Ma Doula

We weren’t sure what Moriah was trying to say. I was making a belly cast of her mama Dakota’s incredibly beautiful 8 ½ month belly and had invited her little 5 year old to join us in the room where we do them. She hopped off the chair I had designated for her and started by saying, “Ma doula, can I do that?” and “Ma doula, I wanna help.” So I told her where to smooth out the plaster and gave her the job of holding up the gauze strips before I dipped them into the warm water to soften them. 

“Ma doula can I have a belly cast too?” I told her when she is bigger and gets a baby in her tummy she can. Then her mom said, “Baby, whats you keep callin’ her?” Moriah ignored her mom, too engrossed in smoothing out any microscopic wrinkles in the gauze as I laid in on, layer upon layer. We let it go and kept chatting about finally getting to meet her son and how stressful the time had been, especially being homeless. 

She had moved up to Minnesota from Mississippi but had not been able to get an apartment in time for the birth. She had some family and friends here so she wanted to be close to them when he arrived.

“Ma doula, how do I get this stuff off ma hands?” I directed her to gently rub them together in the bowl of warm water until it all came off.

“Ma Doula, do I get tah paint it too?”

Dakota had had enough. “Girl! Whats youz callin’ her anyway?”

Before she could answer, it dawned on Dakota. She had told her mom and sisters earlier that day on the phone and several times during the week that she was “goin’ tah see ma doula”. Moriah thought that was my name! I could hear Mary and Debby, my supervisors giggling from their offices nearby every time Moriah called me that. So now we knew. It is ma new nickname at work: Ma Doula. I suppose it could also be spelled Madoula or Ma'doula or Mahdoula.... 

Stay Tuned! This and other stories will be available in my book, Ma Doula coming out in May 2015!

Welcome to the Land of Birth! Doulas, mothers and miracles

… where we often have little or no control, where we are wading into uncharted territory, where the rules might change at any minute, and where brave women (and not-so-brave women) have dared to go for millions of years, and succeeded. If they hadn’t we wouldn’t be here today.

My own birth journey essentially began with my first baby. The only alternative (read SANE) book out there in 1980 was the first edition of Spiritual Midwifery by Ina May Gaskin. I devoured that book. I could do this. And I did, having my almost-10 lb. Abraham in a little birthing room in a hospital before the doctor even made it. We checked out and went home 6 hours later.

I wanted to do the same thing when I became pregnant again. We knew it was twins before the doctor did. I scheduled my own ultrasound to convince him. The only way I could have them in MN in 1982 was in an operating room after being prepped for surgery. Then they would let me try to have a natural birth -- which they were terrified of.

So I called Ina May for advice, who invited me to The Farm. I moved there for the fall and had a beautiful birth which they filmed and called “Twin Vertex Birth” which by the way has been used recently in the movies “Birth Story” and also “More Business of Being Born”.

After the twin we had two more babies, three years apart. They were both unassisted home births … though I had planned to have a midwife both times but they never made it. By the time we had 5 children I had taken a few courses and began to seriously think about become a midwife. It all came together when I received a fellowship in 1988 to go back to school and received my midwifery license.

Fast forward to 2010. We had just returned to MN after living in England. I was turning 60. I did not want to work in a hospital as a midwife and be assigned two or three or more families per shift, and have to learn all of the new electronic monitoring and charting. I did not want to do the boards all over again which could take up to 2 years to prepare for, so I looked at my credentials and decided I could teach… and then I discovered the birth community here and Doulas!

This is my dream job. I don’t have to leave at shift change. I can be a grandma or a surrogate mom to a refugee family who have no one else here. I am already called Mommy in the Ethiopian immigrant community. I am honored and humbled that I can still witness birth.

There are over 30 doulas in our group at Everyday Miracles. We have classes in Somali, Spanish and English. If you haven’t already, please check out the website or better yet, come visit. Call ahead if you want to sit in on a class or follow one of us around for a day.

Yes, my scope of practice has changed. I don’t check dilation or fetal heart rates, but I get to connect with amazing mamas and support them during the most momentous event in the entire universe at that moment at their birth. I am with them as their doula when they go from being a woman to becoming a mother. I feel so blessed.

Stay Tuned! This and other stories will be available in my book, Ma Doula coming out in May 2015!

There’s a placenta in our freezer...

There’s a placenta in our freezer and my husband doesn’t know. He would freak out and then insist I bleach the whole refrigerator and freezer and I would never hear the end of it.

One of my clients had a scheduled C-section last week. There were multiple medical problems on board, not the least being that she had bariatric surgery earlier that year, lost over 150 pounds and then got pregnant. She had one complication after another after that. She was very nauseated the entire pregnancy, had bleeding on and off into the 8^th month, remained anemic and had dizziness throughout, causing her to fall several times a week.

Bariatric surgery essentially reduces the size of the stomach making it almost impossible to eat large quantities of food. There are several surgery options ranging from restricting the stomach with rubber bands or a sleeve, to stapling or sewing a part of the organ off. In this case Megan could hardly eat at all which served the purpose of losing the weight, but in the process her body became depleted of much needed nutrients. Her hair started falling out, she couldn’t maintain enough red blood cells and became dangerously anemic and by 7 months, her baby’s growth all but stopped.

