I have semi-retired from
full-time doula-ing. I write every day now, so I only take 4 or 5 referrals
from our ‘head doula’ (Reverend Mother Doula? Doula Supervisor? Doula
President? In-Charge Doula? Debbie, what are you, anyway?) at Everyday Miracles
(http://www.everyday-miracles.org/)
for new mothers-to-be every few months. That way I have been, so far, having
about one or two births a month or so. We are required to visit with the mom
four times before her due date, attend the birth, and then do a postpartum home
visit afterwards on day 1 or 2. Until this week at least, I could write 5 or
more hours a day, update or post a new chapter on my blog (callthedoula.blogspot.com) fit in a couple of prenatals a week, and fill in the
rest of the time reading, researching new information and visiting refugee
families around our neighborhood. Until this week…. And it wasn’t even a full
moon. I am not sure what it was, but it was busy!
An
Amharic* translator I had worked with before called me from a hospital in St.
Paul, Minnesota to let me know one of ‘my’ ladies was in labor and didn’t I
want to be there? I had worked with her before, a gem of a woman. I have been
encouraging her to go to medical or midwifery school. She is brilliant,
and a ‘natural’ with caring for women. She already has a bachelor’s degree,
too. Belem is an observant Muslim, and one of the funniest ladies I know. She
laughs at everything! I suggest a warm bath for the laboring woman, set out my
little battery-operated candles around the tub and she laughs her head off! (I
am not allowed to have real candles in the hospital – a fire hazard. We are
also no longer allowed to bring in a heating pad or sock filled with flax to
pop in a microwave and use for labor – a burn liability.)
So
I rush over to St. Joseph’s hospital and find out that not only has Keleme not
called me, but she has been in labor for over 24 hours already. So we settle in
and visit and with her midwife figure out how to help her rest for a bit. I
guess that she is just exhausted and hasn’t eaten or had enough to drink during
labor and her midwife suggests some IV fluids along with a muscle relaxant so
she can sleep for a bit. It works. Three hours later after the drug wears off she has a beautiful little 5-pound boy, her first baby, with only 3 pushes!
He is tiny but nurses immediately. He is going to catch up just fine.
By
2:00 a.m. I am on my way home. I shower and slither into bed – it feels soooo
good – and fall asleep, only to wake up to the phone by my bed ringing at, ugh,
I can’t even read the time without my glasses. Oh there, 7 a.m.? OK. It is my
lady from Laos. Her water broke an hour ago. Should she go into the hospital
yet? “Yes” I tell her. “I will meet you there. Remind me, which hospital. Good.
Ok, honey. We’re gonna have a birthday party today aren’t we?” Also a
first-time mama. I grab her file. Yes, I thought this was early. Only two
weeks. Not bad. So I dress in my next clean outfit and call a taxi.
I
have a new driver that I have not met before. I can tell by his accent he not a
native “Minn-ah so-‘n” as they say here. I ask where he is from and he hems and
haws a bit and then says, “Iran.” I answer, “Oh, that’s great! I am a doula and
I am on my way to my second birth in 24 hours.” He is visibly relieved that I
am actually
happy that he is Iranian. There have been numerous
attacks recently on the streets here. Lots of anti-terrorist feelings flying
around since the Boston Marathon bombing, and anyone who even looks Arab has
been getting harassed by ignorant locals who think all Arabs are horrible
people.
He
actually melts and says what a blessing that is, that I help women have their
babies, and proceeds to tell me all about his two kids. I ask for his card and
say I will call him next time I need a cab. He drives up to the hospital and
before I realize what he is doing he has run around and even opened the door of
the taxi and holds it for me!
As
I ride up in the elevator to the Birth Center my phone rings. It is another mom
letting me know she just lost her mucus plug. I congratulate her hoping she
will be a bit more excited about her second baby than she’s been all along and
tell her to keep me informed, day or night, reminding her that she could still
wait several more days for labor to kick in.
