanzania or Zimbabwe? Would either of them have survived? Or if he was born in the 1900s here in this country? Fetal macrosomia comes with a whole host of complications including dystocia or a baby getting stuck in the birth canal. Unstable sugar levels after birth are also common problems with larger babies. But he was here now, and healthy and his parents are very relieved and happy. And exhausted. I continued to ponder these things in my mind as I left later that evening. Before going I reminded Fred to protect mother and baby now in the next few days and not let her get overwhelmed with visitors. I told him in no uncertain terms that now this space around her is sacred and it is his job to protect it, and they can have their families descend upon them next week, or better yet, the week after that, but not now. He agreed and gave me a big hug goodbye.

Stay Tuned: This and other stories will be appearing in my upcoming book, Call The Doula! a diary© by Stephanie Sorensen.
The babies pictured in this article are credited to Anne Geddes with many thanks!

Friday, November 22, 2013

Thanksgiving 2012 and being a doula

Our family has started a tradition in recent years. We invite all of our single, stray, pilgrim souls, travelers and friends and acquaintances who would otherwise not have a place to go for Thanksgiving. Last year we were 15 people. Whoever is able is asked to bring a dish. A potluck Thanksgiving. I didn’t assign anyone what to bring, knowing we could possibly end up with 8 desserts (I wouldn’t mind that) or three or more different salads. But I didn’t want to make this any more stressful than it had to be. I wanted it to be fun and just plain spontaneous. It was.

I still had two ladies who were due soon. If either one went into labor, I had plan B all ready. My husband would follow my step-by-step written (and typed) instructions and put the turkey in the oven at the designated time. It was on the top shelf of the refrigerator already prepared and sitting in its roaster pan. Then my daughter Ruth would be alerted and she would come over earlier than she otherwise would have and help him with the rest of the preparations. I had actually set the table the night before and started preparing the food ahead too. Potatoes were peeled, the gelled cranberry-orange relish was made, lettuce was washed, wine chilling in the 'fridge and the fall Indian corn, wheat stalk and dried hot pepper centerpiece was all made and in place.

The year before I had planned out the whole day for myself, getting up early to clean the turkey at 6 a.m. and have it in the oven by 7 thinking it would need close to 6 hours for an 18 pound turkey. And, according to the old adage from Robert Burns' poem “To a Mouse” which he penned in 1786, and which is of course is the source for the title of John Steinback’s 1937 novel Of Mice and Men, “the best laid schemes of mice and men….” who should decide to arrive barely two hours into cooking that turkey but a baby who wasn’t due for more than 2 more weeks?

Needless to say, I shut off the oven, made room for the roaster in the fridge, showered and dressed, popped the turkey into the ‘fridge and called a cab which got me to the birthing center at the same time as the excited couple. The midwife drove up minutes later, unlocked the door and turned up the heat and we had a baby after about 4 hours. My family wasn’t planning to eat until later that evening, so I offered to stay and do the postpartum shift and discharged them in time to catch up to my family, who had all pitched in and got dinner on the table in plenty of time. Back at the birthing center, the family’s relatives showed up right after the birth with a cooked turkey and all the trimmings, took charge of our little kitchen and laid out a spectacular feast. The whole place smelled exquisite! I was handed a full plate along with the new parents who ate theirs in bed with their new baby lying between them, peacefully sleeping. So rather than miss Thanksgiving, I enjoyed it twice that year!

Although I am now an avowed vegan, my husband David had long ago forsworn his brief sojourn into vegetarianism while a novice Trappist monk in Iowa in the 1970s. Brother Gilbert, who was brother cook at the time created a novel alternative that year for the community’s Thanksgiving Day meal. He sculpted an amazingly realistic-looking turkey out of a tuna and breadcrumb mixture that he baked and garnished with all the traditional trimmings. David had asked the question (that ultimately made it apparent during that year that he did not, in fact, have a monastic vocation) why they couldn’t instead have turkey in the shape of a tuna? There is a newer alternative now to the yearly slaughter of the country’s turkeys: Tofurky is the brand name of an American vegetarian turkey replacement (also known as a meat analogue) made from a blend of wheat protein and organic tofu and spices. I have not tried it yet.

