Sariah knocked on my door at 12:10 am and said “It’s baby time!!” Her face was so hyped up. I was immediately thankful that I was feeling better. “Ok,” I said, “I’ll be right up.”

I went into the bathroom and got my ziplock bag of a mini-version of my doula kit. I had good feelings all along that it was going to be a fast birth so I didn’t feel like I had to bring very much. I went upstairs to their apartment. Charlotte greeted me with a big grin. She said “I’m having lots of contractions and I can’t talk through them.” We were all excited.

She phoned the doctor, as she was standing on the second step. She began having a contraction so she handed the phone to me. I heard a beep and I wasn’t sure if it was an answering machine so I just started talking.

“Hi, this is Amanda, Charlotte's doula. Charlotte is in labour and we are going to head to the hospital.” Then I heard a very groggy voice say “Ok, Charlotte…. right…. ok how long until you are at the hospital?” 
“45 minutes,” I said.
“Ok, I’ll meet you there.”

We phoned Oscar, our taxi driver who was going to be on call for her birth. Charlotte had a few more contractions and then Oscar knocked on the door. Eric grabbed the bags and we were headed upstairs.

As we were gathering our stuff, Cora woke up. She hadn’t woken up in the night for over a year, Eric told me later. She woke up, sat up in bed and said “Baby sister is moving.” Charlotte went over to her and said “Yes, baby sister is coming.” Cora said, “Um, yes. I’d like some milk.” Sariah and Charlotte laughed. “Yes, Cora. You can have some milk.”

We went upstairs and got in the cab. Charlotte was on her hands and knees in the back seat of this huge van that Oscar brought. We all got in and Oscar tried his first attempt at the very steep driveway. The tires squealed in protest. He reversed and tried again.

Oscar’s friend who was with him hopped out. Then Eric got out too and they were trying to figure out how to get the van out of the steep driveway. Charlotte was getting anxious as she didn’t want the van to roll back and squish Eric. She was yelling at him a bit from inside the van. Then they reversed and tried going up the other side of the driveway. (The driveway was a circle.) No luck on the other side either and then Charlotte said, “Oh, my water just broke!”

I yelled at Eric that Charlotte’s water broke. It was clear the van was not getting out and the bumping and jostling was really hard on Charlotte as she barely had any time between contractions.

Finally she turned and yelled at Eric out the window, “We need to get out of here!” He said “Ok babes, I got this! I will get us out of here!”

By this time the taxi drivers were talking to this other woman at the top of the driveway. Eric walked up to her and asked “Can we get a ride to Puerto Vallarta please! My wife is in labour and her water just broke.”

The lady said “Of course. Jump in!”

The lady, who introduced herself as Georgina, and her English husband Danny owned the smallest car in existence. And in the backseat was a carseat. Georgina wedged herself into the carseat. Charlotte was in the front seat on hands and knees. I was in the middle, leaning forward, rubbing Charlotte’s shoulders and whispering encouragement into her ear. Eric was beside me in the backseat.

Danny was an excellent driver. Between he and Georgina, they knew every bump and pothole along the way. He was careful and he was very fast. Charlotte worked on keeping her moaning low pitched to allow her cervix to Open Open Open. I would count on her ear when the contractions came, to give her something to focus on. We would come up to a red light and Georgina would look and say “Ok, Danny. Just skip in. We have to keep moving!”

Outside of Bucerius, there was a police car going the same direction as us, we pulled up beside it and Georgina, sitting in the child’s car seat, yelled out the window to them, asking for a police escort.

They pulled ahead of us, lights and sirens going, and we went very very fast behind the cruiser. He pulled off as we got to Nuevo Vallarta, and waved us onward. Charlotte was doing so well through all this stress. The contractions were strong and very frequent. She concentrated on her noises and said “Open open open.” Her ability to remain as calm as she did through all this uncertainty and near-disaster impressed me to no end.

The epidural was in place and Dra Laura said “I have to move the baby’s head just slightly. I am going to stick my hand up and when I tell you to, I want you to push just a little and I can tip the baby’s head.”

Dra Laura did just that and Charlotte looked at me with wide eyes and said “I can feel the baby coming down the birth canal.”

They decided it was time to move Charlotte to the delivery room. They told Eric and I to go put our stuff in her postpartum room and then come down and get in our scrubs. He and I got into the elevator with all our stuff and were just told a room number. The doors shut as we saw Charlotte wheeled down the hall and Eric looks at me and says “And this is when we steal your baby!” And I laughed. But we both felt a bit uneasy.

