Karen is one of my doula-friends in Bakersfield. She is reliable, knowledgeable, and serves families in a loving and caring way. I remember when she had this client, because she asked me what my experience was with cholestasis as a doula. One thing I realized was, information changes, and I had old information. Karen has recently been able to help me navigate a similar situation as I have supported a client through this condition -- doula sisters are always good to have! Sharing and integrating knowledge keeps us all informed and better able to help families as they whether their own storms.
Justine was a young woman, expecting her first baby when she asked me to be her doula. In a roundabout way she was family. Even though there was no genetic connection between us, I immediately felt bonded to her as if she was family. She and her husband, David, were so excited about welcoming their baby into their family. From the beginning she had a hunch that she was carrying a little girl, which was later confirmed.
She was appalled to learn that her regular OB/GYN had a policy to automatically induce a woman as soon as she hit the 40 week mark. Justine had done her research and knew that this was not an evidence based policy. She also really wanted an unmedicated delivery and knew that this policy would throw a road block up for that. Early in her pregnancy she discussed this with me, and we were able to get her under the care of another OB who had a much friendlier attitude towards her desires to attempt an unmedicated and intervention free delivery.
She had just formed an affinity for this new OB when life presented the first “storm” of her pregnancy. Within a week of each other, she and David both lost their jobs, which meant that she lost her insurance policy! I went to her next appointment with her to the doctor. Her plan was to tell him that she had lost her insurance, had applied for Medi-Cal (the California form of Medicaid) and ask him for a recommendation for an OB who would have similar practices and also took her Medi-Cal insurance. All this stress, combined with her pregnancy hormones, had kind of left her in a very fragile emotional state. She was crying as she explained all this to him. He gave her a big hug and informed her that, while he did not advertise it, he was actually an approved Medi-Cal provider! She could continue to see him! Not only that, but he worked with her husband (whose prior job had been in pharmaceutical sales) and helped him find new employment! She began to have faith that things were going to work out fine!
Things were going along quite well with her pregnancy. She found out that she was carrying a baby girl and they selected the name “Noah Grace” for her. Did you know that there was a female person in the Bible named “Noah”? I certainly didn’t! The story is found in Numbers 27. She was quite a woman for her day. You can read about her story here . What an amazing woman to be named after!
We did a private childbirth and breastfeeding education class in their home. They were both so excited about what they were learning about the physiology of birth and coping techniques for labor. Of course we touched on interventions (including inductions) and complications, but all of us thought that this info would be unnecessary in their actual birth. However, within a few days, the second “storm” arrived: she called me complaining about intense itching, mostly on her hands and feet.
I advised Justine to contact her OB right away. I knew that she had had a pre-existing condition with her liver and was quite concerned. Her doctor also suspected that this was being caused by an issue with her liver and she was quite quickly diagnosed with Cholestasis (a problem where the mother’s liver is producing excessive bile acids). This condition, in addition to causing the intense itching, can also result in a fetal death in the last few weeks of pregnancy. Justine was placed on medication to control the bile acids. Medi-Cal delayed in getting the prescription filled, and she told me that many nights David would place his hands on her and pray for her for relief of the itching just so she could get some sleep! She truly felt like his prayers helped her both physically and emotionally. She was also referred to a perinatologist for concurrent care along with her regular OB. Overnight, Justine’s and David’s focus switched from preparing for an intervention free birth, to a quest to just birth a live baby. She did say that one bright side of having to see the perinatologist on a weekly basis was that it also gave her an opportunity to see her precious baby girl on ultrasound every week. It was comforting to see that visual reminder that baby Noah was growing and thriving.
Her concern was compounded by the fact that her own mother had died at an early age due to liver failure, and Justine has had elevated liver enzymes herself in the past. The perinatologist explained to Justine (which concurred with the research she was already doing) that her baby would have to be delivered at 37 weeks to reduce the risk of stillbirth (a recommendation that is changing now to 36 weeks gestation). In a facebook post just a few days before her baby’s birth, Justine wrote, “Everyday I get asked when my due date is and and every time I have to explain that my baby will come early due to Cholestasis of Pregnancy. Most people assume I'm fine because I look okay and since the itching is gone they assume I must be better but the truth is that I constantly am concerned with my growing child and the closer to my due date I get the more I worry!”