So this year I felt that I was ready for any eventuality, though everything went off without a hitch and no babies arrived that day, either. It was definitely a unique spread. Our Moroccan friend Jaafar brought an eggplant dip and spinach hors d’oeuvres. Our master scuba-diving Indian friend Lorna brought sausage-stuffed date canapés. Her girlfriend brought an arugula and mandarin orange salad. I could have feasted on that one alone, and the list goes on. Aane brought roasted herb-y yams and Hannah brought pies. Someone else brought a wild rice pilaf dish. It was beautiful. 

One friend brought along another friend of hers whom I had not met before. She was a lively addition to the already eclectic conglomerate. I was fascinated by her description of her work as an Oriental practitioner. We hit it off immediately and sat together when the food was served. Now before I tell her story, I need to regress to a decade earlier when we had 5 teenagers at home all at the same time. They had grown up with all the unpredictability of living as the family of a midwife, the interrupted birthday parties, having to be mousy-quiet in the morning because mama is sleeping after working all night, and so on.

I need to preface this too with the fact that I love my work and assumed everyone else on the planet was as enthusiastic as I was about the miracle of birth. So at dinner I would often recount the events of the night before in all their uncensored glory. And the kids would object. I tried to remember that some were more squeamish than others and diluted the events considerably, but at dinner one night, the kids said that they had come to a united decision: I could no longer spoil their supper night after night. The new rule was: NO BODILY FLUIDS AT THE TABLE. None. At all. Ever. They made me promise. I did. 
So back to my new friend/Oriental practitioner/dinner companion. She had heard that we had gone to The Farm in Tennessee in order to have our twins naturally with Ina May Gaskin back in 1982. We could not find anyone in Minnesota who would agree to a natural twin birth back then. She was asking about the birth, how big each baby was, and so on. So I told her that Isaac came first and was 7 pounds, 15 ounces and 6 minutes later Ruth was born weighing 7 pounds and 7 ounces. I explained that the two placentas looked like one, fused together with two separate sacks and weighed in at over 5 additional pounds. At this she blurted out, “That placenta must have been HUGE!” and before I could hush her I heard an audible gag from across the table and looked over to see Hannah glowering at me, David shaking his head and Ruth rolling her eyes. Sorry guys, it wasn’t me!

The rule still holds, even to this day. I am often reminded to stifle it until after the meal if I forget and proceed to tell them about the latest birth when we get together. The other night the phone rang and I jumped up to answer it. A first-time mom was calling asking how she would know if she was in labor, so I asked about any rushes (contractions,) water bag leaking perhaps and then asked, “do you think you have lost your mucus plug yet?” I knew I had failed to take the phone out of range when I heard a chorus of groans from the table and one of them saying, “Geez, Mom!”

So, next week will be Thanksgiving once again. It looks like we will have all the ethnic orphans again this year. I have four clients in their 8th or 9th month just now. We will see what happens this year.

With special thanks for these babies by Anne Geddes.

Stay Tuned: This and other stories will be appearing in my upcoming book, Call The Doula! a diary© by Stephanie Sorensen.

Sunday, November 17, 2013

Suzanne and Forgiveness

I kept bumping into this dear lady in the Somali neighborhood I mostly work in. She runs a little store on one of the side streets. A single mom, thoroughbred Irish with flaming red hair, in her 40s, recently separated from an abusive ‘other’ raising 2 boys and a daughter with her own baby. And she just realized she is pregnant. Could her life become any more complicated? It seems likely.

We got along as if we had been kindred spirits in a past life, funny how that works sometimes. We were both very moved by the recent influx of African refugees in the city, both finding little ways to make them feel welcomed and their move half way around the world possibly easier. Suzanne (not her real name) was able to employ some of their teenagers in the store, and begged donations of warm coats during the winter months to give out during their first winter in America. For most it was their first experience of snow.

We soon realized we could do twice as much if the two of us teamed up, so that is what we did. With her car and my referrals for expectant moms in the neighborhoods nearby, we started doing what we could, finding food pantries to match families up with and free clothes and even picking up homeless moms and finding shelter for them. We took one mom on a shopping spree when it looked like she would burst her non-maternity clothes. And then Suzanne found out she was pregnant. It had been over a decade since her last baby, so she didn’t think it was even possible, but it was. An unexpected gift – her little miracle, she calls her. I don’t know who was more excited: me or her. And of course she wanted me to be her doula.

