On December 18, 2014 I wrote this with a sick baby in my lap. Ezra was 8 months old and had his first doctor-worthy illness -- croup. I had been talking to a former doula client about her second birth, which I wasn't able to attend as her family had moved. After that phone call, coupled with the inability to leave the house or put my baby down, The 12 Hours of Labor was born. I made some visual updates because I was never happy with the quality of the print -- hopefully this helps!

Recently I was watching The Labyrinth, that incredible movie of my early teenhood. I watched that VHS tape so much it started to warp. I know just about every line, I sing every song, and I am ALWAYS ready for it to have a different ending, even though I know that never really happens.

I was struck by the opening credits -- when the words "It's only forever," play. This one day, when we birth our babies, stays with us forever. Shouldn't we do all we can to improve our experiences so the memories bring us happiness instead of disappointment? Enter, the Labyrinth...

The basic premise: Sarah is an imaginative girl who loves to dress up and pretend play. She has to baby-sit her half-brother, Toby, and she dreams her story to be that of having a wicked stepmother and she being forced to work and have no life. Her brother begins to cry from his crib. She accidentally sends Toby off to the Goblin King, Jareth. She then has to rescue him, through the maze of a huge labyrinth, or he will be lost to her forever. Ultimately she has a few choices -- live in her pretend world forever and forget about Toby, become Jareth's queen and live happily ever after with him, or fight to get Toby back -- and of course, that's what she does. 

​But did I mention who Jareth is? 

Um, yeah -- that's why I was always Team Jareth...but I digress.

Often labor starts out so small, we work up confidence and think, like Sarah after making a good choice, "this is a piece of cake!" That's right before she falls into a hole with nothing to stop her except a bunch of "helping hands."

While early labor is often something we can handle on our own -- occupying our minds, resting, bouncing on a ball, relaxing in a tub or shower -- as things progress, our bodies will demand more from us. Instead of worrying that this is  a predictor of how hard labor may be (at some point in the future -- I call this 'catastrophysing,' and in real life, I am pretty good at it), we need to enlist support from those around us. This is where partners, doulas, midwives, mothers, nurses -- whoever is there to fill that role, come in. 

Labor WILL get more intense -- that's the nature of the process. With support, we can be lifted up by those caring people on our birth team, those helping hands. 

There is an average amount of time women will labor. For first time pregnant people that is 12ish-24ish hours. Be mindful of that when you start telling people you are in labor, people forget birth is a marathon, not a sprint. It may only be an hour of time that has passed and well-meaning friends and family can start to ask if your baby has been born yet! 

Some families consider sitting with this information for a while until there is something more exciting to report. Often the invitation (or expectation) that people will wait happily in the lobby can be a lot of pressure to the laboring person! I have been at more than one birth when a guest pops into the laboring person's room, unannounced, and either there was nothing going on, or the person had to be shooed out quickly because it was pushing time or naked time or toilet time -- this doesn't have to happen to you! You can decide where your loved ones will bide their time, and it doesn't have to be at the hospital.

Whether it comes as a loss of control, or a needed suspension of reality, staying in our left brain where logic and reason try to make sense of things isn't always productive in labor. 

As labor progresses, we need to move to our right brain and listen to what our bodies are saying. Linear flow of time, labor math, and trying to make predictions according to what we know and what has happened all need to go by the wayside. Our team should help protect this state of mind by moving with us, going at our pace, finding another place for their fears besides our ears, and knowing how to help if we are truly lost -- like getting into take-charge mode. Labor is challenging, and we are working hard enough to keep our own heads straight -- partners and others can respect this and flex to it as long as we are feeling safe and moving forward. 

We learn. We read. We immerse ourselves in information and do our best to plan for our births. But in the end, there are so many things that aren't in our control. Does this mean we shouldn't even try?

What can we really plan about birth? We'd like to think we can plan a lot -- hospital, support team, safety. But we've all seen videos of women birthing unexpectedly in their cars (as a doula I had that happen once). So what's a pregnant person to do? I'll tell you: take a comprehensive childbirth class where you'll learn your options in a nonbiased way. Understand the labor process, how to cope, and what to expect. Build your dream birth on a foundation of sound evidence-based information -- this will ensure if your Plan A becomes a Plan B, you will know exactly what your new set of choices are -- because you ALWAYS have choices. Birth, like life, may not be fair, but you can adjust the scale in your favor with knowledge and options. 