We dumped the bags and headed back down. The hospital was entirely empty so we weren’t sure where to go. We saw someone and asked. They gave us scrubs and we were changing and trying to figure out a one-size-fits-a-mammoth scrubs. Eric’s head bandana looked like a nun’s hat until he tied it. Then he tilted it to the side, real gangsta’ style.

We got in the delivery room, as Charlotte’s baby was starting to crown. She said “The baby will be here any minute!”

Within 10 minutes, the baby’s head was clearly going to come out. In between contractions, Eric started telling me a pirate joke, which I honestly can’t remember a word of. Then suddenly, out came the baby! They cut Lyra’s umbilical cord and lay her on Charlotte’s belly. Charlotte cried and said “Hello, welcome baby!” Eric too was making joyful exclamations of being a dad again. 

They took Lyra to the warmer, and checked her out. The pediatrician suctioned out her nose and she put her hands up to fight him. She was immediately alert and looking around. Charlotte quickly delivered the placenta so that no one but the doctor even noticed.

The staff put Lyra in an incubator and took her to the nursery with Eric following closely behind. He was clear and confident in his role of dad. I mean, he’s done this all before!

Charlotte and I stayed in a corner of a hall for more than an hour while we waited for the effects of the epidural to wear off a little. Then after a few times asking the nurse, they moved her upstairs to her room. Soon they gave her baby Lyra and Lyra latched on immediately.

Mom and baby safe and happy. After such an adventurous and fast labour, they were home from hospital that very afternoon.

It was such a privilege to be a part of a whirlwind Mexican birth experience. Charlotte, I am extremely proud of you at what you accomplished. Eric, you were a fantastic and assertive father in exactly the role you needed to play. You together make a great team and I am nothing but grateful to be included in such a momentous day.

I had a doula at my second homebirth. A lot of people asked me why. Here is what I have come up with.

1-First, a doula is not the same as a midwife. Your midwife takes care of all your medical needs and your baby’s medical needs. Your doula isn’t a medical professional. She gives understanding and support for you while you are in labor. She also gives support to your husband.

2-After my first birth at home with a CNM, everything was great. My midwife came with all her supplies. She was perfect at helping me get the birth I dreamed of in the medical way. But I did feel I needed more of the kind of support a doula could give, meaning, just focusing on me and my emotions and physically having labor and my baby. My midwife was taking care of me and my baby, but it was hard to get the support I needed to cope with everything I was feeling.

3-My doula came before my midwife. This was great for me and my husband. He was very worried the first time around. He kind of hung around not sure what to do. I know he was worried and even with good classes he didn’t know what to expect. When our doula came it helped my husband see that laboring was going smoothly. He was also able to relax and know we were both being watched out for.

4-My midwife wanted me to tell her when things were happening with labor. But that didn’t mean she was ready to come and stay with me yet. My doula was able to come be with us earlier in labor and just hang out. She went for a walk with me, and she made me and my husband some sandwiches. She suggested I lay down for a while to rest. She helped remind me of how to take care of myself.

5-My doula and my midwife made a great team. They had worked together at births before. My midwife said I might want to look into a doula the first time but I felt secure with my midwife and her help. Even if the second birth was just like the first with only my midwife, it would have been good. I wanted to try a doula the next time. And I am glad we did. With a doula, I felt like I was being catered to more and taken care of more. It was the difference between a homemade chocolate chip cookie fresh from the oven, or a homemade chocolate chip cookie from the oven with ice cold milk. I am glad I had the full experience. Now I know the best combination for me is a doula and a midwife. 

I believe I’m the youngest doula in my area at just 20. I have two young babies of my own and I’m learning to balance work life with mommy life, along with being married and having my own home. This last week has been crazy with two births back to back -- six long days of trying to get my footing and figuring things out. I learned five key facts this week that will help me get through many more times just like this one!

1.      Have stable childcare! I’m serious. I wasn't expecting two clients to have babies so early so I still hadn't set up childcare. I was rushing around like a mad woman trying to find people to keep my two while I ran off at odd hours to births. My dad and my best friend ended up taking the blunt force of my lack of planning. Random calls of “Can I drop them off right now?” and having to answer the question of, for how long with, “ I HAVE NO IDEA." So this is definitely of primary importance as a doula and a mom of 2.