The
rushes (contractions) have started by the time I enter the room. I scrub up at
the sink and go over to the bed to hug her. Der is as stiff as a board,
obviously very nervous. The monitor is blaring away and something else is
beeping in the room. I hit the nurse button and ask if someone can come down
and turn off all the noise. That done, I massage her hands while we chat about
what to expect next. Her midwife has prepared her well. Der insists she can do
this without drugs. She knows even a small amount could affect the baby. I
don’t try to steer moms into having all natural births, but if they are at all
interested, I am 100% behind them. Some people just aren’t there yet, and as a
doula I need to respect that.
We
walk around after a while, sit on a birth ball, drink juice and munch on snacks
and walk around some more. The nurse checks her and announces “Five
centimeters! Great” and leaves us alone again. Less than ten minutes later
during a rush Der suddenly holds her breath and pushes for all she’s worth. I
know that, in spite of being told she was only 5 cm. that she knows what she is
doing, in spite of this being her first baby, so I hit the nurse button again
and try to calmly say, “we are feeling a bit pushy down here and I think you
ought to come. NOW!” Nurses rush around setting up the room; an instrument cart
and baby warmer come in from the hallway where they have been on stand-by
draped with sterile sheets, chairs go out the door and the bottom half of the
bed is removed. Stirrups pop up, though I show Der how to sit up and hold
behind her knees with her hands and we don’t use the stirrups at all. (I avoid
them if at all possible.) Another push and we can see baby’s black curly LONG
hair! I help her rest and slow her breathing after the rush and she appears to
instantly go to sleep. When she wakes up as the next rush builds she pushes the
little head out. It is perfectly round, hardly cone shaped at all. The rest of
the baby slides out and Der reaches for her baby. She immediately starts
talking to her little girl in Lao. I have never heard her speak it since her
English is so good. I ask what she said to her little girl and she laughs and
says, “Oh I just said ‘hi, I’m your mommy and this is your daddy.’” We are able
to keep baby on her mother’s chest skin-to-skin for a couple of hours, both
covered with pre-warmed blankets. A wonderful birth.
I
get home, shower, warm up some leftovers and catch up on paperwork. I won’t
remember when what baby was born or dates or weights if I don’t write it down.
Finally I decide I need a nap before my husband gets home. I have hardly seen
him this week. It’ll be nice to have supper together.
The
lady who had called me while I was in the elevator going to the last birth
calls back as we are getting ready for bed. It is midnight. She is having
contractions but they aren’t regular and they have been coming and going for 2
days and she is done doing this and lets me know she is going to the hospital right now and insisting on being induced and wants me there, too. She will start week 39
in two days. Yes, she is not even due yet. She has already hired and fired two
doulas before me. She had numerous issues with them but for some mysterious
reason decides I am OK. I find out her mother died two years ago this week and
she is angry that her mom couldn’t hang around long enough to help her with her
kids. I met her in a clinic I had never been to in town just a
week ago. The entire area reminded me of Harlem in the 1960s. I had no idea we
even had such pockets of poverty in Minnesota. She was in the waiting room with
her partner and their 3 year old the day I came to meet her for one of her
prenatal appointments. The little boy was snarfing down a whole bag of mini
Milky Way bars and the mom was munching on Cheetos. After 10 minutes she says
to the little guy, “OK baby, let’s trade” and they exchange bags and continue noshing.
This is lunch. Yes, really. No, I don’t do my nutrition schpeil. I
am sure her doctor has had this conversation already, many times.
I
talk to her awhile on the phone and she calms down. I remind her that this is
still 2 or could be even three weeks early and I really don’t want to see her
deliver prematurely and not be able to bring her baby home from the hospital
with her if he ends up in the NICU. She finally agrees and asks what she can do
to hang on a little longer. I try to encourage her and tell her again to feel
free to call me any time. I remind her that we’ve all been through this and
acknowledge that it is hard to wait when you are so uncomfortable but she’ll be
OK and will soon see baby boy #2.
I
sleep like a log. I needed that. When I got up I called my single mom who was
due the day before to check in. She tells me she had been contracting all night
but the rushes aren’t yet 5 minutes apart. Her water hasn’t broken, so I offer
to come to her house or meet her when she decides to go to the hospital. She is
doing well, has girl friends over and says she will stay in touch. Within an
hour she calls back to tell me she can’t handle this at home anymore and asks
me to meet her at the hospital. She gets there before I do and lets me know she
is already 3 centimeters as I walk in with my pink Happy Birthday tiara on. It
always makes people laugh, so I bring it when I think we will need a bit of
light humor. She puts it on as she gets in the tub. I turn on the jets – this
one is a real Jacuzzi! – and she sighs with pleasure as she relaxes into it. No,
sorry but I don’t have a picture of this. So cute!