The doctors considered inducing labor so that the baby could be born 6 weeks early and begin to get nutrients pumped into him via IV after birth. There were tests to see if her hormone levels were mimicking labor which would let them know that preterm labor was a possibility. She tried liquid diet supplements like Ensure which didn’t help much, even when she could keep it down. This was baby #4 so it wasn’t possible for her to rest much during the day. At night joint pain became unbearable, probably caused by the extreme anemia and vitamin deficiencies. A chiropractor was able to help a bit and had some good suggestions as far as nutrition. Megan tried yoga and meditation.

Then the day before she would hit the 39-week mark her water broke at about 3 a.m. She called me, not believing that she was capable of doing that without medical intervention. She had never been allowed to let the bag of water break spontaneously with the other 3 births. I congratulated her and for the hundredth time told her that her body really can do this and she is stronger than she thinks!

I had sent her this quote the week before:

Promise me you’ll always remember:

You are braver than you believe,

Stronger than you seem,

And smarter than you think!

~ Christopher Robin to Winnie the Pooh

I told her to let her doctor know, who in turn wanted her to come in immediately. I met her at the hospital triage wing of the labor and delivery floor. Like a mini emergency room, the nurses there can decide if a mom is in early labor and can be sent home without setting up a whole birthing suite or, if it is active labor (4 centimeters or more with contractions coming about every 5 minutes) they can have her transfer to a proper labor room, at this hospital with a large tub, birth ball, etc.

They first confirmed that the water bag had broken with a test strip. Then they Velcro-ed on the monitors in order to watch the baby’s heartbeat -- which was great -- and the rushes, or contractions – there weren’t any. We hung out and visited while her husband snored away on a lounge chair. Breakfast was served, then later lunch while we continued to flip the channels on the TV suspended in a corner of the room. Later that afternoon the official neonatal team of doctors descended on our room. They explained that they had hoped contractions would start on their own but since they had not and we were at about 12 hours out, they were hoping to talk about some options for birth. She could get Pitocin through an IV or in conjunction with a cervix softener like prostaglandin or Cervidil also called Prepidil or Dinoprostone. Or they could do a C-section, which they would suggest since she had one previously.

 

As a doula it wasn’t my place to push her in either direction. I had done my best at our prenatal visits to extol the obvious benefits of vaginal delivery and try to realistically enumerate the very risks of surgery, but at this point Megan was so sick and undernourished and anemic that she could not imagine summoning up the strength to endure labor. It was a catch-22. She had thought the stomach surgery would solve all of her weight issues, not knowing the havoc it could wreck on a body, much less a pregnant one. She chose the Cesarean route.

 

She woke up her sleeping beauty in the chair and asked him if he would want to go into the OR with her. He had not planned on that. It had never even occurred to him. It sounded overwhelming. What if he fainted? There’d be a lot of blood, right? What if he had to leave? He was working himself up to a panic attack. I got out my phone and found some photos of C-sections that I had posted on my blog. I pointed out that there is a huge drape that separates us from the actual operation. That it is bright in there but relatively quiet. That is takes only about ½ hour and that he can go over to the warmer and be with his baby and then bring him over to Megan and get to know him when he has been wrapped up. He studied the pictures and finally said he could do that.

 

While the nurses prepped Megan, Dad and I put on sterile ‘bunny’ suits to cover our street clothes. We donned our blue shower caps and masks and put blue booties on over our shoes. Megan walked down to the operating room with the nurses and we waited in the room until they would call us. Dad quickly fell back to sleep. He had been doing nights all these months with their other 3 children to let Megan rest and regain her health, so I didn’t grudge him these naps.

 

Finally we went back too and were given our posts on two little swivel chairs that had been placed by Megan’s head. She had already gotten the epidural and was excited about finally seeing this baby. They were already starting the surgery when we came in and baby was ‘born’ 15 minutes later. He came out with a loud cry – a good sign since he was so little. He weighed in at 6 pounds and 10 ounces, a miracle really considering all of the problems with this pregnancy.

 

Joe did really well, too. I checked in with him several times and told him he was doing great. Then I went with him over to the warmer where he reached out to his little boy who promptly grabbed his finger. Joe started sobbing, so overwhelmed with it all. The nurse wrapped baby up and Joe proudly carried his son back to his wife.

 

In the recovery room baby Abel latched on immediately, another miracle since I had assumed he would act more like a sleepy preemie, but he didn’t. He nursed at both breasts before falling into a peaceful sleep on Megan’s chest.

 

Her recovery is going well. I did a final postpartum visit with her two days later. I had suggested she ask for a belly band, or pregnancy belt which would both hold in her sagging tummy (which was profoundly out of shape after the weight loss) and help put her muscles back in place while she healed from the C-section. They had already delivered it from the hospital pharmacy before she left the hospital and she was again able to eat, though only miniscule portions. 

