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!

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