Sunday, February 18, 2007

Another View of Labor

Posted by an anonymous doula...

Brook and I had been in constant communication leading up to the birth of her second child. Her first child was born within 4 hours of her first contraction, so she was concerned that her second would be born even faster.

When we initially made contact she went on and on about how unsupportive her husband is and that is why she needed a doula. I also did this birth for free as she talked about all of her financial hardships. (I found out there had been a cruise within months of me giving my services for free… among lots of other inconsistencies) I should have known this was going to be not what it seemed when her husband seemed anything but unsupportive. He really loved her and was all on board to be her man and be there for her.

I called her at 7:20 to check in with her. She had been having contractions for about an hour. She talked to her midwife at 9 that evening and was encouraged to take a bath. At 11:45 pm I got the call to meet her at the hospital. I met them within the hour and at 12:50 am her midwife checked her and she was 4cm dilated and 90% effaced. She was GBS + and needed to have antibiotics per hospital protocol. She had her first dose of IV antibiotics at 1:10 am and then was free to walk around, use the tub, etc.

I encouraged her to take advantage of early labor and try to get some rest, but she was unable to settle in and she decided to do some walking to get things moving.

This client was personally very challenging for me. She needed a lot of attention as opposed to support. She seemed to exaggerate things in every aspect of her life, including labor. I had a lot of compassion for her because it was clear that she didn’t know why she did this or that she even did it at all. It made for many challenges for her during labor. It was impossible for her to rest in early labor as she seemed to really not be able to settle into things without an audience. She and her husband did very well walking but she wanted me to walk with her, but not too closely….so I spent a lot of the night walking 10 paces behind her. At about 3am she hooked up to the intermittent monitor for 15 minutes and then resumed walking with her husband while I trailed behind.

By morning she was truly exhausted and I was worried about her. I encouraged her and her husband to go soak in the Jacuzzi for a while in hopes of getting her to rest her eyes a bit and give them some quiet time as a couple. At 9 am she was uncomfortable and was also ready for another round of antibiotics. At 9:30 am she was checked and was now 100% effaced but still only 4 to maybe 5 cm. Clearly, this was not going to be the same labor pattern as she had with her first baby. She was very discouraged by the lack of progress and was given the option of AROM by her midwife. At that point she declined as she was very committed to a birth with minimal interventions.

By 10:30 her contractions were 1-2 minutes apart. She was feeling very nauseated, exhausted and in low spirits. At 11:30 she decided to try and rest in bed a while with warm blankets. She also had a vaginal exam at that time where she was 5cm and still at -1 station. At this point she did have her waters broken. There was something about this client’s personality that proved challenging not only to me as her doula but the midwife and the nursing staff…creating a very uncomfortable dynamic between her caregivers and myself. The nurses wrongly assumed I was ‘anti pain relief’ and would whisper to her husband to let them know if she ‘wanted something’. She was extremely committed to a natural childbirth completely outside of any thoughts I hold about childbirth. It isn’t my role to make decisions for her. In all honesty, I was worried about her exhaustion level and wondered if she could have used something for rest before the pushing stage. As this was NOT her wish, I never suggested this and I supported her desire for a natural childbirth.

I did my best to help the client relax and encourage her to rest as best she could between contractions. I proved unable to make this an appealing option for her. At Noon the midwife came in and seemed annoyed with me that her patient was so chatty and talkative. She gave my client a stern motherly talking to, drew the blinds turned off the lights. I was truly relieved as Brook seemed to respond to this and finally sink into herself and focus on the quiet internal work of childbirth.

All the while, some crazy goddess worship music is on repeat in the background. It was bad yet catchy. It went on for probably 8 hours of the 19+ hours I spent along side her. Being sure this birth would be fast given her prior labor pattern I didn’t pack snacks….in fact, I hadn’t slept since Saturday night (It was now Monday), I had been on a 15 mile hike Sunday, and in four days I would get the completely unexpected news that I was expecting my first baby. I was deliriously tired, and feeling quite guilty as I was not the one in labor.

At Noon time Brook is sure the babe is coming. She is clearly uncomfortable but starts to do some pushing. She pushes and pushes and pushes and pushes and pushes. She does rest at the midwife’s command. She is nauseated and uncomfortable. She needed a lot of quiet encouragement, which I could give her. This was more of my element as a doula. She did seem to at least be more within herself and focused than she had the entire labor. I was happy for her.