I also referred her to a nutritionist. I personally think they are grossly underused. Nutritionists have a wealth of information and can suggest numerous options for regaining your health. I am a vegan, though I was vegetarian throughout all of my 4 pregnancies, and when I began becoming concerned about the sugar that was showing up in my urine I worked with my midwife and a nutritionist to figure out how I could manage my diet without medications. I learned volumes from her. She never once suggested I needed to eat meat and completely understood my choices. After having 5 babies

--- one birthing suite birth, two home births and twins born on The Farm (see Twin Birth story) -- my sugars no longer seemed to be able to be tamed by my diet alone, so I went back to a nutritionist and learned how to further manage without meds. I am still insulin/Metformin-free today at 61 years old.

 

As a doula it is hard to work with women who apparently give up like Megan and simply opt for a C-section. I do not respect her any less, though. She is not where I am at. She may share my views someday, but she also might not. I also could not imagine how sick she felt during this pregnancy, nor how stressed and worried she must have been. My role here was to listen and show love and simply be there with her.

 

And when Joe first balked at the idea of bringing the placenta home, Megan patiently explained the value of encapsulating it and the benefits it could afford her. He got more grossed out by the minute and then flatly refused to carry “THAT THING” home on the bus in a red hazardous materials bag. She begged, she pleaded. Finally from across the recovery room, I offered. I knew how much it meant to her. She could collect it in a couple of weeks and I would get to see her baby again that way. We were all happy, then.

 Stay Tuned! This and other stories will be available in my book, Ma Doula coming out in May 2015!

Welcome to the World of Doula!

How would I describe them? Not shiftless, just idealists. Anarchist perhaps. Communists? No, but maybe Socialists. Hippies … I think that could fit too. They were living in a community of sorts; four houses on one street, vegetable gardens and chicken coops in between the houses. Yes, in the city. Faded jeans and unbleached diapers always hung on the lines above the chicken coops. There were usually kids playing some game of tag, running past you at the speed of lightning.

We had gone to a few of their neighborhood cookouts and a potluck wedding once. The square block of bicycle parts that had formerly littered the drive were miraculously all put away before the wedding. I can’t crack on that wedding. It sure beats taking out a loan just to get married in a dress you’ll only wear once (like I did) and to pay for a caterer when you could have cooked much tastier food yourselves. There is something to be said for living simply: no debt, no car, no insurance, no phone bills; just hang out and find a job you like. Go dumpster diving behind all the co-ops and bakeries and grocery chains and harvest all you need for a whole week’s worth of food. Sure, the luxuries of life will be gone, but you’ll find treasures hidden in Nature and other people instead. They had a point there.

But when it came to babies, I would have drawn the line. Sure, I had mine at home, some with midwives and 2 in such a hurry three years apart that no one made it to those. But if something had gone wrong we would not have hesitated to transfer to a hospital. That’s what they are there for. And there are countries all over the world where babies and mothers die every day because they don’t have the facilities that we have. But to boycott all hospitals under all circumstances because they are part of a materialistic, consumer-based conglomerate and perpetuate our capitalistic policies, and they only enable the rich and don’t serve the poor equally, does not mean we should never, in any unforeseen eventuality set foot inside their marble halls. Except this is exactly what they had decided: to do without ‘the system’ entirely and live in the fringes at the edge of the rest of the population. So when Juliette got pregnant, they looked for specifically and found an unlicensed home birth midwife who shared their world view.

Then they asked me to be their doula. I hesitated. Did they have a plan B should they need to employ one? No. Did the midwife have any backup? No. If she needed it what would she do? “Nothing” was the answer. They were on their own there. They could show up at a hospital, according to her, but she would not come along. Oh boy. I wasn’t sure. It grew on me slowly. They rented a birthing tub for their tiny room. They ate well enough and she was gaining steadily. Then came the last straw: she told me that had high blood pressure and a congenital problem with a kidney. Holy @$#&!

I told them that I couldn’t be their doula unless they had a doctor backing them up. And she would have to do that before her 8^th month. If I was going to be their doula and be her primary care provider at her home until we called her midwife, I would need to know that she had been screened and approved for a home birth. And my scope of practice as a doula would not have me doing blood pressure or sugar checks anyway. Then we would have to have a plan B, but the doctor who already knows her would be meeting us at the hospital, should we need to transfer.

I didn’t hear from them for over a week. At this point it was clear that they were obviously battling between themselves over priorities versus idealism. She understood my concern. He did not; he dug in his heels and did not want to budge. This one definitely threw a wrench between them. Their relationship had not been a committed-until-death-do-us-part arrangement and I didn’t want it to get to the point where she could actually be at risk for leaving us all together, as in some fatal complication, which was not entirely far-fetched on my part, knowing of some of the medical issues. I know I didn’t trust enough that Nature knew how to birth this baby, and I had perhaps lost sight of the midwifery model of care favoring instead our allopathic brand, but….

Juliette called me the following week. She had been to a regular ‘establishment’ doctor whom she said cleared her for a home birth. Great! Her blood pressure and sugars were within normal range, so they were delighted with this and wanted to proceed with their original plan, but then as another week unfolded things changed. Drastically. She was sick and not having much luck getting back on track. She went back to the doctor and as she edged nearer her 8^th month, was put on several medications and a restricted diet in the hope of stabilizing both the kidney function and blood pressure. In spite of the ominous recent chain of events, her midwife told them it was still the better choice to have their baby at home. Really?