I find it amazing that she thanks me for some of our adventures. But then, I guess my life seems exotic to someone who grew up next to a corn field in a suburban neighborhood in Minnesota. I grew up the eldest child of Greenwich Village bohemians – the hippies of their day, back in the 50s. My mother sang opera, my dad became a professor. We travelled, we entertained people from all over the world. I was told that I could do anything with my life that I wanted, I could even become the first woman president of the United States when I grew up! Yeah, right, a pudgy Jewish girl becomes the first woman president. Well, anyway, they believed in me and it was a heck of a fun family to grow up in, sometimes. Like when my brother announced he wanted to be a fire truck when he grew up. No, not the driver… the truck! And when my mom brought a live lobster home from the fish market when I was two and I asked her if it was perhaps a pussy cat.

So for me to walk into a housing project and not be afraid for my life, seemed to Suzanne to be downright foolishness, if not dangerous. But I knew I could size up a dangerous situation pretty fast, and this was not one of them. I always texted her whenever I had a new ‘adventure’ for us like the day we needed to pick up Shavonne because her boyfriend’s alcoholic mother had just kicked her and her 4-day-old baby boy out – in the middle of January in Minnesota. And now Suzanne was having her little miracle girl. We needed to find baby clothes and things so we started hitting the garage sales on weekends with quite a bit of success. We both felt, before we even talked about it together, that this baby must have a very special mission here on earth, though we could not imagine what that might be. We would find out soon enough.

We spent all our free time together haunting the thrift stores, visiting expectant moms and figuring out how she was going to manage to keep her family together. I referred her to a low-cost clinic which turned out to be a very wise choice. She had decided early on that in spite of her age, she did not want any testing done that might suggest she consider interrupting the pregnancy, like a diagnosis of Downs or some other problem with the baby. The doctor and midwives at the clinic were very respectful of her choice to do nothing extraordinary and that helped take a bit of stress out of the whole situation. I visited a food shelf in my neighborhood and found out that I could pick up food for families I visited as a doula, sometimes up to 85 pounds of groceries per family per month. This way I could help Suzanne with her food bills and she wouldn’t have to take time off from the store to do it. I resurrected an old shopping cart I had found one day in my travels around the neighborhood and we were in business. I could walk to the food shelf from where I lived and then take the shopping cart on the bus and deliver the goods right to her car at the store.

I had not pried into the circumstances of this baby’s appearance but one day Suzanne offered to tell me about it. She had been praying for her husband for most of their 19 years together. Years ago a priest had counseled that if she fasted and prayed enough, she could fix their marriage and somehow ‘cure’ her husband’s alcoholism. Year after year of abuse continued and the advice that she got was that she just had to pray harder. At one point she did pray harder: that she would die and the whole nightmare would be over. She fantasized about a car accident that would be swift and virtually painless. She fasted until she became anorexic. Then she met me.

I figured the bad marriage stuff was none of my business but when she and I became such close friends, she decided to tell me her story. I listened. He father had also been abusive, so when she married and things began to go downhill she figured this was just the ‘new normal.’ She blamed herself and her lack of faith. Maybe if she was able to become ‘good enough’ he wouldn’t be so bad or drink so much. She went to church sometimes daily. They drifted into two molds: one good, attempting to be a martyr perhaps, the other, an unrepentant sinner whom the world judged.

I listened. I couldn’t believe that in this day and age people could put up with so much hurt for so very long. How was it possible? I had taken a continuing education course on abuse the year before and what I was hearing was so very, obviously, there on every point. Every single box on the class handout could be checked ‘yes.’ I told Suzanne that I only wanted to support her and be a friend, but that I could not have put up with what she had endured for so long. I told her I would kick him out and only then pray for him. I did not believe any God or higher power would demand this suffering of her. There was no way that that was right. End of sermon.

So she did. Kick him out. It was liberating. Freeing. And it was hard raising teenagers alone and trying to work and keep the business afloat. The business did go under, but that was the least of her worries. Then she told me that while she was working there she had met someone: tall, dark and handsome. Except he wasn’t dark. He was nice, and Irish. He was the nicest man she had ever met. He knew how to treat women. This was totally new to Suzanne. No one had ever not hurt her, or been in a relationship where he was only in it for his own gain. She fell in love.

Three months later she is telling me her story over soup at my apartment. And she is three months pregnant. She is convinced her kids will hate her, her church will judge her, and her family will be furious with her. She admitted that she thought about an abortion for a fleeting moment, but that was all. She could not do that. I told her that this baby must have a very special task here on earth. I told her that I still loved her and would do anything at all to help her in the coming months. And I would be her doula!