Upon the recommendation of her perinatologist, Justine was admitted to the hospital at 37 weeks for an induction. At her OB appointment just prior to her admittance, the doctor declined to even do a vaginal exam. He told her that he was certain that her body was truly not ready for labor and so there was really no need for it. Instead he sent her to the hospital for the induction. This started her third and final storm of this pregnancy. She was admitted and they started the process. Justine was given a vaginal dose of Cervadil (a cervical ripening drug). When the nurse inserted the Cervadil, she informed Justine that she was already 2 cm dilated and 50% effaced! That was so comforting to her as she was certain that her cervix was not going to be anywhere ready for delivery yet! It was like her baby girl was telling her that everything was going to be alright with her coming at 37 weeks!
Justine gradually began dilating and effacing and having some contractions. This process was very slow getting started, but picked up over the next few hours. About 13 hours after the medicine was inserted, Justine was almost 4 cm dilated. She had a very painful moment, which she had a difficult time recovering from, when the nurse was having trouble removing the cervadil strip. She did ask for some IV pain medication to cope with that pain. At this point she, along with her doctor, made the decision to rupture her membranes to see if she would continue to labor on her own, without the need for Pitocin. This accomplished exactly what she had hoped for and her contractions picked up significantly. She asked for IV pain meds again. She was having a difficult time coping with the frequency and intensity of her contractions. She said that if felt like she was getting no break between them at all. About an hour later she made a decision to get an epidural for pain management. Finally she was able to rest and let her body do its job.
About 14 hours after getting the epidural, and after getting some much needed rest, she was ready for pushing! Soon after, Justine had her precious Noah Grace in her arms. Baby weighed a healthy 7lbs 6oz and had Apgar scores of 8 and 9! It was like she knew she was coming early and just developed a bit early to make things easier! Baby appeared to suffer no ill effects at all from her early delivery!
Justine said “Having you as a doula emplowered me to be brave when I was oh so scared, and helped me to have the knowledge so that I can now help other women!”Today, Miss Noah Grace is quickly approaching her first birthday! She and momma are both in good health, and baby is still nursing like a champ!
Working with Justine and David was such an honor! They were truly a team in every aspect of her pregnancy and delivery. Their love for each other, their faith in God, and their trust in their health care team got them through a very scary time in their lives. While they say that they learned from me, I know that it was truly I who learned the most from them!
Karen Berhow serves the greater Bakersfield, CA area. She has over 20 years experience supporting women through labor and birth. Although she started helping friends, she is now a professional doula, offering childbirth classes, breastfeeding help, and general support for new families. Karen has been on the Board of Directors for the Bakersfield Birth Network, and she loves her involvement with other professionals as they try to bring awareness of birth options to their area. The mother of three grown children, she recognizes her personal birth experiences shaped and motivated her to reach out and help others on their journeys.
I must preface this by stating, it is not an uplifting tale of birth. I know in our culture we hear more birth horror stories, and it is not my intention to perpetuate that. This is the beginning of my birth experiences, and although I take credit for my missteps, I hope 1-it can serve to help get you thinking about your birth options, and 2-you will read my other experiences of birth to see the evolution which came through my personal education and faith.
When I was pregnant for the first time, I fit the typical American mom-to-be stereotype. My older sister was three months behind me pregnant with her first, and she was planning a homebirth with a midwife. Not me, I wanted a hospital birth, and the cherry on top was, I chose a female obstetrician just knowing she would "get me."
My appointments were a lot of waiting, waiting, waiting for her to show up, and then her rushing me out in important-doctor fashion. One time I was made to wait so long, naked bottom on the papered-table (in a very hot, windowless room) that I sweated through the paper -- how terrible was that? But I was a good girl, and I did as I was told. "Take off your pants and sit here, she will be here soon." How humiliating. (Please, if it is not too late for you, keep your pants on until you practitioner arrives, and just sit in the chair while you wait -- it's allowed!).
