Tuesday, December 30, 2014

It Takes a Village

I was filling out Tiana’s paper work as I was signing her up for our doula program and at the same time gathering some information about her wishes for this birth that would eventually evolve into a proper birth plan. I asked her who she wanted to be at her birth. She answered, her mom, her step mom, her mother-in-law, her brother, her husband, and her husband’s sister. I put my pen down and gave her my little canned speech about not inviting everyone because you might end up feeling like you’ve got all these people watching and waiting for you to ‘perform’ rather than just making the birth room yours, essentially owning it; a sacred space wherein to welcome a new little soul to earth. I have also learned from experience that sometimes relatives are not all that helpful. Often, during labor, they will start telling all of their own birth and labor horror stories—definitely not helpful—or start suggesting interventions, like an epidural, that they used and thought was the best thing, while you are trying your darnedest to at least try to go naturally. I have even had one family set up a bar (BYOB, and not Bring Your Own Baby) and begin the celebrations before the little man even arrived! Other mothers-to-be have been asked by their mother or best friend or mother-in-law if they could pleeeeaaaaasssseee come to their birth, and they aren’t assertive enough to say no, and, well, if she comes, and I don’t let his mom come, then she’ll be mad at me… and soon you have an entire congregation attending.
So, I had my say, for what it was worth, and finished up the paper work. That done we watched the DVD called, “Doula” made locally here with many of the doulas I’ve worked with. The interviews with the midwives, doctors, new parents, and doulas in the film are wonderful, but even more importantly, I like to have first-time moms especially see all the diverse families and what they wanted for their births and how your doula tries to create that birth experience for you. There are home births with siblings present; home water births with dad in the pool, too; hospital water births; hospital medicated and un-medicated births; au natural births and moms dressed in their own clothes; unplanned Cesarean births and planned C-sections.
So, now empowered with all this information, I ended our first meeting and encouraged them to read as much as possible and suggested checking out some of the videos on my resource handout, pointing out the starred ones that I was designating as their homework for that night.
1    1. *You Tube: Breast Crawl by UNICEF ` A MUST SEE!
      2. Breastfeeding Resource Pages – La Leche League International: www.llli.org/nb.html

