20 Lessons from 20 Births

I've been practicing as a birth doula for a year now, and just a attended my 20 birth. It has been an amazing journey and I am deeply grateful to all the families that took a chance on a new doula. I try to come away with something new from every birth I attend. It isn't hard to do, since birth is so different for everyone and I have so much to learn. Here are 20 lessons and reflections from my first 20 births. Some are practical techniques, some are observations about the nature of labor and birth, and some are observations that have lent emotional nuance to my dealings with clients, care providers and nurses.

1) Labor is strange and unpredictable. You can experience it in ways no one has ever heard of before.

2) Second time moms are not messing around.

3) Labor is not all physical. You can psych yourself out with very real physical consequences. I also learned a focusing technique from a midwife that I have used many times since.

4) First time moms can have quick labors, too, and transition can be quiet for a mom who is deeply focused. Always believe the mom when she says "We need to go now." If it takes over 30 minutes to get down the stairs and out to the car because the mom has to stop every few steps to deal with a contractions, it is probably a good time to head to the hospital.

5) Posterior labors can have their own particular pattern that can be recognized if you are looking for it. And it is possible for a posterior baby to be born quickly and easy.

6) You can do everything "right" and still end up watching a client brave a c-section. A good heart, a good attitude and a good provider can make the most difficult labor (even one that veers wildly off course) a positive experience in the end. This mom was truly the strongest woman I have met.

7) Inducing with a negative Bishop's Score is not a great idea, but you can't make the decisions for your client.

8) Inductions aren't always bad, and Hypnobabies can get you through 18 hours of Pitocin-induced labor without drugs. This was my first VBAC mom, and she was so inspiring.

9) You are helping and guiding your clients even when you don't know it. This couple seemed to work so beautifully together without any help from me. When I mentioned this postpartum, they both said, in unison, "NO!" The dad then said "I just started doing whatever you did; you helped me find my rhythm and be more relaxed and involved."

10) Second time moms are seriously not, under any circumstances, messing around.

11) Learning to facilitate and honest discussion between parents and care providers in the heat of a potentially unnecessary c-section call is an art. I need to work on it.

12) Supporting a mom (and dad!) to stand up to a pushy, unreasonable OB who just wants to go home is stressful. But it is so amazingly rewarding when she gets every single thing that she wants and takes back her voice and her power after two previous birth experiences that were catastrophically bad.

13) A quick first stage does not equal a quick second stage. The fear of becoming a parent and uncertainties about one's partner can make labor longer and more difficult than it might be if those fears are dealt with and released.

14) A baby born en caul is incredibly rare and amazing to witness. And the look on this dad's face after his wife's successful VBAC was absolutely priceless!

15) If you have a client who gets an epidural, you can give the baby more room to descend by having the mom lie on her side and prop one knee on the bedside table. Epidurals can be a great tool that when utilized in certain situations, can prevent a c-section. This dad caught his baby and I still wish I had had my camera to capture the look of awe on his face as his child was born into his hands.

16) My job is much more than just making mom comfortable or offering informational support. Knowing she has someone to help her through contractions when her husband vomiting violently because he has food poisoning from the bad calamari he ate can be very helpful. This was the weirdest birth I've ever attended. Food poisoning, people yelling at the nurses, mom kicking her husband out, dad pilfering the thermometer to see if he had a fever, people trapped and screaming in broken elevators. Weird weird weird.

17) If mama wants an epidural, mama's gonna get one, even if she's nearly complete when she gets to the hospital. The OB at this birth was marveling over and over about how this mom made it all the way through her birth without the use of Pitocin. Like she had never seen it before.

18) You can't make everyone happy. Sometimes you will do or say something that may mean nothing to you, but that deeply affects the mom or the dad in a way you couldn't ever anticipate. And you may never know what it was or why it upset them. Always gets a signed contract at or before the first prenatal. Consults are mutual interviews. If you have a niggling feeling that a family isn't a good fit, then don't under any circumstances take them on as a client.

19) I love love love to witness a woman in her power, birthing exactly the way she feels best. It is such a blessing.

20) It is harder to get what you want when you and your doctor are not on the same page. It is easy to get caught up in the energy of the nurses counting and the doctor shouting to push harder. Always ALWAYS be the quiet voice in the mother's ear that says "follow your body, listen to your wisdom."

I love this work. I am so lucky. Looking forward to the next 20 births.

 

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Kaylee and Alyssa's Birth Story

This is a twin birth story from my online mama friend, Lori. I love when a cesarean birth story ends with a perfectly happy mom who got everything she needed AND healthy babies. Goes to show that there is joy in every birth, no matter the mode of delivery!

***

We were told at our very first ultrasound that we were having twins. We had done IUI (a fertility procedure) and Clomid (a fertility drug) so we always knew there was a chance - but the surprise was that they were identical, which neither of those things can cause! From the next appointment on (and there were many many appointments and many ultrasounds) we were thoroughly explained the many risks of carrying not only twins, but monozygotic/diamniotic twins. I had been told that the hospital and doctors were willing to allow a vaginal birth in the case that: Baby A (the one presenting) was head down and that a doctor comfortable with a breech delivery (in case B was breech or flipped to breech during A’s delivery) was on staff and willing to do the delivery. I did every amount of planning and “type A” preparation that I could. I had a birth plan written out and my hospital bags packed and in the car by 28-ish weeks. They had both been head down for weeks, and at around 30 weeks, it seemed like something had “slipped”, causing me to be in enough pain to go into triage to be monitored - babies were okay, but were both now breech.

 

Contractions began on their own at 35+1. I kept a pretty good record of them via a phone app (highly recommended! the app will do the math for you, especially once they really start up, math is hard to do.) and I was only having them every 7-10 minutes, if that. Lots of yoga ball bouncing and trying to stay comfortable for the night and calling triage nurses to confirm when they wanted me to come in. We all agreed on “when they get closer together” because the hospital is about an hour from us (the closer to us does not have a NICU and weren’t able to deliver identical twins without the risk of being flight transferred to Seattle while I was stuck behind). The next afternoon they jumped pretty suddenly to being about 5-7 minutes apart, so we hopped in the car and went to the hospital.

