Karen is a doula I am lucky enough to have in my own backyard of Bakersfield, CA! I am always impressed by her thoughtful and wise words. I knew she had acted as her daughter's doula, and I asked her to share that experience -- this mixture of doula and mother offers more leeway than we may have in a normal doula situation. And it sounds like this was just what Jessica needed.
It’s Sunday afternoon and I am just enjoying a lazy day, knowing that any day it will change very quickly with a phone call. My daughter is 39 weeks pregnant with her first baby. After many years of wanting a baby more than anything, she is finally going to be a mother at the age of 38! She had really wanted a home birth (all those stories of me birthing her at home had really soaked into her psyche), but she finally came to terms that, due to her financial situation, she would be birthing in a hospital. She did a lot of research, spoke to some midwives, and had found an OB who would support her dream of having an intervention-free, natural birth. The phone rang and I could immediately hear a bit of concern in her voice. “Mom, how do I know if my water broke?” She had stood up and felt warm fluid trickling down her leg. After our conversation she was convinced it was not urine, but the leaking seemed to have stopped. I suspected that she may have had a small leak of fluid from the space between the amnion and chorion. She was not experiencing any further leaking or contractions so she decided to just ignore the occurrence. I, on the other hand, saw this as a sign that things may be happening and asked her if it was OK for me to go ahead and make the 2 hour drive to her home on Monday to accompany her to her doctor’s appointment on Tuesday. She was very pleased at the idea and told me to just pack to stay until after little Reyelle came earthside.
I arrived at her house and got settled in (as much as you can settle in when you are sleeping on the sofa!). On Monday we just hung around the house and tried to organize all the cute baby stuff. Well, maybe we played with all those cute little cloth diapers a bit too much! But it was a fun day just talking and dreaming about her future. It was a very special time of mother/daughter bonding. Tuesday came around and it was time for her appointment. She decided to tell the doctor about her “leaking” on Sunday. Needless to say he was not happy that she had not called him when this happened. And, yes, even her absolutely fabulous, natural-friendly doctor, pulled the “dead baby” card (which, of course, left her in tears). He did check for the presence of amniotic fluid in the vaginal canal and did an ultrasound to check fluids and did finally say that all was fine. He did not see any signs that it was amniotic fluid (although I still suspected it may have been a small leak).
On Wednesday she and I decided to do some shopping. She was 39 weeks 5 days at this point. She had a few last minute items she needed to purchase and/or exchange and I knew that walking would do nothing but positive things for her. At 5:15 PM we were at home and relaxing after our long day of shopping. Jessica went into the restroom and suddenly hollered out “MOM! Oh my goodness, my water just broke for sure!” I went into the bathroom and found her standing next to the toilet, straddling a large and growing puddle of clear fluid on the floor. I grabbed a feminine pad and a towel and got her into the living room. I had a pack of PH test strips ready for just such an occurrence (yes, I know it is “out of scope” for a doula, but this was my daughter and I thought I could take some liberties!) and went back into the bathroom to clean up and test the fluid. It was clearly 7.5 to 8.0 on the ph scale so I knew that it was definitely her amniotic fluid this time. I reminded her that her doctor had told her to call him or go into the hospital if her water broke. He had also told her that, absent a rupture, he was fine with her laboring at home as long as she wanted, even waiting till she felt the urge to push to make the 5 minute drive the hospital. She decided that since she was not contracting at all, she was just not comfortable with moving to the hospital at this point. My advice to her was that, if SHE did not want to go in yet, then the best thing she could do was for her and her husband to try to get some rest until things picked up. She decided that that was what she wanted to do and got her hypnobirthing audio going on her phone and went to bed to rest. She said that around 6:00 PM she began to experience very mild contractions but she could completely relax and even sleep through them. I periodically went in to check on her but she seemed to be resting quite comfortable and did not want to disturb her peaceful state.
A little after 9:00 PM she called me into her room and told me that she felt it was time to go to the hospital. She had decided that she did not want the drama of waiting too long before arriving at the hospital and would rather go now and get settled before things really picked up. She got dressed and just kind of casually got her stuff ready and packed in the car. At times I was unaware that she was even having contractions, although she did sometimes have to stop walking and talking to focus on her script and relaxation. Parking and getting into the hospital proved to be an adventure. We had to enter through the ER and check in with a security guard. He offered to get her a wheel chair but she declined. I am sure he must have been wishing she would have taken him up on his offer when twice, on the way to L&D, she had to get down on all fours on the floor of the corridor during a contraction!
