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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