Friday, January 3, 2014

Doulas and Dads - the first post of 2014

Last night I watched the British PBS TV series’ 2013 Holiday Special “Call The Midwife!”* At one point we see the drama being played out between one young couple as the mother goes into labor while our dad-to-be is suffering symptoms of what was referred to back then as ‘shell-shock’ which we now recognize as PTSD after his stint in the Korean War. As soon as their baby girl is born, the wise midwife hands the baby not to the mother, but to the father. He sees blood, one of the ‘triggers’ that has been setting him off since the war, but this time it is “good blood” as the midwife tells him. He is healed as he holds his tiny miracle. His wife has been through the worst with him and now he is no longer the victim and not only supports her but shares this amazing gift of life with her. It is a very moving moment. (Below: your doula says, "Please remove your shirt, your Highness")
It struck me as quite a coincidence as I watched it since I had been thinking very much about two recent births I had attended as a doula in the past 3 weeks. Under two very different circumstances both mothers were not able to hold their newborns immediately after birth and their babies, in both cases had been brought and left alone on warmers at the other end of the room. Only a month ago I had the privilege of meeting and spending time with Dr. Nils Bergman, a researcher from South Africa, at a summit in Minneapolis. He speaks all over the world about his findings concerning skin-to-skin contact, especially the benefits to premature infants. He goes so far as to say that preemies will actually do better if ‘kangaroo care’ is introduced immediately at birth and we do away with incubators all together. My own research into bonding or maternal-infant-maternal** attachment (see my book Stone Age Babies in a Space Age World: Babies and Bonding in the 21st Century© – publication pending) also points to Zero Separation at all births and is now being scientifically confirmed by Dr. Bergman’s studies and others.***
In the first of these two births a couple from Spain who are living in Minneapolis asked me to be there doula toward the end of their pregnancy. We were able to squeeze in two visits before her labor began. It was their first birth. The mom had been dealing with multiple chronic health issues and was quite successful in controlling many of them with natural methods. They had really done their homework and were determined to have a natural birth. We put together a birth plan listing all of their wishes and all of the things they hoped to avoid, though they were very realistic about the possibility of interventions in their case in particular.
They called in the middle of a snowstorm a week later. I met them at the hospital as the nurse was hooking up a monitor on her belly. Baby sounded fine. We had been put into a triage room. This particular hospital felt that so very many couples were coming to the hospital far too early and were being sent home to labor until contractions were closer to 5 minutes apart which would ensure that they were indeed in active labor. This way only the exam rooms would need to be ‘broken down’ and sanitized and not an entire birthing suite had they been immediately roomed there. So her midwife was called and luckily she was in the hospital and walked right over to check the mom’s dilation. We were breathing through each contraction which were very regular. I thought Conchetta was handling this stage very well and expected to hear she was two, or maybe 3 or 4 centimeters along at this point, being a first baby. When the midwife announced that she was 8 already and, all in one breath indicated that we were moving into a regular room, like IMMEDIATELY, I was surprised. This lady should have written the book about dealing with first stage labor!
With a flock of nurses now setting up the room and the midwife gowning up I continued to breathe with Conchetta. With the next contraction she instinctively pushed for all she was worth. I knew she didn’t need to be checked again, but the midwife wanted to be sure she was fully dilated, which of course she was. Two more mega pushes and the head was born. Another contraction and their beautiful baby girl slid out followed by a rather impressive river of blood. It looked like a lot to me, so I waited to see how I should help and back up the midwife’s next move. The nurses also saw that there would be something other than the regular plop-baby-on-mom’s-tummy program happening next and brought the baby to the warmer after hastily clamping the mother’s end of the cord and cutting baby loose.
The dad had never seen a birth so he thought this was all very normal and routine. He would be OK for a few minutes I figured, so I went over to the warmer. Their baby was doing beautifully with a #10 Apgar score and the midwife was talking to Conchetta while the nurses were hooking up an IV with Pitocin and fluids. I was mainly concerned that baby not be left alone. Especially after my own work on bonding and the summit by Dr. Bergman I was completely convinced that babies are born fully expecting a continuum of contact and that there should be Zero Separation from now on. Not only are human babies fully hard-wired with this expectation, but they will not thrive unless this is provided. We are the only mammals that consciously defy Nature and dress and take our baby mammals away from their maternal environment at birth. The consequences are dire. Researchers are now even going so far as to suggest that many if not all of the multitude of developmental disorders that are mysteriously proliferating in our century in spite of all our advanced science and medical knowledge may very well be caused by this unnecessary separation. And I would posit even further that we are looking at what is called iotrogenic disease which is now resulting in a doctor-induced diseased generation.   