 

Upon arrival, they hooked me up to the monitors and I was checked for dialation, at that point I was at 3cm. They weren’t all too sure about whether or not I would deliver or be sent home, but because of both babies still being breech, we filled out the c-section consent form so it didn’t need to be done in a rush of activity later. They let 2 hours go by and checked me again (while having constant back labor, all contractions showing on the monitor, and me stuck on a break away bed with the break right where the contractions were in my back, mind you!) - I was now a 6-7cm and Kaylee kicked the doctor!

 

This is where things became a blur; We were delivering that day and quick. They confirmed when the last time was that I had eaten, discussed giving me my epidural in the triage room so it had enough time to take effect before being rushed to the OR for a c-section (they didn’t end up doing this). Because I had dilated relatively quickly (and babies clearly wanted out!) they were concerned with both being breech that they would continue to try to come on their own before they could get in for the c-section. We were taken to a delivery room, epidural given, and moved to the OR pretty quickly.

 

From there, it really became a blur in the quickness of activity, the drugs, the hormones, and the emotions. We had arrived at triage around 4pm and Kaylee and Alyssa were born via c-section at 8:38 and 8:39pm, both with Apgar scores of 9! Kaylee (5lb 3oz) immediately came to the room with me, Alyssa (4lb 2oz) was admitted to the NICU per policy due to being low weight. She was able to room-in with me and her sister after overnight monitoring.

 

I went into my birth with a full researched plan of what I wanted in a best case scenario, but also knowing at that point I needed to “let go” and that the girls may have their own plans. I controlled what I could, I stood up for what I needed to, and the girls came out healthy and happy.

 

 

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Adventures in Placenta Encapsulation

Placentas are really cool. Like " Holy cow, I grew a new organ that grew a baby and then my body totally just got rid of it and now it's been in my freezer for four years because that is way too fascinating to just throw away" kind of cool. Seriously, I could just look at placentas all day long. They are bloody, messy, gross, slippery, slide-y and amazingly, astonishingly unequivically beautiful. A true testament to the power and wisdom of the human body.

And people just throw them away every day! I know a lot women think placentophagy (mammals consuming the placenta postpartum) is gross or off-putting, but really, it is no grosser than popping a vitamin. Unless you are planning to eat it raw and steaming straight from your uterus. That's pretty gross, in my opinion. But to each her own...

A couple of weeks ago, I had the opportunity to learn how to encapsulate and tincture placentas. It's a pretty cool process, and since I am not sure how a paying client would feel about me documenting their placenta encapsulation, I decided to thaw my own two frosty life-popsicles and make some medicine. Since I had my kids, I have found that I have raging, horrifying, lock-myself-in-an-underground-bunker-for-a-week PMS. I'm hoping that if I take these capsules in during that hell week might make life easier for my family and co-workers. I also want that tincture since it will likely last me through menopause, and if that is anything like my PMS, we are all gonna want a little help.

So here it is: Lucy and Malcolm's placentas, medicine-ized.

Lucy's placenta, with extra-long cord:

One of the first memories I have of Lucy extra-utero is the midwife unwrapping the cord from around her neck two times. In my memory, she is swinging it around my slimy newborn like a lasso, though I highly doubt the cord was flying as widely as I am remembering.

But seriously, it was long enough to spell out LOVE:

Malcolm's placenta was smaller, with a much shorter cord:

One of my first memories of Malcolm was not being able to get him up very far on my chest, because his cord seemed short. It was pretty short, but I could still make a little heart with it. I placed the cords on the dehydrator.

So the first thing I did was thaw the placentas in the fridge for about 3 days. My intention was to get to them as soon as they were unfrozen enough to work with, but I needed to go to the liquor store to get some vodka for the tincture. This week, I discovered at the Montgomery County liquor stores don't open until noon, and stopping at the liquor store after picking up your kid from preschool is awkward. Perhaps less awkward than being the lady waiting at the door for the store to open and promptly buying the largest bottle of 100 proof vodka available, 4-year-old in tow. Maybe that's totally justifiable...

So, thawed placenta. I decided that since I had two placentas, I would use the two most common methods (maybe the only two?) for preparation: raw and Traditional Chinese Medicine-inspired. Lucy's was prepared raw, Malcolm's with TCM. First, I rinsed them and removed as much blood as possible. Lucy's had a lot of blood in it, Malcolm's looked as though it had been drained already, although there were several large clots on the maternal side. I set Mal's aside and worked with Lucy's. After rinsing, I patted it dry as thoroughly as I could with a paper towel and sliced it into chunks. After slicing and dicing. I placed it on the dehydrator tray. Yum!

After the chop chop, I dropped a good-sized chunk of placenta into roughly 18 oz of vodka. This will sit in a cool dark place for about six weeks, after which I will strain it through cheesecloth and use it to tame the wild hormonal beast. I made a tincture from a piece of both placentas, since it can also be used for the child's hose placenta it was. I have heard it is like a "reset" button for a kid having a crappy day. I am hoping it is sort of like the "Easy" button from the Staples commercials, though I am sure to be disappointed in that regard, as I don't expect an army of nannies to arrive when I use it on the kids, nor do I expect they will bring me a million dollars.

Lucy decided she wanted to help, so of course, she had to wear gloves like Mama. It's pretty cool, though. I mean how many people can say they've seen and held their own placenta??!

She wasn't entirely sure she wanted to be holding it.

But while we are looking at pictures of my kid, is she not the cutest girl EVER?

 

Moving on. I got to work on Malcolm's next. Traditional Chinese Medicine says that we steam or simmer the placenta with warming herbs (lemon or lemongrass, ginger and a hot pepper). I sliced up a lemon, a good-sized chunk of ginger and a hot pepper, placing them in pot and filling with enough water to cover. My teacher said to lay the placenta on top of the herbs and gently simmer for an hour. I am pretty bad at remembering things on the stove for more than 20 minutes or so. Just ask my husband who more than once has come home to a house filled with burning something-or-other and me blithely taking a shower or napping or something else that didn't involve remembering stuff on the stove. My first attempt at TCM ended with a huge, stinky placenta mess all over the stove because the whole shebang boiled over. So I decided to steam instead of simmer, since steaming was a 12-15 minutes on one side, then flip over and steam for another 12-15 minutes kind of process. Better for my attention span.