I am not sure if you know this or not. With your first pregnancy it may come as a surprise -- with subsequent pregnancies it is an easy thing to forget until it creeps up on you, but it gets terribly uncomfortable growing a baby who sits on top of your bladder and underneath your rib cage. I have long told my childbirth classes this, and as of late, I am reminded again of its truth.
Being 33 weeks pregnant, I have my list of complaints. I feel like this baby can't come fast enough. I even imagine going into labor early -- like today early -- just to be done with it.
My back and hips are aching like never before (surely a sign my body is feeling too old to be going through a pregnancy again, right?). Sleep is something that comes in fits and pieces. I feel bad for my husband as I toss, turn, try to roll over but feel more like Ralphie's brother in "A Christmas Story," lying on the ground in his snowsuit saying, "I can't get up!" Add to that restless legs that shake and quake of their own volition, the 5 pillows I have behind, around, under and between various body parts, and the snoring (yes, the snoring!) that wakes me -- the snorer! -- and I imagine there's nothing peaceful in our bedroom right now.
My baby is still high enough that I can relate to this scene from "Tommy Boy," just replace bear claws with baby butt:
It is surprising how hard a baby butt can actually be -- but there is not a lot of fat there, and it becomes this firm blockage that prevents me from bending over to put on socks or tie my shoes or reach down to release the emergency brake on the car -- and it is just plain uncomfortable.
Even with the baby still not having "dropped," my poor bladder is being pushed to its own limits. I am convinced I am currently the top toilet-paper-user in the house, visiting the bathroom 4-5 times a night, and so many times during the day I probably use a roll every 24-hours. I have adopted a policy of mandatory-usage if I get within 12 feet of a bathroom. My logic is, even if I don't have to go right now, I will in 10 minutes, so I just pre-emptive-strike it.
I notice I make a lot more noises as I progress through the normal tasks of the day. I sigh and groan and yelp as I shift from sitting to standing, getting in and out of the car, bending down to (attempt) tying my shoes. I swear I am not doing it on purpose, these sounds just escape my lips before my brain can even say, "That was quite the old-lady-carrying-the-cat-food-bag-into-the-house noise." No offense to old ladies who have to carry the cat food bag into the house and may make noises while doing so.
This baby gets the hiccups probably 6-8 times a day. I can't figure a pattern -- sometimes it seems like they may come after I eat, other times they come when I am hungry. Sometimes they just come. They aren't the worst things in the world, they just feel like lttle spasms that jolt my uterus in various places every two seconds. They can space out longer or shorter, but in my scientific explorations, I have noted they most frequently come every two seconds.
These are just the things that bother me the most. There are more issues I can mostly overlook. With this list of complaints, though, it isn't hard to see why so many women press for inductions or agree to inductions when offered. It is hard to wait! It is uncomfortable to wait! It pretty much sucks! Don't believe that rare woman who, at 38 weeks pregnant says, "I still feel great, I am in no hurry to be done," because while she does exist, she is generally the exception, not the rule.
The way we look at due dates, we often feel "overdue" by the time that day rolls around. We are conditioned to believe our (bad, uncooperative, lazy) babies are just kicking back in there, buffing their ever-growing nails on the inside of our uteri, taking up time and space, while we grow more and more uncomfortable.
When I was pregnant with my first baby, I read in "What to Expect When You're Expecting," that doctors only induce if it is medically necessary; so when my doctor offered, on my due date, to induce me, I took her words as medical advice being as they came from my medical practitioner's mouth. Maybe my first clue should have been the way she asked without giving any scientifc rationale: "Are you ready to get this over with?" Well, heck yeah, I was ready to get this over with! That's a vulnerable place to be! Miserable, anxious, wanting that baby out from under your ribs and into your arms. Who would say no? And with that one question, I was set up to believe my body was done doing anything important for my baby and wouldn't go into labor on its own.
I am not a patient person. I hate waiting for things. It took every ounce of confidence and trust I could muster, and some I didn't even know I had, to wait on my babies and pregnancies the next two times around. But the evidence shows birth is safer for mom and baby when they are allowed to work together -- like Mario and Luigi saving the princess in tandem -- to let labor begin on its own.
