The Threshold Theory or A meditation on strollers: Why we should get every last one of them off the planet.

A truth’s initial commotion is directly proportional to how deeply the lie was believed. When a well-packaged web of lies has been sold gradually to the masses over generations, the truth will seem utterly preposterous and its speaker, a raving lunatic. ~ Dresden James

Just put yourself in your baby’s stroller, visually rather. The kind where s/he faces out as if in the driver’s seat, ready to see the world. Or is he? At 6 months? At 1 year? Now, go to the mall. Walk around. What do you see? Legs. Shoes. Other strollers. More legs. People. Children. Some even zoom in for a closer look. They are loud and scary…. I haven’t seen my mom in a long time. I wonder if she is coming back. Ever. I fuss. I call for her. I get a Nuk popped in my mouth. I spit it out. I cry. I get a bottle next. Still haven’t seen Mom. 

Babies don’t know if we are coming back. Ever. They have no experience of time: either you are there or you are not. And when you are not and they call for you and you don’t come, they are learning something, true, but it is that you are gone and may never come back. They can actually begin to grieve. They do not learn to put themselves to sleep nor do they learn that after a certain interval of time to expect you will return. You are simply gone. And in their minds that may mean forever. And if later you do show up and then disappear all over again, they still don’t learn the meaning of that. It does not register as it would with Pavlov’s dog. We don’t ‘train’ them to learn our erratic schedules. We simply fail to respond in the ways they have been wired for since the beginning of Time.

Their voice is all they have to use to communicate with. That is it. If this doesn’t produce the results that have been programmed to work for millions of years, then we are in trouble. And the consequences are tragic. Their one and only means of communication is cut off. It should work but it doesn’t. They cannot smell you from their position in the stroller. They do not see you. They gaze around and crane their little necks to find your voice but cannot locate you even if they do hear you (on your cell phone). So, let’s say they do get a quick look. What are you doing? You are talking to an inanimate object and not to them. They learn something else: we can bond with inanimate objects. And talk to them. Don’t some children with severe emotional problems also do this? They are not touching you either. They expect to be kept warm at least against you if not skin-to-skin. For 9 months they felt and heard your heartbeat. That is what all our sh-sh-shushing imitates when we try to calm them - that familiar heartbeat. So far their senses of touch, sight, sound and smell have failed them miserably -- the only means they have built in for the purpose of survival. They aren’t working and they don’t know why. Oh, yeah, there is still taste. And the Nuk doesn’t do it. Not what I expect or had imprinted at birth. So, if she is not coming back, I am finished. Might as well go to sleep. And give up. Forever. (It is also called failure to thrive.)

How many of these missed opportunities to bond will it take to convince my baby that his instincts aren’t worth much? How many times for each attempt? Researchers now say that by 9 months they can find babies that will not hold your gaze. They are using this to predict those babies who might be pre-autistic. They are showing the early symptoms aren’t they? They don’t ask why they are seeing this in a certain percentage of infants, only that they are. And they ask, can we trace this back to genes? Yes, that must be it! Back to the laboratory. Back to that DNA and the mysterious world of genetics. Wrong. Those early cues that they sent out were not rewarded: either at all, or at levels below the threshold for that bonding connection.

While I am at it, I would also ban those little car seats with handles from the Earth. The ones you clip into the frame you’ve secured in your car. When you get to the grocery store you unclip it and carry it in, placing it on top of the shopping cart, pushing the thing down each aisle, dashing right or left out of your baby’s line of vision, returning with more items, only to disappear from sight once again. When you are done shopping you push the cart to the cashier and unload the cart from the other end while baby stares at the ceiling. Next you get to your car, fill up the boot with the groceries, put baby into the back seat once more, facing the rear window, and drive home. If your baby has fallen asleep on the ride home you will quietly unclip it and carefully pick up the carrier and set it down in the kitchen while you put everything away. You let baby sleep where she is until she wakes up. You have not held baby for over 3 hours or more, much less skin-to-skin. She may have made vocal attempts to locate you, looked for your familiar eyes, certainly hasn’t smelled or touched you… exactly how many cues has she sent out during that time? Now add those all to the list of missed bonding opportunities.

How many times does it take for a baby to send out a cue with her eyes and not get a return glance in order to give up on that specific instinct? By 9 months? How many attempts will an infant make to coo and then fuss and finally cry and getting no result chalk that mechanism up to failure, too. Smell? Same thing. Touch? Are you getting the picture?

There is a threshold, I believe, for each sense and what that minimum requirement will be for bonding to happen. We do not know yet how much of each sense needs to be reciprocated by a baby’s mother (or surrogate caregiver) in order for successful bonding to occur. Perhaps ten times a day that baby initiates a sound and is rewarded by something – anything, even some nonsense in motherese (baby talk) will do. The same holds true for when he looks at you and sees your eyes in the first weeks and later is able to take in your whole face. And when he reaches out or opens his mouth are those cues recognized and rewarded? If they are not, will 5 times out of 10 still ensure bonding? Or are we already sending a poor signal? How much is enough? How much is just too little? Could this also work if a caregiver and not the mother responded appropriately as happens in orphanages, though we already know that babies who spend a majority of the time during their first year in a crib are well below the threshold to bond in any recognizable form which we now call attachment deficit disorder. Failure to bond has dire consequences. This refers to the research being done both here and in Russia by the eminent scholar, Dr. Seth Pollak at the University of Wisconsin-Madison.

(See: https://www.youtube.com/results?search_query=this+emotional+life+episode+1)

I have wondered which factors or senses are more important than others. Is touch paramount? Or must there be an equal amount of reciprocal voices? A study of deaf mothers and their hearing babies and their high levels of successful well-being leads us to believe that sound or the lack of it may not be as important in the overall picture of bonding as touch is, for example. Because in autism there is such an extensive spectrum of disabilities for example, might we hypothesize that perhaps different combinations of differing levels of non-response to the cues of bonding may affect different babies differently?

We know from the early studies done by Harry Harlow with baby rhesus monkeys that were taken away from their mothers shortly after birth that all of them consistently preferred the wire frame surrogate ‘mother’ covered in cloth to the un-huggable ‘mother’ that was only a wire figure, even though she had a ready source of milk attached to her frame. Those monkeys deprived of even the cloth covered frame mother exhibited severe emotional trauma. What does this ghastly experiment teach us? (Psychologist Harry Harlow conducted his work in the 1950s on maternal deprivation in rhesus monkeys which became the landmarks not only in primatology, but in the evolving science of attachment and loss.) 

If we had a grid or bonding index/assessment tool© (copyright pending sss) to rank or grade cues and their response from both baby and  mother and then the responses in return from each, could we see where the deficit might lie? I think we would at least see a pattern of cues that a particular baby initiates over a period of time and then count the times he receives a response/reward and the times that doesn’t work as he expects.

