Overdue - Monday, September 27, 2010
It is 42 weeks exactly when I am waiting in the family area for mom and dad to arrive for their induction. They have worked hard, taken Bradley classes, read every book proffered, taken the advice of all their consultants (teacher, doctor and doula) and family. They are perfectly prepared. It is 6:50am as I sit chatting with a new Gramma about her daughters recent emergency ceserean birth. I counsel her on how to support her daughter through recovery as I stare, waiting for familier faces. There they are, she in her bright blue dress from Turkey and him in his Istanbul football t-shirt. I watch them for just a moment, as I tell the new grandmother congratulations and bid farewell, they look happy and calm. I call to them and embrace momma and hold her for just a moment and then hug dad. We check in and walk back to labor and delivery. The room is big and comfortable and we get mom all settled and all our paperwork done and wait for doc who arrives around 9:00am. Mom has shown no signs of labor as of yet and we are hopeful that doc will report some change, but no change is evident as doc performs a balloon insertion for mechanical dilation of the cervix. The balloon is to stay in for six hours unless labor begins. We get mom comfortable with lots of pillows and aromatherapy. She will have to be monitored most of the time, but we can do intermittent if baby is doing well. Gramma and Grandpa show up and do a little visiting. About 10:00am Mom has a seismic contraction and baby does not respond well. His heart rate plummets for a few moments. We get mom onto her left side, the contraction ceases and baby returns to normal. Things seem to settle down and we take it easy for awhile, just talking and getting ready for the labor we know will begin soon. During this time, she drinks lots of water and juice and fills up on granola and fresh fruit, dad occasionally tries to feed her through her nose, which causes eruptions of laughter from everyone. At 1:00pm mom decides she wants to get up and do something different. We set her up a nice space in the rocking chair and recharge her aromatherapy so she can relax. Mom eats some chicken and beans to build up her protein. Baby seems to be doing well through everything, but when we see decelerations they are usually late. Mom is having light contractions at fairly regular 7-10 minute intervals, but they seem ineffective. At 2:30pm doc returns and explains her plan and discusses options with mom and dad. Labor is definitely not evident at this point, so the plan is to remove the balloon and break the amniotic sac and give mom time to go into labor on her own. Mom and Dad seem optimistic that this will induce labor and doc is very easy going about it telling mom she can walk, labor in the tub, be on the birth ball...whatever she likes. At 2:50pm the nurse removes the balloon catheter, Doc arrives ten minutes later to rupture the bag and reports mom is 4-5 cm dilated and 50% effaced, but baby is still high and cervix is mid to posterior. There is a little bit of meconium in the fluid, but it is barely perceptible and causes no worries. Mom goes back to the rocking chair and starts laboring almost immediately. Contractions every three minutes or so and we are all so excited to see labor begin so readily. To our great disappointment, after about thrity minutes, it stops. Now, we must work for labor. Up and out into the halls. Mom, Dad, baby and I walk. Around and around...stopping for five minutes every once in awhile to listen to baby. First we walk and we talk. Things are not getting more intense or regular and I caution mom and dad to be patient and work hard... we have a long time to get labor started and this has only just begun. We squat with each wave to try and encourage descent, but still labor is slow and mom can talk through the waves, even laughing when Daddy is comical. He is so in love with his wife and it is evident in the way he touches her and moves her hair from her eyes, the way he tries to keep her light. Around 6:00pm we decide to take a different tack. I send everyone to dinner, including me. Mom and Dad need some time alone and I hope privacy may be what is holding her back. We talk about nipple stimulation and make a plan for the next hour or so - I will bring dinner back for dad, Gramma and Grandpa will go take a break and get some dinner and mom and dad will work towards achieving labor. When I return, essentially things are the same. We can get the contractions to come using accupressure and nipple stimulation, but they are not increasing in intesity. We begin to talk about options. Doc arrives around 7:20 and talks about the plan again. At 11:00pm she would like to start a low dose of pitocin and see if we can jump start labor. We work for another two hours, trying hard to get labor going. Mom is on the birth ball, rocking in the chair, doing the runners pose surrounded by pillows. Still, all is quiet. At 9:30pm they decide it is time to rest. They hope to get a couple of hours rest before the pitocin is administered and hard labor begins. I send Gramma and Grandpa home to rest themselves and Mom, Dad, baby and I settle in for a little nap. It is 11:00pm when the nurse arrives with the bag of pitocin. The lights come on and we all talk about what is going to happen, baby boy is not happy about this discussion and his heart rate reflects his displeasure - mom has a good series of contractions and we all think maybe this is it...the nurse decides to wait a bit on the pitocin and see what happens. Mom agrees to adminster IV fluids because of continued late decelerations, hoping this will help baby tolerate the bigger rushes. Baby perks up, but labor slows again. Between 11:30 and midnight sometime we start the pitocin drip. Mom starts contracting a little more regularly. Things