      The following is the connection to an amazing group in Canada with seemingly endless information – all excellent. IBC is composed of three departments: the Newman Breastfeeding Clinic, the Centre for Breastfeeding Education, and the Centre for Breastfeeding Studies:  http://www.nbci.ca  You can call them for help anytime, too: PH: 416-498-0002
3.      AskDrSears.com – valuable advice on breastfeeding and parenting (my personal favorite)
4.      Google on YouTube: “Extraordinary Breastfeeding,” real food for thought!
5.      *You Tube: “The Dramatic Struggle for Life” – very amazing footage from Bali
5.      *And here is one for your partner: https://www.youtube.com/watch?v=ws3MoSZrb58
7.      *YouTube: see https://www.youtube.com/watch?v=OPSAgs-exfQ
8.   *on Netflix see “Doula”
Our next couple of meetings went well as we were getting to know each other. Zion had some really insightful questions about birth and labor and was really getting “charged up” as he put it, for birth. Tiana was less vocal. I wondered if she was just plain scared. Most of her answers to my questions about how she was preparing for their baby were all monosyllable answers, “yes,” “no,” or “I dunno.”
Then as week 38 was quickly approaching I gave her a sample birth plan and suggested she change it to fit her expectations. She never worked on it, which was also OK, but I had been hoping she would take a more active role in her birth. I did learn that her mom had four very fast, natural births, so she thought she would try that. We were at her 39th week appointment when she asked if she should just show up at the hospital on her due date and wondered how they “start it up.” The midwife we were seeing that day laughed and said, “Remember when we went over the signs of labor starting? Well, we wait until your body tells us it is ready. You will see some spotting, though that doesn’t always have to happen first, or your water breaks, or you have contractions that don’t go away when you try to rest.”
Tiana thought about that a minute and then frowned. “You mean I gotta wait for that? It ain’t jus’ gonna all be over on my due date?” Whoops. I thought we had been preparing for this all along. Tiana was still in high school and at one appointment had told me about the birth classes the school also had for young moms, so I had thought we had plenty of childbirth ed going on here, but I was wrong. The midwife went over the basics of early labor again and reassured Tiana than this was all perfectly normal and that often first babies decide to arrive after their official due date, which is in fact only a guess date. There is no magic formula to predict when each baby will be born.
“Shee-it!” was her response. Tiana was tired of being pregnant. She was tired of heart burn and swollen ankles, uncomfortable nights and constipation, all normal side effects of pregnancy. She had been all geared up for this pregnancy to be done with on The Day, which was now one week away. Her mom was going to come up to be with her on that day and needed to go home shortly afterwards. She got dressed and left, a very disgruntled mama for sure.
A week later we met again. As soon as the midwife came in the room and started to measure her belly, Tiana asked if she could schedule an induction. The midwife asked why?
“’Cause I want this baby to come while my mom is here.”
“I can’t do that. Your baby will come when he is ready.”
“But if I am really overdue you could induce me, so why can’t you now?”
Patiently the midwife tried to explain that there has to be a good reason to induce babies and that her mom being here for a short time isn’t one of them. This did not sit well. Tiana left shaking her head while Zion practically danced out of the clinic singing a little made-up rap, “I’m gonna be a daddy, YES! I’m gonna be a papa….”
That night I got a call from Tiana asking if there was anything she could do to bring on labor. I explained that she could ask the midwife what she thought about what we call “stripping the membranes” where, if her cervix has started to dilate, the midwife can sweep a finger around the cervix while gently separating the bag of water from just inside the cervix. Sometimes this will trigger the uterus into thinking it is time for early labor. I also told her how I had gotten on a bike one day and rode for an hour up and down a dirt road when my twins were due and I couldn’t eat or hardly go to the bathroom anymore because I had two big babies inside and no more room left and that it helped start labor then. 
I also said that some midwives suggest that having an orgasm, with or without sex can also trick your body into thinking contractions have started. Some suggest that the male hormones from the dad during sex help labor start. Nipple stimulation can also trigger contractions. Then she told me she heard that using Pitocin helps but that it makes the contractions super painful and unbearable. I explained that that used to be the case, but what I have seen more recently is that smaller doses are used just until active labor is established and that often the Pitocin is turned down or off when the uterus responds well. Again I said that they have to wait to induce for a true medical reason. I also encouraged her to keep in touch with her midwife who might have other suggestions or tricks up her sleeve.
Well, the Guess Date did come and then go. Then two days later at 4 A.M. the phone rang. YAY! We had contractions. I said she should call the midwife and let me know if they wanted her to come in. She called me back and said they wanted her to wait until she had contractions for two hours that were five minutes apart. She told me they were already unbearable and I suggested she get in a hot tub or shower and keep me posted. An hour later I received a text that she was on her way to the hospital. I was off, too.
Our hospital has a Triage unit where moms first go to be assessed. Too often women come in very early labor, only one or two centimeters, and are encouraged to return home where they can labor in familiar surroundings and rest and eat until labor is truly established. When moms come in too early they often end up with interventions that could have been avoided. In Triage the baby and the contractions are monitored and if everything looks good they can be reassured that they are doing well and that labor will pick up exactly at the right moment, and that they should not be discouraged. My twin birth in 1982 seemed to have kicked in one night with some whopper contractions and I was slowly dilating, but suddenly they stopped. After another hour without any appreciable contractions I was sent home where I went to bed and did not have any signs of labor after that for five more days—until the day I got on the bike, determined to have my babies then and there. They had understood the eviction notice. That night they were born after a 58 minute labor. Finally.
The midwives assured Tiana that her body was getting ready, that this was all perfectly normal for a first-time mom, and that her baby sounded great, but that this early labor could go on for another day and they really thought she would be more comfortable at home. Zion, however was not phased. He was shimmying around the room with another original rap about his son who he couldn’t wait to meet. Tiana’s step mother, Imani, was helping her dress to go home when we all heard a tiny wet splat or plop. Tiana looked down and exclaimed, “EEEEEUUUUWWWWWW!!!” There on the floor was her mucus plug and water was running down her legs, filling her slippers.
“That’s so damn GROSSSS!” was her next expletive. I laughed and said, “Your water broke! Congratulations! See, your body knows exactly what to do.”
Her reply as I grabbed some gloves and paper towels to wipe it up before anyone slipped was, “EEEEEEEEEEEEEEUUUuuuuuuuWWWWWWWWGROSS!!!”
Imani steered Tiana into the bathroom to clean up as I cleaned up the floor, skirting Zion as he tiptoed around the room humming his little song like a big Black Pooh Bear. I told the nurse that it appeared that her water just broke. She went back to the nurses’ station and got a test swab to confirm that it indeed had. By the time that Tiana had dressed the contractions had picked up appreciably and the nurse put her back on the monitor. We weren’t going home or anywhere else for that matter. We were going to have a baby.
Soon we were roomed in a proper birthing room. I got a birth ball and filled a pitcher with ice water. Zion had texted his mom and sister and before I knew it I was being introduced to the whole tribe: her mother-in-law Alexi, her brother Naveah, her husband’s sister Jayla, her sister’s cousin Kiara, Tiana’s sisters Trinity and Onieda, and cousin Melida. Then her brothers arrived, Shay-shay and Diamond. As we got settled and hung up coats and collected more folding chairs from the other rooms around the hallway, I found a quiet corner and parked on an exam stool to update my paperwork. Everyone got comfortable while Zion wrestled with the lounge chair, trying to figure out which nobs to pull to turn it into a day bed. He was ready for a nap, having been up since 3 A.M. I poked around the cupboards in the room until I found some sheets and a pillow and helped him make up the bed. As relatives continued to arrive and greet one another, I tried to get near the bed. I wanted Tiana to know everything was going really well. The contractions were picking up and their baby sounded wonderful. I reminded her to breathe slowly and remember to relax her face, and throat, then shoulders and legs. I massaged her hands during the next contractions and then as her mother-in-law took over the hand massages on her own I moved down to her feet. 
She said that all helped relax. During the next hour Tiana asked to just be allowed to rest in bed. They had been up since 3 when the contractions started.
At shift change I wiped the white board in the room and updated it with our new nurse’s name, the new midwife’s name and under the title “Goals” wrote, “Have Baby Boy!” I invited Tiana’s sisters to fill in the rest of the box marked, “Companions.” They managed to squeeze them all in: Zion, Imani, Jayla, Alexi, Kiara, Naveah, Trinity, Onieda, Melida, Shay-shay, and Diamond.
One of her cousins busied herself with Tiana’s make up. She wanted her to look her best for the pictures they all planned to take. She suggested only above the waist photos for before baby comes and maybe a few as he is crowning. Tiana wasn’t sure about that. They continued discussing pictures while Tiana had her eyebrows sculpted. Lip gloss completed the procedure. I noticed how relaxed she was while being made up; no complaints about the contractions or rushes. Hmm. How could I tap into this and get her to relax?
Suddenly about 6 cameras started clicking and flashes started going off, now that the star of the show had on her makeup. It looked like a scene on the news of some diva rock singer showing up for her debut as she steps out of her limo, mink coat trailing, in front of the night’s venue. I had been wondering when her midwife would comment on the sheer numbers of people in the room and now she did.
“Maybe you can put away all the cameras and phones for now, at least until the baby is born, so we can work around the bed and help Tiana relax.” Very diplomatic.
I sat next to the bed and encouraged Tiana through each rush. After another hour she asked how much longer this could go on. I explained that for a first baby we expect about 1 centimeter dilation every hour, or sometimes every 2 hours and that is perfectly normal. I also said that she would feel a whole lot better doing anything other than being on her back in bed. We finally helped her up and walking down the long halls with Zion. I demonstrated with his cooperation how to lock her hands behind his neck and hang that way during the rushes and that moving her hips from side to side and in a spiral or circular motion would also help the baby move down.  