All babies are born with initial instincts that Nature put there and intended to be used reciprocally as tools of survival. Bonding is not a one-way, occasional process that can be eventually done away with as superfluous. It is part of a grand continuum that we have ignored, forgotten, and completely dispensed with. No wonder we are where we find ourselves today. I think we can all agree that far too many children have far too many irreversible problems in this most advanced of all ages of Man (and Woman) and that there are more possible diagnoses than  ever before in history for these behavioral aberrations. Not that we now have more names for things that we couldn’t name before or can now diagnose. Rather, that there are more failures than ever before in the continuum, and we have not found the answers to this dilemma but are actually further than ever from finding a cure. We are looking in the wrong place.

My premise is that we are bringing stone-age babies into a space-age world.§  Their needs have not changed in tens of thousands of years. Their needs have not magically evolved over millennia.  But we treat them as if they have.© sss 2011

Many great thinkers have puzzled over this one for many years. The noted psychiatrist, Dr. Oliver Sacks, in his book, An Anthropologist on Mars,* also recognized these earliest bonding connections or disconnections as observed in autistic children, but was berated by defensive parents for labels such as ‘‘chilling relationship with mother.’’ Other researchers have also noted similar findings.  In “Bad” Mothers,** by Molly Ladd-Taylor and Lauri Umansky, in chapter 11, an essay by Jane Taylor McDonnell, she talks about labels like, “refrigerator mothers.”

On Blame

This subject is surrounded by much controversy. We avoid it but shouldn’t. I propose that any and all blame/guilt is held by the medical community alone, and not bad mothering or parenting. How many generations have been telling their daughters and sons not to spoil their children and instead let them cry? That it is good for their lungs? Before we knew what damage cigarettes caused infants in utero, or alcohol (FAS), or the deadly risks of Thalidomide, the drug notorious for severe flipper-like birth defects seen in the 1950s, we the medical community, could not warn pregnant women of the risks and dangers. Instead we went merrily on our way endorsing an awful lot of wrong and even devastating trends, as if we were experts. Likewise, we are not able to teach/warn/look for clients at risk until more studies on bonding and others like it are conclusive.

A new model for research

I propose, however, an interesting paradigm to the dilemma. Instead of delving into studies that will take decades of collecting data and testing more babies, which I do not advocate, and will not benefit anyone, much less these little people during all those years, why not experiment with a new idea? Flip the traditional research model on its back this way: Instead of collecting data ad nauseum, put in place a preventive plan, in this case, continuum bonding. Teach an entire generation what continuum bonding should look like. Give them the tools and education they need to un-learn the only patterns they and past several generations have seen and we know now do not work. Then, after a period of time, go ahead and collect all the data you want, but ask these questions as you do so: Did this work? How did it work? For whom did it work? Do we have happier children in the groups that applied this knowledge? Will they now pass this onto their children? This research model has been used recently at Harvard Medical School in their studies of autism. It is so simple and makes so much better sense that it challenges our intellects: what have we been doing all these years in research, anyway? (See http://www.marthaherbert.org/)

Whoever brought up the idea of a 'nature deficite disorder' in recent history is on the right track, I believe. Not only do we NOT need over-stimulated, over-scheduled children needing to be driven to various activities throughout the week and twice that on weekends; not only should we unplug and power-down anything and everything electronic, wireless, nature-less and virtual, but when are we going to reconnect to what is real and in this moment?

The recent movement around the world to resurrect the age-old custom of wearing your baby – which many Third World countries had never given up – is making a comeback now. Your baby needs to smell you, taste you, be kept warm by you, fed by you and needs to hear and see you at a moment’s notice. Don’t miss these moments. They will soon be lost opportunities to bond which is an ongoing continuum relationship, not just occasions that are convenient for you.

What if bonding looked like this:

‘Drink your tea slowly and reverently, (substitute here ‘interact with your baby’ for ‘drink your tea…’) as if it is the axis on which the world earth revolves – slowly, evenly, without rushing toward the future. Live the actual moment.’ ~Thich Nhat Hanh, a Vientamese Buddhist monk, poet, scholar and peace activist.

* An Anthropologist on Mars: Seven Paradoxical Tales, by Oliver Sacks, published by Alfred A. Knopf, 1995

**“Bad” Mothers, by Molly Ladd-Taylor and Lauri Umansky, New York University Press, 1998, chapter 11, essay by Jane Taylor McDonnell

COMING SOON: This and other stories will be appearing in either Call The Doula! a diary© or Stone Age Babies in a Space Age World:§ Babies and Bonding in the 21^st Century© pending by Stephanie Sorensen

§This phrase was first coined by Dr. James McKenna, used here with permission and gratitude for his work. A world-renowned expert on infant sleep – in particular the practice of bed sharing, he is studying SIDS and co-sleeping at his mother-infant sleep lab at Notre Dame University. He is the author of “Sleeping With Baby: A Parent’s Guide to Co-sleeping,” 2007, Platypus Media, Washington, D.C.

“For things to reveal themselves to us, we need to be ready to abandon our views about them.” ~ Thich Nhat Hanh, Being Peace

Mothers' Day Proclamation Boston, 1870

Mothers' Day Proclamation

Boston, 1870

Mother's Day originated after the Civil War, as a protest to the carnage of that war, by women who had lost their sons. Here is the original Mothers Day Proclamation composed by Julia Ward Howe. The evil it addresses, the slaughter of one mother's child by another mother's child, is at least as prevalent today as it was when the ink of this Mother's Day Proclamation was still wet 144 years ago. 

Arise, then, women of this day!

Arise, all women who have hearts, 

Whether our baptism be of water or of tears!

Say firmly: 

"We will not have great questions decided by irrelevant agencies, 

Our husbands will not come to us, reeking with carnage, for caresses and applause. 

Our sons shall not be taken from us to unlearn 

All that we have been able to teach them of charity, mercy and patience. 

We, the women of one country, will be too tender of those of another country 

To allow our sons to be trained to injure theirs."

From the bosom of the devastated Earth a voice goes up with our own. 

It says: "Disarm! Disarm! 

The sword of murder is not the balance of justice." 

Blood does not wipe out dishonor, nor violence indicate possession. 

As men have often forsaken the plough and the anvil at the summons of war, 

Let women now leave all that may be left of home for a great and earnest day of counsel.

Let them meet first, as women, to bewail and commemorate the dead. 

Let them solemnly take counsel with each other as to the means 

Whereby the great human family can live in peace, 

Each bearing after his own time the sacred impress, not of Caesar, 

But of God.

In the name of womanhood and humanity, I earnestly ask 

That a general congress of women without limit of nationality 

May be appointed and held at someplace deemed most convenient 

And at the earliest period consistent with its objects, 

To promote the alliance of the different nationalities, 

The amicable settlement of international questions,

The great and general interests of peace.    

 

A Mother’s Pledge to and Covenant with

Every Other Mother

I will not raise my precious child to kill your precious child.

And if it is within my power, I will

not hand over my beloved child to others

to kill your beloved child, or

to learn how to kill the one you cherish.

Spanish

Promesa de una madre y convenio entre todas las madres

No he de criar a mi adorado hijo para hacer morir a tu querido hijo.