I thought now, “What do we do with baby?” No one was paying much attention to her at this point. All of the drama was across the room while everyone was trying to figure out where this hemorrhage was coming from. So I loosely wrapped up baby, replacing her soggy little hat with a dry one while I talked to her. I held her close and went and got her Dad where he was still standing at the head of the bed by his wife. The midwife was trying to sound calm and reassuring as she explained to them that she was poking around down there trying to find the source of this bleeding. I walked back to the other side of the room with Dad and motioned for him to sit down in the rocking chair by the warmer. I suggested he take his shirt off and keep his baby nice and warm and skin-to-skin until Conchetta could get her back. He did what I asked immediately. I find that dads are especially compliant at this stage and will do absolutely anything I ask them to. I could have just said, “strip” and he would have, I am sure! 
His baby girl had already started blowing bubbles and rooting around while I picked her up. I told him she already knew him and his voice and was smelling him as she got to know him. The look on his face said it all. He was smitten. As she cuddled into his chest I could tell he had probably never held an infant. Then she started throwing her head back and wiggling. I told him just to hold her as I wrapped them both in blankets. When she reached the point where her head was cradled in the crook of his arm and her cheek was touching his furry chest, she stuck out her tongue and started licking his nipple! I giggled, but Dad looked up at me with tears in his eyes. He completely melted. I just repeated to him that she knows him and needs to stay with her parents. In the meantime, the room had now filled up with a couple of OB doctors and additional nurses. 
They had found the source of the bleed. Its apex was behind the cervix in the posterior or back vaginal wall that rides above the rectum. One of the medical issues that Conchetta had been dealing with was a problem with the clotting factor in her blood. Because her baby had descended down the birth canal so very quickly, where most women would have stretched slowly as the baby’s head molded, her ‘friable’ tissues had simply parted and broke open. This was about the worst 4th degree tear I had ever seen. They were tying off the bleeding veins and soon had the situation under control.
Time passes outside of our usual frame of reference during emergencies. It had only been 20 minutes or so but felt like hours from my corner of the room. Dad did not really have an inkling of what was going on and I was glad I could reassure him and get him and baby away from the electric vibes on the other side of the room and actually create a safe or sacred space for his baby during this time. I kept wondering what my friend Nils Bergman or his ‘kangaroola’ wife Jill would have done in my place.
Within an hour we were able to get baby onto her mother’s chest where she immediately raised her head and latched on the first try without any direction from us. I visited this couple the next day in the hospital and the day after that at home and both times found the Enrik√© still holding his baby with his shirt off. I doubt very much he had put her down at all in the interim. I marveled that this was indeed continuum bonding as I had rarely seen it since becoming a doula. How could I do this more? How could this affect father-baby bonding especially? I did not have long to wait to find out.
A week later I was at a birth at a different hospital with a couple who were living in one of the highest crime-ridden neighborhoods in the city. You can automatically add on social and economic poverty to the list of things this family was dealing with. It was this mom’s third baby, though it was his first. He was clueless. But it was his baby and he was going to give it a shot. Unfortunately, the African American community continues to struggle with the highest rates of absentee fathers in the nation. According to 2011 U.S. Census Bureau data over 24 million children live apart from their biological fathers. That is 1 out of every 3 (33%) children in America. Nearly 2 in 3 (64%) African American children live in father-absent homes. One in three (34%) Hispanic children, and 1 in 4 (25%) white children live in father-absent homes. In 1960, only 11% of children lived in father-absent homes.
Children who live absent their biological fathers are, on average, at least two to three times more likely to be poor, to use drugs, to experience educational, health, emotional and behavioral problems, to be victims of child abuse, and to engage in criminal behavior than their peers who live with their married, biological (or adoptive) parents.