So, I wrapped the placenta in the membranes, such as they were. I remember after the birth, my midwife showed me that the two layers of amniotic sac had separated, and so it was a somewhat slippery mess, especially after 2+ years in the freezer.

Looks a little like a heart in an autopsy tray.

I brought the water to a boil and then turned it WAY way down, to minimize boil-over risk. I steamed it for 12 minutes, flipped it over they steamed for another 12 minutes.

The first placenta I prepared according to TCM started out the size of a salad plate and was about the size of my fist after I boiled it over. It should cook down a little bit, but not THAT much. After it cooled a bit, I removed the membranes and I sliced it into little chunks.

I placed it on the dehydrator tray and set it for ~150 degrees. Basically, anything above 140 is fine. Anything below that temperature will not inhibit the growth of bacteria, and so...y'know...yuck.

Now, the part about TCM preparation that you don't hear about a lot is that the mom is supposed to drink the broth created by the steaming process. So...I strained the herbs and pepper out, poured a big steaming cup of placenta tea, put some honey in it and gave it a try!

And the verdict is...HOLY SHIT THAT'S SPICY!

Oh yeah...hot pepper...Damn. It was not expecting that at all. It really wasn't bad, per se...just...that was a lot of ginger and hot pepper and I was drinking it. I did manage to drink about a cup of it before it was just too spicy to continue. The taste definitely grew on me, but I froze the rest in an ice cube tray and plan to use it a cube or two at a time, diluted and (heavily) honeyed, during my cycle.

Back to the dehydrator! It ran for about 20 hours. Here is the end result:

 

 

 

 

 

 

 

 

 

 

 

A cord dehydrated fresh will be more of a tan translucent color after dehydrating. You can see the blood vessels better in a more translucent cord, but this one is really beautiful if you hold it up to the ligh

After dehydrating, I put the dried placenta into a blender. It made a great deal of noise. And powder flies out like crazy. I would recommend putting a piece of parchment paper or Saran Wrap under the lid of the blender to keep the dust to a minimum, since I am pretty sure no one wants to breathe powdered placenta.

It turned out like this:

I loaded the capsule filler:

Scooped a heaping tablespoon of powder in:

Filled and tamped down the capsules:

Put the tops on:

And ejected the capsules into the waiting bin:

Malcolm's placenta yielded 73 capsules, which is a pretty skimpy number. Lucy's made 108, also a pretty small-ish number, though more in the range of average. I'm wondering if TCM preparation reduces the yield of capsules, since they were both pretty similar in size to begin with. The other TCM prepared placenta I did only yielded 86 capsules...though that may have had something to do with the fact that I boiled it to within an inch of its life. Or perhaps past an inch of its life. It was bad. At least I wasn't charging her for it.

See? Nothing gross about this!

I wish I had separated the raw from the TCM capsules, but I just went on autopilot and they all ended up in the same bin. I popped two of these suckers today, just to see what (if any) effect there would be. I felt a definite mood boost, though no difference in energy. The placenta broth/tea gave me a burst of energy.

So now I have two cord keepsakes...and what does one do with dried umbilical cords? Lucy really wants to keep hers, and I am inclined to let her. It is her cord, after all. Malcolm could care less, I'm sure. Maybe a shadow box? They are actually really pretty. Especially, I imagine, if you don't really know what they are.

 

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Postpartum Haze: Impressions from Day One

The feeling of his head in my hand as I waited for the last contraction to help push him out.  Angel-soft hair.  Little wiggles – he is moving! – as he works to get his shoulder free and join the world.  A strong wave of pressure, a breathless second, a loud cry, my baby is born into my own hands.

Joy!  The air comes back into my lungs, back into the room.  Labor is over, life is beginning.

Catching my breath.  Lucy is coming up the stairs, walking towards us.  Kevin at my side, kissing my head, welcoming his son.  Slippery little man in my arms, crying his little head off!

Out of the pool, onto the couch on shaky legs, surrounded by loving arms, beautiful women, ecstatic family.  Is this umbilical cord a little short?

I feel triumphant, breathless, strong, a warrior, a goddess!  To say “I did it!” seems trite and silly, but I did it!  I made this!  I birthed my baby, in my own house, on my own terms, letting my body do what it needed to do.  Birth is involuntary; you just have to allow it to happen.  And I did.

Oh the perfection.  Sweet-smelling, gooey little baby snuggling against my chest.  The warm, safe presence of my husband beside me.

Hungry baby, latching on with no trouble, eat eat eat!

And then Lucy is with us.  What happened to my sweet baby girl?  Who took my little girl and turned her into this GIANT?  She’s HUGE!  And what big TEETH she has! Lucy, “Want MAMA MILK!  MINE!”  Meltdown in the works.  Oh dear, here we go.  I am not sure I want to nurse this enormous wolf-child who has somehow replaced my daughter.  But the wolf-child insists and I am blissed out on birth and baby, so have at it, kid.

Tandem nursing for the first time.  I am already stark butt naked in front of a roomful of people, why not sling a few boobs around for good measure?

The room clears out.  We are alone, me, Malcolm, Kevin.  Admiring our handiwork.  My God he is perfect.  Are those pointed ears?  Does he really have pointed ear??  My God he is perfect.  Sweet smelling.  Soft.  Squishy.  Still covered in mayonnaise and goop, but wonderful to seem smell, kiss, cuddle.  Bliss.  Absolute bliss.

Mairi (midwife) makes eggs.  Lots and lots of eggs with cheddar cheese in them.  I devour a heaping bowl.  The more.  Then toast and pineapple coconut water then chocolate.

I take a delightfully hot shower.  OH GOD I AM SO HAPPY NOT TO BE PREGNANT ANYMORE!  Oh God, what a smooshy misshapen belly is left over from being pregnant.  It looks like someone took a purple marker to a lump of sloppy bread dough.  Racing stripes.  Don’t look.  There will be time for assessing the damage later.  I am scrubbed and clean and cozy in my red bathrobe and snuggled back on the couch to watch Kevin watching his son.  More bliss.