We arrived in L&D at 10:00 PM and were admitted to triage. Of course she got the scolding again from them about the fact that she had been leaking fluid for almost 5 hours now and was just now arriving to the hospital. They examined her and found her to be dilated to 6 cm. But now, my baby who had been handling her contractions so incredibly well, was forced to lie on the gurney in triage, on her back while they hooked her up to the monitors. She now was having a hard time coping with her contractions.
The orders from her OB were for her to have intermittent monitoring (15 minutes out of each hour), a hep lock instead of IV, minimal cervical exams, no offers of analgesia, for her to be allowed mobility to labor in any position she desired when she was not on the monitor and, lastly, for her to allowed to push and deliver in whatever position she found the most comfortable and effective (unless, of course, there was an emergency situation that negated it). The nurse in triage was an absolute angel. Even though she had to make Jessica uncomfortable with the contractions during the exam and monitoring, she spoke nothing but positivity to her about her ability to birth her baby naturally if that is what she wanted. However, the nurse actually assigned to her once she was moved to a labor room was a different story (I will refer to her as “Nurse Sour Puss”!). We had to keep reminding her of the orders. The lovely nurse from triage even came in and backed us up! They were having a difficult time keeping the monitor on the baby and kept insisting that Jessica stay in positions that were very uncomfortable for her. She managed to do as they asked and, finally, at 11:00 PM, they were able to get the monitors off.
After that, I immediately suggested Jessica get into the shower. You could tell that Nurse Sour Puss was not happy with her patient being out of bed with ruptured membranes, but I just reminded her of the doctor’s orders, and Jessica told her that she was doing it anyway. Jessica spent the next 45 minutes in the shower and was doing very well. You could tell when she was having a contraction, but she coped quite well with them. At various times she would have me running the stream of water over her belly and at other times she wanted it on her lower back. She was making very little noise, just a low moan during the contractions. I noticed a couple of times that Nurse Sour Puss would be standing at the bathroom door just observing. I got the impression that this was the first time she had had a mother use the shower as a pain management tool and actually found it fascinating (hopefully she learned something!).
At 11:45 PM she insisted that Jessica get back into the bed for more monitoring. Again, my daughter (who had been managing her contractions quite well) started struggling with control. About 11:55 she was kind of thrashing in the bed and I thought that perhaps she was wanting to try another position. I asked her, “Honey, what are you trying to do? Do you want me to help you into another position?” She kind of whimpered and said, “I don’t know what I want! I am just trying to get away from it!” I leaned down and whispered to her that it certainly sounded like transition and that those feelings were just proof that she was making good progress and would be holding little Reyelle soon! The nurse kind of looked at me as if to say “How can you possibly know that without a cervical exam?!” She did not believe that this first time mom, who had just been 6 cm less than 2 hours ago, could be close to the pushing phase.
With the very next contraction Jessica began making some grunting sounds at the peak of the contraction. I asked her “Are you pushing?” She said that she wasn’t sure. But with the very next contraction (it was now midnight) she looked at me and said “Oh yeah, I need to push!” The nurse, still being the naysayer, told her to not push, wait for a few contractions to pass, and IF she still felt like she wanted to push then she would check her for dilation. Around 12:15 AM she did a cervical exam (only her 2nd exam since arriving at the hospital at 10:00 PM) and seemed quite surprised to announce that Jessica was complete and could push. Jessica was just experimenting with a couple of positions in the bed for pushing . At 12:30 the nurse just abruptly said, “Ummm, I will be gone a few minutes, stop pushing till I get back!” and abruptly left the room. Jessica was really struggling with the whole “don’t push” thing, so I gently reminded her that this was her baby, her body, her delivery and for her to do what she felt comfortable with. When, after several contractions, the nurse had not returned, I pushed the call button and asked when her nurse would be returning. The charge nurse came in and told us that Nurse Sour Puss had gone to lunch and that she would be helping us. While I was appalled that the first nurse decided to take off for lunch without so much as informing us what she was doing, it actually turned into quite a blessing that the charge nurse took over. This woman was convinced that Jessica (who had been struggling with moving the baby down at all) could and would push this baby out. She made some suggestions on positions/techniques and finally Jessica appeared to be making progress.