look promising, but when the rushes get a little more intense, baby says no with a big late deceleration. We all jump out of bed and encourage mom to breathe deeply and relax, oxygenating her blood for baby. The pitocin is stopped and mom and baby are allowed to rest and recover from the trial for about an hour and then we try again. This is the pattern we are to see all night. Baby will not tolerate pitocin, everytime we try - he says no. Mom continues with hope of a change - going to the bathroom and nourishing her body with the occasional trail mix or granola, but we fear to push on, for the health of the baby. About 5:00am the nurse informs us we will stop trying and wait for doc to arrive. We talk amongst ourselves about what will happen. We hope for good news when the doc arrives, there could be a change. Maybe mom has dilated more or baby has come down. We hope for this news as we prepare for the possibilty of a ceserean birth. It is gut wrenching...trying to hold onto hope, while preparing for what mom and dad see as the end of their plans. Mom looks at me as I sit on the end of her bed, "I don't want to be a statistic...". I hold her and tell her she is not. No matter what happens, she has been empowered today. It has been a hard road, but every decision has been hers and dads and it will continue to be that way. I tell her we still have hope for a vaginal birth, even though that hope is being ticked away with every second on the clock.. She is afraid for her baby now, afraid for her self and afraid for the loss and through all of this fear - she smiles, she is brave, she is bold, she is strong and I am so proud of her and dad. I know, whatever happens, we will all come away joyful for the honor that they have been shown throughout their pregnancy and birth. We rest again and Gramma and Grandpa arrive around 7:00am and like us they are hoping to hear good news. Doc has not arrived yet so we take this time to relax and visit. Rushes are again 7-10 minutes apart, but seemingly ineffective. Still, we hope. The moment of truth...Doc is here. I can sense the tension and hope as mom lays back for her first exam since her bag was ruptured. The news is difficult, no change in position, no change in dilation, only a tiny bit more effaced. Mom and Dad are visibly disappointed. We all sit together around mom as doc explains all the options. She says lovely things and touches mom as she speaks. She tells personal stories to comfort mom and guide her. She says, "You can keep going...we can keep trying...whatever you want to do." Then she counsels her on the option of ceserean birth. While the option to keep trying is there, doc feels ceserean birth may be the end result for the safety of momma and baby. In the end, when she leaves she says, "you just let me know what you decide. It is in your hands." We spend a little while talking. We go over the risks and benefits of each decision they could make. Doc will return around noon and we have plenty of time to decide which direction to go. I tell mom and dad I will give them time to talk. We agree on about thirty minutes and I go out into the hallway and talk with the nurse. I tell her they need privacy for thirty minutes to talk about their options and decide which direction is best for them. As I walk down the hallway towards the family waiting room I have to stop. I am exhausted and this is a moment I need to take. I stand and lean my head against the cold wall and say silent prayers. Tears come and I let them fall to the floor. Deep breaths. It is just a moment, feeling the cool against my head and preparing for the talk I must have with Gramma and Grandpa. They are there waiting to hear some news and I have none to give them yet. I let them know mom and dad are talking and weighing their options. Gramma is shaken, but Grandpa is stoic and hard to read. I hope I am saying the right things. I hug Gramma and head back to check on mom and dad, it has been over thrity minutes. When I come in I can tell before they speak - it is decided. They feel there is too much risk to baby to keep trying. Momma is brave. It is 9:15am. Mom, Dad and I talk about how to emotionally prepare for what lies ahead. Doc has talked about priorities: healthy momma and healthy baby, vaginal birth, no medication, no intervention, etc... Slowly mom and dad have been moving toward just that one goal, the primary goal, the penultimate...healthy mom and healthy baby. I remind them there is one more goal that the doctor forgot: empowered positive birth. This goal is still attainable. Walking away from this and being able to tell your story as a success. Embracing the circumstances you were given and doing everything you could with them. Being empowered to make your own decisions and not having other people make those important calls for you. I reminded them of the path they had chosen and also of the path they had walked together. Lastly, I encouraged them to be together now. To grieve the loss of their hopes and try to get to acceptance. To cry, to let go...together, as they had done everything together. They wanted to be alone and so I left with the promise to be back by 11:30 to help them prepare for their upcoming birth. I went out to the family area again and told Gramma and Grandpa about their decisions and their desire to be alone. I encouraged them to go back and give her a quick embrace and kiss and say a few words of encouragement. After that, Dad crawled into bed with Mom and held her as I left to get a bite to eat and try and process on my own so I could be better support to them. At 11:30am I walked back in to find the nurse in scrubs already. She told me outside the room that we would be going back in 15 minutes and so I walked into the room and started trying to get mom and dad ready. As with all things in the hosptial it was