There is a minor amount of poking and prodding and checking and measuring done on me and my girlie parts.  It feels like there must have been an atomic bomb that went off down there.  I am glad that I don’t have to look at it. No tear, just a split, just swelling, little bleeding.  Kat (student midwife) says “Seriously, Jenny, I was wondering if you lost any blood at all!  But it’s in the placenta.”  Oh.  Okay.  Good…?

Newborn exam. Malcolm does not like it.  He’s a big boy!  8 pounds, 14 oz!  Lucy watches.  Kat explains to Lucy what she is doing.  Lucy cares very little.  “Want to see Baby Muffin,” she says, not fully understanding that Baby Malcolm IS Baby Muffin.  I am now almost certain she thought that my belly button was the baby I was growing in my belly.

Bed, blissful, beautiful, cozy, clean.  My bed.  Ah.  I cuddle up with Malcolm on my chest, skin to skin, and Kevin at my side.  We can hardly sleep for being so exhausted.  We can hardly sleep from being so in love.

But sleep overtakes us and afternoon slips into evening.  He sleeps on me all evening, all night long.  I can’t think of a sweeter day.

Malcolm’s Birth

I had woken up for 2 or three days feeling very energetic (despite sleeping very poorly)…and I tried very hard not to do anything useful with this energy, hoping it was a sign I would be having the baby soon.  But I was still 2 weeks from my due date, so I assumed that it was a fluke and I would soon go back to feeling exhausted and crabby.  On Thursday night, I went to be early without eating dinner, which was very weird for me, since I had been eating like a starving horse for weeks.  But I just wasn’t hungry.  I lay in bed reading, playing scrabble on my phone, re-reading the last 2 chapters in my Hypnobabies workbook.  I was laying there for hours, not being able to sleep.  I wasn’t having any contractions, other than the strong Braxton-Hicks I had been having for several weeks.  Around 11:30, I started to feel a change in the contractions.  They were coming regularly and starting to feel a little more “real”.  Nothing urgent and nothing painful, just…real.  So I started timing them and was a little surprised to see them coming 5-7 minutes apart.  I tried to get to sleep, but it just wasn’t happening.  I got up to use the bathroom and noticed some spotting.  It wasn’t enough to be called a bloody show, but definitely spotting.  Funny what thrills you when you are nine months pregnant!  I was thrilled to see that little bit of blood!  Maybe this was it!

I got up to walk around and have a few glasses of water to see if that would stop the contractions, but they kept coming.  They were not terribly strong, but definitely regularly.  Around 3:00 am, I sat on the couch in the living room trying to decide if this merited a call to my midwife when I had a really strong, long contraction, as if in answer to my uncertainty.  So I called Mairi to let her know I had been up for a while with fairly regular contractions.  She suggested taking a shower and trying to get back to sleep.  So I took my late-night shower and oh did it feel good, but it didn’t do anything to make the contractions slow their pace.  I tried really hard not to wake up Kevin, figuring this would put me to sleep, but also wanting him to get a good night’s sleep if this actually was it so that at least one of us would be well rested.  I climbed into bed and he said “Are we having a baby?”  So much for not waking him.  I said I didn’t really know, but that we should try to get some sleep.  We both lay in bed for a while, and finally Kevin got up and I rolled over to try to sleep again.  All this time the contractions were staying regularly at around 5-6 minutes and lasting about a minute or so.  At 4:00 am I gave up trying to sleep.  I went downstairs and found Kevin watching TV and he asked if this was it.  I was sort of thinking I was going to have another start-stop-on-and-on-for-days labor like I had with Lucy, but it was feeling pretty progressive at this point, so I said “I think maybe yes…”  At this point, I could still talk through contractions, but I had to stand up and lean over the couch or stairs or something to work through them, so I knew they were getting stronger.  I had stopped timing them, so I didn’t know if they were getting closer together or not. 

So for the next hour and 45 minutes, we set up all the things that we should have had ready before I went into labor.  We dragged the birth pool and supplies up from the storage closet.  We dug out the electric air pump, the pool liner, the thermometer, towels, shower curtains.  We tried to figure out how to turn on the electric air pump without waking up Lucy 2 hours early.  We ended up plugging the pump in out on the deck and attempting to keep the pump outside and the pool inside, hopefully making it quieter, but in actuality, we were just allowing dozens of mosquitoes to pour into the house (this we didn’t discover until later in the day when we all ended up covered in red bumps).  Of course, all efforts to remain quiet were thwarted by the fact that every 4 minutes or so, I had to drop what I was doing without ceremony and get on all fours to work through another contraction.  After literally tossing the air pump across the room as another contraction started, I decided that it was time to call Mairi again.  So at 4:45, I called Mairi and told her I never got back to sleep and the contractions were now strong enough not to talk through.  She called Kat (the student midwife who would also be attending the birth) and they were on their way.  I was starting to think I wasn’t going to have time to even fill the birth pool at this point.  But I was desperate for the warm water, so I went ahead anyway, as Kevin laid out the shower curtain and towels on the couch, lit some candles and got snacks out for the descending hordes.  I started filling the pool, and called my dad to let them know that if they wanted to be at the birth, they should get on their way as soon as possible.  Apparently my mom was not convinced and repeatedly told my dad this was false labor and they should wait for another phone call before heading out in the middle of the night.  I am so glad they didn’t!  Then I noticed that I hadn’t put the liner in the birth pool.  This wasn’t really an issue…but it sure would make clean-up a lot messier without a liner.  There was already 6 inches of water in the pool, so instead of taking the time to drain it, I just put the liner in over the water and started filling again.  And of course, I accidentally moved the faucet while I worked through a contraction and only noticed when the pool was almost full that it was only 80 degrees.  Never try to do anything requiring any measure of precision when you are in labor. 

Kat and Thaddeus (her 4 month old son) arrived around 5:15 and Mairi arrived a few minutes later.  I sat and chatted with Mairi and Kat between contractions.  I hadn’t gotten to practice my Hypnobabies as much as I intended, so while I was not experiencing a perfectly comfortable birth, it certainly wasn’t mind-numbingly painful.  I sat on the couch and breathed through a contraction, and I remember feeling like the earth was opening up and pulling me down.  I literally felt as though I was sinking down further into the earth with every contraction.  Mairi said that was Gaia reaching up and embracing me.  What a lovely image to get me through each increasingly challenging contraction.  We finally got the pool hot enough and I jumped in and stayed there for the next three hours.  I dozed between waves of increasing pressure, trying to remember my relaxation cues.  I read a quote recently that said “birth is involuntary; you just have to allow it to happen”.  It was so much easier – and much more effective - to just let all my tension go and relax into the pressure than to tense up and fight it. 

