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!