time to hurry up and wait. We did not go back in 15 minutes. I talked to mom about what would happen during the birth. How it would feel, who would be in the room, where the baby would be, what recovery would be like. I told her if she wanted me to be with her and the doctors would allow it I would attend on her in the OR. She said she would prefer it if I were there. Gramma and Grandpa came back and kissed their daughter. Dad put on his scrubs. Everything was in readiness. Mom and Dad both held their composure, but you could see they were nervous. Doc came in around 1:10 and we talked again about what would happen - I asked doc if I could attend on mom during the birth and she told me she would prefer if I did. She would check with anesthesia and hopefully I could be there. A few minutes later the nurse came back with scrubs for me and told me I was clear to go in. They took mom back and dad followed her into the hallway, talking to her and kissing her. When he came back in I could see he was having a hard time and who wouldn't be....the two people you love most in the world had just been taken back for surgery. We talked a little bit and I tried to help him, but I knew the only thing that would make him feel better at this point would be to be with his wife and child, safe and sound and through this trial. He was not the funny, jubilant man I had come to know, but serious and scared. I touched his hands and shoulders and said things I hoped were kind and comforting, but in the end I knew this was his cross to bear and so I simply sat with him and waited. They called us back at 1:30pm. We were all dressed in our blue scrubs as we entered the operating room. Dad virtually flew to mommas side and wiped the tears from her face. I stood behind them, one hand on mommas shoulder and one on dads. I couldn't tell you what dad said, but he looked in her eyes and started talking, alternating between Turkish and English. Something soothing, he touched her right eyelid and then her left. She smiled and the tears rolled down and pooled next to her on the table. A low hum of words was coming from him as they made the first incision. She would smile and he would kiss her. He never stopped talking in that low urgent way, he seemed a man possessed in the most beautiful way. As if he could somehow take her to another place, another time, a moment suspended where she was safe and warm. I watched as they pulled back the abdominal muscles and made the second incision into the uterus. There was babys head and the doctor said so, "I see a little head...not much hair...". And then, within seconds, he was there. The loud cry ringing in the room as we lowered the partition so mom and dad could see their healthy, pink baby boy. He had the cord wraped around his neck, but it was loose. Doc handed that boy off to the baby nurse and Dad, giving one last kiss to momma, followed baby to the warmer. I sat down with mom and told her how proud I was. How beautiful their baby was. How healthy his cries sounded. I could see them, but she couldn't. I wiped the tears from her eyes and held her hand tightly. Suddenly there was dad, beaming like the proud papa we all knew. I asked doc if we could try to breastfeed and she said no problem. That baby boy took to the breast like a champ, even in his awkward position - with mom still flat on her back. Doc and company were doing sutures as mom, dad and baby bonded. I sat behind them and encouraged them, trying to walk that fine line of helping without interfering. Mom and Dad cried as the beheld their little man. Mama named him...I think he whispered it to her, it seemed magical - as if they had just met and he had introduced himself. With everything complete we headed to recovery where the new family could do some real bonding. I headed out to the family area to give Gramma and Grandpa the news. As I walked down the long hallway I could see her. Her hands wringing, I could almost hear her heart beating. I knew what she was thinking and thought the long walk was too much for her, so I raised both my hands and gave her the thumbs up from about 50 yards away. I could feel relief flooding from the room and as I closed the gap Gramma hugged me with all her might, tears running down her face. "I was getting worried..." was all she said and I said, "they are together. He is beautiful. Congratulations Gramma!". Things moved so quickly after that. I let the little family bond for awhile, then tried to get them settled in as best I could before I departed. I kissed mom and baby and hugged Daddy tight. As I stood next to the bed, holding mommas hand, something unexdpected happened - Grandpa reached out with his arm and embraced me. I gave him a tight squeeze, kissed grandma and took my leave. In the hallway outside I took a moment to say my thanks. Thank you for this baby, this birth, this experience, this family, this joy, however mingled with confusion it may be. I suspect the placenta had detiorated to the point where it was unable to provide baby with adequate oxygen to endure labor, but that is just a guess. Mom and Dad will have to live with this mystery, probably forever. But on their path they met every roadblock with intelligence and love and patience. They gave of themselves to their child, before they knew him they gave him everything they had.Mom and Dad started looking late for a doula. They are both doctors and they had already delivered two beautiful little girls. This time, she wanted to try and do things a little different. I couldn't help but fall in love with this family. The first time I arrived at their house and heard two little voices squealing, "it's the doula!". I knew I wanted to be there for them, support them and honor the growth of their family. It was Friday when I got the first call. It was Dad. Mom had been to see the doc and came home