Monday, February 10, 2014

China: Can I keep her forever and always?

This is a love story.
I never thought we would ‘click’ at all. Everything was wrong from our first appointment. China complained about how awful pregnancy was. (I would give anything to have just one more baby. I loved being pregnant!) She accused her baby of hating her -- why else would he kick her so much? She told me she was having this baby with the wrong man. She confided that he was a loser and she hated him, he couldn’t even find them decent housing. They were homeless and camping out at his sister’s house. Then after the tour that OB patients were offered she called to tell me that the hospital was all wrong. She could not, would not bring her baby into the world in such a depressing place. I had to find her a better hospital. Why, they didn’t even have pictures in the rooms! I thought to myself, ‘sweetheart you’re not gonna care what is on the walls when the time comes.’ If she blames her baby for her discomfort now, what will labor look like? And she says she wants a natural birth.
I called my supervisor at this point asking for some wisdom. Was I the right doula for this client? Would she be happier with someone younger? Debby told me she wouldn’t choose United Hospital either. It is depressing. OK. I’ll keep her.
I started going to her prenatal visits with China. I needed to get to know her better. I gave her the phone numbers for some of the birthing centers throughout the city. She visited one that is absolutely gorgeous, but they were not a non-profit and subsidized their medical assistance payments from low income families by charging an additional $300. in cash up front. She is homeless, for goodness sake! How can they do that? Is that even legal? I told her I would find a place for her.
So I called some of the other birth centers and found out that most did not take transfer clients after their 34th week. I knew I could probably get her into the midwife program at the local public hospital, but imagined she would be turned off by their ‘public’ image. It is often seriously over crowded, usually very loud, with standing room only in the emergency waiting room no matter what time of day or night it is. I called them and asked for the labor and delivery charge nurse. I explained who I was and what I was hoping to do for China. She explained that it was too late to transfer, but she actually knew who I was from some of the births I had been to there, and asked me if I would hold while she checked with the floor supervisor. She came back on the line and told me that if I could get her to the clinic the next day they would take her. I asked if I could also tour labor and delivery with her and silently hoped that their ‘better’ rooms would be unoccupied so she could see them.
The next hurdle was getting her there. Medical assistance will provide a taxi for medical appointments but only if you schedule it two days in advance. I don’t drive so I was trying to figure out how to get her there in the morning. Her boyfriend’s sister’s where they were staying was out in the suburbs, where the buses only run once an hour. It has been below zero here all week, with the wind chill factors down in the minus 30s. Really! Buses were out. So I called medical assistance’s transportation number and told them that one of my clients had to get special emergency clearance to get next-day rides from here on out until she delivers. They actually approved her if I would arrange the rides for her. Great! It worked!
The next day we were called and roomed in a tiny cubicle to wait for the midwife. China must have gotten out on the wrong side of the bed that morning because the first thing she did when the midwife came in was demand that she be induced! She said she was sick of being pregnant and miserable, can’t eat, can’t sleep, her baby hates her and kicks her on purpose, and that she will only stay if they will get this delivery rolling. Like today! The midwife listened and skirting the issue completely asked if she would kindly jump up on the table so we can hear her baby. The midwife and I both gushed about how wonderfully strong her baby’s heartbeat was when the Doppler was turned on. China just kept griping. I had had enough so I said to her, “you know, I have had ladies in the past year whose babies couldn’t move like yours can. I even had one baby who was born with half a heart! (See the story Emma Hope.) You have a really healthy baby, and I am really looking forward to seeing him, too!” The midwife was nodding her agreement the whole time.
We finished with the appointment and the midwife explained that it was not their policy to induce labor without a good medical reason, like when the mother has pre-eclampsia or diabetes. China grouched a bit more but realized the two of us were not going to be moved on this one.
We went on a walk through the midwives’ labor and delivery side of the hospital wing then, starting with a huge open room, almost a suite, with birthing tub, private bathroom, little refrigerator and yes – there were even pictures on the walls. We saw two more rooms, decorated sparsely but pretty. They passed her royal highness’ inspection. Whew! I thanked the midwife profusely and we went down to the front of the hospital to wait for the return taxi.
Talk about an attitude! Maybe she was feeling so very helpless being homeless and without support that she had decided to demand her rights in the littlest things that perhaps she could have control over. She was 23 but it was like she was going on 12! Then it dawned on me, I would gain her confidence with love. The expression, ‘Kill them with kindness’ came to mind. I would lay it on so thick she wouldn’t know what had hit her. I would smother her with kindness. I couldn’t image how else we would be able to work together through this birth. I knew that she didn’t have a clue how hard it was going to be. And I didn’t want to see her fall apart before she even got into active labor and had to actually work to birth her baby.