Y si está dentro de mi poder, jamás entregaré

a mi preciado hijo a aquellos

cuyo propósito sea asesinar tu adorado niño,

                                o para que lo entrenen a matar a tu ser querido

Italian

Preghiera di una Madre e la sua promessa ad ogni altra Madre

Non faro’ crescere il mio prezioso pargolo affinche’ uccida i vostri preziosi figli.

E se e’ nel mio potere,  non lo consegnero’ in mano ad altri 

affinche’ gli insegnino ad uccidere i vostri amati figli;

O s’impari ad uccidere colui che voi amate.

French

La promesse et l'engagement d'une mère à toutes les autres mères

Je n'élèverai pas mon précieux enfant pour qu'il tue votre précieux enfant.

Et, si j'en ai le pouvoir, je ne céderai pas mes enfants bien-aimés à d'autres pour qu'ils tuent votre enfant bien-aimé ou pour qu'ils apprennent à tuer ceux que vous aimez.

Irish

Cor agus Coinn´ıoll idir M´athair agus Gach M´athair Eile

N´ı chun marbhtha do linbh ionmhain a th´ogfad mo leanbh ionmhainse,

n´a – ar feadh a bhfuil im chumas –

n´ı chun a chur ina dtuilleama´ı si´ud a bheadh ar t´ı a mharbhtha

n´o a chleachtfadh eala´ın a mharbhtha.

— ag tarrac as Soisc´eal na S´ıoch´ana

Doula as Gatekeeper

Khou’s Birth Story*

Midwife: I would like to check to see if you have dilated.

#Vietnamese interpreter: Tôi muốn xem tử cung bạn đã giãn chưa?

Midwife: Is that OK?

Interpreter: Có được không?

My client only spoke Vietnamese, a beautiful first time mom whose water broke 2 days ago and who only this evening called me.

Midwife: Now, put your heels together and let your knees fall back…

Interpreter: Bây giờ, đặt gót chân của bạn với nhau và để hãy thả lỏng đầu gối

Midwife: You can relax ... that's better.

Interpreter: Đừng lo….. đúng rồi.

Midwife: Now you will feel my touch.

Interpreter: Bây giờ bạn sẽ cảm thấy tay tôi. I can only guess that she was either expecting labor to be contractions first, or a huge gush. A small tear high up in the bag of water can drip like a leaky faucet and was obviously not noteworthy to this mama. As soon as she called me I insisted on meeting her at the hospital and asked her to let her midwife know before she left the house.

Midwife: Now I want to put this speculum inside to look (holding the thing up).

Interpreter: Bây giờ tôi muốn đặt mỏ vịt này bên trong để xem.

Midwife: Sorry it’s cold.

Interpreter: Sẽ lạnh một chút.

Midwife: I will first test and see if this is amniotic fluid; this won’t hurt.

Interpreter: Đầu tiên tôi sẽ xem đây có phải nước ối không; nó sẽ không đau đâu.

This little exchange would all be fine and dandy except for the fact that the interpreter agency sent a male interpreter to labor and delivery that night. I can’t believe what I am hearing.

Midwife: All done.

Interpreter: Xong rồi!

Midwife: But your water has broken. It seems that it started 2 days ago.

Interpreter: Nhưng bạn đã vỡ nước ối. Có vẻ như nó bắt đầu từ 2 ngày trước.

Midwife: There is some concern that labor hasn’t started and we want to avoid an infection….

Interpreter: Tôi lo rằng bạn chưa lâm bồn và chúng tôi muốn phòng ngừa nhiễm trùng ....

When he walked into the room I had leaped off of my perch on a little exam stool by Khou’s bed, looked straight at him and said, “You and I will go BEHIND that curtain by the door and you can translate from there!” as I ushered him away from the bedside.

Midwife: So would it be OK if we started labor with something that will soften the cervix tonight?

Interpreter: Chúng ta có thể bắt đầu chuẩn bị sinh với cái gì đó làm cho tử cung mềm hơn tối nay có được không?.

Midwife: And hopefully get things going in the morning?

Interpreter: Và hy vọng có thể bắt đầu vào buổi sáng?

There was no way I would have him gawking at Khou lying there. I can’t believe they sent him!

Midwife: Yes? OK. I am going to put some medicine into your vagina and into the cervix. 

Interpreter: Có? OK. Tôi sẽ đặt một số thuốc vào âm đạo của bạn và vào cổ tử cung.

That’s IT! I am about ready to stomp out to the nurses’ station and demand a woman interpreter. How can they do this? I am furious!

Midwife: You will need to stay flat for 2 hours then. Do you need to go to the bathroom first? 

Interpreter: Bạn sẽ cần phải ở lại căn hộ cho 2 giờ sau đó. Bạn cần phải đi vào nhà vệ sinh trước không?

Why should you come to a foreign country and have to put up with this? I would feel so ashamed!

Midwife: Can you put your fists under your bottom so I can reach your cervix a little better?

Interpreter: Bạn có thể đặt nắm tay của bạn dưới mông của bạn để tôi có thể tiếp cận cổ tử cung của bạn tốt hơn một chút được không?

This is awful! He acts as if he does this every day. He does do this every day. She must be feeling sooooo embarrassed. The last time I had to throw someone out during a birth was when I worked at a free-standing birthing clinic and found both sides of the family of the couple in the kitchen smoking up a storm and setting up a bar. They were going to party until their baby was born! I tried to nicely explain that we weren't set up like a hospital exactly...we didn't have a waiting room and we would need the run of the whole floor so she could walk around during labor (much less any other clients who might show up that night to fill the remaining 2 birthing suites.) I suggested a motel down the road -- some of them had driven from more than an hour away -- so they reluctantly packed up and camped out in our parking lot for awhile, serving drinks from the car's boot until it started raining around midnight. We assured them we would have the couple call them when the baby arrived. BYOB to a birth. Really, now!

Midwife: Just breathe slowly. You will feel my touch now….

Interprer: Hãy thở chậm lại. Bây giờ bạn sẽ cảm thấy tay tôi ....

How humiliating! “You will feel my touch now…” his deep smooth voice coming from behind a flimsy curtain. This is like something out of a horror movie! I couldn’t do this! It’s awful!

Midwife: Just breathe slowly. Great. Thank you.

Interpreter: Thở chậm lại. Tuyệt vời. Cảm ơn bạn.

Midwife: I hope you can get some sleep now.

Interpreter: Tôi hy vọng bạn có thể ngủ một lúc bây giờ.

Midwife: I’ll check back in the morning.

Interpreter: Tôi sẽ kiểm tra lại vào buổi sáng.

  

One Friday night I brought my baby doll named Tofiq (toe-FEEK, an Ethiopian boy’s name,) a life-like 7 lb. African-American demo doll that was donated by an educational catalog company for my work with African refugee families in Minneapolis) to a women's shelter where one of my clients lives. The shelter is just for Ethnic women; there is that much domestic violence here in Minnesota to necessitate a culturally-specific shelter all their own!