with contractions. She was due today and it was looking like maybe we would meet a little one. But no - Dad texted me just a few hours later and reported moms contractions had stopped as soon as she was with her two older daughter - the Labor Unablers (as Dad coined them). Things tapered off and I went to bed early hoping to be called in the night. I was not disappointed. At about 2:00am the phone rang. Dad says Moms contractions are getting difficult and she is asking for me. I roll out of bed, run through the shower, gather my doula things, kiss my sleeping family good-bye and head out for the almost hour long drive down to see my laboring momma. The house is dark when I arrive, so I knock quietly and am greeted with a smiling grandpa. Dad comes out and tells me mom has just settled down for a rest, contractions are big then small then big again, but she is able to rest through them. I go into the very dark room and lay my hands on a super relaxed momma. Reassured that she is resting, we all tuck in for a little nap. A couple of hours go by and the house starts to stir. I hear the whisper of fairy voices and am awakened to find myself in someone elses house, looking into bright blue eyes. The siblings are awake. Two of the most beautiful and treasured little girls make ready to go to Gramma and Grandpas house so Mom and Dad can focus on labor and bringing home baby brother or sister. Moms labor has slowed down a little and I worry she will not pick back up with prying eyes around. Once we get everyone out the door, we talk a bit and decide some time alone might be needed. I head out to do a couple of appointments, it's about 9:30am at this point. Mom is definitely having contractions, but they are far apart and she is able to talk through them. Around noon Dad calls and let's me know Mom is ready for me to return. So I grab a sandwich and head back. I arrive and Mom is down on the floor, she is resting through the contractions, but now I can see...it is a struggle. She opens her jaw, releases her shoulders - but that pelvis tightens right up. We work. Counterpressure. Dad is so soothing, reminding mom to stay loose, to open, to release all tension and she is trying. It has been a long time. She has been laboring actively for more than fourteen hours, probably longer than that. Mom wants to go to the hospital....transition seems miles away and she needs a marker, a timeline, something so that she can see the end. "am I being a wimp?", she asks me and I tell her no. We all talk and decide it is time to go. It is so hot outside, in Houston, in August. Mom can't stand to be outside, waiting to get in the car, but she is patient with sweat rolling down her back. I stand there with her, still counterpressure, talking her through each rush while Dad gets the car ready to go. When we arrive we are brought straight to the room and start working through the rushes again. Mom gets checked, the news is about what we expected, 4-5, 80%, -1. About halfway there....but it has been so long already and mom is discouraged. She wanted to hear more. She is really proud of herself...this is the longest she has ever made it in labor without any kind of intervention. I am beaming as she says it....we all know it is time to rest, work has been hard, but I need her to tell me. "I want an epidural." "I know you do and you can have one.....are you sure?" "yes, I am okay and I need to rest...it has been so long...", "tell dad," I say. And she tells him: I need to rest, I am proud of myself, We have worked hard....I give myself permission to do this. Dad and I have to leave....hospital policy. Dad and I wait and talk while mom gets some pain relief. She has worked hard and I can see exhaustion is bearing down on her....time for a rest. Dad heads out to grab some dinner and is gone all of about twenty minutes....maybe. Then it's my turn. When I come back, I can see mom is really uncomfortable. The epidural is light. She can still feel alot and has full mobility. At this point we are going side to side trying to relieve moms discomfort. "in my bottom. I feel pressure..... "she says. But, it is not time....we have a little work to do, yet. Baby is on the run....we can not seem to keep this child on the monitors and with the epidural, came the the monitors and IV....it's a package deal. Mom is a good 8cm with a stretch to 9. The pain is surprisingly intense, even with the epidural. As we chase baby...for 30 minutes, unable to locate this sweet child...getting glimpses every once in a while...110, 148, 90, 191, 87.... Where is this child???? Doc is now in the room. Kind and patient she helps us, but to no avail. Mom says, "I can feel him coming down.....the baby is coming down." Doc says we might have to go with an internal monitor and in that moment Mom sits up, "what?', she says.....and there it is. Budump budump budump budump.....baby. Just in time too, because mama wants to push. While we have been chasing this sweet babe mom has finished her labor and is ready to start pushing. She is a warrior - pushing steady and hard. Strong pushes that bring baby down quickly. Can we talk about crowning? I love this trans-formative moment, when mom has pushed past the pubic arch and it is just time to let baby stretch mom out. I have NEVER seen a dad look away from it. It is mesmerizing. Time stands still, stretching, waiting in awe at what mom is capable of. Daddy is ready to catch. Suddenly, she bursts forth - pushing through that last barrier with the birthwail trumpeting her arrival. Straight up to mommy. She is beautiful. As ever, I step out and watch as Mom and Dad discover they have another daughter. Glowing, mom finds me with her eyes and mouths, "thank you". I smile and close my eyes and quietly give thanks that I have found this path....this gift of joy that I hope to share with everyone.