I recently had a conversation with a pregnant woman who shared: "I know no one can make me do anything I don't want to do. I can always say no or ask for other options. That's my right."

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Not sure what your rights are? According to the American College of Obstetricians and Gynecologists (ACOG), pregnant people:

• ​have the capacity to make decisions
• have their right to refuse treatment respected
• should not be motivated into a specific clinical decision through  manipulation, coercion, duress, physical force, threats or threats of court action
• should have their experiences and beliefs valued, respected, and factored into their decision making
• should ultimately have their wishes respected, even when refusing treatment

A year ago dad was diagnosed with stage 4 cancer. His first oncologist ran him through an intense course of chemotherapy which nearly killed him. My dad's heart isn't in the best shape, and the chemotherapy was at too high of a level. At the suggestion of a good friend who was also a doctor, my dad got a second opinion. This doctor immediately told my dad to see his cardiologist to have his heart checked, stop the chemo (with two sessions remaining), and to work on getting his health back. Dr. Wong said, "I know they are giving you too much chemo, because I can see it in your face." The first oncologist made my dad feel as if he didn't have a choice -- this was what he needed to do or he would die. Faced with that choice, my dad complied without thinking twice. His second oncologist looked at the overall picture, he asked my dad what he wanted to do, he gave him choices. My dad questioned some of these choices, such as stopping the chemo early. His doctor said, "Your old doctor's ideas are to blast the cancer away -- and that was also at the expense of your quality of life and immediate health. I am the expert of this cancer, and you are the expert of your body. I am open to listening to you, offering you options, and helping to support the course of action you choose." His doctor explained there are no guaranteed outcomes, and because of that, no one can make these choices for my dad except my dad. 

This is what ACOG is laying down that many physicians aren't picking up: no one can guarantee the outcome for you and your baby -- and because of that, the choices we make during pregnancy and birth are ultimately our own. This doesn't mean you have to be contrary out of the gate, this simply means when you have researched, thought over, pondered, prayed about a decision which may differ from that of your medical provider, no one holds more power than you.

This woman had it all covered! Not only did she bring her own lighting to the hospital, she had a diffuser, and her own Tupperware rolling pin, the one you an put cold or hot water in! She was, in just about all ways, prepared. And she did it in a way that made sense to her. 

Pink was the theme! She beautified my suggested birth plan template and framed it -- setting it on the counter in her room. Every nurse that came in stopped, ooohed and awwwwed over it, and took the proffered chocolate treats sitting next to the frame. 

Knowing her husband might need important information to be easily accessed, she put a list of must-dos on the back of the front door, so nothing would be overlooked or forgotten before leaving the house. She also had a small photo album full of ways to support her,  phone numbers, and small self-care steps he could take for himself. 

A packing list was created so all items this woman wanted would be included. Then it was broken down even more to specific location, so others would be able to find what she was needing or wanting without digging into the wrong place. 

Another photo album was filled with calming images the woman could look at during labor. 

Does this seem like a lot of work? Or does it sound like your style? You don't have to be this thorough! The key is to make your plans in a way that speaks to your own sense of organization. In labor, we can utilize comfort measures that we are familiar with and turn to during times of stress or discomfort -- we don't have to learn a lot of new-fangled coping measures that might feel unnatural or hard to remember. It works the same way when getting ready for labor and birth -- rely on an organizational strategy that feels good and works for you!

​I worked with somebody once that had a definite “bubble” of personal space. It was kinda fun to subtly test the limits of those boundaries. I finally determined, through months of occasional observation and experimentation, that the space was 3 feet. Step, even 1-inch, into that invisible 3-foot force-field, and my subject would move away to reestablish the 3-foot bubble.   

I, too, have a bubble.  When it comes to supporting a woman in childbirth, I temporarily deflate my bubble to support my client AND the rest of her support team. Conversely, I understand that my client may also have that bubble.  So, how does that work in such a short amount of time and in such an intimate setting?

