My Third Birth as a Doula
Monday morning I was awoken by a text from my client's husband saying "mucus plug is out!" Ah, the life of a doula ;]
At about 1:45 he called me to let me know that your contractions had begun and that you had left work to go home and would be timing your contractions to figure out if you were in labor. You told me you were going to try eating, napping, etc for a while to see how the contractions behaved. I didn't hear from you until about 7:15. You said you were watching tv and your contractions had been about 3 minutes apart, then up to 5 minutes apart, and were bouncing around like that so you didn't know if they were progressing or not. I figured you were in early labor, but since this was your first labor I knew it could take a while. As I left for my first birth I hoped that you would hold off until tomorrow!
I didn't hear from you during the entire time I was at the other birth so I was hoping things were fine. You had told me that you wanted to labor at home as long as possible, right up to the last minute if you could have your way. Secretly you'd love a home birth but your husband would be too nervous for that and your insurance covered your hospital expenses. So I was surprised when your husband called me at 12:30 am as I was driving home and asked me to meet you at the hospital. After we hung up I called the boyfriend to let him know I would not, in fact, be home any time soon and to express my frustration. 1. I was already in a weird mood at the nurses from the first hospital who wouldn't give mom her baby for 3 hours. 2. I was a little bit sad I wouldn't be sinking into my comfy bed after all, and 3. I thought that if I was meeting them at the hospital it would be too late to count for DONA certification again! Plus this had never happened to me before and I was very nervous.
I drove 45 minutes to the hospital. It was extremely quiet and empty and calm. I met your husband on the L&D floor and he told me you weren't actually admitted yet because you were only 2 cm dilated. PHEW! I wasn't too late! He went to find some coffee and a snack while I walked around the floor with you and we chatted. You said the contractions were very painful. The staff had wanted you to wait an hour and then check your progress again. While we waited dad-to-be brought me some yogurt, which was nice of him! You felt a little sick and spent some time in the bathroom. I gave you a cool, wet washcloth to wipe your face with. You couldn't get comfortable standing or on the bed as you worked through your contractions. I suggested you lean over the back of the bed and you liked that one. An OB came in to check you, about an hour and a half after your first check, and found you to be at about 3-4 cm. He said they could start getting your admission paperwork together. Your husband was pleased with the progress, but I think we were all a little unsure about staying at the hospital for what could be a very long time still.
A second OB came in to talk to us. She told us that she noticed in your birth plan that you do not want to have your membranes artificially ruptured or any pitocin, but that if you stay there and you're not progressing quickly enough they would want to do Pit or AROM. I thought it was really nice of her to come in and let us know that this was the reality, did we still want to stay? I helped you both weigh the options. The hospital generally like to see a dilation of 1 cm per hour, which isn't always realistic, and like the doctor said there is a likelihood of intervention. I reminded you that you had wanted to labor at home as much as possible. I let you know that you'd probably progress faster and more comfortably in a private, stress-free environment. You and your husband decided to go home and we could all get some rest.
When we arrived at your home at about 4 am you went straight into the bedroom and I turned the lights off for you. You had been contracting for probably about 16 hours at this point and you were tired. Your husband offered me a snack and proceeded to blow up an air mattress for me on your living room floor. This was sweet, but I would have just stretched out on the carpet with a blanket! He went into the bedroom with you and I tried to close my eyes and rest. I didn't manage to fall asleep before I heard someone get up and go into the bathroom. Your husband came in and told me that your water had just broken (4:30 am). You got into the shower for a little while. When you came out you began laboring in the hallway. You were standing and swaying and breathing. I suggested to your husband that he put on some relaxing music for you. It seemed to be a playlist on a loop of the same 3 songs over and over. When I commented about this later he told me that it was because he had left your computer with your chosen playlists in the car! I wish he had let me know because I have a ton of relaxing music on my ipod :)
Your husband and I sat with you a bit. You didn't want to lean over the birth ball but you did get into hands and knees for most of your contractions. You mentioned to me after that the contractions that came after your water broke were much easier to manage than the ones before. You were totally in your zone, doing perfect breathing and swaying and positioning. Your husband kept asking me if we should go to the hospital yet. I said I didn't want to rush you. He was eager to do something and to know your progress. I suggested he read a birth affirmation narrative to you that I had given you. I asked you if you'd like him to massage your back and shoulders and you said yes. He put oil on your back but then you realized you did not want him touching you during contractions so he stopped.
I reminded you to change positions after 30 minutes. You went back to standing. I suggested that you and your husband slow dance if that would feel nice, but you declined. I remembered the ways to check labor progress without an internal exam and asked your husband to try to check for the "bottom line," but he didn't know what he was looking for and I had never seen it before so I couldn't describe it. Then we tried the fundus method, where 3 fingers between your bra line and the top of your uterus meant 5 cm dilation, but that didn't seem helpful either (and I learned later it was probably wrong). Oh well.