A Vacation Birthday - July 6, 2010
I have been eagerly anticipating the arrival of my last baby in June (turned into July). When we first met, mom was convinced she would be having this baby in June and I happily reset her due date for early July - boy am I happy we did that. After many false labors, we turned the corner in July to find baby still not wanting to join us in our extrauterine world. On July 3rd Mom and Dad had gone shopping and Mom reports losing the last of her mucous plug. She arrives, in the afternoon, for a relaxing massage with an amazing friend of mine. About an hour after the massage is schedule to begin I recieved a text from said awesome friend - SROM - for those of you not 'in the know' - Spontaneous Rupture Of Membranes - in other words, her water broke on the massage table. Mom and Dad call me on their way home and are having contractions as they drive home - water is definitely broken. Surges are strong and close together, mom is handling them well. I gather all my things together - kiss the kids, kiss my husband and call my mom to arrange some alternate plans for my relatives who were all supposed to be converging on my house later that evening. Dad calls and asks me to please meet them at home as soon as possible. When I arrive mom is working in the bathroom - the surges are coming close together and while not impossible - they are definitely stopping her in her tracks, "women really do this?!?!?!?", she asks. I reassure her that not only do women do this, but there are women all over the world doing it right now with her. She is glowing and beautiful. At this point, we talk about options. She is birthing in hospital, with midwives. She is GBS+ so antibiotics are recommended and there is definitely meconium (early baby poop) in her fluid. They decide - with the contractions so close together, her bag broken, the meconium and the GBS+ - to go to the hospital. We fly down Houston freeways to the hospital. We arrive and are brought into a L&D room. The first nurse insists she lay in the bed with the monitors - we talk about options and I offer to hold the monitor on to get good readings, but mom relents and gets into bed for her strip (reading baby hearttones). The surges are much more difficult this way, but mom powers through with Dad providing counter pressure on her back and some light aromatherapy, we talk her through them. "you are so strong", says dad. They are in love when they look at each other and he is all supportive tension, never leaving her side, always watching her face - waiting for a small signal from her to change, to do something....different. He is the ideal picture of concious concern and love. The midwife arrives, no pressure to examine. Baby is Beautiful - Labor is Lovely! We move to the birth ball for a while, me sitting behind offering counterpressure, effleurage and gentle words, Dad in front being her rock, her stability - his eyes never leave her. After a while the pain is difficult and she wants to move to the shower, we take turns holding the shower spray against her back and talking with her, trying to keep her warm and distracted. Eventually, Dad changes into swim shorts and just hops in there with mom to better help her. We stay like this for a long time - Mom, Dad, the Midwife and Me - in the bathroom, listening to baby on the doppler every once in a while, talking and just laboring. After a bit mom is tired of the shower and is complaining of back pain. We move to the bed where the midwife (finally - I am not complaining) encourages a vaginal exam. She does the lovliest thing - she doesn't tell anyone how dilated Mom is, babys station, effacement....it is not relevant to the task at hand. She does however find a pocket of water that is keeping the babys head off the cervix and offers to break it, with no pressure. We all talk for a couple of minutes about the pros and cons of doing this. Mom and Dad decide that since the bag is already ruptured there is no harm in opening this pocket and letting the fluid out. Immediately after Mom goes to hands and Knees and labors well. With the midwife there, I step away for a moment to call my kids. When I return she is still on hands and knees - but grunty. So fast, I think. We move to the toilet and stay there for a good long while. Mom is feeling more and more pressure building into her bottom and we encourage her to grunt with it and push a little. Mom Ikeeps checking to make sure there is no baby coming out and the midwife is checking heart tones every once in a while. An hour or more goes by and the midwife asks for another check and suggests active pushing. We go to the the bed and mom is ready - everything seems to be right for baby to arrive, but something is holding her up...... We all want to meet her so bad. The midwife is patient, but firm - instructing mom how to push - squatting, hands and knees, side-lying and supine. We try everything, but with every two steps forward we take one and a half steps back. It seems she will not descend and her