She couldn’t tell anyone else, not yet. She wasn’t showing at all, but she knew that would change soon enough. Eventually she did tell her kids. The older ones were shocked, one still has not talked to her since. The youngest was still confused by the separation, and now this. She assured them all that they will make it, that things would get better and that she was excited that there would be a baby in the house. It would just take time for this all to settle down. They were still a family and they still had the house and each other. It would be OK. Then the tall, handsome love of her life vanished as if into thin air. Disappeared, and no one has heard from him since.

The kids told their dad the latest news the following weekend. It turned out to be a wake up call for him, though we didn’t see that at the time. Suzanne and I continued to do what we could at the women’s shelters and in the refugee community. Time flies when you are having fun. Before we knew it, her midwife was talking about induction and a C-section for a whole host of reasons, though her age was not one of them and her care was transferred to the clinic’s OB doctor. Suzanne was ready to be un-pregnant by this time. Pregnancy in your mid-40s is not fun. The date was set and we tried to get psyched up. It wasn’t what we had hoped for this birth, but it was OK.

And the week before D-day, who should appear but her ex asking if they could go for a walk and talk. They met and walked every night that week. He had started therapy to address his issues, the drinking and the abuse -- all of it. He also wanted her to know he had started going to church. He didn’t want to lose his family or his wife. He asked her forgiveness and said he would agree to counseling or anything else she wanted. He knew she had no reason to take him back. Then he also pointed out that this baby will need a daddy to bring her up. She was floored, to say the least. Then she asked his forgiveness. She had never gotten herself in such hot water in her life. She couldn’t imagine why he would want her back, especially with a baby that was not his. At this point they both realized that they were no longer a lost soul and a saint. They were both on the same bench for the very first time in their 19-year relationship. They both felt somehow unworthy and needing forgiveness. It was enough for him, perhaps since the dynamics had changed. He wanted to step up and be there for her now, be a better dad to his kids and stop throwing everything that was dear to him out the window. I continued to be wary of his sincerity. Suzanne agreed to try this on a trial basis with absolute agreement on his part to her list of requirements. He agreed. Then he told her he wanted to be at the delivery to support her. He had been there for the last 3 and didn’t see that this one was any different. I doubted that this guy was for real. I had turned into a skeptic, but she was determined to give him yet another chance.

And he was there. He asked to hold the baby as soon as she was born and proudly danced around the operating room with her. One of the nurses commented, “Oh, look! She has your eyes!” to him at which Suzanne and I rolled ours at each other. 

He has turned out to be for real. It isn’t always easy, but when Suzanne told me one day that she found it sad that her baby would never know her real dad, I told her in no uncertain terms that her husband was her real daddy, that the Creator had brought the perfect daddy for her back and she should never again doubt that. This baby does have a mission: she is a real peace-maker, as much as Gandhi or Mother Teresa. I had never seen anything like this before. This time it was Suzanne who took me on an adventure, not the other way around.

Stay Tuned: This and other stories will be appearing in my upcoming book, Call The Doula! a diary© by Stephanie Sorensen.

Sunday, November 3, 2013

Waiting for Radiya … kangaroo care and male circumcision in Minnesota

"We are the mothers, after all, the ones who speak the cultural narrative and teach it through ... well, old wives' tales, which is to say, the ancient, subversive, and immediate mother tongue, the language of metaphor and myth." -- Ellen McLaughlin

It took a while, but now we have an awesome arrangement in place with some of the numerous clinics that serve the immigrant-refugee communities here in Minneapolis and St. Paul. (See: “Welcome to the Twin Cities of St. Paul and Mogadishu” story at my blog:

Thursday night
My bag is packed and sitting by our front door. Two whole outfits are clean and hanging in the closet. There is a sticky note on the door by the lock that I can’t miss reminding me to bring my phone, phone cord, keys, snacks, etc. 

Radiya (not her real name) was due yesterday. She works nights at the St. Paul-Minneapolis Airport assembling the little meals that you can buy on the planes. She stands at an assembly line with hundreds of other immigrant men and women from 3 a.m. until 11 a.m. every night and her swollen ankles can attest to that fact.