They had scraped together the midwife’s fee by begging and borrowing from family and friends and selling an old car he had fixed up. She was officially hired. I, on the other hand knew that they didn’t have any savings and offered to barter. Pierre, an accomplished carpenter could suggest something he could build for us in exchange for my doula services. Everyone was happy.

About 6 weeks before her guess or due date, Juliette called me saying she was having horrible head aches and feeling really crummy. I insisted she return to the doctor and get it checked out before it got any worse. It could have come from stress, she admitted. Her partner was nowhere ready to have this baby. He wouldn’t pack up his tools or the mountains of junk that covered the floor of their tiny room in the house. The birthing tub had to somehow fit in there. And she had expressed the wish that they move their mattress onto the floor in the main room from its place in the loft where it stood on a platform up on stilts. It was stuffy in there and too high to climb up and down with a baby. But he was not moving to help with any of this. Juliette blamed herself for being so picky and cranky, but they weren’t really as together as she had hoped they would be, especially with a baby on the way. I could only encourage her to keep the lines of communication open with him and that in the end she had to do what was right for her and her little one, even if he didn’t agree.

The report from the doctor was not good. He strongly recommended that she check into the hospital that same day and be induced. Her overall numbers were not good. Her kidneys were being taxed and the blood pressure was too high. He felt that her health could still recover after the delivery, though she was getting into hot water already and waiting would not guarantee that she might not come out of this without some permanent damage, and the baby’s health would only be compromised and at risk if she didn’t deliver soon with these new developments.

Negotiations with their midwife went back and forth all that day. She was willing to help them should they choose to stay at home, but I made it very clear that I could no longer be part of it then, and she countered that her job description didn’t include being with them throughout the whole labor, that was why she had recommended they find a doula, even though they had paid her several thousand dollars. I told them that the hospitals are there precisely for these kinds of situations and that I felt the doctor was on their side, committed to having a healthy baby and a healthy mother in the end. The battle had begun.

So the cards were blatantly stacked against them. Her health might not recover if she didn’t deliver the baby soon and may even become permanently damaged, putting her at grave risk. I pointed out that her baby needed a mom and that although we would like to have control over our health and our births this is not always the case. Welcome to parenthood. I could not tell her what to do, but I could encourage her to think on her own, without Pierre going on and on about corporate greed and disregard for the poor and multi-billion dollar facilities. He just didn’t get it that her life was creeping closer and closer to a point of no return at this rate, her numbers were now that bad. I had never had a mother this sick in my 30 years of midwifery practice, partly because high risk births were screened out through my protocols and I would have been required to transfer care weeks ago in her case.

I told them to call me if I could do anything for them and let go. I had not been this frustrated in a very long time. I said a prayer and made supper. Later that evening she called to tell me that she had decided to go to the hospital and asked if I would be able to meet them there. I said I would be glad to.

I explained what induction meant and how that might be attempted 5 weeks before a due date. She had written a birth plan and we had talked about the numerous options that she had for a home birth, but then tailored that for a hospital birth. Now we had to add induction and what she could agree with and what she did not want to try. Her choice was to have her baby as naturally as possible with as little intervention as possible. I outlined the various options the doctor has for induction, explaining that some were more invasive than other interventions and that she would have time to ask questions and could ask for privacy to decide what she wanted to do. Once she was settled in her room the doctor suggested a plan to start up labor by using a ripening agent placed at the cervix that would help get things started. Then they could start a small amount of Pitocin by morning and get her into active labor. Sometimes these will work quite well but occasionally they don’t do much at all and then the doctor will suggest the next trick up his or her sleeve. So the couple asked for some time to discuss this privately. We all left and I went down to the coffee shop to get a drink.

They called me on my cell phone shortly after that to tell me that they had called their midwife for advice and she had warned them about what not to let the hospital do to her under any circumstance and suggested some alternatives to try. I did not realize she was still in the picture and found this rather bold for her to be making decisions from some undisclosed location. So the night started off with a bang. They agreed instead to a non-medicated approach and opted for a balloon catheter to be placed that would stretch the cervix open and hopefully trigger labor on its own.

By morning it had succeeded in getting the cervix to dilate slightly but not appreciably. The next suggestion was to try Pitocin and then perhaps breaking her water if the baby’s head came down further. Again the couple asked us to leave and talked it over, and as I suspected, again called the midwife who told them not to let them break the water under any circumstance. I had never seen anything like this. I did not understand their trust or devotion toward this woman. I was mystified by it. I knew I was considered a close friend, but somehow by my being a licensed midwife and certified doula, I had gone over somehow to the ‘other side’ and was deemed too medical or too swayed by ‘the system’ to be consulted on how to stay on the natural side of things, is all I can guess.