recovery is taking longer and longer after each contraction. I go to get more water for mom and the midwife meets me in the hall. "We have to work harder" she says. We go back in and I tell mom, "It is time....to push, harder, longer, stronger, past the point of pressure and burning. You have to push past all of that and bring her to you." Mom is ready and this time when she pushes we see her stay...more head, further down, closer and closer now with each push....she is amazing. Dad cannot speak, tears fall from his eyes and he is in awe of his wife, "I didn't think I could do this. Look at you do this....this is amazing". Crowning is amazing, the baby resting there, stretching, pushing, mom working to hold her there, letting her body stretch, the midwife, guiding her with her hands and words. Again, I am thunderstruck by the gravity, the awesomeness and the power of this. She arrives, bursting from her mother - but, there is no cry. The nurses rush in and I tell dad, "follow your baby". They take her from her mother to the warmer and dad follows - they work. Everything is suspended - an ant trapped in a water bubble...no time exists, there is nothing, me holding mom, Dad trying to see what is going on - from elation to the worried father. The flurry of nurses, hands, masks, gloves. "I can see her," I tell mom, "She looks pink"...... then it happens, the most beautiful sound...not a cry, but a squeak. A small sound that fills the room, everyone breathes as this sweet baby girl is rushed out of the room and far away from mom to recieve additional help, with Daddy in her wake - tied to her, never leaving her - ever again. It was the meconium - it seemed like there was more than I had ever seen. She had aspirated the meconium and her lungs couldn't work right with all that sticky stuff in there. Mom and I wait, reassuring each other, "She is fighter," mom says. "she is tough," I say, "like her mom - a warrior". We wait and talk and repair and clean and wait. Sweet baby girl had a nuchal ARM - the whole thing up around her neck - keeping her from coming down. It gave mom a pretty good tear and that gives us something to focus on while we wait. The reapir hurts, but soon it is over and we are waiting again. Dad comes back with baby....for just a moment. She is intubated and incubated. She will be going to the NICU - we don't know how long. But, she is beautiful, a miracle, a gift. Daddy follows in her wake - a dark shining hero, full of joy and misery, hope and despair.
I am happy to report this beautiful baby girl is stable and doing great. Mom and Dad hope to have her home very soon. They are working hard to stay positive, as baby seems to make improvements every day. It was an amazing birth, with an amazing result: a strong family
Positive Hospital Birth - June 26, 2010
Mama had been calling me for two days. She is in prodormol labor. Things are moving slowly and she is getting tired. I encourage her to eat well and rest - early in the morning on the 24th. Around 3:00pm labor gets more difficult. I gather all my doula things, kiss the kids goodbye and head out for a long night. When I arrive mom is in good active labor in the bathtub. The contractions are all in her back and we think the baby might be sunnyside up. I have to say....this mom is strong - she is handling everything well in the tub, moaning low on hands and kness with the contractions - but, she has had major back problems in the past and my normal comfort measures for back labor are not only ineffective, but actually seem to make things worse. We are lucky, daddy knows her well and understands her body. He works hard to help her and I watch, learning from him and helping with soothing and encouraging words. He says I am a miracle - that my presence seems to make her better, but I know it is really that she has not found her comfort with me and is not ready to be vulnerable and instructive while I am there - as we work, her barriers crumble and we begin to see hard labor. They decide to stay home for a while, hoping to arrive at the hospital before transition, but late in active labor (also, to avoid Houston's atrocious traffic). We leave for the hospital around 7:30 or 8:00pm and arrive about 30 minutes later. We meet our lovely nurse and are whisked straight to a labor room (no triage). Mom is put on the monitors, while I negotiate intermittent with the staff and talk about delaying blood draw until we get setteled in and mom is not so nervous. Baby looks great and mom is a champ. We get off the monitors and she is offered a check, she consents....4-5, nice and stretchy, -1, 80% - cannot tell babys position, but we all still suspect baby is posterior - as moms back labor seems to be getting worse. our nurse is amazing - we love her. She is so kind, helpful and encouraging. Mom is up, on the toilet, walking the room, riding the birth ball and showing signs of transition (shaking, vomiting, etc...). 