We had been meeting for the past 3 months discussing her birth plan, and seeing videos together on birth and the stages of labor and breastfeeding , and going to classes about interventions and options. She asked if I had a camera and begged me to bring it to her birth. I promised I would.

Khou* though barely 18, had asked at our last appointment who was going to teach her how to bathe her baby when s/he is born, so baby doll and I arranged for a translator and we all crammed into her tiny bathroom that evening: Khou, me, Tofiq, the interpreter and the shelter director, a young social worker who had never bathed a baby before either, so she had asked to come, too. (See The best baby video yet! At this blog in the March posts.)

So I filled the tub, lined up the soap, shampoo, towel, and washcloth, and gave Tofiq a real bath, showing Khou how to first test the temperature of the water by dipping in an elbow and then how to support him in the water (he is even anatomically correct which sent her into giggles!) Then I had her do it all over again by herself. She did a great job until she laid him on the towel on the floor. I suggested at that point that her baby looked pretty cold to me. She quickly dried him off and wrapped him up in the towel and held him close, looking up at me for approval. I said he looked better, but, see his mouth is open (it really is) and that he is probably hungry. I didn't need the interpreter to repeat what she said then: “OH, NO!” as in, ‘what do I do now?' a look of panic spreading across her face. So we had a mini class there on the bathroom floor about how to get him in the best position for nursing: “Belly to belly, chest to chest… nose and chin should touch the breast!” Then she reminded me for the umpteenth time to be sure to bring a camera to the birth. I promised again that I would. I had to laugh seeing this teeny Oriental lady hugging a big Black baby doll to her breast.

Midwife: Now, put your heels together and let your knees fall back…

Interpreter: Bây giờ, đặt gót chân của bạn với nhau và hãy thả lỏng đầu gối

Midwife: You can relax ... that's better .

Interpreter: Bạn hãy thoải mái người…. đúng rồi

Midwife: Now you will feel my touch....

Interpreter: Bây giờ bạn sẽ cảm nhận được tay tôi....

YUCK! I am never letting this happen to one of MY ladies ever again! I hate this! Mental note: see nursing supervisor after this birth.

Midwife: Well, you have dilated to 5 centimeters! That’s great news!

Interpreter: Ồ, bạn đã giãn ra đến 5 cm! Thật tuyệt!

I rummage through the cupboards in the room until I find a dilation chart. I get the interpreter to explain what dilation is and what 5 looks like. Finally I can say, “You can GO NOW!” I point to the door and thank him. At last he is gone. It isn’t his fault. But couldn’t he protest? She could have been his daughter, for heaven’s sake!

Ok, breathe deeply. Relax. Doulas need reminding to breath slowly too sometimes, I guess. ARGH! I will explain myself in pantomime from now on if I have to and show her how she will open up the rest of the way until she can push her baby out.

The nurse wheeled in some kind of a Lazy Boy lounge chair and to my utter surprise made it up with clean sheets and pillows for me. Gosh! I could have done that. We finished the last of the snacks I had brought along and I went down to the nutrition room and got us hot drinks. Most hospitals will even give us doulas the door combinations to the kitchen or linen closet so we can help ourselves and take care of our moms without having to get a nurse every time. Warm blankets? No problem. Just dial 1532 on the door’s lock pad.

The rushes kept up for another two hours but eventually settled down so that Khou was sound asleep by about 3 a.m. I lay down and didn’t hear anything until she called me at 8:00 a.m. In her limited English she sheepishly said, “Stephy-ah, me hungry.” I stretched, got out of my little bed and fumbled around the bedside stand until I found the folder with the menu options and the extension to call to order meals. She knew the words for bread, eggs, tea and meat, so I ordered it. She again asked while we waited for her breakfast if I had the camera ready. I pointed to it right there on the counter. When the food tray arrived she dove into it. They had also included a blueberry muffin which is now her favorite food. She tried to order just blueberry muffins for lunch but we were told they are only a breakfast option. Later that day I let the secretary at the ward’s front desk know so she could make sure Khou got 2 blueberry muffins on her tray every morning while she was in the hospital.

No sooner than she had finished eating, the rushes started up again in full force (it is amazing what a little food and sleep will do!) and breakfast suddenly made a surprise appearance once again. I told her not to worry about it and helped her clean up and rinse her mouth. I told her what Ina May Gaskin says about this: that you actually dilate one centimeter every time you vomit during labor. It works this way because you can’t totally relax your throat and mouth without also relaxing the sphincter muscles down below. There is a connection: Wet your lips. Now just try to pooch your lips out and blow – we call it ‘horse lips’. Now, try to do a Kegel by contracting or pulling up on your bottom and the floor muscles of your perineum … hold it … and blow out through your lips again. It can’t be done at the same time. (Kegel exercises are used for strengthening your pelvic floor muscles.) You have to relax those muscles when you throw up and there isn’t anything that can’t be cleaned up in a few minutes. As a doula it is funny how fast you get used to these things. In spite of having just lost her breakfast, Khou cleaned up the last crumbs of the blueberry muffin and got up to brush her teeth and go to the bathroom.

Before long her labor was picking up speed beautifully. We stood, we walked, we sat on the birth ball (Khou did – I didn’t).  She asked for pain medicine at one point and asked about an epidural (and in the same breath asked if I still had the camera handy). The midwife said that she could get an epidural if she wanted it, but that she had other options too and suggested some fentanyl which would take the edge off the pain but still allow her to be up and moving around. She explained that it worked for an hour or two at the most. Khou said she wanted something and agreed to try it. She was very happy with the results and was able to rest. She asked again if I had the camera ready and I assured her I did as I pointed to it on the bedside stand. She closed her eyes and was able to manage the rushes better now.

She asked the midwife the next time she was in the room if Mary, the midwife she had been seeing in clinic was going to be at her birth. She was able to assure her Mary had been called. Khou again closed her eyes. We breathed through each rush and then rested. We were in a pattern now: breathe, slowly… blow it away… rest; breathe… slowly…blow it away….

Suddenly Khou’s eyes opened wide and she said, “I go toilet. NOW!” I knew this was the urge to push without even knowing if she was at 10 centimeters. The midwife with us did too and didn’t even check her cervix. Then Khou asked, “Where is Mary? I want Mary!” just as she walked in. She checked Khou and said, “Well, she’s complete. Can we get the room ready?” The nurses spun into action. The warmer was turned on. They checked the equipment, unfolded baby blankets and stacked up towels as Mary robed up and I tied the strings at the back of her gown.

We helped Khou lean forward from her sitting position and put a squatting bar in place while I stacked pillows behind her with one hand, the camera ready in my other hand. The nurse lowered the end of the bed slightly before the next rush. Khou flashed Mary a panicked glance which we recognized as the classic ‘tell-me-what-I-am supposed-to-do-next look.’ Mary smiled and told Khou that she was doing just great. She waited for the next rush and nodding her head said quietly, “You can push a little now.” It took a few more rushes for Khou to get the hang of it but very quickly the little head was crowning. Then baby literally dropped out onto the end of the bed during the next push, completely surprising Khou. If looks could talk I would swear she said, “Where did THAT come from?!” And I did get pictures – lots of them.