​Simply being Probably the most important. The care team for my client become protective. We hold the space, her privacy, her concentration, her focus, her rhythm, her ritual, HER ever-evolving strategy for bringing forth her infant into this world. In the early stages of labor, a knock on the door is a welcome distraction. In the final stages, a knock on the door is met with looks of annoyance and protective aggression.  

Birth is a short, intense, intimate journey. Some are “mush longer den udders.” Sleep deprivation joke, get it?!? Guffaw, snort! Emotional support begins long before labor begins. Physical intrusion into the bubble is typically a gradual process, becoming more involved as the intensity of labor calls for more support and the temporary removal of the bubble. Informational support never ends. Doulas aren’t medical experts, but we are quite familiar with the key terms to know in the chapter of life called the Journey to Parenthood.

​A few days back while I was in the hospital visiting a friend of mine after their surgery, I saw a family with a brand new baby heading home from the hospital. As I walk past them, I see a lady walking next to them, pushing a hospital cart filled with a few balloons and flowers resting on top of a couple of Trader Joe’s reusable bags and a duffel bag.

This brought back so many memories of my own discharge from the hospital I gave birth at and how it was a cold December morning that we walked to the parking garage with our newborn daughter dressed in a red fleece dress and buckled up in her car seat. I don’t think we realized how cold it was for her tiny little feet to be outside in the breeze.

My baby girl was upset with the draft of the cold breeze and I was so upset with her crying as we tried to get her into the car. Fumbling through the seat belt and a bunch of other stuff to keep her warm, we managed to at least get out of the parking garage. I sat down in the front passenger seat (mind you this was the one time I hated sitting down because of the perineal pain). If I had known what I know about mother infant separation and how I could have been closer to her and kept her less stressed and more warm by being in the seat next to my daughter I would have been able to keep her calm. But what did we know as new parents, apparently nothing, but as they say ignorance is bliss and bliss we did feel when we had her in our arms after a long traumatic birth.

Here we were leaving the hospital, embarking on this journey as three of us instead of two of us, completely oblivious to what was ahead of us. The drive home was not too pleasant and every bump in the road was causing me pain. It felt like I was hanging on to the handle on the inside of car so I did not have to put any pressure on my perineum. At home my kind and loving parents were waiting for us to get home with our little nugget. I just wanted to lay down but the pain was too much and by the time I reached home, my feet had gotten half a size bigger. I still had no idea what was going on. I could not walk properly or sit properly and then the idea of breastfeeding my baby without any help from the nurses seemed daunting. My mom was really willing to help and she did try but somehow my daughter could not latch without a nipple shield. Also no one at the hospital had shown me how to breastfeed my daughter lying down and that was a completely foreign concept to me. Every time that my little girl needed to breastfeed I would sit upright in my bed, get my Boppy pillow ready, cover it with a receiving blanket to protect the pillowcase (mind you I was a clean freak back then) and have my mom bring my baby to me to feed, and every time she tried to latch, either the nipple shield would fall off or she would accidentally whack it out of place and then the whole saga of a screaming baby and flailing hands and crying mama would begin.

By Day 3, my breasts were getting engorged and my feet were super swollen. I could not walk to the bathroom, which was only 10 steps away from my bed. I called my OB's office and they said I needed to come in as soon as possible because they were not sure what was going on with my swollen feet. When my OB came in and saw my face, my feet, and my hands, she smiled and said, “You look like the Michelin Man”. I was unfamiliar with who the Michelin Man was but figured it was a character out of some movie. She gave me a script for diuretics and sent me home. She did not even tell me that the number of times I would need to get up to pee would be exhausting in and of itself. I came home and breastfeeding was still difficult for me and my baby. I kept using the nipple shield and having the struggles. I went to develop mastitis and had a really high fever which put me into a delirium. I kept telling my mom, that she should take care of my baby in case something terrible were to happen to me. The pain with breastfeeding was excruciating and I was feeling like I was going to die.