My supervisor had suggested I bring China a book from our library called, “Bonding With Your Baby Prenatally” which I had brought along. I gave it to her as I hugged her goodbye that morning. It was almost Christmas.
The following week I collected all sorts of baby clothes and wrapped up a beautiful scarf a friend had just gifted me with. I already had 4 others so I thought it was just the right thing to give her. My old heroine Dorothy Day said that “the extra coat hanging in your closet actually belongs to the poor.” I decided this must apply to scarves too.
(See: http://www.catholicworker.org/dorothyday/daytext.cfm?TextID=150) I have never been very good at hanging onto things that people have given me. My own mother had become furious with me years ago and finally asked me before my birthday one year, “If I give you a gift, will you give it away because I will never buy anything for you again if you do.” I confessed that I could not promise her that.
The next week I was given some donations to give to some of my mothers, so I started another ‘care package’ for China. She was charmed, to say the least. And we even got along well enough to talk about a birth plan and her wishes. This was better, but when I asked at this point if she wanted the boyfriend in the room at all, or what was she thinking she said, “He is gonna be there the whole time and see what he did to me!” Oh dear, not a good reason to add him to the birth plan.
Another week and she called me and we were back to her demanding induction. I very calmly explained that she was only at 36 weeks and that I would find it really sad if her baby couldn’t go home with her after she had him and had to stay in an NICU. I told her all that happens in the next couple of weeks to ensure that he is really healthy, and that his lungs might need extra help at this point should he come out now. She backed down. I told her to call me anytime and stay in touch.
A Korean graduate student in my apartment building was moving out about this time and asked if I could find takers if she gave me any nice but used clothes. China was just as petite as Song. I looked in the box when I got it back to my place. I never would have been able to afford the cute sweaters and dresses, even designer lingerie! It was a huge success. I had found China’s weak spot! And we were buddies – at last.
One evening in her 38th week she called to ask if she might have lost her mucus plug and described what she was seeing. I agreed that it sounded like it and congratulated her! It brought back memories from when my own kids first pooped on the toilet and I would clap and enthusiastically praise them for their accomplishments. I cautioned her that though her body
knew exactly what to do and would certainly kick into gear on his exact birthday (that of course only he knows), that this could still be several more days and that she should just keep doing whatever she had been doing, resting, eating, watching movies and walking.
Two days later she called screaming that she couldn’t sleep all night and she couldn’t do this anymore, and that her back was killing her and she was nauseated, etc., etc. I was quite excited that this might be early labor. I was really looking forward to meeting this baby. I told her to eat and rest and call me if things changed or she gets regular contractions. I also told her to call the hospital and let the midwives know and that they might want her to come in to check her. I hung up and went back to our supper. By the time we were washing up the dishes a very hysterical China called to say she had been on the phone with her grandma when her water broke. What should she do? I suggested she call the hospital and let me know what they say. I knew they would want her to come in, but that isn’t my call as a doula. I made her promise
to let me know. YA-HOO! We were going to have a baby! I realized then how much I really cared about China. She was the same age as my own daughter. I really wanted to see her succeed, to be a good mom and get her life back on track. It wasn’t until I stopped judging her and started listening that I realized how very hard she really had it: parents on drugs, foster homes, you name it. I had to hand it to her though. She told you what was on her mind and she wasn’t bashful about letting you know how she felt that day. There was no guesswork at all, you got the whole story whether you wanted it or not.
“However much we know about birth in general, we know nothing about a particular birth. We must let it unfold with its own uniqueness.” ~ Elizabeth Nobel
Almost 2 centimeters, 95% effaced, contractions picking up. This was it. The midwife confirmed that her water had broken. China wanted to rest for a bit so she lay down and closed her eyes. All of a sudden she rang the nurse’s button and sat up. The nurse came in and China announced that this wasn’t the room she had seen on the tour of the unit the week before. That room was pink. This one was an ugly tan. I tried to ignore this comment, but she wasn’t going to let it go. She dug in her heels. She threw on a robe and said she wanted to check out all the other available rooms. The midwife took a deep breath (and I think she hinted by the look she threw my way, ‘what have you dumped on us?’) and said, “OK” and led the way.
We walked into each of the other 6 rooms on the hallway and then back tracked through each
one of them once again, China leading the way and all of us in tow. She settled on a pink room and ordered us all to go get all her stuff and bring it in. The rest of the afternoon and evening was uneventful. She was dilating at about 1 centimeter every 2 hours and baby sounded great. It was slow, but not unusual for a first baby. By 4 centimeters China asked the nurse about getting something for pain. The nurse reviewed all of her options and China chose a low dose of an IV drug to take the edge off but not make it impossible to get up or get into the tub. In the end it hardly worked at all and wore off before an hour was up. It also affected the baby and his heart rate flattened out to a low 100 to 110 beats per minute, which isn’t all that great. When