I voiced my complaint about the male interpreter as civilly as I could manage on my next trip for coffee as I passed the nurses’ desk and was able to get a woman interpreter for my postpartum visit the following day. I had waiting at my bus stop in the snow earlier that morning in front of a florist shop. It occurred to me that no one would be bringing Khou flowers after all her hard work. If I had the money, I pondered, I would have loved to have bought her a huge bouquet but I had just spent the last of my savings unexpectedly the weekend before in order to attend a funeral in Seattle. Friends of mine had lost their 19 year old daughter in a tragic accident while she was visiting friends in Taiwan. It was a sad trip and I couldn’t say anything that would take away their pain, but I hope just being there with the hundreds of others who came would give them strength for the days and weeks and months ahead.

I thought of my friends in Seattle once more as I walked into the room. A young nurse was just arranging a beautiful little arrangement of pink tea roses on Khou’s bedside table. It was this nurse’s birthday and someone (special, I could imagine) had flowers delivered to her at work but she said she wanted Khou to have them. I had never seen such an act of kindness as that in a hospital before.

I asked Khou if anyone had explained how or what they had done to fix her tear after her birth. She shook her head. I know she had been quite mystified by everything at the time and knew she could not take in one more thing, so I postponed this discussion until now. At the time her midwife had simply explained that she was going to repair a tear though I doubt any of this registered with Khou then. I brought along my sketch pad and drew a picture of her anatomy at the time of birth, explaining how the baby’s head was stretching her vagina as she crowned: 

Then I drew a picture of what it looked like after birth with the tear along the vagina’s back wall. I explained that Mary had used a round needle to first pull together the underlying muscle, pushing everything back into place there and then closed the tear with small stitches along both edges of the torn skin. I told her that the string is a self-dissolving material so the stitches won’t need to be removed later. Then I told her that her midwife is a real artist and that she looked absolutely beautiful down there. She questioned the interpreter if she had heard that last comment right and I assured her that she had and that I had seen lots of women so I should know!

At this point another nurse came into the room to do a blood pressure and stopped to look at the diagrams. She glaced at Khou and then back at me looking very puzzled. I told her that no one had explained to Khou what had happened or why, so I was taking the time to show her what had gone on ‘down there’. I added, “I think she should know what happened and understand what was done to her own body.” This seemed to be a completely foreign concept to this particular nurse. Should a young, homeless, illiterate, refugee woman be treated any differently from you or me?

Another thought on the bus on my way home: what if we had gotten a male midwife? Or if the only resident on the floor was an African American and I knew that my Asian lady was not assimilated enough yet to be OK with that because no one in the jungle village of Phongsali where she comes from had ever seen a Black person? Should I just chalk it up to her American education or make her as comfortable with each member of her team as I am humanly able? Would they understand? I am not sure yet what is the better course. More to ponder…. I will throw this one out at our next doula meeting.

*All names, places and other identifying characteristics have been changed to protect privacy

** Heartfelt thanks to Vu Nguyen, University of Minnesota, Minneapolis for his excellent translations for this article!

COMING SOON: This and other stories will be appearing in either Call The Doula! a diary© or Stone Age Babies in a Space Age World: Babies and Bonding in the 21^st Century© pending by Stephanie Sorensen

When you were born, you cried and the world rejoiced. Live your life so that when you die, the world cries and you rejoice. - Cherokee

Check this one out!!!

A True Tiger Mama:
http://www.cnn.com/2013/05/10/opinion/keltner-tiger-mom/index.html?hpt=hp_bn7

Rose: A postpartum depression success story

The phone rang early one Sunday morning. I often volunteer at a women’s shelter run by Mother Teresa’s nuns, the Missionaries of Charity Shelter. There are 7 beds, ready at a moment’s notice for any woman who is homeless and pregnant in Minneapolis. Sister Rosetta was calling to ask me if I could come and decide what they should do for one of their guests who had recently had her baby. They didn’t know what they were seeing, but wondered about postpartum depression.

            I visited later that morning and tapped on Rose’s* door. She called for me to come in. Her 2 year old Elizabeth was bouncing up and down in her playpen, grinning from ear to ear. Rose had Luke in her lap and was giving him a bottle. He looked washed and had on a clean little outfit. Rose was dressed and her hair looked nice, too. Not quite what I was expecting.

            I had met Rose before Luke was born at least once when I worked at the shelter earlier that fall. She was usually upbeat and friendly. Hannah was a handful but awfully spunky and bright. I picked her up and sat down on the end of the bed and asked Rose how things were. She told me about the birth, how he was such a good baby, how she was looking into a permanent situation for her little family with her social worker, and so on. She mentioned that she didn’t want to go back east to an abusive father and addicted boyfriend. She really wanted to go back to school and get her life back on track. I encouraged her and told her that she was still so young and could do so much. I had returned to school after five children, so she should be able to manage with two.     Elizabeth: right

I finally said I wanted to talk about what we call ‘baby blues’ or depression, because it is very real and especially after birth with all the other things going on in her life that made it frankly very stressful. I knew she had a history of mental issues, though I didn’t know specifics. She admitted that she felt frustrated trying to keep her kids quiet at bedtime and that she couldn’t always let Elizabeth run loose when she had to feed the baby so Elizabeth would scream. Then she just mentioned in passing that they had not given back her meds after the birth, even though she had asked for them at her postpartum appointment. I asked what they were and it turned out she had been treated for bipolar disorder. I could not believe she had fallen through the cracks in the system just like that. Of course she had agreed to try to hang on without the meds during pregnancy if at all possible, and it had been OK, but as soon as she delivered, she knew she should go back on the program she had been on which had worked so well for her. Yes, she was depressed now but felt that this could all be sorted out. She was also prepared not to breastfeed her baby, though she would have liked to, knowing the medication was not good for him. She was willing to forego nursing in order to be a more together mom who needed to take care of her kids and happened to needs meds.

            Sometimes women only exhibit symptoms of bipolar disease for the first time after having a baby. If they are referred they can work with a doctor and have it under control quickly. We have all these fears about sharing our feelings when they don’t seem to be in line with what is going on in our lives: we’ve just had a beautiful, healthy baby. Shouldn’t I be happy? Grateful? Cheerful? I shouldn’t be crying all the time, or having scary thoughts or flipping out, should I? No one would understand if I told them even half the things I am thinking, right? Will they take my baby away and put me in a hospital?

            Postpartum depression is actually 100% curable. Research has now found that the flood of hormones released immediately during and after birth account for much of the mood swings and problems women run into. The sooner you get help, the shorter the time it will take to overcome this period. If we didn’t talk about it, it would remain a taboo subject. And women would believe that they are the only person to ever feel this way. The fact is that it is far more common than we thought before. And there is more help than there ever was, too.