The doctor’s office called in a prescription for antibiotics and I started them immediately. They told me to use the manual pump that I had to relieve any engorgement. I ended up using the nipple shield for 3 months before I went in for a lactation visit at our local hospital where I met a lactation consultant who helped me breastfeed my baby for the first time without a nipple shield. I had never pictured myself not using the nipple shield.

Fast forward my life 10 years and now I was a veteran mom who has helped her friends through their postpartum journey, and my kids were growing up and I was doing the best I could to fit this mold of a supermom, partly created by the expectations of the society, the family and myself. Due to a life event, I had to make the choice of going back to school to get a vocational certificate that could get me a job and somehow I chose to go to nursing school. I became a CNA and then started taking my prerequisites to apply for nursing school. I was also working as a CNA at a private nursing home. I worked 4 half days and learnt so many things on the job as well. During my year as a CNA, my younger sister who was pregnant at the time sustained a fall and broke her leg. She could not move and had to have surgery. She had to stay in bed until her baby arrived and I left my job to care for her. She had her baby and I was there to help her during her postpartum recovery and so were my parents. She was having breastfeeding troubles, her baby was not gaining weight very well and had jaundice. The hospital lactation consultants came and helped as much as they could and then we went home.

The breastfeeding continued to be a struggle and she had to start supplementing with formula. We tried to look for someone who could come to her home for a lactation consult and finally found a lady who did. The lactation consultant started her visit and I was a mute spectator in the room, and all I could think was, who is this person who is so knowledgeable about breastfeeding and was able explain everything to us so clearly? Her name was Meg Stalnaker. Why did I not meet her when I had my first baby ? I absorbed and listened to everything she did and said, as did my sister and brother-in-law. I just had a lightbulb moment. I wanted to do what she does. That was it. I did not want to be a nurse. I wanted to be a lactation consultant. I talked to my sister and she told me that I should ask for the contact information for this angel who helped her. I don’t know why, but I did.

I kept doing my own research about what classes I needed to take and signed up for them at the local community college. I kept in touch with the Meg via email. After I finished my community college classes, I contacted her again and asked her if she could be my mentor. She said yes, but there was a caveat. I needed to wait until she finished mentoring two other students she had at the time.

I was really sad that there was not enough guidance on how to find mentors for the pathway I had chosen to become an International Board Certified Lactation Consultant. It also felt like there were a lot of negativity in regards to choosing to become an IBCLC as a career. I kept looking to see if someone would be interested in being my mentor and taking me on as a student.

During one of my lactation classes at the community college, we had a guest speaker by the name of Peggy Andrews, who was giving a lecture on the topic of jaundice and breastfeeding. I saw a tall woman with golden and white hair walk into our classroom with a smile. She had the brightest smile I had seen on someone’s face. She started the lecture and I was just mesmerized by her way of teaching and felt like I was back in India in my middle school, listening to my favorite biology teacher. At the end of her lecture she shared her email address with our class and something in my head said, “Sejal, you need to email Peggy and ask her if she could be your mentor.” I mean that was a spur of the moment thought and I acted on it by sending her an email asking if that was possible.

The next moment I thought, oh boy, have I made a big mistake by asking this guest speaker to be my mentor. I was hoping that I would get an email saying how inappropriate that question was. To my surprise, I hear back from Peggy saying she loves to mentor students. I was cooking and jumped up and down in my kitchen saying, YESSSSSS!! Wait that is not it, I actually got a call that evening from Peggy asking me if I wanted to go on a lactation visit in Washougal the next morning. I said, I most certainly would, but then I thought, where in the world is Washougal? Well it is in our neighboring state of Washington.

The next morning I meet Peggy at a designated location and she said to me that she will be driving me to the appointment since it is so far. I was so excited and off I went on my first official visit. I started learning about how to talk to a new mother, ask specific questions and give her plenty of time to tell her story. We were there for an hour and a half and I felt like I still made the right choice by asking Peggy to be my mentor. I have learnt so much about being a good listener from Peggy.

I never for one moment thought that Peggy was keeping any information from me when it came to lactation. I had asked a few other local lactation consultants and they said that they don’t mentor students and I was quite discouraged. I am sure other students like me were discouraged as well. Meg, also let me go on a few lactation visits with her and I kept learning from both Peggy and Meg.