One
of her friends is a mom herself, studying infant massage. I noticed when I came
in that this friend was guiding Stacy through the rushes so beautifully. I held
back a bit and just watched how she was able to calm Stacy and saw that they
were really a great team. I brought in a stool and put it by the tub and
invited her to just be there for her. I left them alone and busied myself
cleaning up the room a bit. I walked down to the nurses’ station and asked our
nurse if we could order breakfast which she agrees to right away. I knock and
go into the bathroom and offer to call in her order. This hospital has 24-hour
cafeteria service and will deliver a tray to the room ½ hour after you place
your order. You can even get breakfast 24 hours a day!
As
her doula, I could have just ordered her breakfast and not asked her nurse’s
permission. I could also have just turned off the beeping machines at the last
birth, too. I don’t have to get the official OK either just to unplug monitors
to take
my client to the bathroom. But I have discovered that
by setting the tone with these completely benign protocols, I can get an awful
lot of mileage with the birth team. I often try to find one or two ways of
deferring to them early on in labor. It is a kind of body language that almost
suggests subliminally that we can work together just fine and that I am not
there as a raving advocate for
my lady ready to do battle on
her turf.
Somewhere along the line doulas, and midwives too for that matter, have become
known as radical militants in our own rite, and many health care professionals
are not happy to see us. I am trying to change that image by looking for ways
to work together and earn some respect for our profession. So far it has worked
very well. They can tell right off that I have a relationship with the mom that
they I don’t have, especially if the mom asks me what I think about a
suggestion the nurse may have posed and the mom wants my opinion on it. That
could set me up for becoming a referee, which is not who I am. I just
know that
the nurse will go right back to the nurses’ station and inform all of the other
nurses to ‘look out for that doula back there.'
Last
year I was at a birth with a first time mom and the baby was definitely not
tolerating labor well. His heart rate would decelerate with each rush and take
a whole 2 minutes to recover before the next rush. Finally, they stopped going
back up all together. Her doctor was worried and asked her to consider a
C-section since she wasn’t even dilated to 6 centimeters yet. She did not want
a C-section and had visions of a natural birth which we had talked about all
along. So she turns to me, with the whole birth team looking on, and says,
“Stephanie, tell me what to do!” Oh gosh! I wish I was a doctor at these times,
or had more confidence in this baby, but I told her, “Dear Felicity, I wish I
knew what to do, but
if this was my birth, my baby, I would go
for it, I would have a Cesarean right now.” She couldn’t see the doctor’s face
from where she was lying but I could. He was shocked that I would be on their
‘side’ which, while I had never considered ‘sides’ assumed we all wanted the
very best for this sweet lady and her baby, though he had assumed otherwise.
And in the operating room, after her baby was born and cried and she burst into
tears, I whispered in her ear, “Honey, I am so very proud of you! You did it!”
and she answered through her tears, “Yeah, I did it!”
In
an article recently posted by DONA, International called, Commentary:
Nurses, Doulas, and Childbirth Educators - Working Together for Common Goals by
Amy L. Gilliland, BA, CCA, CCE at http://www.amygilliland.com/pdf/commentarygoals.pdf she
writes, “I can't speak for all of Eastern Canada, but I know here in St.
John's, one of the biggest challenges our doulas have experienced is trying to
build relationships with hospital staff and forge a place for ourselves in the
case room and on the birth support team.” The article goes on to so eloquently state, "birth is an
experience parents and especially mothers will remember forever. The behavior
and acceptance of the hospital staff coupled with the interactions they have
with birth doulas will make the difference for each women and her childbirth
experience. This can result in a safe, women-centered and empowering birthing
experience or one filled with tension, resentment and disempowerment...the
choice is yours."
Sometimes the only thing that makes a woman’s
pregnancy high risk is her choice of a care provider.