The nurses soon got the hang of how to approach this couple. Each step would require consultation, then consideration in private, then double checking what I thought (but only after the other midwife was called) and then the nurses and/or doctor could come back in and negotiations would resume. I was beginning to feel like an international conflict-mediation envoy deliberating the politics of civil unrest. Many of the suggestions only met with rejection as being too invasive or they simply felt that things were being unjustly and routinely rushed and asked for a few more hours of walking or sitting on the birth ball to let things work. I took to listing options for them from least to most invasive, knowing they would veto any and all suggestions unless the guru midwife approved of it. The nurses started asking me to ask them thus and such – hoping I had more say because they realized they did not have in fact any at all. My only objection to their midwife was that she was simply calling the shots in a realm that I felt was now outside of her sphere of skill or experience. 

I do not go to a birth at home or in a hospital ready to do battle. I sincerely feel honored to be welcomed onto a birth team and readily defer first to Mom and her wishes and then follow her midwife’s lead. But this tug-of-war went on all night and all the next day. By evening I was called out to the nurses’ station and given an overview of the bigger picture. Baby was still doing remarkably well. Mom was OK, blood pressure and other numbers not off the charts yet. But it was time for baby to be born. I asked what options they would propose next and breaking her water was the least ‘medical’ in their eyes and might speed labor up appreciably. I went back in and sat down, slowly rubbing her feet as I balanced on a birth ball at the foot of her bed. They were not agreed between themselves what to do next. I told them that they were doing great, that baby was sounding really good and that she was actually making progress, which is not the same at an induction as it is in a term birth. I proposed I go home and sleep and that they try to rest, even if it was only dozing between the rushes or contractions. She was able to eat and drink and was doing OK there. She had refused all IVs and meds up until this point. I knew they would continue to call their midwife whether I was there or not, and was frankly at my wits’ end at 48 hours. I hugged them each good bye, assuring them I would be back within 15 minutes if they wanted me.

I walked the short 6 blocks home. I was so tired and drained that I just showered and cried until I got into bed. I did not ‘get’ this. 

I had a call a week earlier from a birthing clinic asking if I could consult on a breastfeeding problem they were seeing. The couple was from the same tribe as my laboring mom and dad were. They were vegans. Fine. I was too during my twin’s pregnancy and birth and since then. That was not the problem. The issue was that he thought she should be able to skip drinking altogether until they could find a 100% pure reverse-osmosis water source and that they could get along just fine with just raw foods they would ‘harvest’ from around the city. It quickly became obvious that he was dictating or controlling everything she put into her mouth! It turned out she had not eaten that day and possibly the day before. She was very thin and very pale, had not taken vitamins and as soon as I started prying a little further, she simply looked at him. He then tried to assure me that he had studied nutrition and that we should respect their choices. Their midwife, who had called me, felt that the baby was getting dehydrated and loosing precious ounces that he should have been gaining by now. The father would not let us visit with her unless he was in the room. We both spoke to them rather firmly, hoping to wake him up a bit. She had already given up any autonomy she may have possessed, though I doubt she ever had any, at least since she met him. When I called the next day to see how they were the phone had been disconnected. The midwife went out to their house and was told by the landlady that they had moved out that morning. They were gone. Vanished.

I slept in and called the hospital once I was awake. The nurse told me that they had just had a healthy 8 pound girl. The midwife came in after she heard I had left, though they were instructed to say she was just a supportive friend. She helped them try different positions that helped baby along, which they were very glad for. Later that evening I called the couple and asked if I could visit. I congratulated them and told them how glad I was that they had been able to have the natural birth they wanted. She was nursing which her baby took to right away. She was still 5 weeks early but was doing really well and did not have to go to the ICU. I was so glad all the drama was over.

I got a call from another woman who was living in their communal house two days later. She explained to me that public health nurse had come by to make sure the baby was doing well. She looked at the baby and voiced some concern about his color and that he seemed to look jaundiced to her and also that his skin appeared dehydrated. They had read all of the natural birth books

and said they had chosen to nurse on demand,meaning only when he awoke or fussed and asked for it. They had thrown out the doctor’s program for preemies in which he insisted upon waking the baby to eat every two to three hours at the most until she reached the due date. He had explained that their baby may act very sleepy and need to be fed to catch up, whether she appeared interested or not. But they thought the doctor was just going into some routine medical jargon and that they thought ‘nursing on demand’ sounded more natural. Never mind that the baby came 5 weeks early! Or that she was sleeping up to 6 hour stretches and did not cry. The nurse took a blood sample and explained that they needed to know what the bilirubin numbers were and she would call back later that same day after she got the results from the clinic. They added her to their list of ‘establishment’ care providers, turned off their cell phones and went back to sleep.

Their baby did have seriously high readings for jaundice and she was in the danger zone for being dehydrated. When the nurse called both numbers over and over and they didn’t answer she did what she felt she had to do. She called Child Protection and explained her concerns which were bordering on dire at this point. They had to re-hydrate this baby now and get her under lights right away.

So a police car and an ambulance pulled up in front of the commune and I get a call explaining all this. I had told them I was a lactation consultant/educator and would gladly give them any help they needed 24-7 and they knew I wasn’t charging them, so why didn’t they even ask? Later that night I went to the hospital and sat with Juliette for a while. She was nursing her baby and had moved into the NICU. The hospital gave her a room with a real bed so she could stay right there. She told me that they just assumed newborns sleep a lot. They thought she would let them know if she was hungry. I explained again that she is premature, that the rules all change at this point. She said, sounding surprised, “Oh. That is what the doctor keeps telling us, too!” She was still pretty shaken up by the whole experience. It didn’t help that she had not slept since labor started, going on day 4 now. She also told me she had decided to stay in the hospital this time until everything was taken care of and they understood what they needed to do, even if her partner didn’t agree with this. 