In walks repair guy. Big annoying hospital repair guy to futz with the phone. The room was crowded with people and it somehow seems to only be ridiculous to me that someone would choose this laboring mom’s transition stage of labor to be clanking around the room.

“Is this quite necessary right now?” I ask. Apparently, yes it was. This day couldn’t seem to get much weirder. And yet, it does.

Brook finally was ready to push. Her baby was coming down and crowned for what seemed to be an eternity. Maybe it seemed so long because the client was insistent that she wanted multiple pictures of her baby crowning. Surely this would come in handy one day for her son. Okay…I can do that. I start to snap pictures…Lots of them. This was her wish and I was her doula helping her get what she wanted even though it wouldn’t have been my choice. A nurse starts yelling at me to stop, this was not allowed; they do not let people take pictures of birth. Um, whatever lady. Believe me when I say it wasn’t my idea. Yet, it is her body, her birth, her baby. She can have video of it as far as I am concerned.

The midwife eventually cuts Brook so the baby can be born. I was pretty horrified that the midwife gave her an episiotomy. As far as I could tell from the tone of the room and what the medical staff was discussing, this baby was not in distress. I get shivers thinking of her doing that to Brook.

Her beautiful son was born late in the afternoon. He was over 9 lbs and was healthy and beautiful. Brook and her husband were thrilled.

As I was leaving the hospital I had to get paperwork from the Midwife regarding my role as doula. I was collecting feedback for certification purposes. The midwife lays into me at the nursing station about how laboring mother’s don’t need all that hand holding and being told ‘oh that was a good job, you’re doing wonderfully’ talk. They need to be quiet in a dark room so that they can move deep to labor. She acted as if I had somehow disrupted this process and made more ‘work’ for her as a midwife. She didn’t give me great feedback and wrote snotty comments that weren’t especially helpful or offering of guidance.

As soon as I walked into the elevator I burst into tears and cried all the way home. I drew myself a hot bath and was sobbing in the tub when my husband got home from work. I really wondered if I was cut out to be a doula.

In the end, Brook and her husband were ecstatic with their labor support. I feel proud about the way I handled myself in retrospect. Two of my own pregnancies and childbirths, and several other births as doula, and almost 4 years of life behind me I still think of this family now and again. I can’t believe I went on to attend the births of other women after such a difficult experience.


Anonymous said...

It sounds like this was a really tough experience and yet you did everything that you needed to do for your clients. If they were happy, that's what's important (although the misrepresentation is another story altogether).

I had a lot of questions about the way my first clients' midwife handled the birth, too. I still want to talk to someone about it, as I'm not sure everything that was done was done appropriately (e.g. hiding information from the client, AROM before she was 4 cm dilated).

I'm sure that many of your clients are so glad that you kept going, despite the problems with your first experience.

ewe are here said...

It sounds like you provided what your client needed in terms of support, i.e., you did your job well.

As for the midwife who lit into you, hopefully you know now she was not only out of line, she was wrong. You were your client's advocate and support system; you were not there to make the midwife's job -yes, job- easier/different/better/done her way. In fact, she was supposed to be making it easier for your client as well; sounds like she failed her. Not you.

Ru said...

i am just now getting ready to get involved in the process and work of being a doula, and it is beyond measure how much i appreciate having this story told. it is reassuring to know that even in such a difficult situation, you managed to stick with your purpose and get things done.

Kyla said...

It sounds like you did your part exceedingly well. The patient misrepresented the situation to you and also seemed to make it difficult for you to assist her, even though it seems your presence was a comfort. The midwife shouldn't have reacted that way. You sacrificed a lot to help them through that birth, I'm glad you went on to assist others and you didn't let the bad experience hold you back.

Anonymous said...

I'm an L&D nurse and I would love to have you as my doula if I were to have another baby.

From your description of the events it sounds like you did an incredible job for this family. That midwife had no right to rip into you. That was totally unprofessional.

We get 'unusual' clients through the L&D Unit every now and then and they are indeed a very huge energy draining and mind boggling challenge. That fact that you survived 19 hours of that for free is a testament to your dedication.