Lucy woke up sometime before 6:00 am and came down to see what all the commotion was.  She was so

incredibly sweet the whole time.  She brought me water and kissed me and patted my head and said “Feel better, Mama” and asked me what was happening.  We had watched a lot of birth videos in preparation for her being at the birth, so I told I was just working hard to get our baby out, like the moms in the videos we watched.  She seemed to understand and was perfectly at ease and really happy to be helping Mama to have the baby.  Eventually, though, she wanted to get in the pool and when she wasn’t allowed to do that, she got bored and restless so Kevin took her to get dressed and play downstairs.  I kept looking at the clock, knowing my parents were on the way and wondering when they would get there.  I wanted Kevin with me, and I didn’t know what we were going to do with Lucy if this lasted all day, which I was fully expecting.  I remember noticing that the sun was rising, seeing that it was 7:30 am, and thinking “30 minutes and my parents will be here to help…”

I heard ELMO’S WORLD starting on the DVD player, and then I heard my parents coming in the front door.  30 minutes had passed in what seemed like an instant.  I had been having pushy contractions on and off for a while.  There were super intense, 90 second or more, this-baby-is-coming-now contractions interspersed with gentler (relatively, anyway), calmer pressure waves.  I was grateful for this unexpected pattern, since it gave me a chance to rest and gather my strength, even though there was never a full break between contractions.  My dad and mom were talking loudly as a particularly long, strong wave hit me, and I remember having my one, less-than-zen moment of labor when I shouted at the top of my lungs “PLEASE STOP TALKING!”  Actually, I might have shouted “PLEASE SHUT UP!”…you’d have to ask my parents.  And I am sure I had more than one less-than-zen moment, I just don’t recall themJ  At one point, after breathing my way through another pushy contraction, I opened my eyes to see that Kat had put Thaddeus in the bumbo right next to the birth pool.  He was smiling and cooing like he was cheering me on.  It was such a delightful, unexpected surprise to see his sweet little face smiling at me – it reminded me what all this was for! 

A few minutes after my parents came, my water broke (according to my labor summary report, this was at 8:09 am).  Clear water, lots of vernix, all is well!  I don’t know how many times I pushed, or how many contractions I had after my water broke.  I don’t remember having a conscious urge to push.  Each pushing contraction did all the work for me.  I tried just to let my body go limp and allow my uterus to do the work for me.  I honestly don’t know how anyone could do anything BUT allow the process to unfold – it was so completely out of my control.  I couldn’t control what sounds were coming out of my mouth, I couldn’t control how my body was moving, and I certainly couldn’t control what was happening in my womb.  The impression I have from the last few contractions was of me, hanging over the side of the pool, body getting jerked downwards and arms flailing about as if I were being mauled by a shark or rolled by a crocodile or something.  Kevin assures me this isn’t what happened, but that is the picture I have in my mind.  These contractions felt like there was a very strong someone pulling downward on a rope tied around my solar plexus on the inside.  On Kat and Mairi’s suggestion, I checked myself and found the baby’s head was less than an inch away from crowning!  Soon, soon, soon!

I had torn pretty badly with Lucy, and really didn’t want to do that again, so as I felt the baby crowning, I covered his head with my hand and applied a lot of pressure where I felt the most stinging and pulling.  Then suddenly, his head was out!  Kat urged me to push again, without a contraction, to get the rest of him out; I guess there is only so long you want a baby’s head underwater before there is a possibility of him trying to take his first breath underwater – which isn’t a great idea.  I gave some pretty hard pushes, but he was not moving anywhere.  I still had my hand on his head, and I could feel him wriggling and turning, helping himself to be born.  This was absolutely the most amazing thing I have ever experienced.  My sweet baby and I had been working together this whole time so I could finally hold him in my arms.  Mairi thought his shoulder was a little sticky (not quite stuck, per say, but not in a hurry to come out), so Kat gently helped the shoulder out while I waited for the next contraction.  Ouch.  One more wave, one more push, and Malcolm

swam out into my hands.  I pulled him to my chest and sat back, giddy and laughing and crying all at the same time.

At Malcolm’s huge first cry, I saw someone ushering Lucy up to meet her new baby brother (I have no idea who it was, who was actually there when he was born, or what might have been happening outside the little circle of me, the baby and

Kat).  She stopped at Thaddeus and patted him on the head  – she might have thought he was the new baby - and came over to me and the baby.  She put her little hand on his tiny head.  It was so wonderfully, deliciously sweet to have my husband and my baby girl a breath away as we all met our baby boy together.  MALCOLM OLIVER CORBETT was born on 9/23/2011 at 8:27 am, 8 pounds, 14 oz, 21” long.

Later, Kevin told me that Lucy had been downstairs saying “Mama’s making lots of noise.  Like a heffalump!” 

We moved to the couch where Malcolm took to nursing like a pro – I didn’t even need to help him latch on!  When Lucy saw Malcolm nursing, she immediately wanted to nurse as well (had to stake her claim on Mama, I suppose!).  We had our first tandem nursing session ten minutes after Malcolm was born. I credit Lucy with helping to birth the placenta a few minutes later, and for the amazingly small amount of blood I lost. 

A Birth Story

I don't normally write birth stories for the births I attend. I don't consider them to be my stories to tell, and mine is an outside perspective. No matter how close I am to the process, I am still outside the mother's skin. But this birth was pretty special. This mom (we'll called her A for Amazing) and her previous experiences with birth was the one catalyst I can readily identify as the reason why I became a doula. I had inklings that this was a direction I wanted to take, but this mama and her second birth really clarified it. She had had one c-section and one hard-fought VBAC. After her second birth, she said to me "I heard your voice in my head saying 'you can do this, your body was made for this' and I knew I could keep going". When A said that, it flipped a switch in my brain and opened my heart to following this calling. I knew I wanted to be in the birthing room. So when she had a surprise third pregnancy, she called me and I immediately jumped at the opportunity to be her doula.