            Postpartum depression can occur anywhere from the first days or weeks after birth to anytime during the first year after having a baby. If not treated, the symptoms can get worse or postpartum psychosis could become an issue. What is crucial to remember is that 1. It is 100% curable, 2. That you must seek help early, and 3. That no one is going to fault you for not being cheerful and happy or having it all together. We simply aren’t made that way. I personally think this has become even more prevalent in our Western society because we don’t have an intact extended family system any longer. In other cultures women are cared for after they’ve had a baby and are never left alone. They are free to rest as much as they need and don’t have to cook, clean, tend other children, do laundry, or lose sleep much less go back to work within weeks of delivering. We are doing a disservice to our mothers in this country by ignoring this important aspect of care. Many countries -- France, England, Denmark, Sweden and Holland to name a few -- offer all mothers a helper for up to a year in the home paid for by the government to take the work off of new mothers so they have the time needed to bond with their babies and recover. These governments understand that this investment will pay off in the long run with healthier, happier families.

            So I suggested a plan for Rose. I asked her to call her local church ladies and find someone who could watch her children for a few hours later that evening. Then I told her I would go with her back to the hospital and we’d ask for her meds. I suggested she try to ‘keep it together’ because I told her if they decided to admit her and I had to refer her babies to foster care then I would be depressed, too. I was hoping that they would believe me that I would be in contact everyday with Rose and she wouldn’t be alone at the shelter at any time either. Supervision is important for someone using strong medications, but I reasoned that she had been on it before and tolerated the meds well then. She readily agreed and started calling. I went home and took care of what I needed to finish up there (including doula backup for the night for my other clients) and then later that day I picked her up and we went to the hospital. I had packed some snacks thinking we would be in the emergency room for hours, waiting our turn. This was one of the biggest medical centers in the city and known for waiting room marathons.

            Rose had delivered there earlier that month so I knew her records were there. When we got to the emergency department we settled in on a couch for the long haul and I went up to the desk to register. I couldn’t believe it when the receptionist told me they would call the resident doctor on the psych ward and had a room we could wait in all ready, please come right this way. Wow, talk about service! So we picked up our coats and snacks and bags with magazines and followed her to a little room. We didn’t wait very long there, chatting about some of the funny things Elizabeth has come up with since Luke was born. Then Rose asked me if I noticed anything funny about the room. I looked around and said, first, there weren’t any cupboards with meds or equipment. Right. What else? I noticed the two chairs were bolted to the floor. Oh, I see. What else? Well, there’s a window in the door. That’s right, she agreed. You couldn’t hurt yourself in this place. Oh, I get it, I said. She explained that she was a veteran of the psych wards and could spot the program a mile away. I told her that I was glad she wanted to get her life back on track and that I really admired her for setting goals like school for herself. We agreed that Minnesota had more programs than most states for scholarships and other possibilities. We talked about some of her ideas about different colleges and how to find out more information.

            Then a nurse from ‘upstairs’ came and introduced herself. I was immediately impressed by how respectful yet straight forward she was. Rose talked about not being able to get a new prescription even though she had asked for one and said she was more than willing to be compliant, take her meds and attending therapy or whatever else they recommended. Therapy could address many of her problems and give her the help and support she needed during the time ahead. Then I told her about Rose’s living situation and that I thought it was an ideal arrangement for her to start back on her medication there. Soon a doctor came in and introduced himself. The nurse filled him in and he readily agreed that our plan sounded fine to him, too.

            We both thanked them profusely. They were really concerned, respectful and listening. I don’t know what I expected, but this was amazing. We were a really great team, all rooting for Rose to do well, all doing what we did best and coming together to support her. I was so grateful. It changed my perception of the big, impersonal medical center.

            Rose returned to the shelter and I checked in with her by phone daily. When it warmed up finally, I met her and took her along with Elizabeth and Luke out to lunch. It was scattered, like any meal with two little guys vying for attention is, but we did manage a nice visit. Rose still has her ups and downs, but I don’t know if I have ever been so proud of a young mom before. I know I haven’t met many with as many obstacles in front of them and yet could overcome so much. We are still in touch. She has her own apartment now. She is truly another amazing woman that I have been honored to know.

Steps to take if you have symptoms of depression or anxiety during or after pregnancy:

1.      If you are having thoughts of harming yourself or your baby, it is very important to get support immediately. Call 911 or go to the nearest emergency room.

§  Though it can be scary to ask for help, they can help keep you and your baby safe and help you take the first steps towards getting better.

2.      Tell someone you trust how you are feeling. It is important that you feel safe with the person and that they support you in a non-judgmental way. Ask them to help you find support. Examples of someone you can tell:

§  Your partner

§  A family member

§  A friend

§  A healthcare professional

§  A pastor or someone at your church

Other Resources:

Jenny’s Light http://www.jennyslight.org

http://www.mayoclinic.com/health/postpartum-depression/DS00546

http://www.babycenter.com/0_postpartum-depression-and-anxiety_227.bc

 http://hcmcmn.org/index.php?content=mother-baby-day-hospital&clinicid=393 :

Hennepin Women’s Mental Health Program, Minneapolis, MN, Dr. Helen Kim, MD

http://www.maternaloutcomesmatter.org/http://everymothercounts.org/film

*Not her real name. All names and identifying characteristics have been changed.

COMING SOON: This and other stories will appear in one of these books soon: Call The Doula! a diary© and Stone Age Babies in a Space Age World: Babies and Bonding in the 21^st Century© pending by Stephanie Sorensen

Call the Doula! a diary ~ May 1st An Unplanned Natural Birth

I am given a new referral. Another mom whose OB has concerns about a big baby. Doesn’t speak English. Has serious diabetes. Gravida 2 (a history of having had 2 pregnancies so far, this one included). Not due for another week and a half. The midwives at her clinic have had to refer her to an OB. He suggests an induction. We are now on a high risk track. Again. Ugh.

Many of the women at this clinic are recent refugees from Ethiopia. (There are over 80,000 African refugees in Minnesota at this time, not to mention an additional 50,000+ Southeast Asian immigrants here too.) All of us hope to make their experiences of pregnancy and birth in their new country a positive one. We have all read everything out there about cross-culture medicine and tried to learn from the earlier mistakes made during the beginning of their assimilation. One of my favorite resources is the book, The Spirit Catches You and You Fall Down, A Hmong Child, Her American Doctors, and the Collision of Two Cultures, a brilliant, timely work by Anne Fadiman, first published in 1997. All of the universities and medical school programs in Minnesota now offer and require courses that concentrate on helping us understand the barriers facing diverse immigrant communities in our state, which include especially cultural and linguistic challenges.

In Minneapolis alone more than 66 distinctly different African languages are spoken in the public school system, just to give you a glimpse of only one of the challenges facing us. I didn’t know there even were that many African languages. I didn’t know that French is the official language of Togo, (and I failed French twice in grade school, though I have since learned Chinese Hmong and Korean and can get by in Spanish.) I have to confess I even had to find out where Togo is. Ghana is on its left, and Benin and then Nigeria are on its right, just above the equator on the far western coast, under the big rounded side on the left of the African continent. It also borders the Gulf of Guinea in the southern part of the Atlantic Ocean.