I remember pushing for almost 2 hours with my own first baby, and, as a doula, had seen many mothers push for long periods so I was not really surprised when things did not progress quickly. The new nurse was very encouraging though. She cheered for the tiniest bit of progress! What none of us realized was that the slow progress was due to an asynclitic baby! Mommy ended up pushing for over 3.5 hours. During that time there were numerous times when they had trouble keeping the baby on the monitor. While this nurse was obviously concerned with monitoring the fetal heart tones, she also was equally concerned with keeping mommy as comfortable as possible. Several times Jessica would say something like, “I don’t think I can push her out!” but the nurse was always encouraging to her. This phase was where I was so happy to have my doula training and experience to rely on. It was really hard to see my daughter trying so strenuously to bring her baby down and getting so discouraged!
Finally, after over 3 hours the baby was crowning. Because of the long pushing phase and the difficulty in keeping the fetal heart tones monitored, they called in the pediatric team in case there was a problem with the baby. The room was full of various personnel who were all in their little corners, chatting casually with one another, and just waiting for the baby to arrive so they could do their job. In the midst of this the doctor arrived and observed the atmosphere (discussions were going on about what they had for dinner, where they went that past weekend…). He announced to the crowd “I want the lights dimmed and everyone to be quiet and respectful! This mom wants a natural, peaceful delivery of her daughter and we are going to give her what she wants!” You could have heard a pin drop in the room! The lights were dimmed, the doctor asked for some warm oil and he started massaging the perineum. With the very next push Jessica made tremendous progress and within 3 pushes the baby’s head was out. It was at that point, upon seeing her lopsided cone head, that it became clear that her asynclitic presentation was probably the cause of her slow descent. With the next contraction the doctor instructed mom to reach down and grab her baby. Jessica was literally shaking with exhaustion and said “I can’t, I am afraid I will drop her!” The doctor assured her that he would NOT let that happen and to just grab her baby.
There could never be enough words to express the swelling in my heart when I watched my exhausted daughter reach down and pull her daughter out of her body and up to her chest! I had a new level of respect for my daughter! The pediatric team was quickly dispatched out of the room as it was immediately obvious that the baby was doing great. All she needed was a little skin to skin time with mom. Thankfully, this was at a hospital that has already obtained the “Baby Friendly” certification so they were not trying to hasten the separation of mommy and baby.
At this point I was able to kind of take a back seat and just observe the new mommy and daddy reveling in their new roles. Baby stayed on mommy’s chest while the doctor waited patiently for the cord to stop pulsing. It was quite something to observe. This long awaited baby was here and being loved on by her new parents. I could not help but think back to the births of my own children 40, 38 and 33 years ago. So much has changed since then, but so much is still the same. My daughter had managed to achieve a hospital birth that was very close to the home birth that I had experienced at her own birth 38 years prior. In my job as a doula, I know that the birth of the baby usually signals the beginning of the end of my relationship with this new family. This was so different. I knew that this was just the beginning of a lifetime of love that I would be able to shower on this baby and her parents!
PS: Some of you may question the fact that I do not mention dad much during the labor and delivery. Let me assure you that dad was very much there and involved in the process. This family has a unique circumstance where daddy has some severe disabilities in his legs due to burns he suffered many years ago. He is very limited on the amount of standing he is able to do. So, while dad was there and contributed very much to the emotional support of his wife, I was the one who provided most of the physical support to my daughter during her labor and the birth of her baby.
Karen is a mother, grandmother, and doula. She had a home birth in 1975 with a chiropractor attending. Karen is a Christian who doesn't think God made any mistakes with the way He designed women's bodies. Ever the caretaker, she has an adult, adopted developmentally-disabled brother who she helps care for. Karen loves to sew and cook, but she hates to clean up after both! Reyelle is her 5th grandchild. Find her on Facebook to learn more about her doula services.
♥ four young boys and a boy dog (offspring)