I still see them from time to time. Luna looks too big for her little mama to be carrying her around anymore. She is very sturdy and has gained beautifully. Juliette is feeling well and taking care of herself. It was another example I could chock up to education. I don’t know what I could have done differently. I am just very, very grateful everyone is OK now.

As a doula I think back to experiences like this one and wonder if I could have done anything differently. I think not. I wanted to respect them even when our values differed and I wanted to advocate as much as possible for what her wishes were. I did not feel at any time that it was my place to act as marriage counsellor either. These were two adults whose ideas were different from mine, which did not make mine better or more valid. I come away from experiences like these convinced we must above all respect each woman we work with and allow that their point of view may not be our own. But I have also learned that I must have my own boundaries and equally respect those. Welcome to the world of doula!

STAY TUNED! This and other stories will be appearing soon in the book Call The Doula! a diary© - by Stephanie Sorensen

China: Can I keep her forever and always?

This is a love story.

I never thought we would ‘click’ at all. Everything was wrong from our first appointment. China complained about how awful pregnancy was. (I would give anything to have just one more baby. I loved being pregnant!) She accused her baby of hating her -- why else would he kick her so much? She told me she was having this baby with the wrong man. She confided that he was a loser and she hated him, he couldn’t even find them decent housing. They were homeless and camping out at his sister’s house. Then after the tour that OB patients were offered she called to tell me that the hospital was all wrong. She could not, would not bring her baby into the world in such a depressing place. I had to find her a better hospital. Why, they didn’t even have pictures in the rooms! I thought to myself, ‘sweetheart you’re not gonna care what is on the walls when the time comes.’ If she blames her baby for her discomfort now, what will labor look like? And she says she wants a natural birth.

I called my supervisor at this point asking for some wisdom. Was I the right doula for this client? Would she be happier with someone younger? Debby told me she wouldn’t choose United Hospital either. It is depressing. OK. I’ll keep her.

I started going to her prenatal visits with China. I needed to get to know her better. I gave her the phone numbers for some of the birthing centers throughout the city. She visited one that is absolutely gorgeous, but they were not a non-profit and subsidized their medical assistance payments from low income families by charging an additional $300. in cash up front. She is homeless, for goodness sake! How can they do that? Is that even legal? I told her I would find a place for her.

So I called some of the other birth centers and found out that most did not take transfer clients after their 34^th week. I knew I could probably get her into the midwife program at the local public hospital, but imagined she would be turned off by their ‘public’ image. It is often seriously over crowded, usually very loud, with standing room only in the emergency waiting room no matter what time of day or night it is. I called them and asked for the labor and delivery charge nurse. I explained who I was and what I was hoping to do for China. She explained that it was too late to transfer, but she actually knew who I was from some of the births I had been to there, and asked me if I would hold while she checked with the floor supervisor. She came back on the line and told me that if I could get her to the clinic the next day they would take her. I asked if I could also tour labor and delivery with her and silently hoped that their ‘better’ rooms would be unoccupied so she could see them.

The next hurdle was getting her there. Medical assistance will provide a taxi for medical appointments but only if you schedule it two days in advance. I don’t drive so I was trying to figure out how to get her there in the morning. Her boyfriend’s sister’s where they were staying was out in the suburbs, where the buses only run once an hour. It has been below zero here all week, with the wind chill factors down in the minus 30s. Really! Buses were out. So I called medical assistance’s transportation number and told them that one of my clients had to get special emergency clearance to get next-day rides from here on out until she delivers. They actually approved her if I would arrange the rides for her. Great! It worked!

The next day we were called and roomed in a tiny cubicle to wait for the midwife. China must have gotten out on the wrong side of the bed that morning because the first thing she did when the midwife came in was demand that she be induced! She said she was sick of being pregnant and miserable, can’t eat, can’t sleep, her baby hates her and kicks her on purpose, and that she will only stay if they will get this delivery rolling. Like today! The midwife listened and skirting the issue completely asked if she would kindly jump up on the table so we can hear her baby. The midwife and I both gushed about how wonderfully strong her baby’s heartbeat was when the Doppler was turned on. China just kept griping. I had had enough so I said to her, “you know, I have had ladies in the past year whose babies couldn’t move like yours can. I even had one baby who was born with half a heart! (See the story Emma Hope.) You have a really healthy baby, and I am really looking forward to seeing him, too!” The midwife was nodding her agreement the whole time.

We finished with the appointment and the midwife explained that it was not their policy to induce labor without a good medical reason, like when the mother has pre-eclampsia or diabetes. China grouched a bit more but realized the two of us were not going to be moved on this one.