I knew all this already, but wondered if there wasn’t a possibility of perhaps connecting some of the dots here by finding a way for dads, especially ones who didn’t have a mutual agreement of commitment yet in place, as in being married to the mother of their child, and if by better, earlier bonding these statistics might be reversed. While I was busy pondering this, I was referred to this particular family.
I was able to meet with Sh’neice four times in the weeks before her guess date, (formerly called the due date.) I collected baby clothes from friends for her and made sure she was connected to WIC and any other services that they could use. She was taking very good care of herself and her other kids and we had enjoyed getting to know each other. 
I went to her last prenatal clinic visit with her at her request. She had hoped to have a chance to have a VBAC but her OB wasn’t budging. In the end the doctor convinced her that after 2 C-sections already, this was the best choice for her. At this point as a doula this is not my call. As much as I would love to support her having a VBAC, it would only undermine her physician’s relationship with her, and also be outside of my current scope of practice. I bit my tongue. Hard.
I met her at the hospital on the appointed day at 7 a.m. When she was finally wheeled down to the OR at 11:00 her boyfriend and I put on our scrubs that the nurse had handed us. They wanted us to wait while they did the epidural and prepped her for surgery. Then someone would come and get us. He looked at himself in the mirror and I could just barely hear under his breath, “I will not faint… I will not faint.…” I then realized that this was his first-ever birth. Was there any way I could involve him and have him feel intimately a part of this birth? It was easy when a dad is at an all-night birth and I can have him rubbing her back, fetching juices, wiping her face with cold rags and walking the halls for hours on end, but this was all going according to protocol and I didn’t know what I could do to fit him into this picture. I did all the usual things I did at C-sections like having him take pictures as his baby is brought to the warmer and hold his baby’s hand or foot as they assess her. I also direct him when he is finally holding his baby back to mom and help her also hold her baby. Sh’neice was still quite uncomfortable and the doctors had a lot to do to repair not only this incision but also deal with extensive scar tissue from 2 previous Cesareans, so she was not ready to hold her baby when he did return. 
Dad was happy to just sit there holding his fat bundle where she could see him. I checked in with him periodically to make sure he was OK. He did really well, which I made sure to let him know I thought. It was finally time to move into the recovery room so we all followed the bed out of the OR and down the hall, Dad proudly carrying his very own baby now. As soon as we got there Sh’neice began vomiting, which is not all that unusual after surgery. She still was not ready to hold her baby and I didn’t think I should push her at this point but rather thought to let her take her time to recover.
I looked over at Dad standing aside nearby rocking from side to side with his little bundle in his arms. He was oblivious to the rest of the world. “Good” I thought. But then it occurred to me that we could even improve on this. I pushed over a glider-rocker that was in the room and offering to take baby suggested he take off his shirt and hold her skin to skin to keep her warm. Of course I have him under my spell by now, and he will gladly do whatever I request! As he sat down I handed him his baby and helped him unwrap her, too. I wrapped them both back up then with a warm flannel blanket. The next time Sh’neice looked over to see where they were, she saw him talking to his baby who was now looking up into his eyes. She had not tried to open them in the OR with all the bright lights in there. I thought to myself, “This is right. Only this baby can change this big dude with all his huge tight abs and fly swagger. Only this baby can turn him into a real father.”
I am definitely going to keep this in mind for my next births. I think we are on to something very significant here. Stay tuned!
This and other stories will be appearing in my forthcoming book, Call The Doula! a diary© pending publication.

More pictures of daddies with newborns at Google Images.

*a true story re-enactment of a diary written by a novice midwife sent to the notorious East End of London to practice in the 1950s.
**I now insist on using the term ‘maternal-infant-maternal’ attachment, instead of the former, ‘maternal-infant attachment’ to exemplify the fact that the infant is also displaying cues and instincts that he expects will be reciprocated, despite the persistent thinking by some doctors even into the 21st Century that bonding is only ‘one-way’ or that the majority of bonding is from mother to baby if not exclusively initiated by her. Dr. Bergman and many other researchers are now proving unequivocally it is indeed otherwise.
***See: http://www.skintoskincontact.com/dr-bergman.aspx for Dr. Bergman’s mission statement.