Monday, January 5, 2015

Guinea Pigs and Doulas

We received a request at work from an instructor at one of the local colleges requesting a volunteer doula who would be willing to act as a laboring woman during several nursing courses covering birth and delivery and the nurse’s role. Of course I was intrigued. I had never done anything like it. Why not? The instructor herself had played the part until this year, which wasn’t easy as she was simultaneously showing them how to chart stages of labor and prompting her students to ask meaningful questions of their patient. And, no, I did not have to submit to pelvic exams. I sat next to a very sophisticated manniquin (woman-quin would be more accurate) who had a “baby” in her tummy, a too big hairless (I know, shaving is “in”) pale pink rubber vagina that flopped open when you parted the lips, and a cervix that the instructor could dial up from 1 centimeter all the way to 10, effacement and all.  (By the way, I looked it up and these models cost about $54K per mannequin!) So while Ms. Jones lay on the bed, I answered for her.
First I introduced myself by saying that I am 61. I knew they would be thinking ‘this lady is too old for this part’ but I went on to tell them that in the 1990s there were over 194 documented cases of women over 50 giving birth, some for the first time and that one woman in India was 74 years old; Another lady in Spain was 66.
What do you wear as an actress simulating a patient? I arrived in my long flannel nightgown and hospital slippers with the rubber treads on the soles. The class was divided into two groups of 10 students. While one group went to an overflow room and watched birth videos, the other half of the class stood around the bed and asked their questions. We had one hour for this birth.
Student #1: “Have you been having contractions?”  
Me: “Yes.”
Student #2: “Since when?”
Me: “Three a.m.”
Student #3: “Is this your first baby?”
Me: “No, my third.”
Student #4: “How close are your contractions?”
Me: “About 5 minutes apart.”
Student #5 to teacher: “So, if they are 5 minutes apart, when will the baby be born?” He was dead serious!
Instructor: “When do you think?”
Student #5: “Well, is there a formula to figure out the time, you know, just approximately?”