2.      Remember you need to eat too! We are constantly encouraging moms and dads during births to eat and stay hydrated. Well I forgot that I needed to, too. I got home from day one of births this past week and realized I had eaten a pack of mini donuts and a Dr. Pepper -- and that was it all day! I suggest having small snacks in your bag like granola bars and a bottle of water that can be refilled.  How can you care for mom and dad if you, yourself, have no energy whatsoever? 

3.      This one is super difficult. Balancing sleep/work/ motherhood. I was coming home from nights at the hospital at 3 and 4 am.  I would come home to my very lived-in house and shudder, knowing that I needed to do housework. I would go and lay down in my bed and fall asleep doing none of it. My husband, I’m one of those super lucky women by the way, would get up with the kids in the morning allowing me a few extra hours in the bed. I would then get up, still exhausted, to spend time with my kids, not knowing when I would need to rush off again. You have to find a balance between them all. I know its hard, but it's a necessity!

1. As birthworkers we must acknowledge our own biases and limitations.  We must also acknowledge that no one doula can be the right doula for every client.  If a woman of color/queer identifying/transgendered/teen parent needs a doula of color/LGBTQ/teen to feel understood and supported, that is her prerogative.  If you're a middle-class, white doula, it's not personal, so don't take it personally.  Side note: If you identify in one of those former categories, the birthworker community and birthing families need more of you.

2. We all have birth stories which are valid and worthy of being heard.  None is more or less significant than the other.  Each individual story has something from which we can all learn.

3. One can and should be open to hearing and trying to understand the experiences of others, but this willingness is a lost opportunity when those with wisdom refuse to share it.  If all you know is your own experience, your universe will remain hopelessly small.  Engage and seek knowledge.  Side note: Be mindful of respectful discourse.  Don't expect that it's anyone's obligation to teach you.  

4. Be kind to the students.  We are all children of this earth and as such we all ask dumb questions sometimes.  Side note: The teacher and parent in me feels obligated to say here that there are no dumb questions.

5. Loretta Ross said some brilliant words that resonated with me: First, don't be allies, be a "co-conspirators."  Second, invite people into dialog, especially those with whom you don't agree.  Call each other "in," don't call each other out.

6. Every community of women deserves a red tent.  Apologies for the cultural appropriation, but it's a useful adaption.  In this case, women (all people actually) deserve a place to come together in safe harmony to share their stories and repair their spirits.  In the birth community, we sometimes call that space a red tent.  The refuge of the red tent at the Summit was lovely and restorative.  Many thanks to whomever put that together.

7. Paraphrasing Michel Odent speaking on the research done on initial stress responses and their effects on newborns who experience immediate separation from mother at birth: "It's taken 100 years for the medical community to figure out that a newborn needs its mother."  We've still a ways to go on reclaiming that "golden hour" of bonding time for healthy newborns.  Side note: He's also got intriguing data collection on what happens to babies who aren't given a trial of labor.  If you don't know who Dr. Odent is, look him up.

8. As a birthworker, who immersed myself in the culture of evidence-based care for an extended weekend, coming back to the real world was painfully hard.  My first week back involved supporting a mom who was fighting against a 39-week routine induction and whose care provider had no interest in hearing about her evidence-based arguments.  On the plus side, ACOG's letter for the BKS organizers announced that they were considering "collaborative team-based care that includes the mother as a member of the team and a key decision maker."  One can hope that in my life time this becomes the new standard practice. 

9. Listening to Katsi Cook and Isa Gucciardi, I became envious of cultures that retain a process of initiation.  Modern American culture has forgotten how to initiate people into parenthood (and adulthood for that matter).  A baby shower, grocery store encounters with strangers, and well-meaning but often fear-filled birth stories hardly fulfill that role.  I'm not sure the appropriation of blessingways do the job better, but they are a step in that direction.  Side note: Take a minute to celebrate your mother, because chances are good she had to figure that role out all on her own (see above about being kind to students...).

10.  Lastly, to the doulas out there: Take a minute to honor yourselves.  You do hard work, often without a lot of compensation other than the satisfaction of knowing you made a difference to every family you worked with. 