Me and Baby P

A little background: After each birth, A had suffered some sort of awful postpartum experience. Her blood pressure skyrocketed after each birth, requiring medications incompatible with nursing and after her second she got a case of Cdif which landed her in the hospital again and ended her nursing relationship after a month. Her blood pressure issues the second time around got her passed from doctor to doctor and in and out of the emergency room as each subsequent doctor washed his hands of her (her OB actually said this to her literally). She also suffered a spinal headache for over two months postpartum from the epidurals she had had for each birth. As her doula I focused on helping her line up a team of caregivers that included a cardiologist and a lactation consultant. We hashed out a birth plan that included refusing all IV fluids and medications in the hopes that the artificial raising and lowering of blood pressure that happens with the administration of IV fluids, pitocin and epidurals might stave off a sharp rise in blood pressure postpartum. If it didn't stop that issue (and I wasn't by any means sure it would - it was just a factor she could control that might make a difference) then at the very least no epidural would mean no spinal headache. She was open to an epidural if her blood pressure started to rise during labor as this might prevent a c-section.
A's third birth really started two weeks before the baby was born. She was wakened each night with prodromal labor. Real, intensifying contractions that kept her up most of every night. Twice she thought her water had broken, and twice was sent home from the hospital with her waters intact. By the time she was 38 weeks, she was over 4 cm dilated and 60% effaced. At 39 weeks, she was 5 cm and 75%. Contractions every evening and night, painful baby wiggling all night long, no sleep and two other boys (3.5 years and 17 months) keeping her busy all day long. She carries her babies deep and low, so he was firmly engaged and making very step agony. Misery.
My thought was that the baby was poorly positioned and trying to move around into a better position for and easy birth. So we tried The Miles Circuit, lunges, stairs, birth ball, steep inversions, belly sifting, pretty much everything in my fairly small bag 'o tricks to get the baby to shift and get labor started for real. Nada.

