Sleeping on the Job

​I had a doula birth this weekend. This family was having their second baby; I was with them during the hospital birth of their first daughter almost two years ago. This time they planned a homebirth with our community midwife (whom I love).

I was struck by this couple's groundedness during their first birth. Mom labored for about 5 hours, and then had her baby, with no interventions or medications. She never complained, even when it was within her rights to do so. She never said, "This hurts," or "I want this to be over," or "It's hard." She did not utter one complaint during the whole birth. It really got me thinking: There are people out there who never complain; they just deal with what life offers them and move through it. What a lesson for someone like me.

After their baby's birth, Mom started losing a lot of blood. Her placenta would not release and come out. Because of this, her uterus could not clamp down and involute, the process which normally stops the full-force of that bleeding. Her midwife tried quite a few tricks before she had to call her supervisory physician for direction. Now, I don't think she really needed "direction," but the way the laws work here, she had to inform him of the situation and see what he recommended. They discussed manually removing the placenta, and the doc agreed the midwife could try -- that would keep him home for the time being (it was after midnight).

This experienced, well-respected-in-her-field midwife then slowly reached her hand into this new mother's birth canal in hopes of bringing the placenta down and out. This mom was stoic. With her midwife's hand reaching into her uterus, she did not cry, scream, or make any "normal" sounds one would associate with this very painful procedure. She knew this was work that had to be done. Her husband watched as (what he later called) "rivers of blood," ran out of his wife. After a second attempt at this and still no placenta, the midwife administered narcotic medication to help the mom relax and feel less pain. This midwife also called the doctor back, and he was on his way. The third attempt did not look promising. "Visualize your placenta letting go -- visualize it releasing." Just as the doctor opened the door to the room, the midwife came out with the prize-in-hand -- the placenta.

The midwife, in her best judgement, said this was a fluke. 

21 months later this mother is laboring again, this time in preparation of a homebirth. I joined them at about 8 in the evening. We went for a walk, stopping every few minutes to "honor the contractions," as the mother put it. Around 10 the midwife and her assistant dropped by, fresh from another birth. This mother guessed she was about 2-3 centimeters, still in early labor. The midwife suggested we all go home and let Mom and Dad get some rest.

I watched a movie when I knew I should have gone to bed. Then I dawdled around a bit more, finally snuggling into bed between my husband and toddler around 1:15 am. I placed the phone on the windowsill so I could reach it quickly, and pressed my cheek into my pillow. Just as I shut my eyes, the phone rang. I was back at their house by 1:30.

Mom still wasn't quite in active labor yet, but things were picking up. Mom moved from a hands and knees position over the couch, Dad holding both her hands and me pressing on her back, to the birth tub, to the bathtub, and then back to the couch. She laid on a mattress on the floor for a while, still being diligent enough to get up and empty her bladder every 30 minutes or so.

At about 5 am Mom decided she wanted to lie down in her bed. She crawled up into the middle, facing her husband, and I laid facing her back. For the next hour, the three of us moved into place when her contractions would start -- I would press into that small triangle on her lower back, Dad would offer his hands to be squeezed, and Mom would make the noises to cope with the sensation. As her voice started to sink, slowly I would lighten my touch, and Dad would claim his hands back. Then we would sleep. Dad laughed at one point that it was a good thing they had a king-sized bed for this threesome. Mom and Dad (can't say for myself!) would both snore between contractions. I knew I was dreaming because I would wake with other thoughts floating in my mind. But we would shift into action to help support this woman as she moved through her experience of labor.

At about 6 am, Mom said the sensation had shifted, and she felt, at certain points during a contraction, a little like she wanted to push. Although she had a longer latent phase than with her first birth, I imagined once she got close to complete, she wouldn't be there very long. I made the call to the midwife, and she was there by 6:30.

Mom was checked and found to be 4 centimeters, almost fully effaced. She decided to "do laps," around the circle of her living room, dining room, and kitchen. This helped the intensity and regularity of her contractions. By 8 she was feeling the urge to push, and the midwife found her to be without any cervix. After a few different pushing positions, the mother eased her baby out sitting on a birth stool. She was asked to, after the birth of the baby's head, breathe through contractions so the midwife could suction the baby's airway as there had been some meconium in the water. Baby came out, right to Mom's chest, as Mom was leaning against her partner -- and we were all struck by the beauty of such a simple birth.

But only for a moment.

What was said not to happen again did indeed happen. The placenta was not coming. Through nipple stimulation, herbal tinctures, and finally a shot of pitocin, the placenta stayed tight. This midwife also tried to manually extract it. One, two, three times -- to no avail. Mom was losing blood. It was not critical, but the midwife feared if we got Mom vertical and out the door to the car, she would likely lose a lot of blood by the time she arrived at the hospital. The decision was made to transport by ambulance. Mom and Dad were calm. They knew this must be done, so they simply got down to business and made the best of it.

Mom went in an ambulance and her midwife followed behind. Imagine, Dad home with his minutes-old baby while Mom is being ambulanced to the hospital! But this dad is calm and confident. He dressed and diapered the baby, I threw together essentials for Mom and Baby, and then Dad, Baby, and I headed to the hospital. The midwife's assistant stayed to began the clean-up.

The doctor-on-call tried to manually remove the placenta twice, and he was going to try one more time before Mom said, "No, I want go to surgery." They took her back and gave her general anesthesia, and they were able to fully remove the placenta -- the placenta that did its job so well -- too well. Mom and Baby were reunited and, aside from a delay in breastfeeding that seemed made up for later, were doing just fine.

On the way to the hospital, Dad shared with me, "Having been through this before, I knew what to expect. I also knew she didn't lose as much blood as she did last time. I wasn't worried at all." I absolutely believed him! I could feel his energy as he made the preparations to meet the needs of his wife and his new daughter.

I asked Mom later, are you still glad you planned a homebirth? "Absolutely. I was able to labor and have my baby at home, and aside from the placenta issue, I wouldn't have changed a thing."

Birth doesn't often go as we plan. We can be in-tune with our bodies and our babies and understand, sometimes physical need has to take priority over envisioned ideal. Even if we are caught sleeping on the job.

A few relevant resources for further exploration:

-Homebirth Safe for Low-Risk Women
-Choosing the Right Sized Bed
-Bedsharing with Your Baby (couldn't find anything about bedsharing with your doula, sorry!)