Friday morning
We had met at the clinic where I can avail myself of their Amharic translator. After her
appointment they had given her a portable crib, still new in its box and another box with baby clothes, diapers and blankets. Her husband is still in Ethiopia. She can become a citizen and then sponsor him, though she might have to wait up to 5 years for the whole process. As a resident with a green card, she can go back to visit him and still come back into the U.S. So she came here and works and hopes while she fixes up her little apartment for when they can be together again. I knew she shouldn’t lift the crib box and would be taking a taxi home after her appointment. I had taken a bus to the clinic so I offered to go home with her in the taxi and do the lifting.

When we got there the taxi driver unloaded the stuff in the trunk onto the sidewalk and drove off, so I wrestled with the boxes while she held the doors to the building. I unpacked the crib and found the assembly instructions. Not as simple as I thought. While I worked on it in the living room she had gone into the kitchen to fix us some lunch. I finally got the thing together and standing up but when we each took an end and tried to walk it into the bedroom we couldn’t get it through the doorway. I tipped it up on a side and it still wouldn’t fit. I didn’t know that doulas need a certificate in carpentry besides! So I measured the crib after we brought it back out to the living room and then dis-assembled the thing, carried all the pieces into the bedroom and set it up once again from scratch.

It barely fit between the wall and the bed but we got it in. The bed took up more than ¾ of the tiny bedroom. I suggested she leave the crib in the living room so she had a place for baby while she cooked and just keep her baby in bed with her during the night. She had been well drilled at the clinic about the dangers of sleeping with her baby and seemed shocked that I would suggest that. I asked if they had cribs back in Ethiopia and she laughed and said, of course not! So I asked her which her baby would prefer: being with her where he could nurse and see and smell his mama or off in a crib? I went over the basics of safe co-sleeping and told her how we had done it with our 5 children, even with our twins, reminding her that all pillows and blankets should be clear of the baby and he could have his own small blanket or go to bed in a warm bunting or suit. See: Sleeping With Your Baby: A Parents’ Guide to Co-sleeping by James J. McKenna, Washington, D.D., 2007 Platypus Media Press.   

When all the plastic wrap and boxes were cleaned up she invited me to the table to have lunch with her. She made her own bread, a round white loaf fragrant with spices and black pepper. The ever-present banana was by each place and a mug of hot sweet milky cardamom tea.

The next evening my husband and I drove to the same housing project to do a postpartum follow up visit with another Ethiopian family. We were surprised when we got there to see Radiya in the kitchen. They were best friends, it turns out and Radiya was coming every day to cook for her friend after she came home from the hospital with her new baby. I had called ahead and explained to the new daddy that we wouldn’t stay long, but that I wanted to drop off some baby clothes and have them fill out the survey for the doula program that I would then turn in. So when we got there and Radiya and another woman were busy cooking, I thought to myself, there is no way we are going to be leaving in the next hour.

It was an interesting visit. I looked at the baby in his crib and asked when he had last nursed. He was tiny at birth, just 5 lbs. She said it had been at least 3 hours. I asked how long he has been sleeping during the night and they both agreed it was 3 or 4 hours or more. It was sweltering in the apartment, though it is fall here, so I suggested they unwrap him a bit and as they did so, I realized he had on two blankets, a fuzzy sleeper, a little dress under that, and a Onesies T-shirt under that. And socks. When he stretched and yawned I noticed his mouth and lips were quite dry. No jaundice though. His mom changed him at this point and I was very surprised to see that he had not been circumcised. I looked at his dad and he explained that the insurance company just cut off (pun not intended) any non-emergency services and they couldn’t have it done in the hospital because of that. They had shopped around and the going price at all of the clinics that did offer that service charged a flat $600.

I explained that it was no longer deemed as a necessary medical procedure by all of the American doctors' and pediatricians' organizations. Half of the people at the apartment were Muslim and the other half Ethiopian Orthodox Christians, all educated, some with graduate degrees. I also explained that there are numerous studies that now disprove that by not having it done increases the child’s chances of getting infections, or HIV or AIDS later in life. I explained that all little boys need to be taught correct washing and that it is even considered by many today as genital mutilation and an offense against boys who have no say in what is happening to them.
None of the people present that night felt that it was part of some tribal rite of initiation. None subscribed to the idea that it was exclusively cultural, either. For both the Christians and Muslims, it was ordained by their religions. The Ethiopian Orthodox Christians sited the Old Testament injunction and the Muslims the Qur’an. And I am Jewish.