We went on a walk through the midwives’ labor and delivery side of the hospital wing then, starting with a huge open room, almost a suite, with birthing tub, private bathroom, little refrigerator and yes – there were even pictures on the walls. We saw two more rooms, decorated sparsely but pretty. They passed her royal highness’ inspection. Whew! I thanked the midwife profusely and we went down to the front of the hospital to wait for the return taxi.

Talk about an attitude! Maybe she was feeling so very helpless being homeless and without support that she had decided to demand her rights in the littlest things that perhaps she could have control over. She was 23 but it was like she was going on 12! Then it dawned on me, I would gain her confidence with love. The expression, ‘Kill them with kindness’ came to mind. I would lay it on so thick she wouldn’t know what had hit her. I would smother her with kindness. I couldn’t image how else we would be able to work together through this birth. I knew that she didn’t have a clue how hard it was going to be. And I didn’t want to see her fall apart before she even got into active labor and had to actually work to birth her baby.

My supervisor had suggested I bring China a book from our library called, “Bonding With Your Baby Prenatally” which I had brought along. I gave it to her as I hugged her goodbye that morning. It was almost Christmas.

The following week I collected all sorts of baby clothes and wrapped up a beautiful scarf a friend had just gifted me with. I already had 4 others so I thought it was just the right thing to give her. My old heroine Dorothy Day said that “the extra coat hanging in your closet actually belongs to the poor.” I decided this must apply to scarves too.

(See: http://www.catholicworker.org/dorothyday/daytext.cfm?TextID=150) I have never been very good at hanging onto things that people have given me. My own mother had become furious with me years ago and finally asked me before my birthday one year, “If I give you a gift, will you give it away because I will never buy anything for you again if you do.” I confessed that I could not promise her that.

The next week I was given some donations to give to some of my mothers, so I started another ‘care package’ for China. She was charmed, to say the least. And we even got along well enough to talk about a birth plan and her wishes. This was better, but when I asked at this point if she wanted the boyfriend in the room at all, or what was she thinking she said, “He is gonna be there the whole time and see what he did to me!” Oh dear, not a good reason to add him to the birth plan.

Another week and she called me and we were back to her demanding induction. I very calmly explained that she was only at 36 weeks and that I would find it really sad if her baby couldn’t go home with her after she had him and had to stay in an NICU. I told her all that happens in the next couple of weeks to ensure that he is really healthy, and that his lungs might need extra help at this point should he come out now. She backed down. I told her to call me anytime and stay in touch.

A Korean graduate student in my apartment building was moving out about this time and asked if I could find takers if she gave me any nice but used clothes. China was just as petite as Song. I looked in the box when I got it back to my place. I never would have been able to afford the cute sweaters and dresses, even designer lingerie! It was a huge success. I had found China’s weak spot! And we were buddies – at last.

One evening in her 38^th week she called to ask if she might have lost her mucus plug and described what she was seeing. I agreed that it sounded like it and congratulated her! It brought back memories from when my own kids first pooped on the toilet and I would clap and enthusiastically praise them for their accomplishments. I cautioned her that though her body

knew exactly what to do and would certainly kick into gear on his exact birthday (that of course only he knows), that this could still be several more days and that she should just keep doing whatever she had been doing, resting, eating, watching movies and walking.

Two days later she called screaming that she couldn’t sleep all night and she couldn’t do this anymore, and that her back was killing her and she was nauseated, etc., etc. I was quite excited that this might be early labor. I was really looking forward to meeting this baby. I told her to eat and rest and call me if things changed or she gets regular contractions. I also told her to call the hospital and let the midwives know and that they might want her to come in to check her. I hung up and went back to our supper. By the time we were washing up the dishes a very hysterical China called to say she had been on the phone with her grandma when her water broke. What should she do? I suggested she call the hospital and let me know what they say. I knew they would want her to come in, but that isn’t my call as a doula. I made her promise

to let me know. YA-HOO! We were going to have a baby! I realized then how much I really cared about China. She was the same age as my own daughter. I really wanted to see her succeed, to be a good mom and get her life back on track. It wasn’t until I stopped judging her and started listening that I realized how very hard she really had it: parents on drugs, foster homes, you name it. I had to hand it to her though. She told you what was on her mind and she wasn’t bashful about letting you know how she felt that day. There was no guesswork at all, you got the whole story whether you wanted it or not.

“However much we know about birth in general, we know nothing about a particular birth. We must let it unfold with its own uniqueness.” ~ Elizabeth Nobel

Almost 2 centimeters, 95% effaced, contractions picking up. This was it. The midwife confirmed that her water had broken. China wanted to rest for a bit so she lay down and closed her eyes. All of a sudden she rang the nurse’s button and sat up. The nurse came in and China announced that this wasn’t the room she had seen on the tour of the unit the week before. That room was pink. This one was an ugly tan. I tried to ignore this comment, but she wasn’t going to let it go. She dug in her heels. She threw on a robe and said she wanted to check out all the other available rooms. The midwife took a deep breath (and I think she hinted by the look she threw my way, ‘what have you dumped on us?’) and said, “OK” and led the way.

