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!

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