At 5 days past her due date, she threw in the towel (and who wouldn't?!?). Her OB asked if she wanted to go have her water broken immediately instead of wait until 41 weeks. Shew as relieved to say yes, and just get the show on the road already.
And now the real stories starts.
I met them at the hospital at around 1:00 PM. At 1:30 PM the OB on-call came in and said hello. They chatted a little and Dr...we'll call her Dr. I for "I'm Dreadfully Inconvenienced By My Job" or "I'm So Impatient" or "I Prefer Fear Tactics To Real Information" or...I could go on...and I'm sure I will later! Anyway, Dr. I seemed really nice and chipper and on A's side. She said one thing that gave me a little pause when referring to A coming in when she thought her water broke. "We want you to come in if you think your water broke! We don't want you sitting around getting infected!" Hmm... She also says "I ordered the epidural already, so if you want it, you can just ask and they don't have to track me down." Another pause...but I gave her the benefit of the doubt.
Anyway, Dr. I checked her (6cm, 80% effaced) and broke A's water at 1:35 PM. Contractions had been going on and off all day, but pretty mildly. They picked up quickly in intensity, but just to the "Early Labor" sort of intensity and regularity, instead of the prodromal on and off stuff. I thought that was fine. For all intents and purposes, it was early labor. She was 6cm, but her body still needed to warm up to labor. We did belly lifts, squats, lunges, birth ball, and all the other physical stuff we had been trying throughout the week to get things moving. After about 2 and a half hours of us being pretty much left to our own devices, contractions really picked up into active labor territory. The nurses were amazing and supportive, the doctor was absent.
Within the next 90 minutes, things got really intense. A stopped chatting between contractions, using the time to recover and get ready for the next one. She started moaning and deeply breathing during them. All signs pointed to her being deep in active labor.
Dr. I Am Too Impatient To Wait For Your Body To Work came back after roughly 4 hours. She said, before she did anything, "Something is keeping the baby in. It should be out by now! I'm going to check you and see if maybe you need a little help." She spoke in a chipper, high-pitched voice, alas kindergarten teacher. She checked A.
Dr. I: You're at 6.5 cm and your body is really not making much progress. The baby really should be out by now. We are going to put you on a little Pitocin. You need to be progressing, and if that doesn't happen unfortunately we are talking about a c-section.
A: (Her face got pale, her eyes got wide. Panic face. I hate this doctor instantly and notice she is the perfect height for me to elbow her directly in the nose.) Um...can we wait an hour?
Dr. I: (cheery as hell) Nope! We won't use too much, since you're a VBAC we are not going to be super aggressive, but the baby needs to come out. You really should be progressing at a centimeter or even a centimeter and a half per hour, and that's really the lowest 95% percentile of how most women progress at this point.
She looked at me nodding, as if to get me on her side, my eyes went wide and I looked at A. I couldn't shake my head, I couldn't say "Wow, you're full of shit!" All I can say is "Do you and J want to take a minute to talk about this?"
Dr. I kept talking about how she's going to give her Pitocin and A's husband J cut in.
J: You don't have to, A. You don't have to do anything you don't want to. (I mentally punch the air "YES!")
Dr. I: (backpedaling and talking in an "I think this is a terrible idea and later I'll say I told you so" voice) Well, ultimately, yes, this is your show, you're in charge here so I'll let you have an hour, but this baby should really be out by now.
I thought "So the real answer is 'yes, of course you can have an hour." Grumble.
She stalked out. A got up, and kept laboring, but really worked hard to get the most intense contractions as possible. A is for Awesome. She kept going, practically begging for more, more intense, more close together. She did NOT want Pitocin. I reminded A & J that they can't do anything without A's consent. I reminded them to ask the doctor is she and the baby are okay, and if the answer is "yes" then nothing more needed to be done.
Dr. I Just Want To Go Home came back 15 minutes later.
Dr. I: So I'll give you an hour, but if you don't make any progress, we can let you go any more without help.
J: Is A okay?
Dr. I: Yes, for now. (Emphasis NOT added)
J: Is the baby okay?
Dr. I Am Not Above Playing The Dead Baby Card: Yes, for now. The issue is the scar can only contract so many times, and we don't want the uterus to rupture. This is her third birth...(kindergarten/speaking to the mentally deficient voice again).
J: The first was a c-section. This is only her second vaginal birth (points to dad for saying "vaginal" without stammering!). And she was in labor for 14 hours with the second, why are you concerned after 4?
Dr. I: (getting deeply annoyed) Okay, fine! Her second birth, but still. You're not understanding that she came in at an advanced stage of dilation and it shouldn't take this long!
I stood across the room helping A through really hard contractions. I was seriously in love with this dad for is tenacity and willingness to stand up to Dr. I Should Have Chosen a Different Specialty If I Didn't Want to Deal With The Unpredictibility of Labor.
J: Okay, but if A is okay and the baby is okay, a c-section is not an option. And she doesn't want the Pitocin right now.
Dr. I stalked off ostentatiously.
I was so proud of them.
We worked hard for the next hour. Well, A worked hard. Really hard. And J supported her like a champ and I guided them and spelled J when he was tired of hip squeezes. Dr. I came back in an hour and checked A. "You're 7 cm, so you're progressing, just very very very slowly." No mention of Pitocin that time. She left again, we kept working hard. Another hour, another check. She was 8 cm.
Dr. I Just Want To Cut Her Open: You're 8 cm and it's all anterior. And the cervix is starting to swell.
J: What does that mean?
Dr. I: The baby is pressing on the cervix from all these contractions. I've seen a baby be born with a swollen cervix before, but...
I thought "All these contractions?!? She's only been having real contractions for 4 hours!" Holy crap!
Dr. I Don't Like This Doula turned to me and practically spit "Get her in a position to get rid of that lip," and stormed out. She spent a good deal of her time with us storming out.
Sorry we ruined your evening with our excruciatingly long, abnormal, clearly dangerous birth.
I suggested A get on hands and knees on the bed. Within 20 minutes, she started having pushing contractions. She angel nurse checked her and says the lip is almost completely gone, but wait just a few contractions before really bearing down. I whispered to A as I sit by her head, holding her hand "You are doing amazing. Just keep following your body. You are doing this perfectly." She blew through a few contractions, and then couldn't help but bear down. Dr. I came back and checked A 10 minutes later. Complete! Push push push!
Dr. I: So after the baby is out, you're going to have to have some medicine for bleeding. I can give it to you in an IV, in a shot or a tablet in your rectum. Which do you think you want?
A (she's PUSHING HER BABY OUT!): Umm...Ugh. Ooooohhhhh. Do I have to decide now? I don't care right now.
Dr. I: Nope!
I thought "Then why the hell did you ask?"
She left again, but this time just to behind the curtain were she stood looking annoying and texting. Another 10 minutes went by and the pushing was getting real. A was still on hands and knees. J asked Dr. I about the medications she talked about earlier, concerned about A's history of high blood pressure. I didn't catch the whole conversation, but here is some of what I overheard.
J: I'm just concerned because of her high blood pressure.
Dr. I Don't Like To Be Questioned: We give it to patients with severe preeclampsia.
J: How will it affect her blood pressure?
Dr. I: SIR. It is safe. (Not said in the kindergarten teacher voice. This was said in the "You're drunk and you'll have to leave the bar now" voice)
J: I just had never heard of it before.
Dr. I Know More Than You So Just Do What I Say: (in a sing-songy syrupy-sweet voice) That's why you have OBs!
Again with the stalking.
Me: You have every right to ask her questions. And you can keep asking until she gives you answers you are satisfied with.
J: Well she's not. She's not giving me answers at all.
I quietly explained to J what the Pitocin and cytotec are and what they are used for postpartum. I told him sometimes it is given routinely and sometimes they wait until there is excessive bleeding before administering it. The angel nurse added that they often use it routinely after VBACs because the scar tissue sometimes doesn't contract evenly and excessive bleeding is more common after VBAC.
J: That's all I wanted. Just a little information.
Why does a simple request for more information have to be so threatening? No one was questioning her judgement, just asking for the "informed" part of informed consent.
A was getting close. I asked the angel nurse if Dr. I will catch the baby in this position and she laughed. "I like how you say 'catch' the baby. That's pretty much all she's doing. I will ask. I want to applaud you all for standing your ground with the doctor. She could sense you really didn't want to have Pitocin."
I thought "sense it"? They outright SAID it!
I said "I am very impressed with them, too. Thank you for being so supportive."
Dr. I Only Deliver Babies My Way suited up and said "I am not trained to deliver babies like this, so I need you on your back."
I whispered to A "Stay here as long as you want."
10 minutes, heavy pushing, big progress on all fours.
Dr. I: I really need you on your back. Now, A.
Me: Do you want to get through this next contraction before moving?
A: No. Then I'll never move.
I hoped she would decide not to roll over. She did, so I helped. But it is the only point the doctor scored all day, so I'll let it go.
10 more minutes and a gorgeous baby boy is born. 7 lbs, 11 oz, healthy and squalling. 6.5 hours from AROM to baby. How was that "too long"?
Dr. I'm Outta Here cuts the cord immediately, even though A wanted it delayed. So two points for the doc. She checks A for tears, orders preventative Pitocin for postpartum bleeding. Then she leaves.
I wish it wasn't like this.
But...baby nurses. A looks amazing. She feels good. Such a triumph. I am so deeply honored to have been able to share the moment.
A took baby P home less than 24 hours later. He got a tongue tie released at a week old and is now nursing like he was born to it...which who are we kidding? He was! A had a small rise in blood pressure, but after her nursing issues were dealt with and she got some sleep, it went down to normal and has thus far stayed there.
I love my work. I love seeing families triumph and claim - or reclaim - their power. I love seeing babies born. I love witnessing the birth of a mother and of a family.
But I hate that there has to be a fight for informed consent and birth rights. I hate being so powerless in the face of hospital policy and the "cover your ass" practice of medicine. You shouldn't have to fight to get something as simple as information. It shouldn't take three births and an epic battle to feel heard and respected by your care provider. Women don't cease to have rights as human beings when we begin to birth our babies. Everyone has the right to know and understand the care they are being offered and no one should be bullied or scared into a course of action that conveniences the care provider but doesn't serve the best interest of mother and baby. A healthy baby isn't enough. Before anyone starts throwing things at me for that statement, let me clarify - of course, it is the priority. "If the baby and the mother are okay" is the foundation on which everything else is set. No one chooses a good birth experience over a healthy baby, not even us crunchy, home birth moms. But the birthing mother has to be treated with respect. Not only that she deserves to be spoken to as an adult with both rights and feelings about her body, her birth and her baby. If interventions become necessary, fine! No one is arguing against medically necessary interventions that save lives. The arguments come from misinformation, scare tactics, procedures of convenience or expediency masked as necessary, used to open up beds faster or get doctors home for dinner, bullying, or just plain treating a birthing mother as a number to be processed, delivered, sewn up and sent home, not to be checked on by a caring professional for 6 weeks.
A healthy baby cannot be well served by a broken mother.
We can do better. We have to do better.