We walked into each of the other 6 rooms on the hallway and then back tracked through each

one of them once again, China leading the way and all of us in tow. She settled on a pink room and ordered us all to go get all her stuff and bring it in. The rest of the afternoon and evening was uneventful. She was dilating at about 1 centimeter every 2 hours and baby sounded great. It was slow, but not unusual for a first baby. By 4 centimeters China asked the nurse about getting something for pain. The nurse reviewed all of her options and China chose a low dose of an IV drug to take the edge off but not make it impossible to get up or get into the tub. In the end it hardly worked at all and wore off before an hour was up. It also affected the baby and his heart rate flattened out to a low 100 to 110 beats per minute, which isn’t all that great. When

China asked for more, the nurse suggested an epidural, but she really didn’t want that if she could possibly avoid it. I backed her up and pointed out that the baby didn’t do too well with the first drug and that I wasn’t encouraging her to get more. I suggested she try the tub at this point, got her a cup cranberry juice and filled the tub. She really liked that. I had been telling her that being flat in bed was not the best position to labor in. She found a real rhythm then on her own. I was actually surprised and told her how well she was tuning into her body all of a sudden and finding a way with each rush as they rolled in on her. Penny Simkin, eminent author and doula talks about the 3 Rs: relaxation, rhythm and ritual during labor but I had never seen someone find that on her own in exactly this way. It happened when I was breathing with her during a rush and her head bent down and leaned forward and rested on my knees and I automatically ran my fingers through her hair from the back of her neck and then gently pulled her hair back toward me. We did it a few more times and I asked if that helped at one point and she just purred, ‘uh huhhhhh.’ So we kept doing it. She changed position after a while and with each rush ran her own hands down her neck, and rocked gently forward until it passed. For the rest of the labor she found some rhythm to add to the breathing which I found fascinating. She had tuned into some inner strength that I had not seen before and just went with it. Penny explains (See http://www.youtube.com/watch?v=Mo4VmgpHmxs) that from observing hundreds of women in labor she learned that those who were able to cope best found these 3 Rs and used them in their own ways. 

Then, in walks the grand matriarch of the clan: Grandmama! … in flowing black and purple layers of some kind of robe and antique silver earrings, spotted leopard hat to top it all off. Regal is a modest description. She blew me away! (Sorry, but I could not find a picture befitting this lady!) As she glided into the room she set out bags of goodies for all of us. She had thought of everything: granola bars, bottled spring water, snacks, and cookies. Then she looked over at China and beamed, “You are so beautiful! You are a goddess! You are doing this sooooo well!” She proceeded to unpack a huge bag and laid out baby blankets, baby clothes, baby socks, baby shoes, all brand new and all blue! Then she turned once again to China and said, “You can’t have any more kids ‘cause this all broke the bank!”

With the next contraction the Dowager Empress stood by the bed and breathed with China. Then she brushed her hair and massaged her neck. I was still sitting there in awe. And all this loving on China really got things going. Soon she was saying she couldn’t do it anymore and needed an epidural NOW! and I knew we were at least 9 if not at 10 centimeters. I explained that this is transition and it is the end of the very longest part of labor, that she was doing so so SOOO well and that we will help her with each rush until she can push. I said she should rest now in the few minutes in between which she did. She trusted me by now and we were a finally a really great team. I let Grandmama coach her all she wanted and hung back a bit. This lady was truly stellar!

China tried a hands and knees position and then went back to sitting up cross legged. I asked the midwife if they had a squatting bar, thinking that it might be just the right thing, and it was. China leaned into it, threw off her hospital nightgown and pushed! Two more pushes and she screamed. The midwife assured her she was doing it perfectly and was feeling the baby’s head at this point. I tried to help her reach down to feel the baby’s head crowning but she shook my hand away, grabbed the bar once again and pushed her baby out onto the bed. Still squatting she picked him up and held him to her chest. He gurggled a tiny cry and then let loose! He was tiny -- perhaps all of 6 pounds but sure had a huge set of lungs. We helped her back down to the bed where she could lay back on the pillows as I piled them up behind her. She studied her beautiful little baby as he blinked back at her and then said, “I love you so much!”

We let him do the breast crawl and latch on his own when he was ready. He was on within 20 minutes! (See: https://www.youtube.com/watch?v=pjDQN9keKQk)

The next day I visited China one last time. After this I had no reason to visit with her as a doula. I have paperwork to turn in and can then ask for more client referrals.

One of the forms we have is a survey for the moms to fill out rating the usefulness of the doula program from their point of view. There are questions like, ‘Were the techniques suggested by the doula helpful to the mother in handling the physical aspects of her labor?’

So the next day at my last visit, I sat and held little Baby Boy (who didn’t have a name yet) while China filled out the evaluation form for me. When she was finished I took it and stuffed it right away in with the other papers in my bag and hugged her goodbye. I whispered in her ear, “You know, my love, now you can do anything!” She looked me straight in the eye and answered “Yeah, I can do anything!”

When I got home I had supper and pulled out the paperwork so I could finish it up and send it in the mail the next day. As I was stapling the papers, I read the evaluation page. I noticed that China had written a number 10 after the 5 and circled it for her answer to #4. Then I read her comment at the end of the form. She had written, “I love my doula. Can I keep her forever and always?” I cried.

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

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