2 Hours later she is moving along, but really starting to show signs of exhaustion. The nurse has gotten approval for intermittent monitoring, but they will not allow her water (she has no IV)....Dad comes unglued! After a heated discussion, dad calms down and they (mom and dad) decide that she will continue to have fluids by mouth - no doctor consult, just their decision. It is 10:30 - her water breaks and she asks for an exam - she is 6cm, 100% and 0 station. She is disheartened as her body was telling her she had made more progress, but I remind her and dad that she has made tremendous progress - 1 whole station, 1 whole cm and effaced the rest of the way in 2 hours....that is amazing for a first time mom with a op baby. Renewed and refocused - we soldier on. for the first time, mom questions her resolve - 'I can't do this'. Dad is right there, reminding her why she is choosing this. An hour goes by working hard and hoping. most of the contraction has moved to the front, but she is still battling alot of back pain. By this time, we have found lots of comfort measures that work, despite our inability to use counter pressure, pelvic presses, etc... She loves the smell of lavendar, she is soothed by gentle effleurage during contractions with viscous labor ease oil, she needs to close her eyes to focus during contractions, but look at dad in between. She is a warrior, a champion, a patron saint of women who endure - in this moment - she is my hero! she moves to the toilet to try and empty her bladder and feels the urge to push - an exam reveals 8cm, 0-+1, 100%. She is renewed and ready to continue, despite the intense pressure on her tailbone and our inability to find a comfort measure to counteract it. it is midnight. The day is gone and exhaustion is setting in...the urge to push is strong...9cm, +1. The Doc arrives for the first time......this is difficult. She is doing great, she has just been told she is 9cm...she has been laboring off monitors for a while. Doc wants her back on and she agrees - his exam reveals...7-8cm, 0 station. He reports baby is OP - states that she has a long road ahead of her and leaves. the nurse and I reassure her that everyone examines differently. Our nurse feels strongly that she is at least and 8 with a stretch to 9. We refocus and start to work again. Hands and knees alot, mom is tired. For the first time she says, "I can't do this - I need something - I want a break - maybe I need an epidural". We talk and I remind her how far she has come - Dad is soothing her with kisses and kind words - we remind her this is the end of the marathon - how much work she has done already - her body has proven that is can do this... now she just has to rest and let her baby do everything. 'Down baby, down', she says, 'open, open, open.' And we wait, one contraction at a time, one moment at a time, one sip of water, one kiss, making it through every moment and never looking to the next. It is 2am and a firm cervical lip is left. So little work to be done, but there is so much time stretching out before her.....an endless vista of contractions - she cannot see the end. Her husband leads her through visuals of her cervix opening, her baby crowning, holding him, kissing him, taking him home. He is amazing - truly, not a coach, but her hero - who will guide her and help her to safe passage. It is awesome to behold and suddenly I remember how lucky I am to be here, witnessing and helping as best I am able. Mom no longer has the urge to push - she is calm - her back labor seems to be less and with her contractions I see her body arc and her jaw clench. I encourage her to grunt with the contractions, but her exhaustion is overtaking her. I actually encourage a vaginal exam - I really believe she is 10cm and hearing this news may make her want to push.... our lovely nurse who has been bedside for almost the whole labor - informs mom that she is 10cm, +2 or +3. Mom pushes gently and we can see babys head/ As baby is crowning, doc enters. She is pushing in traditional hospital style, but she is echausted and cannot imagine pushing any other way... she says her legs won't hold her anymore and she is okay to push this way. We help her pull back on her legs and we bring the bed up to almost sitting - Dad holds a warm compress to her bottom as the baby begins to emerge - he is brave - mom is strong and powerful - her pushing is gentle and firm, baby is well and responsive - he is born - they are amazing!!! I am in awe, as I step away and pick up the camera to capture these first moments of a new family together!!! I am overwhelmed as I watch Mom and Dad marvel over their little man. Later, it is 5:30am and my head lays on the bed next to Mom, watching her new man try to nurse. Exhaustion and delight are comingled. It is time to go home, kiss my kids, kiss my amazing husband (without whom I would not be a doula), drink a big glass of water and sleep the sleep of the exhausted. I am tumbled in dreams of babies and daddies and mommies. The faces of all the women I have ever watched in labor all together - a universal mother, delivering me into my purpose.