After one lap around the fourth floor she was back, heading for the bed. I grabbed the birth ball and firmly but gently suggested she stay upright awhile longer sitting on the birth ball at the edge of the bed which I then raised up to her shoulder height once she was seated, and positioned a pillow in front of her on the bed so she could really rest in between rushes. After a while, though she admitted it had helped, she asked about pain medication. I suggested she call the nurse and discuss her options together. The nurse told her it was still pretty early in the labor, and strongly urged she try a hot bath. They discussed this back and forth for a while until Tiana agreed to try it. Once she was ensconced in the tub with the lights out and tiny pin lights glowing around the edges of the tub, she relaxed. I got a pitcher and slowly poured a little stream of water over her belly. After a few minutes, I asked Zion if I could show him how to do this. He bounded in humming a new little hum and quickly got the hang of pouring a steady stream of water over Tiana. They stayed like that for almost an hour. When she got out and the nurse checked her she was at 3 centimeters. Not too fast, but definitely progress. We tried the birth ball again at this point and I had Zion behind her on a chair rubbing her lower back with a massage ball. I assured her that the back pain was a good sign that her baby was moving down into her pelvis. He was still sounding wonderful when the nurse intermittently checked his heart tones with a Doppler.
While Tiana was in the tub the sisters had gone down to the cafeteria, returning with covered plates of full of eggs, sausages, biscuits and toast and passed those all around. Another sister came back with a tray of a dozen cups of coffee in paper cups. They seemed to know how to do this—feed a crowd. This tribe knew how to “do family” I thought as I watched in wonder. I had also been figured into the breakfast count, bless their hearts!
Another aunt came in during breakfast and announced that since this was such an auspicious day, the day of their little man’s birth, she had gotten lottery tickets, the scratch kind, and passed them around. Someone was sure to get lucky today, she explained.
As breakfast was wrapping up, Zion went around the room picking up all the paper wear and cups and generally tidying up the room. About this time Tiana, smart girl that she is, asked one of the nurses if they might have an even larger room available than this one. The nurse left to check and soon came back saying that one other mom had just gone home and they had called housekeeping to clean it right away. Within an hour we moved into our new, bigger temporary home.
I thought I had a lot of people at my twins’ birth. We had gone to The Farm in Tennessee to have our twins in 1982 and agreed that all of the midwives there should feel very welcomed, so we had 13 midwives, two Farm doctors, and the camera man (we had also agreed to let them film our birth since a natural twin birth was becoming so rare.) There were also several nurses on hand to help with the babies should they need anything. At the time I didn’t feel cramped or crowded at all, only deeply grateful for the chance to have a natural birth surrounded by so much love, and care and expertise. There were even women in the kitchen in the clinic starting the pancakes I had wished for afterwards. They had thought of everything.
At one point Zion was talking on his phone and seemed to be taking orders of some kind. He yelled across the room, “Yo, Stephanie. Want anything from Cub?” (Our local supermarket.) I said a bottle of orange juice would be nice and put in my order, which he refused to let me pay for when it arrived.
While we continued to breathe through the rushes, we could overhear the older women talking about Thanksgiving and who should make what dish. One of them turned to me and asked if I had to cook the whole dinner for my family this year besides working and I explained that I didn’t have to do anything this year, that our sister-in-law was making it. She asked if I would at least bring a dish along and what I would make. I said I liked to bring stuffed acorn squash halves, filled with wild rice, currants, and minced onions sautéed with a pinch of cinnamon and cumin, and walnuts.
Sometime around 5 centimeters Tiana decided that she wanted an epidural. When the anesthesiologist arrived, I took the lead and announced that we all had to leave so he could set up and promptly escorted the crowd into the hall where the conversations continued.
It was just 5 P.M. Then, as if we had not sufficiently filled up the room, her Aunt Precious showed up with her two daughters, Faith and Charity, who were toting bags of fried chicken, dinner rolls, bottles of soda, chips and I don’t know what else. Oh, yes I do. Now I remember: bags of Halloween loot. I took a short break by the bedside to get some more ice water and on the way out the door passed the cousins and brothers, all big macho guys, Zion still happily humming, with lollipops in their mouths!
Only a few minutes later as Zion dug into the chicken, the nurse announced that Tiana was 10 centimeters and we were going to set up the bed for the delivery. With his mouth full of chicken, he looked at me with a pained expression and asked, “You can’t even eat fried chicken?” Earlier in the day, I had declined the burger and fries he offered explaining that I am a vegan and had brought snacks with me. I laughed and said, “I think Tiana needs us over here just now.”
Zion gulped down some more chicken and stood by Tiana’s head wiping his fingers off on a napkin where I had suggested he go and hold her hand. I was by the head of the bed on the other side, showing her how to hold her legs behind her knees. The baby warmer was turned on and the sterile pack of instruments was being unwrapped at the other end of the bed. About eight ladies were lined up behind that, cameras and cell phones ready. I looked over this scene and thought in my mind, “What is wrong with this picture?” I left Tiana’s side and walked to the end of the bed suggesting that the ladies might want to stand closer to the windows on this side of the room and give Tiana a little privacy at the end of the bed where the nurses were helping her position her legs on two trough-like stirrups. The epidural had rendered her legs numb and as heavy as tree trunks.
I returned to my position and encouraged Tiana during the next rush. She did not have an urge to push, the epidural blocking any sensations there, but the midwife was ready to offer directions from down below where she was now stationed. I was too far up near the head of the bed to see what was going on down there but could tell from the midwife’s response that things were going very well and she could see the baby’s curly black hair even after just the first push. I whispered to Tiana that she could rest now and when the midwife says to push, I will help her take a deep breath, let it out as the contraction builds and then, taking another deep breath, put her chin down to her chest, hold it… and… push… and again…. And then baby’s head was out. Just like that. It was the shortest second stage in a first-time mom I had ever seen. The midwife said the same thing. Another push and he was out. The ladies had migrated once again to the end of the bed during this time (it was nearly impossible to keep the paparazzi away) and the flashes started up again nonstop. The ladies were crying and hugging each other. I looked up and Zion was daubing his eyes and shaking his head in disbelief. One lady moved over nearer to me and said, “I am twenty-nine years old and I have never seen a birth before. This is so AWESOME!” It really was. I whispered into Tiana’s ear, “You did it! I knew you could! You are so amazing and I am so very, very proud of you, my dear!” She was crying too. As soon as Zion cut the cord the baby was put onto Tiana’s chest and a fresh warm blanket was laid over him. She instinctively held him there with both hands and noticing his warm little bum sticking up under the blanket she proceeded to pat it with both hands. She couldn’t say anything yet but just looked over at me beaming, tears rolled down into her ears. Her makeup was still perfect.
The family continued taking pictured from every angle, including the end of the bed where the midwife was waiting for the placenta. Oh, well. I don’t know how I could have managed crowd control any better. Tiana seemed completely unperturbed by it, so I just let her lead the way. I had let her know early on that she could let me know if at any point she wanted me to thin out the audience and send a few people out but she said it was all good. She had such an amazing family and support network. They were really good at this. I could certainly learn something from them.
The next day I emailed a friend/RN/aspiring CNM in St. Paul, asking her what her hospital’s policies were when it comes to families. She wrote back: “Our hospital does not have a specific number, but leaves this to the physician and nurses’ discretion. If the room is big enough, and the family is respectful, we can allow many people to stay. If they have a big family, I try to lay a ground rule early on that only two or three people fit in the room, and appoint a gatekeeper of another family member to do crowd control. There have been times we have needed to invent a unit-wide rule for the sake of getting obnoxious and unwelcome family out of the room, but only if they are truly interfering or causing a safety risk- there are even times we have had to call security to crowd control for us when there are 20 family members trying to take over a room. If we can't get a bed past them out to an OR, or a neonatal crash team in to the room, it's not safe and they need to move. If they are making unhelpful comments or being rude to myself or any of the identified birth team, I'll boot them.”
She continued, “I had a time once with a teen mom where I was certain that the six people she had identified on her birth plan to come would cause me grief all day. They were loud, discussing sports or their own births, and kept repeating untruths about birth and reproduction. I resolved that I would need to thin the crowd as she moved to active labor. But then her friends and family moved to interact with her, every one of them taking a task and becoming the most beautiful team of doulas I have ever witnessed. They all stayed as the baby was born, and they were sensitive and respectful, aware of the space I and the physician needed to work, and quietly efficient! Loved it!”
Another friend, C wrote back also: “Each hospital sets their own number. Here in New Jersey it is 5. You know the saying: the more people in the room the more dysfunctional the family. Much love. C”
But, back to my family. After the birth while Tiana was being cleaned up and wrapped in pre-warmed blankets and her baby boy was nursing like a real pro, I packed up my things from all around the room, quite ready to catch up on missed sleep. The room had thinned out appreciably and I assumed the family had started going home, too. I was wrong. It was time to eat again. They all came back in, this time toting Submarine sandwiches for everyone. As I prepared to leave after hugging everyone goodbye, I made my way down to the hospital lobby. The one group of brothers and boyfriends of sisters and cousins who were not with the sandwich crowd were just coming back into the hospital as I reached the front doors.
“I thought you all left?” I asked. Zion answered for them, “No, we just went out for a smoke.”
I hugged him goodbye as I whispered in his ear, “I hope you can give this up—smoking—it’s not good for your baby, even second hand smoke is really dangerous, you know.”
All I got was a half-hearted, “I know.” I tried.
I came back the next day. The crowd was less today. One of the aunties was changing their baby’s diapers. I mentioned that I had just run across a new gadget for babies that they just must see. I got out my phone and got the website for http://www.amazon.com/Beba-Bean-Pee-pee-Teepee, a soft little cover that you can order to put on your baby boy’s penis while you are changing him to protect his clothes and yours from any unexpected geysers. They thought that it was the funniest thing they’d ever seen!
I finished up my paper work and hugged Tiana goodbye. I will miss this big, loud, loving family, each and every one of them. It will take a village to raise this baby, whether he wants them or not. Lucky kid.
Stay Tuned! This and other stories will be available in my book, Ma Doula coming out in May 2015!