One day I saw a class on hand expression at a local boutique taught by another lactation consultant named Bryna Sampey. I immediately signed up for it, and when I went to the class I was secretly happy that I was one of the two people in class, although I also felt sad that people did not sign up for this informative class. I felt like I had learnt so much about manual expression of breastmilk in this class and that little voice in my head said, “Sejal, ask Bryna if she would mentor you.”

After the class, Bryna asked if I wanted to have a bite to eat at the place next door. I jumped at the opportunity to hang out a few more minutes with this brilliant brain. I was practically salivating. We talked about what I did as a postpartum doula and how I was studying to be an IBCLC and she mentioned to me that she also mentored students. I almost wanted to give her a hug and say, where were you a year ago and why did I not meet you earlier. I did not want to be a total psycho so I did not hug her, but told her that I would love to be her mentee. She said that she would let me know as soon as a spot opened up.

What I learned from Bryna and her brilliance made me think critically about breastfeeding and the challenges that come with it and how she made breastfeeding a breeze with all the techniques and tricks that she shared with her clients. As I followed these three amazing women, as my mentors, each one of them taught me how to help with breastfeeding challenges in their own special ways. I feel blessed to have learnt from them and will be eternally grateful for them sharing their wisdom, knowledge and time with me.

I was talking to other lactation students like me one day, who were in the same boat as I was and one of them told me that when they asked a local IBCLC to mentor them, the local IBCLC said to them, and I quote, “Why would I let you shadow me ? You will take my knowledge and compete with me once you get certified.” I was so shocked to hear this. I have no idea who the IBCLC is and don’t even want to know, but it made me realize how fortunate I was to have mentors like Peggy, Meg and Bryna.

With the struggles I had in finding mentors, I had decided in my mind that if I ever become an experienced lactation consultant, I will mentor students. I am an IBCLC now, and I am a brand new IBCLC, but I hope to someday mentor students. I think it is our responsibility as professionals to mentor the future IBCLCs. My dad used to say, knowledge only increases by sharing. He is a brilliant surgeon and he has helped many other doctors become surgeons and I am certain he never thought this way.

So, why do some people have a hard time sharing their knowledge with others who are seeking mentorship in the field of lactation consulting ?
Maybe the experienced professional does not have the time or the resources to mentor someone. Maybe the experienced professional thinks that, sharing their knowledge with newbies will reduce their chance of personal success.
Maybe the experienced professional does not trust this newbie. Trust building does take time.
Maybe the experienced professional in the specific field is a knowledge hoarder.
Maybe the experienced professional wants to have monopoly in their field.
Maybe the experienced professional feels more powerful if they don’t share their knowledge.

Being a mentor and taking on mentees is also a huge responsibility and one that is not easy. I understand that it may be difficult to take on students, but in the field of lactation consulting, I wish we had more mentors. I wish students had access to mentors without having to wait for a long time. I wish experienced IBCLCs would be willing to share their knowledge and expertise with them.

​Mentors are an inspiration. Mentors can connect you with opportunities. Mentors know ways to make you succeed professionally. Mentors keep you motivated. Mentors invest their time and energy in you to help you grow. Mentors teach you about finding a good opportunity. Mentors have been where you are and can empathize with your struggles and help you find your way through the obstacles and hurdles. I am so thankfull to have found such mentors who continue to be there for me and do not feel threatened by my success.

As a new doula it can be hard to know what books and blogs can be helpful. Today's post gives a list that is sure to get any new doula rolling in resources! 

​Every few months, I make a new friend or get reacquainted with someone and I see that twinkle in their eyes when I tell them that I'm a doula. And I know that before long, I'm going to get an email asking me for suggestions of books and blogs they can read to carry on their excitement about maaaybe becoming a doula. I wish I could go out for coffee with everyone who emails me with their maybe-doula excitement, but since I can't, here are my best recommendations to get you thinking about childbirth in America, doula support, and living the life of a doula.