I met Ayana only a couple of weeks ago. She had not attempted to get prenatal care until her 8^th month, even though she had state-funded insurance to cover her throughout. Coming from a district in Ethiopia that doesn’t have a medical facility left many of the community unaware of the concept of preventative medicine and how it can affect the outcome and improve pregnancy.

During our first visit I explained what the role of the doula is prior to and at birth. She said she was delighted to have so much help as her own family was not in the U.S. She had few female relatives here and her husband had said that his job would be to watch little Omar, their very energetic 2 ½ year old boy while she was in the hospital. It is a pretty universal assumption in traditional African society that birth belongs to the realm of women and that men are not especially welcomed. One father from Cameroon actually took the time recently to sit me down and explain to me that African men don’t like to see their wives “like that” meaning sweating and pushing their babies out, and that we would do well in American to explain this to our husbands and perhaps they would respect their wives more and there would be far less divorce. I didn’t agree nor disagree but just listened and said, “Oh, uh huh. Hmmm,” -- my pat answer when our cultures clash but I don’t see any point in trying to correct what I perceive as error quite yet. Perhaps later there will be an opening to discuss this. He wasn’t ready. And if I wish to continue working with families from another world other than my own, I have learned that I get a lot more mileage from coming to this work with respect and humility than attempting to confront my perception of the differences. A very wise, timely saying from the last century that I believe is attributed to Chief Seattle says,

“Do not judge your neighbor until you walk two moons in his moccasins.”

With that premise I must allow the possibility that he might even be right! So, we will begin preparing for this birth now, however late it may seem. I often meet with women at their clinic appointments. I get a lot of ‘no shows’ if I schedule our meetings outside of other commitments. I am not sure why, though I can guess that with little kids, in a new country and the language barrier, and learning the bus system if you don’t drive, meeting with your doula or midwife for that matter isn’t on the top of today’s to-do list. Just getting to your English class, getting the groceries home, and picking up a kindergartener after school is mind bobbling enough.

At our first meeting I show a wonderful little DVD called Doula that was made here in Minneapolis recently. It is perfect for the population I serve: Not only are there women of color having babies in the film, but there are home births, hospital births, footage of C-sections, water births, hands and knees births and even mamas picking up their own babies at birth. Equally important (though I am sure that the women who made this beautiful film may not have realized it) is that my mothers can see women in American giving birth completely au natural, some wearing nighties, others have their partners in the tub with them – the options are endless. This is important because I want them to know that the birth room is THEIR SPACE, that they will own it and they can do whatever they instinctually need to do to birth this baby and don’t need to worry that there is a certain way they have to conform to, like they have to do every single other day in American society; here they can literally let their hair down – or their hijab! (the Muslim women’s head covering.)

After we watch the movie I often wonder at the look of awe I see. This has opened up a whole new world of possibilities to many of these women. They are being put in charge of something for the very first time since coming here and I articulate it this way: “This is YOUR birth. It is YOUR body and YOUR baby. I will not be making any decisions for you but I will support you throughout your birth. I will not leave at shift change when you get new nurses and often a new midwife or doctor. I will be your advocate for whatever your wishes are.” This is a scary prospect to some. It is exhilarating to others. For every one of these women though, it is a new concept. They are in charge. They are often liberated by this one experience alone.

It's not just the making of babies, but the making of mothers that midwives see as the miracle of birth. ~ Barbara Katz Rothman, Sociologist, Author

The next step is to write a birth plan. I have one that I wrote that I give them suggesting they edit it, completely rewrite it, or throw it out and tell me what they want it to say instead. The interpreters at the clinic can help us with this, too. Recently, when I showed the Doula film at a clinic, the interpreter started crying! She just found it so moving and so different from what her own births in this country had been like.

The birth plan is one page long. I have seen templates for birth plans on the Internet that are 9 pages in all. From my experience, no nurse or doctor will sit down and read anything longer than one page. They don’t have time, and I do not want them to skim over it either. Since it is part of my job to greet anyone who comes to the room I immediately introduce myself and then invite them to read our birth plan. It sets the tone that says this lady knows what she wants and has definite ideas. It says that she has wishes and choices and implies that because I respect that, we expect they will too. It sends a powerful message, I believe.

We usually talk about each entry on the birth plan and what each option means. After we write it, I go through a little exercise I learned in my own Doula training at Enlightened Mama in Minneapolis. See: http://enlightenedmama.com/doulas/doula-training-2/ I suggest she look at her birth plan and if she absolutely had to, decide what 10 items would she keep and which would she be able to let go of? Then, which 5? And then all but one. We don’t have absolute control over how our births will go. This is our first test in the journey of parenthood. It is about what is best for my family, not my mother or my midwife. I believe there is a greater dissatisfaction with our births when we cast our birth plan in stone and then feel like we failed if we weren’t able to do everything the way we had planned. This is a sample of what I like to start with:

Laura’s Birth Plan

I would like my partner to call Stephanie 612-232-2323 when labor starts. I want to labor at home as long as possible.

Who I want in the room: If any residents or students wish to attend our birth, please check with me first. I want my partner and my doula in the room with me at all times. If anyone else arrives at the hospital, please ask me first if I would like them present.

What I want: I want to walk, use the birthing tub, birth ball, etc., and move as much as possible during labor.

I want to eat and drink and wear my own clothes and not be offered pain medication. I will ask for it if I need it.

What I don’t want: to be asked what my pain level is. I will ask for medication if I need it.

I don’t want nurses shouting to push or counting out loud. I want to push with the urge and work with my doula during this stage.

I do not want continuous monitoring but prefer a portable Doppler.

I do not want the bag of water to be artificially ruptured.

I do not want an episiotomy. I would rather tear. I would like my doctor/midwife to use oil on my perineum to help with stretching.

When my baby comes, I want to hold her as soon as possible.

Please delay cutting the cord. Then I would like my partner to cut it.

I want my baby on my chest and to let her initiate breastfeeding. My doula will work with us on baby-led breastfeeding.

I want her weighed and measured and any care done while on my bed after about 2 - 3 hours of bonding.

I want my doula to help me give my baby her first bath in our room before we leave the hospital on day 2.**

I do not want her going to the nursery at all. We will room-in.

I do not want her given formula, sugar water, or pacifiers.

I want Vitamin K and eye drops given after she has been with me for about 2 - 3 hours. I want to hold her for the Vitamin K shot and later also for the PKU.

I will go with my baby to have her hearing screening done. I want to bring my placenta home.

Thank you in advance for your help and consideration!