So I told them that my own sons, Abraham and Isaac were not circumcised and both had expressed when they had grown up that they were glad it had not been done to them as babies. One of the women said that beyond the religious reasons, that women prefer men that have been circumcised. I asked why. I couldn’t believe we were having such a frank discussion in mixed company. This was a first for me. Either we visited as women only and talked about labor and birth, or I visit a couple and the conversation usually stays on a somewhat formal level. She explained that it is just nicer, cleaner, not as ugly and she could not imagine sex with a man who had not had it done. I laughed and discreetly pointed to my husband who was still enjoying his ingera and dahl and didn’t see my message at all. I get what this symbol represents for them within both religions and in the process realized that I had just wandered into quite a mine field! One of the dads even suggested that they could take their sons back to Ethiopia when they were 5 and see the relatives at the same time. The two mothers present protested saying that it would hurt so much more when their precious sons were older. My worst case scenario would be that some immigrant here in Minnesota who had seen it done back in the old country would start doing it himself, ‘underground’ so to speak. 

So I first called a few clinics and found out that yes, very few insurance companies were still covering the cost of circumcisions. The lowest fee I could find was $377 which would still be quite a lot for an immigrant family. Then I found out that one hospital had their residents doing them all gratis – free -- if you delivered there. Next I called the hospital that most of the Ethiopians use here and asked if they knew that the other hospital is offering circumcisions free and that they are at risk of losing an entire customer base because they were not. They had an idea that this had come up but not the full extent of the problem.

Then I called a reformed or liberal Jewish synagogue. I knew that they have what are called mohels or non-medical people who perform the religious or ritual circumcisions at the temple and in homes. The rabbi agreed to email me a list of mohels in the Twin Cities. She could not tell me if they would be willing to do it for non-Jews. Or if they would even be allowed to by their rabbis.

I called one other name on the list that turned out to be an elderly Orthodox Jewish rabbi who was also trained as a mohel. When he started talking he sounded just like my own zaide (grandfather) who had died at 90 in 1981 and I melted. He suggested that I learn how to do it, being that I am Jewish. He suggested I should find a nice doctor who would let me watch him a dozen times or more and then certify me. Yikes! Not where I want to go. I would be excommunicated from the midwifery community.

I found one mohel who is both a physician and Jewish. She was very intrigued with the idea of doing this for the African communities here. She is employed by one of the big health networks and explained that she would have to look into the legal issues that might prevent her doing this outside of her own community. So I am waiting to hear back from her. In the meantime I am getting calls daily now, asking if I have found anyone to help them. Yes, I respect them enough as a people to give them choices, even if I don’t agree with those choices.
No, I could not arrange an abortion for a woman, any woman, though I have never been asked to. If I have a certain privilege in this country, they must have those same privileges. That is justice. Back in the 1970s when we were helping Southeast Asian refugee communities, I had become involved with several families with infertility issues. Some of the options available in the U.S. were not approved by my own church at the time. Yes, I would have been excommunicated then just for assisting a couple to access those methods. But I was not worried about myself. I could not deny someone else the information that I had free access to. St. Thomas Aquinas, who was one of the greatest doctors of the Catholic Church of all time said at his death, after having spent an entire lifetime writing about divine matters, “In the end…we know nothing of God.” I don't feel any hesitation in helping in this area. So I went ahead and explained all the different options and helped many families in that way. Every single one of them was able to start a family. 

Sunday evening
It is my twins’ 31st birthday* tomorrow and we plan to celebrate with a phÓ buffet, Ruth’s favorite. I make a vegetarian version of it. (See: The phone has been quiet all day. I go shopping and get all the ingredients at our local oriental supermarket called “United Noodles.” It is really called that. It is down the street from Have A Happy Day Jewelry store. I can get all the fresh veggies there even more cheaply than the larger groceries. Fresh Thai basil, cilantro leaves, mint leaves, bean sprouts, scallions, and chili peppers. I clean the apartment and make a note for David to remind him to pick up a carrot cake on the way home from work tomorrow. Everything is ready. We watch a movie later that evening and turn in by 11:00 p.m.

Monday morning
The phone rings at 3 a.m. Radiya thinks her water has broken and is having a few random rushes about 15 minutes apart. I suggest she calls the midwife at the hospital and let me know what they say. This is a first baby. We could easily be looking at a 24 hour labor. It takes time. I go back to bed until the phone rings at 4:00. It is a nurse at the hospital asking if I am on my way. The contractions are now 4 minutes apart. They had told Radiya to come right in so she had called 911 and she and a girlfriend who doesn’t drive either were already at the hospital. I called my friendly Iranian taxi driver and raced to get myself ready in 5 minutes. I am off.