1.       How hospitals work:  Hospitals are complex systems that practically have a life of their own.  Many different professions work together to create the beautifully synchronized dance that is a functioning labor and delivery ward.  The various actors all have their own roles to play and each one is important.  Nurses assess and monitor.  Patient technicians take vitals and help with repositioning and other essential tasks.  Doctors and midwives are responsible for the health and wellness of several mothers and babies at a time.  Anesthesiologists administer epidurals.  Even the housekeeping staff have an important role in keeping contamination risks at bay.  This doesn’t even take into account nurse managers, case workers, social workers, scrub/OR nurses and the hospital administrative staff.  If any part of the system isn’t perfectly coordinated, it can cause problems in many other parts of the unit.  My presence as a doula should not be a hindrance to how the unit operates.  In fact, it should add to the effectiveness of the whole team and knowing what everyone else is responsible for and keeping within my scope will ensure this.

In a large birth center, it is very easy to get lost in the hustle and bustle of so many people and so much activity.  I highly recommend that all doulas take a tour of any birth center that they are not familiar with prior to going there to support a mother in labor.  Ask questions about nurse to patient ratio and how many patient technicians or aids are usually on each shift.  Ask about their intake and triage procedure.  Ask if the labor and delivery unit is separate from the postpartum unit or if the mother will remain in the same room throughout her stay.  Orient yourself to the floor, making sure you find the ice machine, the family lounge, the restrooms, and the vending machines. 

2.       What L&D nurses actually do:  When I began my training as a doula, I had a false sense of what labor and delivery nurses actually did.  I assumed that they would be “hands-on” with the patient often, either by taking vitals or doing vaginal exams or other “medical” things that I only vaguely defined in my head.  In reality, most of their job consists of observing, assessing and documenting with a healthy dash of caring thrown in.  Nurses are the primary eyes and ears in the room for the doctor, midwife, and laboring mother.  She is the first one to notice if something just doesn’t look right and the first one to take steps to mitigate any problems. 

As doulas, our job is to facilitate a good working relationship between the nurse and the laboring woman.  Respect the nurse and the important job that she is doing.  Advocate for the mother’s preferences regarding monitoring and assessments.  Better yet, teach the laboring woman how to advocate for herself.  Make suggestions on how to meet both the need for monitoring and the need for freedom of movement, such as moving the birth ball to right in front of the machine so the wires will reach, using a wireless pack, or using intermittent monitoring instead of continuous.  Ask the nurse if there is anything that you can do to make her job easier.  Above all, remember that very few nurses went to nursing school because they like to chart!  These nurses chose to be in labor and delivery because they care about these women.  These nurses may see you as a threat because you are taking the best part of their job away from them – being the shoulder to lean on and the person who gives reassurance.  Let the nurse share in supporting the mother with you – that is a win-win situation for all parties involved.

3.       The rationale behind “Policy”:  The hospital, the doctors, the nurses, and doulas all have one common goal: the health and safety of all of the women and infants.  The hospital’s policies are usually a source of grief for my clients.  They are viewed as rigid rules that impose on their body’s ability to birth naturally.  I am not going to address any one policy in this section, just the reasoning behind these policies.  The hospital wants to ensure the safety of EVERY woman, not just one specific woman.  They know that for every so many hundred births, something will go wrong.  They address this by instituting policies on everyone to make sure that those few who will have something go wrong don’t get missed until it is too late.

Sometimes these policies are out of date or not applicable to a mother’s personal situation.  If that is the case, the mother can always opt out.  It is easier to do this if the mother knows the policies ahead of time and can talk to her caregiver about it, but it is never impossible.  (I know a woman who didn’t just change doctors, but changed hospitals at 8 cm dilated in active labor to avoid a policy that she didn’t agree with.)  For every procedure that is done in the hospital, the informed consent of the mother is required.  Informed consent mandates that the mother understands the benefits of the procedure, the risks associated with it and how likely they are, any alternatives to the procedure, what happens if it is not done, and any implications of her decision.  A woman always has the last say in what happens to her body!  To best advocate for your clients, make sure that they know how to advocate for themselves by asking the right questions, knowing where to look for unbiased information, and ensuring they have enough information to give informed consent or informed refusal.

1.       How I treat my body and my mind now matters:  The thing that prevents complications from developing during labor more than anything else, is not who she chooses as a care provider or what doula she decides to go with – it is how she treated her body in the years before she became pregnant.  Eat healthy.  Maintain strong muscles and healthy joints.  Keep your weight in a healthy-for-you range.  Try to squat sometimes even before you get pregnant, just to get used to how it feels.  Get enough sleep at night.  Get help for your anxiety or depression.  Learn what techniques help you to manage your stress.  Yoga is amazing because regular practice will build strength, flexibility, decreases stress, promotes relaxation, and most importantly helps to develop a trusting relationship with your own body.  You learn how to really think about and focus on your breath.  You learn how to be in and feel your body, how it is positioned, and how to reposition it in a way that it is telling you to.  These are all things that you can do now, even if you are not pregnant to ensure a healthy delivery later on.