Tuesday, April 29, 2014

Ma Doula

We weren’t sure what Moriah was trying to say. I was making a belly cast of her mama Dakota’s incredibly beautiful 8 ½ month belly and had invited her little 5 year old to join us in the room where we do them. She hopped off the chair I had designated for her and started by saying, “Ma doula, can I do that?” and “Ma doula, I wanna help.” So I told her where to smooth out the plaster and gave her the job of holding up the gauze strips before I dipped them into the warm water to soften them. 

“Ma doula can I have a belly cast too?” I told her when she is bigger and gets a baby in her tummy she can. Then her mom said, “Baby, whats you keep callin’ her?” Moriah ignored her mom, too engrossed in smoothing out any microscopic wrinkles in the gauze as I laid in on, layer upon layer. We let it go and kept chatting about finally getting to meet her son and how stressful the time had been, especially being homeless. 

She had moved up to Minnesota from Mississippi but had not been able to get an apartment in time for the birth. She had some family and friends here so she wanted to be close to them when he arrived.
“Ma doula, how do I get this stuff off ma hands?” I directed her to gently rub them together in the bowl of warm water until it all came off.
“Ma Doula, do I get tah paint it too?”

Dakota had had enough. “Girl! Whats youz callin’ her anyway?”

Before she could answer, it dawned on Dakota. She had told her mom and sisters earlier that day on the phone and several times during the week that she was “goin’ tah see ma doula”. Moriah thought that was my name! I could hear Mary and Debby, my supervisors giggling from their offices nearby every time Moriah called me that. So now we knew. It is ma new nickname at work: Ma Doula. I suppose it could also be spelled Madoula or Ma'doula or Mahdoula.... 

Stay Tuned! This and other stories will be available in my book, Ma Doula coming out in May 2015!

Saturday, April 26, 2014

Welcome to the Land of Birth! Doulas, mothers and miracles

… where we often have little or no control, where we are wading into uncharted territory, where the rules might change at any minute, and where brave women (and not-so-brave women) have dared to go for millions of years, and succeeded. If they hadn’t we wouldn’t be here today.

My own birth journey essentially began with my first baby. The only alternative (read SANE) book out there in 1980 was the first edition of Spiritual Midwifery by Ina May Gaskin. I devoured that book. I could do this. And I did, having my almost-10 lb. Abraham in a little birthing room in a hospital before the doctor even made it. We checked out and went home 6 hours later.