Ayana’s doctor scheduled an induction for the following week. The sugar levels and insulin were his main concern. Also her first baby had been only 6 pounds but this baby was much bigger. We met at the hospital and walked up together. She told me that she had just decided on a name: Sisay. She said that in Ethiopian it means ‘an omen of good things’. When we were settled I filled out the white board in her room: baby’s name, mom’s name, doula, interpreter, etc. The Amharic interpreter that came that day is one of the most amazing women I have ever met. Radiya left Ethiopia and moved to New Delhi, India 6 years earlier, all by herself. A traditional Muslim woman, she had earned a master’s degree there in business administration. Then she moved to the U.S. and took a course in medical interpreting and got a job with an agency that serves the hospitals in Minneapolis. This was my second birth with Radiya as an interpreter and we were both delighted when we saw each other again. I had been emailing with her and encouraging her to continue her education. Together we are looking into midwifery programs for her. We desperately need women like her in the birth community. She has a heart the size of Texas and is a natural from all that I have seen.

The induction started out slowly. There were mild contractions and she was dilated to 2 centimeters for the first two hours. I was glad that they encouraged her to eat and walk around. By early afternoon the contractions had stopped. Time for a snack and a nap. The doctor came by and suggested trying some Pitocin next which Ayana agreed to. The rushes picked up slowly and finally we thought that they had gotten a nice pattern when the nurses saw that they were actually coupling, or coming two at a time with longer rests in between. Then the rushes are neither very effective nor helping the cervix to dilate, so the Pitocin was stopped. The doctor suggested that Ayana rest, have supper and then suggested using a medication called Cervidil§ that would help ripen the cervix so that either contractions would establish themselves, or if they had not by morning, then the Pitocin might be more effective. She thought this all sounded OK, though not our plan, but I was glad the doctor was not being more aggressive and actually rather reserved from what I have seen in other hospitals.

By morning Ayana felt much better. Contractions were weak, though regular. Pitocin was started again. Pretty soon we were in business: 4 centimeters and she wasn’t laughing at my jokes any more. This is Active Labor and serious business. We walked and danced a slow version of a belly dance with me humming along while we bonded with walls up and down the four halls framing the unit. On this floor no one looks twice at couples frozen in place as if in an adult game of STOP! I suggested different positions: hanging while holding onto my shoulders, leaning into the wall, squatting by the bed, sitting on a birth ball, and hands and knees. We tried the tub for a while, but Ayana liked walking best. Every time we completed a 4-hall lap, we would stop by her room for a potty stop and another cup of juice.

We didn’t need a nurse to check to know she was opening up. The rushes were closer now and Ayana asked for an epidural. I explained some of her other options, but she had had an epidural with her last birth and had written that into her birth plan this time. Although I would love for every mom to explore natural birth, I have a strong commitment to supporting each one in whatever way they feel is best for them. I can only hope that they will gain strength and confidence with each birth and perhaps consider using less conventional methods in the future. They know I am there for them unconditionally and will not criticize their choices or continue to push in a direction they have decided is not what they want. So I let her nurse know that she was asking for the epidural. She called the anesthesia department with the request and set the room up for the procedure while we continued walking and drinking juice (I was pretty sure they would not let her do that once the epidural was in place. It is usually ice chips only at that point.)

Fifteen minutes later Ayana asked when the anesthesiologist was going to come. The nurses assured her that he was on the way. Half an hour passed and we were doing some pretty heavy duty breathing now. At one point I looked over at the nurse who shrugged her shoulders, looking baffled, too. Where were they? Ayana was obviously miffed at this point and had not planned on this at all. I kept telling her how strong she was, and how well she was doing. I helped her rest between the rushes, but when each one crept up on her again and then quickly intensified, she repeated her little mantra: “When? When? When?” Finally another nurse came in and very apologetically told us that he had been called away to an emergency and will come as soon as possible. I silently wondered why only one anesthesiologist was in the hospital, but I didn’t want to do anything to further disturb our routine at this point, so we continued breathing and resting… slowly... breathing… and resting. Radiya and I were both kneeling on each side of Ayana who was sitting in a rocking chair when all of a sudden she stood up and said she had to go to the bathroom. We had just been so I knew this was the beginning of the urge to push. I was surprised that Radiya could also read the signs and quickly instructed Ayana to sit on the bed where we could help her better. As we got her more comfortable I hit the nurse button said as quietly as I could, “we are thinking about pushing in room 350.”  Sure enough with the next rush Ayana flashed a panicked look at me and then took a deep breath as I did and pushed… and pushed. The doctor ran in the room between two nurses who were pushing in the warmer and instrument cart. Another push and we could see lots of baby’s head. Another grand push and she is here! Ayana looked down and just sobbed as she reached for her baby who was already crying. We got them comfortable while we waited for the placenta. Ayana’s look of absolute shock sent Radiya into another gale of giggles. I told Ayana how amazing she was. I also told her that now she could do anything! It was obvious that she couldn’t believe she had actually had a baby without any medication. We told her how strong she really was. I only found out the next day at our postpartum visit that she is a single mom. Recently divorced, her ex had offered to watch their son when she went to the hospital, but had no intention of helping her further.

In some larger, cosmic plan I believe this birth was meant to be this way to prove to Ayana that she was capable of anything. I think she can now agree, too.

I stay for 2 more hours and marvel at how beautiful little Sisay is and at her courageous mother. Another amazing birth I have been blessed to witness!

I am finally home and soaking in a deliciously hot bath tub. My husband heats up some food for me and has it ready as I sink into the couch next to him just in time to watch the next episode of the BBC's Call the Midwife! together.

(I didn't make that up. It is really true!)

§Unlike Cytotec, a very dangerous drug that is still being unscrupulously used throughout the U.S. and the world, Cervidil is successfully used to aid induction if truly warranted. Cervidil comes in a tiny rectangular pouch with a retrieval cord that looks similar to a tampon. It is inserted into the vagina, and contains prostaglandin, one of the chemicals that play a part in ripening the cervix. A ripe cervix is soft and stretchy, ready to respond to uterine contractions. Cervidil is used to "ripen" the cervix when it is agreed that your baby is safer to be born than to remain in the uterus. Cervidil is the first step in a two part induction process when the cervix is not ready to respond to contractions. Cervidil may increase the activity of non-productive contractions when no other labor stimulation agent has been used. Cervidil allows the mother to use the medication for the prescribed amount of time and then remove it. In some cases a mother may be able to go home after administration to wait for labor to start. Because prostaglandin E2 helps to make the connective tissue of the cervix more pliable while also stimulating contractions, it is more effective than synthetic oxytocin at inducing labor. The rates were similar for women giving birth within 12 hours, but more women had given birth within 24 hours with prostaglandin and the difference is even more pronounced at 48 hours. In addition, the rate of instrumental vaginal delivery is lower with women induced with prostaglandin E2. Some risk factors include side effects such as nausea, vomiting and diarrhea. There is a small risk of uterine hyperstimulation. It also requires continuous monitoring of baby's heart rate which decreases the mother’s mobility. Occasionally it causes abnormal fetal heart rates.

*all names, ages and identifying characteristics have been changed.

** see “The best baby video yet!” Listed under March at this blog.

COMING SOON: this and other stories will be appearing one of the books, Call The Doula! a diary, or Stone Age Babies in a Space Age World: Babies and Bonding in the 21^st Century,© pending by Stephanie Sorensen