There are so many resources out there, this is really just the very beginning! There are resources for supporting breastfeeding, books for all kinds of birthing methods, and MANY collections of birth stories. And I haven't even touched on the vast area of birth trauma, including resources specific to homebirth cesarean, vaginal birth after cesarean (or VBAC), and supporting survivors of previous trauma and abuse. I'm considering writing a follow-up post on resources for practicing doulas, so let me know if you would like to see this on the blog.

Your heart pounds, your mouth dries, your ears begin ringing, and your face suddenly feels so hot!  You just got a call that a potential client wants to meet for an interview.  This often leads to a mad-scrambling of resources, or the paralyzing shock of sudden responsibility.

No need to fear!  First off, keep in mind these people have contacted you because they are aware of the services you provide, and they are wondering how you as a doula can help them as expectant parents.  

Place:  Where to meet?  There are many different ideas about this.  Many doulas feel there is nothing better than to meet in the expectant parents' space -- their home.  The advantage here is, you are able to show them you can fit into their home and life.  Pregnant women are traipsing to a lot of different places -- the doctor's office, the ultrasound office, the hospital to pre-register, their childbirth classes.  Nothing is really accomodating, so to be able to visit a mom in her home can help with the whole why-one-might-want-a-doula-in-the-first-place:  Having an advocate to help with physical, informational, and emotional support who is more just a random stranger on shift.

Sometimes a doula might feel meeting in one's home, without any prior meeting or credible information about a potential client can be a safety issue. For some doulas, if they personally know someone who personally knows the potential client, they are comfortable meeting at their home. If it is an absolute stranger, you can try to supersleuth on Facebook to see if the profile is real, see if there are pictures of the pregnant person, see if you have any friends in common. Going with your gut can be helpful here -- we encourage women to use their intuition to aid in their process of birth, we need to remember that and apply it to ourselves, as well.

There is another school of thought that says, this is an initial meeting where no commitment has been agreed upon yet, so the doula and the expectant family should try to meet in a public location about as in-the-middle as can be, which can be helpful if a doula lives a distance from the potential clients.  This saves her gas money and travel time.  Often if a doula is hired, she makes the full trip to the clients' home for her prenatal meetings.

A good alternative to meeting in a private home is a comfortable, public location.  Places like Starbuck's, Barnes and Noble, local tea or coffee shops work. Other places people meet are parks (good if the weather is nice or the interviewee has other children), restaurants, medical office waiting rooms (this helps streamline a woman's appointments), her work place at lunch, WIC Office, baby store, or an apartment's recreation center.

It would be naive not to take some cautionary measures for your safety when going to an interview.

-Leave a note detailing where you are going, who you are meeting with, and how long you will be gone.  Information that should be included:  The names of the folks you are meeting, the address of the location, the email address or access to any online exchanges you have had with the person.

-Bring your cell phone with you, especially if you are meeting at a private home.

-If you feel something's fishy about the situation, choose a public place, and perhaps have someone come with you, incognito at another table, or as a doula-in-training learning the ropes -- saftey in numbers.  I know this sounds odd, and if you really felt strange about something why go at all?  There are times, however, where you aren't sure about the situation.  If you have a "I'm not sure," kind of situation at or after an interview, or from initial phone or email contact, proceeding with a back-up plan is just an added measure of protection in an uncertain situation.

The point of all of this is not to strike fear into your heart, the point is to remember to listen to your gut and be mindful of your safety as you proceed down this road.  
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What do you remember of yor births? Are there thing you would change? Things you are surprised you did that didn't follow what you learned about or expected? In this feature, a doula shares her birth story with additional hints and advice as seen through her professional lens -- what a great idea!