5 a.m.
3 centimeters, 75% effaced and asking for meds. I suggest that we get out of bed – the nurse has at least 20 minutes of monitoring baby on the graph already, and we get the go-ahead. Radiya says it feels so much better to be up rather than lying down with monitors strapped on. Of course it does! We walk the halls and try the rocking chair in the room. I insist that she drink a whole cup of juice and visit the bathroom. The midwife comes in and offers some options for meds which Radiya agrees to, so she is brought back to bed and an IV is started. As her doula I can’t argue with her though I’ve tried to put this part of labor in perspective: she is doing great, the rushes won’t get beyond her strength, and this is the longest part of labor, getting to 10 centimeters. But she insists on the IV, asking the midwife if it will speed up labor. I point out that she will be more relaxed, which might help her dilate or she could be very sleepy and slow it down.

Now that she is on the IV the nurse asks her to switch to juices only, no food, and explains that they need to do a continuous electronic monitoring of the baby to be sure he doesn’t react to the drugs, which he does in the next few minutes. His heart rate drops with each contraction so the nurses and the midwife watch the machine for a while and consider their next options. In the meantime it appears that though the meds affected the baby, they didn’t do much of anything for Radiya. She is still having some big rushes every 4 minutes and not getting much relief from the IV. They add another bag of IV fluids after she begins vomiting all the juice she’s had so far. We deal with each rush together and get into a rhythm. Breathe in through your nose, hold it... slowly blow it out, breathe in, slowly, now breathe out... and rest. She can do this. Her midwife encourages her as do the nurses. They check her again: 4 centimeters. The meds have worn off completely by now and she is asking for an epidural. I try to point out how well she is doing and talk her through more rushes using visualization, riding over each ‘wave’ and then watching it go away. There, you did it. Blow that one away now. You never have to do that one again. It is gone. It has done its work. Let each one open you up… that’s it. You are sooo strong! Think of all of your grandmothers and great grandmothers… all the women all over the world that are birthing their babies tonight. You can do this… breathe... good job, sweetheart!

7 a.m.
The epidural is ordered though they tell her the anesthesiologist is in surgery just now but will come soon. The nurses all leave the room and I suggest we get up to the bathroom before the procedure. She agrees and then is again surprised how much better she feels standing rather than lying on her back in bed. We get through the next rushes while she is on the toilet and then Radiya closes her eyes and leans against the wall and rests. The rushes seem to be gaining strength, to me at least, so when the midwife comes back to check on her I ask if she wants to see what her dilation is before getting the epidural. The midwife says no, she was only a 4 at the last check, and while we are talking, the next contraction starts and with it we both hear Radiya first breathe in and then PUSH with everything she’s got. I am not surprised but the midwife seems completely flustered. It is only 6 hours since her water broke but it is apparent that her body knows exactly what to do and she is following along perfectly.

7:30 a.m.
The midwife runs out to get the nurses to set up the room and I continue to support Radiya who now has both my arms locked in her grip and rests her head on my shoulder. I am sort of half kneeling, half standing. I ask the nurse to get us some pillows and get Radiya to lean back on them before the next rush. She is still on the toilet. The midwife comes back with a flashlight and checks for the baby’s head. She is indeed 10 cm. and bringing baby down beautifully. After the next rush, without opening her eyes she asks if the epidural is ready. The flustered midwife tries to explain that it is too late to give it to her now and she is sorry about that (I'm not) but her baby seems to be ready to be born. Then Radiya says in that case, they can do a C-section. I help her with the next rush, telling her that she is pushing perfectly and will see her baby soon. She leans her head against my shoulder again and rests, almost sleeps for a few minutes before the next one starts. Behind us in the bathroom doorway one of the nurses is arranging a low wooden birthing stool and covering the floor with a clean draw sheet. She and the nurse help Radiya up and we pivot over to the birthing stool and help lower her onto it. 

7:40 a.m. 
We can all see baby crowning at this point. As she grips my arms even harder, her baby’s head slips out. The midwife asks if she can keep pushing, but Radiya is asleep already. The next rush starts and the midwife has her push… longer…. Push… yes! Do it again… good!... PUSH!… but can’t seem to help the shoulders out. I move further back at least a foot, still attached to our mama, hoping that it might help with the shoulder instead of leaning forward like we had been doing. It works. 