I wanted to do the same thing when I became pregnant again. We knew it was twins before the doctor did. I scheduled my own ultrasound to convince him. The only way I could have them in MN in 1982 was in an operating room after being prepped for surgery. Then they would let me try to have a natural birth -- which they were terrified of.

So I called Ina May for advice, who invited me to The Farm. I moved there for the fall and had a beautiful birth which they filmed and called “Twin Vertex Birth” which by the way has been used recently in the movies “Birth Story” and also “More Business of Being Born”.

After the twin we had two more babies, three years apart. They were both unassisted home births … though I had planned to have a midwife both times but they never made it. By the time we had 5 children I had taken a few courses and began to seriously think about become a midwife. It all came together when I received a fellowship in 1988 to go back to school and received my midwifery license.

Fast forward to 2010. We had just returned to MN after living in England. I was turning 60. I did not want to work in a hospital as a midwife and be assigned two or three or more families per shift, and have to learn all of the new electronic monitoring and charting. I did not want to do the boards all over again which could take up to 2 years to prepare for, so I looked at my credentials and decided I could teach… and then I discovered the birth community here and Doulas!

This is my dream job. I don’t have to leave at shift change. I can be a grandma or a surrogate mom to a refugee family who have no one else here. I am already called Mommy in the Ethiopian immigrant community. I am honored and humbled that I can still witness birth.

There are over 30 doulas in our group at Everyday Miracles. We have classes in Somali, Spanish and English. If you haven’t already, please check out the website or better yet, come visit. Call ahead if you want to sit in on a class or follow one of us around for a day.

Yes, my scope of practice has changed. I don’t check dilation or fetal heart rates, but I get to connect with amazing mamas and support them during the most momentous event in the entire universe at that moment at their birth. I am with them as their doula when they go from being a woman to becoming a mother. I feel so blessed.

Stay Tuned! This and other stories will be available in my book, Ma Doula coming out in May 2015!

Saturday, April 19, 2014

There’s a placenta in our freezer...

There’s a placenta in our freezer and my husband doesn’t know. He would freak out and then insist I bleach the whole refrigerator and freezer and I would never hear the end of it.

One of my clients had a scheduled C-section last week. There were multiple medical problems on board, not the least being that she had bariatric surgery earlier that year, lost over 150 pounds and then got pregnant. She had one complication after another after that. She was very nauseated the entire pregnancy, had bleeding on and off into the 8th month, remained anemic and had dizziness throughout, causing her to fall several times a week.

Bariatric surgery essentially reduces the size of the stomach making it almost impossible to eat large quantities of food. There are several surgery options ranging from restricting the stomach with rubber bands or a sleeve, to stapling or sewing a part of the organ off. In this case Megan could hardly eat at all which served the purpose of losing the weight, but in the process her body became depleted of much needed nutrients. Her hair started falling out, she couldn’t maintain enough red blood cells and became dangerously anemic and by 7 months, her baby’s growth all but stopped.

The doctors considered inducing labor so that the baby could be born 6 weeks early and begin to get nutrients pumped into him via IV after birth. There were tests to see if her hormone levels were mimicking labor which would let them know that preterm labor was a possibility. She tried liquid diet supplements like Ensure which didn’t help much, even when she could keep it down. This was baby #4 so it wasn’t possible for her to rest much during the day. At night joint pain became unbearable, probably caused by the extreme anemia and vitamin deficiencies. A chiropractor was able to help a bit and had some good suggestions as far as nutrition. Megan tried yoga and meditation.

Then the day before she would hit the 39-week mark her water broke at about 3 a.m. She called me, not believing that she was capable of doing that without medical intervention. She had never been allowed to let the bag of water break spontaneously with the other 3 births. I congratulated her and for the hundredth time told her that her body really can do this and she is stronger than she thinks!
I had sent her this quote the week before:
Promise me you’ll always remember:
You are braver than you believe,
Stronger than you seem,
And smarter than you think!
~ Christopher Robin to Winnie the Pooh

I told her to let her doctor know, who in turn wanted her to come in immediately. I met her at the hospital triage wing of the labor and delivery floor. Like a mini emergency room, the nurses there can decide if a mom is in early labor and can be sent home without setting up a whole birthing suite or, if it is active labor (4 centimeters or more with contractions coming about every 5 minutes) they can have her transfer to a proper labor room, at this hospital with a large tub, birth ball, etc.

They first confirmed that the water bag had broken with a test strip. Then they Velcro-ed on the monitors in order to watch the baby’s heartbeat -- which was great -- and the rushes, or contractions – there weren’t any. We hung out and visited while her husband snored away on a lounge chair. Breakfast was served, then later lunch while we continued to flip the channels on the TV suspended in a corner of the room. Later that afternoon the official neonatal team of doctors descended on our room. They explained that they had hoped contractions would start on their own but since they had not and we were at about 12 hours out, they were hoping to talk about some options for birth. She could get Pitocin through an IV or in conjunction with a cervix softener like prostaglandin or Cervidil also called Prepidil or Dinoprostone. Or they could do a C-section, which they would suggest since she had one previously.


As a doula it wasn’t my place to push her in either direction. I had done my best at our prenatal visits to extol the obvious benefits of vaginal delivery and try to realistically enumerate the very risks of surgery, but at this point Megan was so sick and undernourished and anemic that she could not imagine summoning up the strength to endure labor. It was a catch-22. She had thought the stomach surgery would solve all of her weight issues, not knowing the havoc it could wreck on a body, much less a pregnant one. She chose the Cesarean route.


She woke up her sleeping beauty in the chair and asked him if he would want to go into the OR with her. He had not planned on that. It had never even occurred to him. It sounded overwhelming. What if he fainted? There’d be a lot of blood, right? What if he had to leave? He was working himself up to a panic attack. I got out my phone and found some photos of C-sections that I had posted on my blog. I pointed out that there is a huge drape that separates us from the actual operation. That it is bright in there but relatively quiet. That is takes only about ½ hour and that he can go over to the warmer and be with his baby and then bring him over to Megan and get to know him when he has been wrapped up. He studied the pictures and finally said he could do that.