I felt so loved and safe and cozy in our room after that epic experience.  BirthCare is like a hotel with midwives.  The food is delicious and plentiful, the midwives help you establish breastfeeding, and there are educational video streams on the TV in your room.  It makes me so upset that mommas of O’ahu don’t have access to the same maternity care experience covered by insurance.  You can hire a home birth midwife and pay out of pocket for a similar set up.  I count myself monumentally blessed to have been living in that part of New Zealand with my incredible midwife and our amazing natural birth experience at BirthCare.  After three nights there, we headed home with our treasure.  My midwife visited us at home for the next 6 weeks to check on my stitches, help with breastfeeding, and track Madam Blueberry’s growth.  We did well.  My husband had two weeks off work, then Mom and Dad came from Hawai’i for two weeks. We cherish this birth story and are so grateful to our midwife and all the midwives at BirthCare.  DOULA TIP: postpartum blues are normal and the American maternity system is NOT mom-centered.  Ask for help.  A postpartum doula can provide references to services and can support you with newborn care, routines, sleep solutions, etc.     
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Debbie called me at 8:30 am to let me know contractions had started.  I joined her and her best friend Lisa at the hospital – Debbie was 2-3 centimeters.  Debbie and I worked through the contractions.  She would really have to focus.  Lisa  and I would stand on either side of the bed rubbing Debbie’s arms and shoulders, smoothing her hair, and giving her space to focus.  Lisa  was not quite respectful of Debbie’s need to focus and go within herself to endure, and Lisa  would ask Debbie questions about unimportant things while Debbie was trying to concentrate.  I kept redirecting Lisa  respectfully, reminding her that Debbie needed space to focus, and could we wait until the contraction is over to get an answer?  A vaginal exam at 1:15 revealed Debbie to be 100% effaced, 4-5 centimeters dilated.  Debbie had AROM followed by her epidural at 2:00.  The contractions spaced out to 8-10 minutes, and Debbie’s blood pressure dropped dangerously low.  Debbie’s nurse, Mary, stayed with us in the room for almost 2 hours charting and watching Debbie and her monitors.  Debbie’s blood pressure did eventually increase.  At 4:30 pm Debbie was checked and found to be complete.  She started pushing at 6:00, and baby was born via Mighty Vac at 6:52.

Debbie is a single mother and she felt a doula would help her feel supported and informed.  My primary goal for Debbie’s birth was to make her feel special, strong, and empowered.  I knew Debbie wanted an epidural.  Debbie had a severe knee injury which happened about the time she became pregnant.  That, coupled with being very overweight, greatly reduced her options for movement.  I helped a lot before Debbie got the epidural with coping techniques such as counting backwards through contractions, and massaging her hands, which grew tired from gripping her bed rails.  Debbie’s situation reminded me of something Penny Simkin wrote of a client who left an abusive relationship:  I think Debbie did not need to feel any pain on this birth day.

Debbie reacted well to her labor!  She really had to focus from about 11:45 until 2 pm.  She seemed to leave for a minute and find someplace in her mind where she could cope, and once the contraction was letting up, she would slowly open her eyes and release her grip on the bedrails.  When I would say, “Debbie, that was great.  You have found a place and you are really doing a wonderful job focusing and relaxing,” Lisa  would discredit what I was saying by replying with, “Yeah, Debbie’s thinking ‘Whatever,’” or “Debbie’s thinking, ‘Shut-up already.’”  I don’t think Debbie was thinking any of those things.  It really felt like I was being undermined.  When I would ask Debbie the, “What was going through your mind…” question she would usually reply “I just wanted to get through it.”  She never had a panicked or scared reaction.  Debbie reacted very sweetly to her new baby.

I learned some good people-coping skills.  Lisa  is a tough kind of gal.  When Debbie’s blood pressure fell, and then her legs went numb, Lisa  was upset and wondered why they didn’t stop the epidural?  Lisa ’s personal experiences led her to believe the numbing aspect of an epidural was abnormal (“That did not happen with my epidurals”).  I tried to explain how epidurals worked, but she got very defensive.  I finally said I did not know, and she should ask the doctor about it (he was also Lisa ’s doctor).  I learned sometimes it is better to “not know.”  I learned sometimes I need to stand away and be useless, like while the baby was being delivered and I was not by Debbie (Lisa  was to her left, doc at the end, nurse at her right).  After Leah's birth, I was able to help more practically.  Lisa had left, and Debbie was alone.  I stayed longer helping with breastfeeding and ensuring Debbie got a nice meal as well.  Debbie’s father arrived about an hour later, and I was able to help him hold his granddaughter for the first time -- he swayed and shooshed her right to calmness.  I learned even though a person only thanks you for bringing them dinner, that can mean a whole lot more.
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