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The Purpose and Value of Labor Support

I had to write an essay on this topic for my DONA certification packet.  I haven't written a real essay since 1998.  I am also physically incapable of keeping the word count to 1000.  I welcome constructive feedback on the structure, clarity and content of this essay.  I think there are a few awkward paragraphs... 

Please pass it on and share your thoughts!

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Throughout all of human history, women have helped women through the process of giving birth.  When birth migrated from a home-based, women-centered activity into the medical world of doctors and hospitals, this critical element was lost.  As women put their births in to the hands of the doctors, pregnancy and birth turned from a sacred rite of passage, guided and supported by midwives and female friends and relatives, into a condition to be assessed, managed and treated.  Somewhere along the way, the only acceptable goal in this setting became a healthy mother and baby, regardless of what the woman had to go through to get it.  While many hospitals and obstetricians today a least give lip service to the idea of a mother-friendly birth, the fact is that most women who wish to define for themselves what constitutes a satisfying birth experience must fight through miles of red tape and protocol to be “allowed” to labor as they choose and give birth in the way that feels right to them.  Introducing a doula into this scenario brings back a little bit of the human element that was lost in the transition from home to hospital.

A doula is a non-medical, trained birth professional whose primary responsibility is to the woman giving birth.  The doula knows the woman, her birth preferences and her partner.  They work as a team to help the mother give birth to her baby in the way that feels best to her.  A doula is not there to speak for her client, but rather remind the client when the course of events is veering away from her birth preferences and to support the client in getting the information she needs to make an informed decision.  At its most basic, the role of a doula is to provide emotional and physical support for the laboring mother so that she can have a “safe and satisfying childbirth as the woman defines it”. That last part is key - “As the woman defines it”.  A doula must not project onto her client her own desires, fears or “birth baggage”.  Birth is the mother’s journey.  The doula’s role is to follow the mother’s lead and gently remind her of the path she had wished to follow.

Over the last few decades, there have been many studies that show the benefits of providing women with continual labor support.  The largest systematic review of continuous labor support studies (published in 2011), found that introducing a doula into the birthing room dramatically lowered the instances of obstetric interventions, including cesarean sections, the use of Pitocin, and the use pain medications. Besides these medical benefits, mothers who have a doula present throughout their birth are also less like to view their birth experiences in a negative light, regardless of the outcome.  When a woman feels heard, honored and supported during her birth she can own the decisions that are made and deal with them from a place of empowerment instead of helplessness.  It almost doesn’t matter what the decisions turn out to be, as long as the woman can make them with her own voice and under her own power.  Women who have satisfying birth experiences are less likely to suffer from postpartum depression which can disrupt mother-baby bonding and deeply distress the entire family.  The benefits of having a doula go well beyond the birth itself. 

Doulas provide physical, emotional and informational support during the birthing process.  When a doula is present, the mother and her partner have someone there that they know is unequivocally on their side.  The birthing family knows they have an advocate who has no conflict of interest.  A doula is not tied into the often competing demands of the patient’s true best interests and hospital protocol.  A doula is a witness to their process, a shoulder to lean on and a gentle guiding hand to help the mother find her voice.  She helps the mother find ways to deal with her pressure waves by applying comfort measures, assures her that things are going well, tells her that she is doing a good job, helps the partner to participate at his comfort or her level, and finds natural ways to get labor moving past a plateau.  A doula reminds the family when things are veering away from their desired birth and gives them the confidence to speak up when they have questions or concerns about the care they are receiving.  Partners may feel less stressed to have a trained and knowledgeable birth professional present who is not the care provider.  Because a doula is not a family member or close friend, she is not tied in emotionally with what is happening during a birth.  She cares deeply and works tirelessly to help her client have the birth she desires, but she can see things objectively because she has no personal stake in the outcome.  She can provide needed assurance and guidance to a partner who may be distressed to see his or her loved one in pain.  She can also take the pressure off of a partner who is reluctant to participate actively in the birth by allowing the partner to engage with the birthing woman at his or her own comfort level.  A doula provides informational support prenatally and during the early postpartum period to help ensure the family is as prepared as they can be for the demands of labor, birth and caring for a newborn. 

A DONA certified doula has a responsibility to follow the Code of Ethics and Standards of Practice set by DONA International.  She also must not overstep the scope of a doula’s practice by providing medical advice or interfering with the relationship between the mother and her care provider.  Helping a mother find her voice does not mean speaking for her.  A doula also must be committed to providing her clients with the services she has promised.  This includes securing a back-up doula in the event that she cannot attend her client’s birth for unforeseen reasons, and providing a client or potential client with referrals to other doulas if she is unable to serve as the woman’s doula.

            When I had my first child 4 years ago, I had never even heard of a doula.  I did not have one at my first birth.  In retrospect I know a trained doula could have potentially shortened my 50+ hour labor and reassured my very nervous husband that everything was okay.  To some, having a doula may seem like a fad or another way to have a “trendy” birth.  In reality, the resurgence of the doula is a return to our roots as human beings.  In ancient times, women always protected each other in that sacred space between pregnancy and motherhood.  The transformation between “woman” and “mother” was a rite of passage to be honored and celebrated.  Women have always supported, guided, encouraged and upheld the birthing women in their communities.  As the modern world has caused families to scatter and allowed women to have babies later in life, the natural childbirth support system of made up mothers, sisters, aunts, friends has also scattered or been lost altogether.  The doula fills this ancient, sacred role.