Two Births in less than 24 hours!!! - June 22, 2010
So, I have been working as a doula for awhile now and I have always been very lucky. I try to take on about 3 births a month, but sometimes I have a hard time saying no. This month I ended up taking on 5 births and had a feeling I was overdoing it, but things have a way of working themselves out. On June 9 I attended a beautiful short labor starting at home and laboring there most of the day, we went to the hospital early to avoid traffic and were a little surprised to find she was already 4 cm. She labored well, with amazing support from her husband (another doula and me). Never a doubt entered her mind. Within 3 hours of being at the hospital we could see a little of baby's head and we knew we would be meeting him soon. Momma pushed hard and quick. She was amazing and beautiful. a lovely natural vaginal delivery in a beautiful and supportive enviornment. It started my month out great. I was waiting for my next mom to go. I expected to hear from my mom due on June 8th very soon and my mom due on the 15th was showing early labor signs. On the 13th I headed out to do some appointments, still waiting on both moms and I was planning on spending some time with my mom who was post dates, as she was beginning to get a little peeved. I visited her last that day and found that she was, in fact, growing restless. The baby was low and her belly was pendulous. We decided a fun activity to get her mind and body moving would be a belly cast. We had such a hilarious and wonderful time casting her belly and by the time we had a big beautiful cast made she seemed more settled and content. My client due the 15th called on Monday to tell me she was 5cm dilated, but still no action (this was her first baby!!!). On the 16th my postdates mom called around 5 or 6 to let me know she was feeling crampy and she thought this was going to be it. I arrived at her house late in the evening to find her relaxed and fresh from a shower. Her contractions were doing what they needed to, but it still looked early. The midwife arrived right after I did and checked mom, she was at 4cm with her bag intact. Mom and Dad decided to head out into the humid Houston night to have a little walk and get dad some much needed caffiene. They returned a little while later and we all sat in the living room talking and working. Around midnight it seemed like things were slowing down and the midwife suggested some rest might be in order. Dad was hungry, so the birth photographer and I decided to go get some food while they rested. We took our time, hoping everyone would get some rest before the long night, we thought lay ahead. Our timing couldn't have been better....when we walked in the door the midwife said her bag just broke! She had made it to the bathroom and was obviously in transition. We moved into a warm tub and and while the work was hard, she seemed to relax in the warm water, changing positions to help this beautiful baby come down. After an astonishing twenty minutes she was getting pushy and said she really wanted to go to the potty. Once there, it became clear very quickly that she would stay there. With Daddy lovingly holding her, the midwife kneeling in front of her giving her the words she needed to hear - powerful, strong, slow, down, amazing, beautiful and me squatting beside her - she birthed, it seemed without trying. Letting her sweet baby girl fall into the midwifes hands and straight up to the family waiting to meet her. Can you say amazing? It was miraculous. A birth to inspire and witness, to support and guide, but never to interfere. After that things became a blur of cleaning and comforting, admiration and celebration. I headed home around 4:30 or 5:00am....it didn't really seem to matter in the moment, I could have stayed there forever - but I knew I had to leave and let mom and dad revel in their daughters and their families new beginning. So to home I went and crawled into bed at 5:30 in the morning, utterly exhausted. Hoping my husband would stay home so I could sleep a little later. Cut to 6:15am - my phone rings. It is my mama who is due on the 15th. Right on time. (well one day late - who counts one day late?) She too complains that she is crampy and this seems like it might be the day. No, she doesn't need me yet, but she will soon. I got myself together and actually went back to sleep for another hour. She calls again - it seems fairly intense, she says. She is thinking about going to the hospital (she is already dilated to 5 before this started), will I meet her there? Of course, I am on my way. I walk into the hospital moments behind them and meet them in triage - yes, she is in labor, yes the contractions are strong, yes she is dilated to 5.5, yes her bag is intact, yes - we may go for a walk. We got all our stuff together and move to her room, then we walk - up and down the hallways - mom is a champ, a warrior - she is beautiful and clever and funny. We walk until she is tired and we have to listen to baby's heartrate. Baby is good, we sit on the birth ball, do backwork, aromatherapy, breathing exercises and guided relaxation. Dad tells jokes - he's pretty funny and keeping mom lighthearted. She goes to the bathroom and thinks maybe her water has broken, but is unsure. Moments later, around noon she gives her first sign of transition - looking at me and saying, 'I don't think I can do this, Kathleen'. I reassure her that she can, that she is, that she will. Dad is there, encouraging her.... She decides to ask for a vaginal exam to give her some idea of the progress she has made in this short time - All that is left is a cervical lip, a tiny thing....mom is renewed and determined to get this out of the way...she wants to push - squatting with the next few contractions, the lip disappears and she is grunting the baby down....pushing gently with each contraction....talking her baby down. Doc arrives on the scene, in street clothes, throws on a pair of gloves and starts massaging to help stretch the muscles and prevent tearing - she is very focused on helping mom have this baby with no intervention - her green glass necklace brushing moms leg as she leans down to get a better angle. It was beautiful and wondrous and lovely and supportive....did I mention miraculous????? This beautiful baby girl was brought right up to mom's skin where daddy and mommy could love and admire her. I was in awe. TWO AMAZING BIRTHS IN LESS THAN 24 HOURS!!!!! I have never had two of my clients deliver so close together...nor have i ever had two clients have such drastically different and yet eerily similar birth experiences. Both were well dilated before labor, both labored about seven hours, both had amazing support from their families and care providers and yet - one was a third birth after primary c-section, one was a first birth, one was hospital, one was home, one was midwife, one was obstetrician. I was in a constant state of awe all that night and day. Blessed to witness the power of women, the power of birth, the power of CHOICE!