While the nurses prepped Megan, Dad and I put on sterile ‘bunny’ suits to cover our street clothes. We donned our blue shower caps and masks and put blue booties on over our shoes. Megan walked down to the operating room with the nurses and we waited in the room until they would call us. Dad quickly fell back to sleep. He had been doing nights all these months with their other 3 children to let Megan rest and regain her health, so I didn’t grudge him these naps.


Finally we went back too and were given our posts on two little swivel chairs that had been placed by Megan’s head. She had already gotten the epidural and was excited about finally seeing this baby. They were already starting the surgery when we came in and baby was ‘born’ 15 minutes later. He came out with a loud cry – a good sign since he was so little. He weighed in at 6 pounds and 10 ounces, a miracle really considering all of the problems with this pregnancy.


Joe did really well, too. I checked in with him several times and told him he was doing great. Then I went with him over to the warmer where he reached out to his little boy who promptly grabbed his finger. Joe started sobbing, so overwhelmed with it all. The nurse wrapped baby up and Joe proudly carried his son back to his wife.


In the recovery room baby Abel latched on immediately, another miracle since I had assumed he would act more like a sleepy preemie, but he didn’t. He nursed at both breasts before falling into a peaceful sleep on Megan’s chest.


Her recovery is going well. I did a final postpartum visit with her two days later. I had suggested she ask for a belly band, or pregnancy belt which would both hold in her sagging tummy (which was profoundly out of shape after the weight loss) and help put her muscles back in place while she healed from the C-section. They had already delivered it from the hospital pharmacy before she left the hospital and she was again able to eat, though only miniscule portions. 

I also referred her to a nutritionist. I personally think they are grossly underused. Nutritionists have a wealth of information and can suggest numerous options for regaining your health. I am a vegan, though I was vegetarian throughout all of my 4 pregnancies, and when I began becoming concerned about the sugar that was showing up in my urine I worked with my midwife and a nutritionist to figure out how I could manage my diet without medications. I learned volumes from her. She never once suggested I needed to eat meat and completely understood my choices. After having 5 babies

--- one birthing suite birth, two home births and twins born on The Farm (see Twin Birth story) -- my sugars no longer seemed to be able to be tamed by my diet alone, so I went back to a nutritionist and learned how to further manage without meds. I am still insulin/Metformin-free today at 61 years old.


As a doula it is hard to work with women who apparently give up like Megan and simply opt for a C-section. I do not respect her any less, though. She is not where I am at. She may share my views someday, but she also might not. I also could not imagine how sick she felt during this pregnancy, nor how stressed and worried she must have been. My role here was to listen and show love and simply be there with her.


And when Joe first balked at the idea of bringing the placenta home, Megan patiently explained the value of encapsulating it and the benefits it could afford her. He got more grossed out by the minute and then flatly refused to carry “THAT THING” home on the bus in a red hazardous materials bag. She begged, she pleaded. Finally from across the recovery room, I offered. I knew how much it meant to her. She could collect it in a couple of weeks and I would get to see her baby again that way. We were all happy, then.

 Stay Tuned! This and other stories will be available in my book, Ma Doula coming out in May 2015!

Sunday, March 23, 2014

Welcome to the World of Doula!

How would I describe them? Not shiftless, just idealists. Anarchist perhaps. Communists? No, but maybe Socialists. Hippies … I think that could fit too. They were living in a community of sorts; four houses on one street, vegetable gardens and chicken coops in between the houses. Yes, in the city. Faded jeans and unbleached diapers always hung on the lines above the chicken coops. There were usually kids playing some game of tag, running past you at the speed of lightning.
We had gone to a few of their neighborhood cookouts and a potluck wedding once. The square block of bicycle parts that had formerly littered the drive were miraculously all put away before the wedding. I can’t crack on that wedding. It sure beats taking out a loan just to get married in a dress you’ll only wear once (like I did) and to pay for a caterer when you could have cooked much tastier food yourselves. There is something to be said for living simply: no debt, no car, no insurance, no phone bills; just hang out and find a job you like. Go dumpster diving behind all the co-ops and bakeries and grocery chains and harvest all you need for a whole week’s worth of food. Sure, the luxuries of life will be gone, but you’ll find treasures hidden in Nature and other people instead. They had a point there.

But when it came to babies, I would have drawn the line. Sure, I had mine at home, some with midwives and 2 in such a hurry three years apart that no one made it to those. But if something had gone wrong we would not have hesitated to transfer to a hospital. That’s what they are there for. And there are countries all over the world where babies and mothers die every day because they don’t have the facilities that we have. But to boycott all hospitals under all circumstances because they are part of a materialistic, consumer-based conglomerate and perpetuate our capitalistic policies, and they only enable the rich and don’t serve the poor equally, does not mean we should never, in any unforeseen eventuality set foot inside their marble halls. Except this is exactly what they had decided: to do without ‘the system’ entirely and live in the fringes at the edge of the rest of the population. So when Juliette got pregnant, they looked for specifically and found an unlicensed home birth midwife who shared their world view.

Then they asked me to be their doula. I hesitated. Did they have a plan B should they need to employ one? No. Did the midwife have any backup? No. If she needed it what would she do? “Nothing” was the answer. They were on their own there. They could show up at a hospital, according to her, but she would not come along. Oh boy. I wasn’t sure. It grew on me slowly. They rented a birthing tub for their tiny room. They ate well enough and she was gaining steadily. Then came the last straw: she told me that had high blood pressure and a congenital problem with a kidney. Holy @$#&!
I told them that I couldn’t be their doula unless they had a doctor backing them up. And she would have to do that before her 8th month. If I was going to be their doula and be her primary care provider at her home until we called her midwife, I would need to know that she had been screened and approved for a home birth. And my scope of practice as a doula would not have me doing blood pressure or sugar checks anyway. Then we would have to have a plan B, but the doctor who already knows her would be meeting us at the hospital, should we need to transfer.