My step-sister, Michele, had her first baby via cesarean birth. She was set up for an induction, and after many hours she heard the label "failure-to-progress." To the brain, induction sounds good -- let's get this show on the road. The body doesn't always have the same plans, especially when a woman hasn't had a baby before. Even with the medications and procedures offered, the body may not make fast enough progress for the medical establishment. In these situations, a cesarean birth can become necessary.
With her next baby, Michele wanted to try a VBAC. She chose a doctor who was comfortable with vaginal-birth-after-cesarean (although it required her to travel to a bigger city an hour away), and dreamed and planned for her son's birth. As Michele's confidence grew in her body's ability to birth her son vaginally, her fears of the pain and work of labor didn't ease. In order to cope with these intense feelings, she made the decision to get an epidural pretty early on in labor.
Last summer Michele learned her family would grow yet again, and this time she was determined to step it up even one more level -- try for a VBAC with no pain medications. Although she chose her same doctor, she did make one change - she decided she wanted a doula to accompany her and her husband during this birth. That's where I come in!
Every baby and every birth is different, and this was no exception. Michele's labor seemed to drag on and on and on this time. I ended up at her house at about 3 am. It felt a lot like a slumber party, and we let her incredible husband take a nap in bed while we laughed and swapped gossip and stories. I knew we should try to get some sleep, seeing as how any time labor could pick up and we would all be exhausted, but we were truly having too much fun. We finally decided to try resting, but Michele wasn't really able to get any sleep.
The next day (or later that day) found us still puttering around their house, playing with the kids, watching movies (Puss in Boots, Toy Story, something else, I think, and then Baby Mama!). We were still waiting for labor to start rolling...we really had no way to plan for the baby-sitter, or my mom to travel to the hospital -- oh, and Michele's little sister just happened to be flying in that night, of all nights! And my mom was going to pick her up in the event we were off having a baby (Murphy's Law!).
At one point during Baby Mama I had Michele stand through a contraction in a deep lunge position, and I asked her to switch to the other leg during the next contraction. It seemed after that, Michele's contractions really started to pick up. That silent energy that so often comes when the invisible switch flips on inside the mama was humming around us. Michele was buzzing around, calling the baby-sitter, pulling together the kids' supplies, finding her shoes! It was finally time to go!
We climbed into the car, Michele in the back seat and her hubby at the wheel (I had shotgun) and we hit the road. After about 75 minutes we walked into the hospital. There was a woman ahead of Michele in line, but the receptionist could tell Michele needed to be the priority! They quickly got us a room and let Michele start doing her thing. After an intense 90ish minutes of labor, Michele was holding her new, sweet baby girl!
And it was intense! Michele was amazing. She coped in many effective ways. She moved around and changed positions. She verbally told us what she needed. She even prayed outloud (although she said at the time she thought she was praying in her head). I know it is hard to prepare for the unknown urgency of how labor feels, and Michele was able to take each contraction one at a time, focusing her attention on her loving hubby or me -- sometimes both! so she could keep her head above the water of the labor-waves instead of being tossed and turned about in the surf.
I can't say how proud I am of this mama and her decision to seek something different in our not-very-supportive VBAC society. The fact that she challenged herself even more by deciding to work toward a birth free from pain medications is something I am also impressed by. It is scary to do something you have never done before, and armed with support and education, she not only set the goal, she achieved it. Michele, you are amazing! I admire and love you tons, and I will always remember the power and beauty you shared on the day your sweet little R was born.
Many expectant moms find the last weeks before their baby’s arrival to be fraught with a rainbow of emotions. The excitement builds as the due-date comes. This date has been the goal. Although realistically only 5% of babies are born on their due dates, we still cling to that date as if it means something bigger than it does. Just as every fruit on the same tree reaches ripened maturity at different points in time, so do our babies. Another survey suggests 7 out of 10 babies are born past their estimated due dates (as a birth doula, I can say this backs-up my experiences with mothers and babies).
♥ four young boys and a boy dog (offspring)