Instructor: “No.” 
He looked quite perplexed, and asked, “like… well… how will we know, then, when it is time?’
Next student: “When did you last eat?”
Me: “Last night, supper.”
The teacher assured me she would send a signal when I had sufficiently progressed through early labor. Now it was time to go into active labor mode.
OK, I can do this, I thought. So I stood up and paced around the bed, bending in half, bracing my arms on the bed and commenced slow breathing. One student bashed a folding chair up against the back of my knees encouraging me to sit down. I ignored him until the contraction passed and remained standing. One student suggested I go to the bathroom, so I complied and sat at one of the nearby desks, while I breathed through another “contraction.” Another student gently suggested I go back to bed, but I refused, and closed my eyes, saying it felt good being on the toilet and asked for a pillow for my back which another student ran to get while another one brought me a drink.
So it went for a while. I got back up and paced around a bit more, leaning against the wall during contractions, ignoring questions while I concentrated on my breathing. I got a wink from the instructor to ramp up first stage, so I went into serious active labor:
Me: “I can’t do this!”
Student #4: “Yes you can, you are doing great!”
                                                      Me: “I need something for pain NOW!”
Student #3: “You can do this! You are so strong!”
Me: “F&@#! I need a break. I am so tired. I WANT AN EP-I-DUR-AL!”
Student #9: “You wanted to try this without meds. Maybe we should try the tub next?”
Me: “OK.”
I relax and breathe in the “tub,” two folding chairs off to one side of the room, asking if my doula has come yet and if she can pour water over my stomach. I agree it feels good.
After a bit I announce that I have to throw up, which jolts the two students closest to me into action and they drop their clipboards and produce two trash cans at the same time. I “vomit” and announce that I feel better now. I have never acted before, but this is easy. I get out of the tub, I throw off my towel and try the birth ball, then hands and knees, and then ask for some help with back pain. Someone jabs all of her fingers into my middle back and another student does a hip squeeze on my rib cage. I gasp and grab their hands and place them on the right spots. Geez! I guess I really am their very first guinea pig.
I throw up again, ask for water, ask for meds, get a wink from the teacher and proceed to lay it on thick. One student suggests they check my dilation at this point. So they go back to the manikin on the bed and all ten students glove up.
Student #1: “Ms. Jones, I would like to check your dilation and see where we are at this point.”
Me: “Can you just wait until after this contraction?” (Breathe, blow, breathe….)
Student #2: “Ms. Jones, I would like to check your dilation and see where we are at.”
Me: “OK, just hurry up.”
Student #2: “You will feel my touch… a bit cold here….”
Student #3: “Ms. Jones, I am Jody, your nurse and I would like to check your dilation if that is OK?”
Me: “OK.”
Student #4 approaches the bed. He is from Kenya, studying here while hoping to go on to medical school eventually.
Student #4: (in his lovely clipped British accent) “Ms. Jones, I am going to check your dilation now….”
Me: “Oh NO you are NOT! My doula said I didn’t have to have any men in the room. It is in my birth plan! I was sexually abused as a teenager and have trauma issues.”
The class fell perfectly silent at this, eyes wide open, a few open mouths. A couple of them looked over at the teacher as if to ask, ‘is this in the script?’ She smiled and nodded at me.
I explained: “You will get this as male nurses, you two especially. It is a huge issue, actually. You can agree to find a female nurse for her, or you can try to explain that the floor is short on nurses tonight, and if her doula is right there, would it be OK if he checks you if he promises to be super gentle? Or you can just wait until her midwife shows up. What would you do if she were Muslim and also would not let you touch her?”
Student #5: “You are at 9 centimeters! Good job! Let’s try the birth ball again, shall we?”
Me: “I want something for the pain, I can’t do this anymore!”
Student #6: “You ARE doing this. Do you feel like pushing yet?”
Me: “No. I am going to throw up….” Then I take a sip of juice and as another “contraction” comes on, spin around to the handsome guy from Kenya and grab around his neck and lean into him, panting furiously. I get light headed; I didn’t know I could hyperventilate with fake rushes. Male student #2 shoves a chair against the back of my knees once again, encouraging me to sit down, which I couldn’t do at this point even if I tried with a baby about ready to crown between my legs. Mr. Kenya freezes in place, not knowing what to do for me, and tries to peel my hands off his neck, but I pull his hand down to my hip and show him where is hurts. He complies. Some of the students are quietly tittering. Poor guy, why does she keep picking on him? Frankly, I like him.
I detach myself from him and hit the wall, take a deep breath and try a tentative grunt. They all freeze. I do it again and say, “I have to PUSH!” and two students jump forward to maneuver me back toward the bed. I lay down and close my eyes and snore. The instructor moves over to the manikin and directs my pushing during the next contraction, checking for a cord as the head is born, then tells me to push again and I am done, reaching for my baby and telling everyone I couldn’t have done it without them. Then the instructor stops the delivery to point out this circle of bonding happening above my waist and how crucial it is not to disturb that. As long as baby is breathing and pink they have to honor that space and not interrupt what is going on with bonding. "Good girl!" I silently cheer. She is checking the cord for a pulse before inviting “dad” to cut the cord. She delivers the placenta, narrating as she goes. She presses on Ms. Jones’ tummy while looking for bleeding, assuring me that my fundus is nice and firm.
It is 10 a.m. and the next class assembles as I take a quick real bathroom break. Then the instructor and I do it all over again.
After class Mr/Dr. Kenya comes up to me, all smiles, and offers his hand. We shake. I ask him if he will work here in the U.S. or go back. He explains that he is considering medical school after he gets his RN. I ask if he has heard about the free medical school in Havana, Cuba, which he hadn’t. He has a brother already in med school here and marvels at the costs involved. I give all of the students my card, encouraging them to check out my blog and feel free to stay in touch.
I didn’t realize it at the time but there were other instructors observing the class from the back of the room. They introduced themselves afterwards, thanking me and telling me what a great job I’d done. I was hoping I didn’t come across as a total nut case. They seemed to have really enjoyed it.

The next day I received a Thank You card in the mail, signed by every student that was at one of our classes. 
Stay Tuned! This and other stories will be available in my book, Ma Doula coming out in May 2015!

2 comments:

  1. You may have a future as an actor!

    ReplyDelete
  2. Congratulations on your book Stephanie. Truly a 'labor of love'.

    ReplyDelete