I didn’t hear from them for over a week. At this point it was clear that they were obviously battling between themselves over priorities versus idealism. She understood my concern. He did not; he dug in his heels and did not want to budge. This one definitely threw a wrench between them. Their relationship had not been a committed-until-death-do-us-part arrangement and I didn’t want it to get to the point where she could actually be at risk for leaving us all together, as in some fatal complication, which was not entirely far-fetched on my part, knowing of some of the medical issues. I know I didn’t trust enough that Nature knew how to birth this baby, and I had perhaps lost sight of the midwifery model of care favoring instead our allopathic brand, but….

Juliette called me the following week. She had been to a regular ‘establishment’ doctor whom she said cleared her for a home birth. Great! Her blood pressure and sugars were within normal range, so they were delighted with this and wanted to proceed with their original plan, but then as another week unfolded things changed. Drastically. She was sick and not having much luck getting back on track. She went back to the doctor and as she edged nearer her 8th month, was put on several medications and a restricted diet in the hope of stabilizing both the kidney function and blood pressure. In spite of the ominous recent chain of events, her midwife told them it was still the better choice to have their baby at home. Really?

They had scraped together the midwife’s fee by begging and borrowing from family and friends and selling an old car he had fixed up. She was officially hired. I, on the other hand knew that they didn’t have any savings and offered to barter. Pierre, an accomplished carpenter could suggest something he could build for us in exchange for my doula services. Everyone was happy.
About 6 weeks before her guess or due date, Juliette called me saying she was having horrible head aches and feeling really crummy. I insisted she return to the doctor and get it checked out before it got any worse. It could have come from stress, she admitted. Her partner was nowhere ready to have this baby. He wouldn’t pack up his tools or the mountains of junk that covered the floor of their tiny room in the house. The birthing tub had to somehow fit in there. And she had expressed the wish that they move their mattress onto the floor in the main room from its place in the loft where it stood on a platform up on stilts. It was stuffy in there and too high to climb up and down with a baby. But he was not moving to help with any of this. Juliette blamed herself for being so picky and cranky, but they weren’t really as together as she had hoped they would be, especially with a baby on the way. I could only encourage her to keep the lines of communication open with him and that in the end she had to do what was right for her and her little one, even if he didn’t agree.

The report from the doctor was not good. He strongly recommended that she check into the hospital that same day and be induced. Her overall numbers were not good. Her kidneys were being taxed and the blood pressure was too high. He felt that her health could still recover after the delivery, though she was getting into hot water already and waiting would not guarantee that she might not come out of this without some permanent damage, and the baby’s health would only be compromised and at risk if she didn’t deliver soon with these new developments.

Negotiations with their midwife went back and forth all that day. She was willing to help them should they choose to stay at home, but I made it very clear that I could no longer be part of it then, and she countered that her job description didn’t include being with them throughout the whole labor, that was why she had recommended they find a doula, even though they had paid her several thousand dollars. I told them that the hospitals are there precisely for these kinds of situations and that I felt the doctor was on their side, committed to having a healthy baby and a healthy mother in the end. The battle had begun.

So the cards were blatantly stacked against them. Her health might not recover if she didn’t deliver the baby soon and may even become permanently damaged, putting her at grave risk. I pointed out that her baby needed a mom and that although we would like to have control over our health and our births this is not always the case. Welcome to parenthood. I could not tell her what to do, but I could encourage her to think on her own, without Pierre going on and on about corporate greed and disregard for the poor and multi-billion dollar facilities. He just didn’t get it that her life was creeping closer and closer to a point of no return at this rate, her numbers were now that bad. I had never had a mother this sick in my 30 years of midwifery practice, partly because high risk births were screened out through my protocols and I would have been required to transfer care weeks ago in her case.
I told them to call me if I could do anything for them and let go. I had not been this frustrated in a very long time. I said a prayer and made supper. Later that evening she called to tell me that she had decided to go to the hospital and asked if I would be able to meet them there. I said I would be glad to.
I explained what induction meant and how that might be attempted 5 weeks before a due date. She had written a birth plan and we had talked about the numerous options that she had for a home birth, but then tailored that for a hospital birth. Now we had to add induction and what she could agree with and what she did not want to try. Her choice was to have her baby as naturally as possible with as little intervention as possible. I outlined the various options the doctor has for induction, explaining that some were more invasive than other interventions and that she would have time to ask questions and could ask for privacy to decide what she wanted to do. Once she was settled in her room the doctor suggested a plan to start up labor by using a ripening agent placed at the cervix that would help get things started. Then they could start a small amount of Pitocin by morning and get her into active labor. Sometimes these will work quite well but occasionally they don’t do much at all and then the doctor will suggest the next trick up his or her sleeve. So the couple asked for some time to discuss this privately. We all left and I went down to the coffee shop to get a drink.

They called me on my cell phone shortly after that to tell me that they had called their midwife for advice and she had warned them about what not to let the hospital do to her under any circumstance and suggested some alternatives to try. I did not realize she was still in the picture and found this rather bold for her to be making decisions from some undisclosed location. So the night started off with a bang. They agreed instead to a non-medicated approach and opted for a balloon catheter to be placed that would stretch the cervix open and hopefully trigger labor on its own.
By morning it had succeeded in getting the cervix to dilate slightly but not appreciably. The next suggestion was to try Pitocin and then perhaps breaking her water if the baby’s head came down further. Again the couple asked us to leave and talked it over, and as I suspected, again called the midwife who told them not to let them break the water under any circumstance. I had never seen anything like this. I did not understand their trust or devotion toward this woman. I was mystified by it. I knew I was considered a close friend, but somehow by my being a licensed midwife and certified doula, I had gone over somehow to the ‘other side’ and was deemed too medical or too swayed by ‘the system’ to be consulted on how to stay on the natural side of things, is all I can guess.

The nurses soon got the hang of how to approach this couple. Each step would require consultation, then consideration in private, then double checking what I thought (but only after the other midwife was called) and then the nurses and/or doctor could come back in and negotiations would resume. I was beginning to feel like an international conflict-mediation envoy deliberating the politics of civil unrest. Many of the suggestions only met with rejection as being too invasive or they simply felt that things were being unjustly and routinely rushed and asked for a few more hours of walking or sitting on the birth ball to let things work. I took to listing options for them from least to most invasive, knowing they would veto any and all suggestions unless the guru midwife approved of it. The nurses started asking me to ask them thus and such – hoping I had more say because they realized they did not have in fact any at all. My only objection to their midwife was that she was simply calling the shots in a realm that I felt was now outside of her sphere of skill or experience. 

