Day 25: Have a Doula, Be a Doula
Joyce learned about doulas during her first pregnancy, and like so many, she went on to train and work as a doula herself. I am a fan of birth stories, of course, and what struck me about this one is how we are not only seeing Joyce's journey unfold, but also we are learning about physical and emotional changes that occur along the way. This is a great example of what loving support can do for a woman experiencing a difficult labor.
First off, my goal, as long as the baby and I were both doing well, was for a nonmedicated childbirth. To help towards that goal, we hired a labor/birth doula, Marsha, as labor support for me and Justin. A doula's presence speeds up labor, reduces mothers' requests for pain medications, increases babies' Apgar scores, decreases postpartum depression, decreases cesarean birth rates, increases mothers' satisfaction with the birth partner/husbands, support, improves the birth partner/husbands' satisfaction with the birth, and more. They're awesome. Marsha brought along Becky, a doula-in-training, as well.
Carol, my midwife, told me to call her when contractions lasted at least a minute long and were 3 to 5 minutes apart. I woke up at 3:30 am on Friday, Nov 7th, and couldn't fall back asleep. I finally realized I was having contractions at 4:15, so I got up and tried to distract myself by putting together a lamp for our living room. However, I was still having them at 5:30, and they seemed to be pretty regular, so I woke up Justin and we started timing contractions. At this point they were about a minute long and 3 to 4 minutes apart, but I was able to talk through them, so I took a shower and we timed again at 6:30. They were still a minute long, but now closer to 2 minutes apart, but I was still able to talk through the contractions, so we didn't know what to do. You're not supposed to be able to talk through active labor contractions. I called Marsha, who was also unsure, but told me to call Carol. Carol instructed us to go to the hospital, so we started packing the car and left for the hospital just before 8 am. Justin sweetly made me a PB&J sandwich, which I promptly threw up about 10 blocks from the house, right on "A" Street during morning traffic. Poor commuters. This was actually a good sign that this was it.
We got to the hospital and checked in, and Jill, the student midwife who's training with Carol, came in and examined me. I was 5 cm dilated and having regular, long, strong contractions that were now difficult to talk through. Marsha arrived soon, then Carol and Becky. Marsha started helping me relax during contractions and keeping my mind clear between them. One of the things doulas do to speed labor is encourage the laboring woman to change positions frequently, every 20 minutes. First, she had me walk through the halls. That made me puke again, which is a pretty good indicator that labor was progressing quickly! My active labor was from about 8 am until 1:30 when I started pushing, just 5.5 hours, which is pretty fast for a first-time mom!
Doulas also help mom move in ways that encourage the baby to position itself correctly for delivery. Baby K started out facing my left hip, and should have been facing my back, so we tried all sorts of different positions to get him to turn. Unfortunately, my son inherited my stubbornness and independence, and turned to face my front instead. This position leads to "back labor," or excruciating back pain during contractions that typically doesn't abate between them. It's just lovely... Luckily, being able to move around helped with the back pain. I didn't want to change positions, but getting into the new one always felt better. I also used the big Jacuzzi tub in the delivery room for pain relief - once you're about 7cm dilated, immersion in a big bath of hot water has been shown to be as effective for pain relief as an epidural and it can speed up labor because it helps mom relax. I still had terrible pain in my sacrum (very low back) during contractions, but I actually felt pretty good between them. Counterpressure on my back helped a ton, but poor Justin's back started hurting from hunching over me. Luckily, he had lots of people to jump in when his back got really tired. He also was able to eat lunch while I was in the tub - the doulas and midwives took good care of him.
After an hour and a half or so in the tub, I was 9cm and completely effaced. I got out and during the next contraction my water broke. This is when I really entered transition, the shortest but most intense phase of labor, right before you start pushing. For most of my labor, I was pretty quiet, but during transition, moaning seemed to be the thing to do. Apparently something like 90% of no-med women scream during their labor - I guess I'm 1 in 10! For me, transition really felt like (sorry!) I needed to have a bm, but didn't have anything in my colon. Like that nauseated feeling several minutes before you throw up. You want to puke, but you just can't yet. I wanted to push, but I couldn't.
Pushing was the most difficult part for me because of the way Baby K was positioned. When baby is facing mom's front, the angle of their head and neck means that the part of their head that has to fit through the pelvis is larger than if they were facing mom's back. I pushed for 2 hours. He actually crowned after about an hour or so, but we just weren't getting anywhere after that. Jill decided to do a small episiotomy to try to speed up delivery, since his heart rate had started dropping during contractions now, and that did the trick. I watched my son being born in the mirror, Justin got to announce to the room that we had a baby boy, and he cut the cord.
Jill and Carol are positive that if I hadn't had Marsha and Becky encouraging me to change positions and move around, or if I had been unwilling or unable to do so, I would have needed a cesarean because of Baby K's position. He just wouldn't have descended at all. I also think that my pelvis was able to shift and move to get him out partly because I was seeing a chiropractor throughout my pregnancy and my joints were nice and loose. I'm also lucky that I had a midwife who let me push for so long. I'm really lucky that Baby K and I both physically handled labor well and I was able to have a med-free birth like I hoped for. I also couldn't have done it without Justin. He was with me through every single contraction, and he helped me focus my energy while pushing. I am a lucky, lucky, lucky woman.
Joyce Dykema, CD(DONA), HCHD, became a certified birth doula in May 2012. She is also a trained Hypnobabies® Hypno-Doula. Joyce is a woman-focused doula. While passionate about natural birth and what research shows is the best for moms and for babies, the goal she strives for with every client is for women to have empowering and positive births, as the woman defines it. In addition to her doula credentials, she holds a BA in psychology and an MS in biological sciences. She breastfeeds, uses cloth diapers, uses baby sign language, babywears, and homeschools because these choices made sense for her family; she encourages others to explore and find what makes sense for their families. Joyce and her husband have three children, and live in the Lincoln, Nebraska area.
5/26/2015 04:50:54 am
What a delight it was to find Joyce's first labor story shared on Facebook today. The photo of our walking the hall together brought back very warm memories of Joyce and Justin's empowering day. Having served families for years as an educator, labor and postpartum doula, as well as a lactation counselor, the stories that women share when they have felt support are extraordinary. In the most challenging circumstances, support is key to how families process their experiences. Thank you Stacie for the 31 Days of Doulas, and thank you Joyce for sharing your story.
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♥ four young boys and a boy dog (offspring)