2.       The time to prevent interventions is at the prenatal appointment – not in labor:  Talk to your care provider with an open-mind and realistic expectations.  Tell them what matters to you.  Ask them what the policies are.  Try to compromise between the two ahead of time.  There is no prenatal appointment that is too early to start discussing your birth plan!  If your caregiver agrees with you to modify a policy, get it in writing in your chart and ask to speak with the charge nurse on the unit regarding it.  The more the nursing staff knows ahead of time, the more smoothly it will go during labor and delivery.  If your caregiver isn’t willing to compromise with you, hear them out.  Try to understand if they have a different philosophy of birth than you or if it is a matter of safety and you should consider changing your point of view.  If you can’t reach a compromise or you just don’t like your caregiver – shop around for a new caregiver.  All of this is much more easily done before labor, than during and in between contractions.

3.       The importance of flexibility:  Things don’t always go according to plan.  When making a birth plan, remember this.  In fact, make two birth plans.  Plan A: my ideal birth.  Plan B: if it all goes to hell and I need an emergency cesarean birth.  The fact is that even with the ideal caregiver, the best circumstances, the healthiest mother, and an easy pregnancy things can still sometimes go less than ideal.  The world health organization recommends a cesarean rate of 10 to 15%.  This means that for 10 to 15% of pregnancies, a cesarean birth is safer than a vaginal birth.  So be flexible during labor, if things don’t go as you planned initially keep as many elements as you still can.  Ask to be allowed to have skin to skin after delivery.  Swab the baby with vaginal secretions to kick start his microbiome, if you are into that sort of thing.  Make sure your partner still gets the picture of the baby on the scale.  Talk to your doctor about how to still incorporate your personal customs and rituals into the birth.

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.  

My husband was the one who came up with the idea for The 52 Weeks of Motherhood Project. We were watching the snow on a cold, cold Cleveland day in December and talking about stereotypes of pregnancy, birth and parenthood that we see everyday. I wanted a platform for real people to share their stories. And my genius partner came up with this idea. I would collect stories from people who have lived experiences of pregnancy, birth, and the postpartum period and I would feature the stories weekly, corresponding to each week of the year. We are now in our second trimester, entering week 18.

The goal of The 52 Weeks of Motherhood Project is to show the reality of the first 52 weeks of motherhood—from conception through the 4th trimester—from the points of view of people who have actually gone through the experience, instead of the idealized or scary images fed to us daily. So far there have been stories of surprise pregnancies, women who feel utterly awesome and others who feel the worst they've ever felt, reactions to the news of twins and a rainbow baby, and a family dog who knew Mom was pregnant before anyone else. I've loved seeing how different people’s experiences are, but how there are still some threads of similarity that weave throughout the stories. All the stories express at least a twinge of both hope and fear, and lots of expectations. There’s also the eternal negotiation of internal and external pulls and pushes. Being focused on and centered in your body, sensing the internal changes that are so subtle but so profound, while simultaneously working and playing and interacting with the “outside” world... has there ever been a pregnant person who hasn't experienced this?

July 2014 I started my birth and bereavement training through Stillbirthday. I also found out our family was expecting a new baby. I contemplated postponing my training as is it an 8-week intensive training, and for most of that time, I would be enjoying morning sickness.  I decided to go forward, a decision I will never regret. This training is amazingly intense. There were nights of tears while working through my course work. So much pain is discussed.  Our 4th baby was early and had to stay in the NICU -- and although things worked out, certainly it was one of the most painful experiences of my life. I did not expect that pain to be helped by this training, but when we covered the material about babies and NICU stays, some of my pain was smoothed over.

In February, we passed the gestational age of our NICU baby, and I finally let out that held breath. I celebrated and bought my little Amos his first Easter outfit. I was so excited to meet this little man. I had become certified with SBD in December and was looking for a way to provide a support group to our community. Not having much luck, I decided to table it until my little man was born and I was recovered.