They lift a very pudgy baby girl up and I help hold her there while the midwife is busy assessing what looks like a lot of blood from my vantage point. I help rub baby’s back till the nurses take her over to the warmer where she cries right away. The midwife says we have to get up on the bed and as I help get her up on my side with one of the nurses helping from the other side, I watch a steady stream of blood dripping across the floor. She is at the side of the bed and I automatically lift both legs up while the nurses position her top half on the bed. The midwife is rubbing her stomach at the fundus (the top of the uterus) to get the bleeding to stop. She explains that it looks like she tore when the shoulders come through but that the bleeding is under control now. We can relax. 

8:00 a.m.
The nurses bring baby back but Radiya says she needs a clean nighty before she can hold the baby. The midwife explains that the baby needs to be skin-to-skin but Radiya refuses, saying she will wash up first, so the nurses put the baby back on the warmer where she starts to cry. I ask if I can hold her at this point which the nurse agrees to right away. I put a dry hat on baby and wrap her in warm towels and hug her close.

Last week I attended an all-day summit on skin-to-skin and some of the discoveries being made by a pioneer researcher from South Africa. Dr. Nils Bergman (left with his kangaroola wife Jill) has been studying maternal-infant-maternal attachment (your baby attaches to you too, it is not just you bonding with your baby) and can scientifically prove that Nature had this all figured out before we started messing around with an incredibly intricate, fool-proof system. The bottom line is that babies need to be exclusively within the environment of the mother after birth. Zero separation and nothing less is what babies are born to expect, and what Nature has wisely ordained. He even goes so far as to prove that premies will thrive and do better using kangaroo care alone and not by being placed in isoletts. (See:

Dr. Bergman has made it his life’s mission to provide the scientific evidence for the neuroscience of optimal birth, the role of skin-to-skin contact, breastfeeding, parenting for secure attachment and to conduct the research as needed. He further seeks to disseminate this knowledge on mother-infant togetherness by educating all health professionals both here and abroad and by empowering parents. His work promotes practical change in health systems and facilities that enhance mother-infant togetherness. Together with his wife, Jill Bergman who is an educator and doula who also teaches kangaroo care (he calls her his ‘kangaroola’) has written a book for parents, Hold Your Premie, and produced four DVDs: “Kangaroo Mother Care: Restore the Original Paradigm,” “Rediscover the Natural Way,” “Hold Your Premie: the film,” and “Grow Your Baby’s Brain.” There is also a set of talks for parents by Dr. Bergman at:

So, after this workshop I was even more determined to get this baby onto her mum’s chest, and so were the midwife and nurses but Radiya told us she wasn’t ready, so I wrapped up baby and held her close while talking to her. She started rooting and salivating, both signs that she was telling us it was time to eat, and I believed her, so rather than letting her cry I let her suck on my little finger while she gazed into my eyes. Not the right eyes, or the right body or the right smell or the right nipple or the right voice, or the right finger, but she seemed to be OK with this alternative situation at least for the moment. The midwife had the leading OB come in to assess the tear. He was the only OB on that day, though I had assured Radiya that we’d keep her draped and not have any men in the room. She agreed to have him come in if he had to and promptly covered even her head with a blanket and stayed like that until he left. He did not need to do the actual repair and made some suggestions to the midwife who set up a tray to stitch the tear while he left.

8:50 a.m.
I was still holding baby who was still staring at me and nursing on my pinkie. I tried to get her back with her mama but the repair was still uncomfortable enough that Radiya said I should hold her until it was over. I certainly was not going to put her back on the warmer, so I hung out with baby until Radiya was finally cleaned up and ready. She tied up her new clean nightie and I tried to convince her to untie it because her baby wanted to nurse. She didn’t believe me until I gently unwrapped baby and plopped her down in her arms where she promptly latched on and vigorously nursed! Dr. Bergman had talked about alternative caregivers filling the place of the mother in certain cases like adoption, but stressed the fact that it should be the same caregiver for at least the first 2 years, not numerous people coming and going. I hope that we did the best we could have in this particular situation. 

Stay Tuned! This and other stories will be available in my book, Ma Doula coming out in May 2015!*See Stone Age Babies in a Space Age World: Babies and Bonding in the 21st Century© (pending publication) and the chapter “Twin Birth on The Farm.” Also see Spiritual Midwifery© by Ina May Gaskin, chapter on twins, pg. 129, 2nd ed. 1989 with permission.