China asked for more, the nurse suggested an epidural, but she really didn’t want that if she could possibly avoid it. I backed her up and pointed out that the baby didn’t do too well with the first drug and that I wasn’t encouraging her to get more. I suggested she try the tub at this point, got her a cup cranberry juice and filled the tub. She really liked that. I had been telling her that being flat in bed was not the best position to labor in. She found a real rhythm then on her own. I was actually surprised and told her how well she was tuning into her body all of a sudden and finding a way with each rush as they rolled in on her. Penny Simkin, eminent author and doula talks about the 3 Rs: relaxation, rhythm and ritual during labor but I had never seen someone find that on her own in exactly this way. It happened when I was breathing with her during a rush and her head bent down and leaned forward and rested on my knees and I automatically ran my fingers through her hair from the back of her neck and then gently pulled her hair back toward me. We did it a few more times and I asked if that helped at one point and she just purred, ‘uh huhhhhh.’ So we kept doing it. She changed position after a while and with each rush ran her own hands down her neck, and rocked gently forward until it passed. For the rest of the labor she found some rhythm to add to the breathing which I found fascinating. She had tuned into some inner strength that I had not seen before and just went with it. Penny explains (See http://www.youtube.com/watch?v=Mo4VmgpHmxs) that from observing hundreds of women in labor she learned that those who were able to cope best found these 3 Rs and used them in their own ways. 
Then, in walks the grand matriarch of the clan: Grandmama! … in flowing black and purple layers of some kind of robe and antique silver earrings, spotted leopard hat to top it all off. Regal is a modest description. She blew me away! (Sorry, but I could not find a picture befitting this lady!) As she glided into the room she set out bags of goodies for all of us. She had thought of everything: granola bars, bottled spring water, snacks, and cookies. Then she looked over at China and beamed, “You are so beautiful! You are a goddess! You are doing this sooooo well!” She proceeded to unpack a huge bag and laid out baby blankets, baby clothes, baby socks, baby shoes, all brand new and all blue! Then she turned once again to China and said, “You can’t have any more kids ‘cause this all broke the bank!”
With the next contraction the Dowager Empress stood by the bed and breathed with China. Then she brushed her hair and massaged her neck. I was still sitting there in awe. And all this loving on China really got things going. Soon she was saying she couldn’t do it anymore and needed an epidural NOW! and I knew we were at least 9 if not at 10 centimeters. I explained that this is transition and it is the end of the very longest part of labor, that she was doing so so SOOO well and that we will help her with each rush until she can push. I said she should rest now in the few minutes in between which she did. She trusted me by now and we were a finally a really great team. I let Grandmama coach her all she wanted and hung back a bit. This lady was truly stellar!
China tried a hands and knees position and then went back to sitting up cross legged. I asked the midwife if they had a squatting bar, thinking that it might be just the right thing, and it was. China leaned into it, threw off her hospital nightgown and pushed! Two more pushes and she screamed. The midwife assured her she was doing it perfectly and was feeling the baby’s head at this point. I tried to help her reach down to feel the baby’s head crowning but she shook my hand away, grabbed the bar once again and pushed her baby out onto the bed. Still squatting she picked him up and held him to her chest. He gurggled a tiny cry and then let loose! He was tiny -- perhaps all of 6 pounds but sure had a huge set of lungs. We helped her back down to the bed where she could lay back on the pillows as I piled them up behind her. She studied her beautiful little baby as he blinked back at her and then said, “I love you so much!”
We let him do the breast crawl and latch on his own when he was ready. He was on within 20 minutes! (See: https://www.youtube.com/watch?v=pjDQN9keKQk)
The next day I visited China one last time. After this I had no reason to visit with her as a doula. I have paperwork to turn in and can then ask for more client referrals.
One of the forms we have is a survey for the moms to fill out rating the usefulness of the doula program from their point of view. There are questions like, ‘Were the techniques suggested by the doula helpful to the mother in handling the physical aspects of her labor?’
So the next day at my last visit, I sat and held little Baby Boy (who didn’t have a name yet) while China filled out the evaluation form for me. When she was finished I took it and stuffed it right away in with the other papers in my bag and hugged her goodbye. I whispered in her ear, “You know, my love, now you can do anything!” She looked me straight in the eye and answered “Yeah, I can do anything!”
When I got home I had supper and pulled out the paperwork so I could finish it up and send it in the mail the next day. As I was stapling the papers, I read the evaluation page. I noticed that China had written a number 10 after the 5 and circled it for her answer to #4. Then I read her comment at the end of the form. She had written, “I love my doula. Can I keep her forever and always?” I cried.

Don't miss the movie, Gimme Shelter  See: http://www.youtube.com/watch?v=tjyi_dMhyIs

Stay tuned! This and other stories will be included in the forthcoming book, Call The Doula! a diary© 2014 by Stephanie Sorensen.



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