They
are still in the tub room. I read some articles I have printed out and have
stuck in my file marked, “TO READ” which is sorely outdated already, until
Stacy gets out of the tub and decides to walk around for a while. At this point
I asked her friend, Becky if she had ever considered becoming a doula. I assure
her she’s got what it takes. I add that she is really good too. She appears
very surprised but I insist she is really very intuitive and would be a great doula. I
give her my card and tell her to call me and we’ll talk more about it.
Finally
baby is ready to come. After some serious pushing he arrives, a perfect
beautiful little guy. I let Becky stay by Stacy’s head to coach the pushing
stage. I helped by holding her leg and massaging it when it started cramping. I
pitch in to help the nurses clean her up and change the bedding, her little boy
on her chest the whole time. I hug her before I leave and tell her, “you know,
sweetheart, you can do anything now!” and she repeats in complete awe, “Yeah, I can do
anything now!”
I
go home and sleep and eat and nap again and try to get back to feeling normal. Yes, I can still remember the feeling. I do the laundry – no one else
can go into labor until I have clean clothes hanging and ready to go! The house
is a wreck and the dining room table is covered with charts to update and turn
in.
The
next morning the chocolate bars and Cheetos lady calls to tell me that her water broke. I
shout my congratulations into the phone and tell her I will meet her soon.
There are no contractions yet. Her first birth was induced, medicated and
basically a blur, so all of this is new to her. My personal Iranian taxi driver
shows up just in time, bubbling about blessings and new babies, as excited as I
am! He even forgets to ask for his fare when we get to the hospital. I repeat,
“How much?” until he settles down and sheepishly looks at his meter that he
forgot to even turn on. I offer his a $20 bill, which is what the usual fare has
been, and he is ecstatic.
We
walk the halls, and dance, and do circular exercises on the birth ball until
she gets discouraged and asks for an epidural. She agrees to try the tub first
which she really likes. Then we go back to bed and she explores the range of
available meds with her nurse. She is able to rest now and continues to dilate.
It is getting close. The meds are wearing off and she asks for more but before
the next dose arrives she shrieks: “I gotta SHIT!” I laugh and hug her and say,
“Honey, that’s your baby coming!” She insists, “NOITAIN’T!” and starts pushing
really well. I help her sit up so she can push more effectively and help her
rest between the rushes. After one she looks over at me and tells me, “Today is
the day my momma died.” I hug her again and tell her that I am sure her momma
can see her now and will always be watching over her. She names her chubby baby
girl after her mother. Her 3 year old has slept through the entire thing rolled
up in a lounge chair in the corner of the room, his tiny teddy tucked under his
chin. He will have quite a surprise when he wakes up.
The
next day is Monday and I will be seeing my lady who is at 37 weeks now. She
lost her first baby at 5 months along 6 years ago. No one could explain exactly
what went wrong, but it was a wake-up call for Katherine and her husband who
both felt that they needed to clean up their lives. Her health had never been
great but in the next few years they researched and explored and learned all
they could and all of a sudden she became pregnant again. She looks and feels
great and although she was pretty apprehensive as she neared and then passed
the 5 month mark in this pregnancy she continues to do well. They are both
older than most of the moms I see and very excited about seeing their little
boy soon. That will be another story, I am sure.
I’ve
been collecting diapers and baby clothes for my mom with baby #2 (I can’t go on
thinking of her as the ‘Cheetos Mom,’ – that’s awful!) and will visit her later
this evening. It is kind of sad, the last time I say goodbye to my moms. We
have been through so much together. In a way we have bonded and become closer
sometimes than they have ever been able to with other women. I wonder if I will
miss them more than they will miss me. I think so, mostly because they are now
very busy, sleep-deprived mamas, entertaining friends and family who will come
to visit the newest member of the tribe and many will also shortly return to
school or work. I am sure that they will never forget the memory of their
births though. I am convinced of that. And if they look back and think of those
times as wonderful, powerful and sacred and holy or blessed, and I am just a
fleeting shadow in that picture, I have done my job well.
*Amharic is spoken in much
of Ethiopia. We have over 70,000 African immigrants living in Minnesota at this
time.
Stay tuned! This and lots
of other stories will be in the book, Call The Doula! a diary©
pending, Stephanie Sorensen