Finally, we were 4 days from Amos' due date and labor started. We were so excited. Then things changed quickly. This is when you hear the words you never thought you could hear, you never believed you would hear: "Michelle, I'm not seeing any movement and we aren't hearing any heartbeat." In that moment, things changed forever.

I was sent to the hospital for an immediate induction. I was blessed with caring nurses I knew from doula work, my midwife, and even the doctor-on-call -- when I requested Chapstick and there was none to be found, she brought me a new stick right from her own purse. It may seem like a small thing, but tender mercies are all we have in moments like this -- and at the time, it meant everything.

Soon it was time to push. I will never ever forget this part. It's burned into my brain. He was born, and for a brief second, he looked alive. He looked a breath away from life. He didn't move or cry. A caring nurse had said previously one thing that bothers parents the most in situations like these is the silence. She was right -- the silence was deafening; for the first time in my life I understood that saying. In my heart I begged him to breathe. I was screaming for a miracle.  I sobbed and cradled my little Amos. He was perfect. Lots of hair that was a shade of red between his sister's strawberry blonde and his brother's bright red. He never cried, breathed, or opened his eyes. 

My son was born sleeping, and without my training, our hello/goodbye would have looked very different.

I must stop and tell you about the founder of Stillbirthday, Heidi Faith. This woman -- there are no words to tell you the beauty of this woman's heart. This mama experienced her own loss and has brought beauty from those ashes. I will be planning a trip just to hug this woman as soon as I can. She is my sister. I gained so much more than just an organization. I gained a sisterhood. These women are so beautiful -- most experiencing their own losses and turning around to support others through loss. I can't tell you how much love I have received from these women, from gifts to words and prayers. I have so many to hug. 

I have been a couple of days ahead of these 31 days' posts. Yesterday, on day 8, I was ready through Tuesday, including a special Mother's Day post for day 10. All I needed to do upon waking up today was hit "publish" for day 9's post. 

I was called to a laboring mom in Tulare at 2 am, yet I knew I could use my website's mobile app to publish from the hospital -- but not so, I kept getting an error message (while mom was being triaged in a Visalia hospital and I was in the waiting room). I finally gave up and focused on this birth, knowing I could figure it out later.

This birth! This birth was amazing. My friend and fellow doula, Denise, asked me to support her during her surrogacy birth. Her husband, Chris, was a huge helper -- after all, he has supported her through her natural births before. That left me wondering, what would my place be when the partner is already doing great? I did doula the dog while we labored at their house; poor Buddy had been hiding under the bed until I arrived. I walked in to lay my hands on Denise's back to let her know I was there, and from under the bed, something began licking my feet. Buddy!

What we couldn't predict was, once we got to the hospital, Chris started feeling very sick to his stomach. He needed to go to the car and rest for a while, and he was kind of in and out of the scene. When he was present, he was very present, offering everything he could to support Denise (and the way they worked together was inspiring). And when he needed to step out, he knew things would be okay. 

Denise had an amazing midwife, Rita. Rita is a powerhouse. She had five children of her own, and when she enrolled in a midwifery program Stanford offered for three years back in the 80s, she was pregnant with her 4th baby. Many doubted she would finish, but Rita is nothing if not relentless! And this shows when it comes to supporting her patients. Not only did she go to bat for Denise's comfort and preferences, she also knew how to talk to Denise to keep her courage up and help her move forward when she hit emotional and physical walls. 

The intended mother was at the birth, and she quietly witnessed the whole thing, very concerned for Denise's safety and comfort. When this little baby girl was finally born, she was laid on Denise's chest, with her mom right there, awestruck and deeply moved. I don't think any one of us in the room had dry eyes. Soon the mother sat down in a rocking chair and baby was placed skin-to-skin with her. We all watched this new mother interact with her baby -- the sweet words, the lilting voice, the facial expressions and the snuggling; it was an amazing peek into the private world of a mom and her infant. Soon the new dad joined mom and baby, and again, the tender voices and touches were sweet affirmations to those present that this new gift was one worked hard for, one cherished. 

I didn't intend for this to be anything more than a short Day 9 post to stay on track, but it is hard to withhold the beauty of birth -- every birth. I am amazed at Denise's strength and her generosity. She truly went through one of the hardest physical and emotional experiences in her life to grow and birth a baby for a family who did not have this ability. Four hours or so after the baby's birth I finally left, but one of Denise's last comments to me was this: "I am so grateful I could do this for them."

And I am amazed.