I do not go to a birth at home or in a hospital ready to do battle. I sincerely feel honored to be welcomed onto a birth team and readily defer first to Mom and her wishes and then follow her midwife’s lead. But this tug-of-war went on all night and all the next day. By evening I was called out to the nurses’ station and given an overview of the bigger picture. Baby was still doing remarkably well. Mom was OK, blood pressure and other numbers not off the charts yet. But it was time for baby to be born. I asked what options they would propose next and breaking her water was the least ‘medical’ in their eyes and might speed labor up appreciably. I went back in and sat down, slowly rubbing her feet as I balanced on a birth ball at the foot of her bed. They were not agreed between themselves what to do next. I told them that they were doing great, that baby was sounding really good and that she was actually making progress, which is not the same at an induction as it is in a term birth. I proposed I go home and sleep and that they try to rest, even if it was only dozing between the rushes or contractions. She was able to eat and drink and was doing OK there. She had refused all IVs and meds up until this point. I knew they would continue to call their midwife whether I was there or not, and was frankly at my wits’ end at 48 hours. I hugged them each good bye, assuring them I would be back within 15 minutes if they wanted me.

I walked the short 6 blocks home. I was so tired and drained that I just showered and cried until I got into bed. I did not ‘get’ this. 
I had a call a week earlier from a birthing clinic asking if I could consult on a breastfeeding problem they were seeing. The couple was from the same tribe as my laboring mom and dad were. They were vegans. Fine. I was too during my twin’s pregnancy and birth and since then. That was not the problem. The issue was that he thought she should be able to skip drinking altogether until they could find a 100% pure reverse-osmosis water source and that they could get along just fine with just raw foods they would ‘harvest’ from around the city. It quickly became obvious that he was dictating or controlling everything she put into her mouth! It turned out she had not eaten that day and possibly the day before. She was very thin and very pale, had not taken vitamins and as soon as I started prying a little further, she simply looked at him. He then tried to assure me that he had studied nutrition and that we should respect their choices. Their midwife, who had called me, felt that the baby was getting dehydrated and loosing precious ounces that he should have been gaining by now. The father would not let us visit with her unless he was in the room. We both spoke to them rather firmly, hoping to wake him up a bit. She had already given up any autonomy she may have possessed, though I doubt she ever had any, at least since she met him. When I called the next day to see how they were the phone had been disconnected. The midwife went out to their house and was told by the landlady that they had moved out that morning. They were gone. Vanished.

I slept in and called the hospital once I was awake. The nurse told me that they had just had a healthy 8 pound girl. The midwife came in after she heard I had left, though they were instructed to say she was just a supportive friend. She helped them try different positions that helped baby along, which they were very glad for. Later that evening I called the couple and asked if I could visit. I congratulated them and told them how glad I was that they had been able to have the natural birth they wanted. She was nursing which her baby took to right away. She was still 5 weeks early but was doing really well and did not have to go to the ICU. I was so glad all the drama was over.

I got a call from another woman who was living in their communal house two days later. She explained to me that public health nurse had come by to make sure the baby was doing well. She looked at the baby and voiced some concern about his color and that he seemed to look jaundiced to her and also that his skin appeared dehydrated. They had read all of the natural birth books
and said they had chosen to nurse on demand,meaning only when he awoke or fussed and asked for it. They had thrown out the doctor’s program for preemies in which he insisted upon waking the baby to eat every two to three hours at the most until she reached the due date. He had explained that their baby may act very sleepy and need to be fed to catch up, whether she appeared interested or not. But they thought the doctor was just going into some routine medical jargon and that they thought ‘nursing on demand’ sounded more natural. Never mind that the baby came 5 weeks early! Or that she was sleeping up to 6 hour stretches and did not cry. The nurse took a blood sample and explained that they needed to know what the bilirubin numbers were and she would call back later that same day after she got the results from the clinic. They added her to their list of ‘establishment’ care providers, turned off their cell phones and went back to sleep.

Their baby did have seriously high readings for jaundice and she was in the danger zone for being dehydrated. When the nurse called both numbers over and over and they didn’t answer she did what she felt she had to do. She called Child Protection and explained her concerns which were bordering on dire at this point. They had to re-hydrate this baby now and get her under lights right away.
So a police car and an ambulance pulled up in front of the commune and I get a call explaining all this. I had told them I was a lactation consultant/educator and would gladly give them any help they needed 24-7 and they knew I wasn’t charging them, so why didn’t they even ask? Later that night I went to the hospital and sat with Juliette for a while. She was nursing her baby and had moved into the NICU. The hospital gave her a room with a real bed so she could stay right there. She told me that they just assumed newborns sleep a lot. They thought she would let them know if she was hungry. I explained again that she is premature, that the rules all change at this point. She said, sounding surprised, “Oh. That is what the doctor keeps telling us, too!” She was still pretty shaken up by the whole experience. It didn’t help that she had not slept since labor started, going on day 4 now. She also told me she had decided to stay in the hospital this time until everything was taken care of and they understood what they needed to do, even if her partner didn’t agree with this. 

I still see them from time to time. Luna looks too big for her little mama to be carrying her around anymore. She is very sturdy and has gained beautifully. Juliette is feeling well and taking care of herself. It was another example I could chock up to education. I don’t know what I could have done differently. I am just very, very grateful everyone is OK now.

As a doula I think back to experiences like this one and wonder if I could have done anything differently. I think not. I wanted to respect them even when our values differed and I wanted to advocate as much as possible for what her wishes were. I did not feel at any time that it was my place to act as marriage counsellor either. These were two adults whose ideas were different from mine, which did not make mine better or more valid. I come away from experiences like these convinced we must above all respect each woman we work with and allow that their point of view may not be our own. But I have also learned that I must have my own boundaries and equally respect those. Welcome to the world of doula!

STAY TUNED! This and other stories will be appearing soon in the book Call The Doula! a diary© - by Stephanie Sorensen