We left you in your zone after that because you were doing well. I went across the room and took out a book to read. Where you were you could see us both if you needed us. You were vocalizing a bit now and back on the floor on your hands and knees. It sounded a bit like grunts in there with your moans, and I'll know better from now on. It was hard to tell, though, and to believe that you would be at a "pushy" stage, because you had just begun getting vocal. I couldn't tell your progress very well just from sound. I know this is because I am not very experienced, but I'll definitely know from now on! I had been timing your contractions from across the room, looking for the 411 rule to know when to go to the hospital (contractions 4 min apart (or less), 1 minute long for 1 hour). It had almost been an hour of 1 min-length contractions and I was about to suggest we leave when you quietly said, "the baby is coming." I lept up and said "Are you feeling an urge to push?" and you said yes. And your husband and I both said "Ok its time to go to the hospital." And you said, "No." (After the birth you told me that at that moment you were perfectly content with birthing the baby in the house!)
We got our shoes on and you out the door ASAP (6:30 am). Almost to the car, you squatted by a tree with a contraction and said again "the baby is coming." I said "if you feel the urge to push in the car I want you to raise up your chin and arch your back and do light breathing" and demonstrated. She nodded and we got in the car. It took about 15 minutes to get to the hospital. Your husband grabbed the birth ball but you definitely didn't need it! We walked in the lobby and you had another contraction that you grunted through. The woman behind the desk looked shocked and scared and said "is she pushing?!" She put you in a wheelchair and we went to L&D. As soon as we rolled in the nurses and staff recognize you and said "you're back!" and you stood up and squatted. They all jumped into action and said "don't push your baby out here, he'll land on the floor!" I guess you made them all nervous. We got into a delivery room and as the room filled up with nurses and equipment tables they told you that you had to get onto the bed. You said you wanted to squat and they said that was ok as long as you got on the bed. You climbed up and got into a hands and knees position, holding the baby's head with your hand. You were so calm. "His head is coming out and then going back in a little," you said to me. I said yeah thats how it happens! The staff were lowering and raising parts of the bed while the OB's (two, one was in training) tried to configure themselves to catch the baby in your position.
A nurse came in and said, "I noticed it said on your birth plan that you want to catch your baby, and you can't do that in the position you are in. A squat would probably be a better position for that." So awesome that she remembered that! You got into a squat on the bed, with dad supporting you on one side and a nurse on the other. You were bearing down with your urges and smiling in between contractions. It was beautiful to see... you knew exactly how to listen to your body and you were so happy to be pushing! The female doctor held your baby's head as it began to crown and told you to bear down. I did not give any instructions because I could see you were doing great, and you did not want any directed pushing. After the baby's head was out the OB maneuvered his body out and your son was lifted into your arms at 6:57 am. I wish I had captured your face on camera at that moment. You were so calm the whole time and then you had a huge grin on your face. You you were immensely pleased! And then I noticed there were tears streaming down your husbands face. It was an awesome moment.
You held your baby to you as they examined your small tear and third stage began. You insisted they not clamp the cord until it stopped pulsing and they honored that wish. They kind of tugged on the cord to get the placenta out which always makes me nervous... I'm not a fan of managed third stage, but it turned out fine. The OB administered some local anesthetic and stitched up your small tear. I think that you probably would not have teared at all if they hadn't tried to direct your bearing down, because you were pushing the baby out perfectly on your own with great perineal tissue stretching. I chatted with you and told you how amazing you were and tried to distract you from your stitching which was causing you discomfort. I took a bunch of photos, and loved watching your husband speaking in Hungarian to his first baby boy. You were still holding your baby since his birth, wrapped up and keeping him warm on your chest, when you said, "what his weight and height? did I miss all that?" And I laughed and said, "they haven't done that yet - you're still holding him!" And you said "oh yeah!" :)
After the OB's and nurses mostly left I grabbed my DONA evaluation form and ran out to chase down a nurse and doctor to ask, though I wasn't sure who to ask since there were more than one! A nurse saw me walking towards the nurses station with a piece of paper in my hand and she yelled, "I'll do it!" and put out her hand for the paper. I looked her like ...huh? Because she hadn't even seen the paper yet! She said, "I'll fill out your evaluation! I'll help you get certified!" haha it was so funny. And then she rushed off and made copies of it and had a second nurse fill it out for me as well. It was such a nice surprise, even though I only need one nurse eval! :) Then I asked her which of the OB's I should ask, and she grabbed a form and said, "I'll take it to him." And went and got the OB to fill it out for me! It was so great. I was really loving the L&D staff of this hospital.
We were only in the hospital for about 15 minutes of pushing, mind you, so no one really had much to go on to evaluate me, but I did get great reviews. I noticed in the comments section on my form the nurse had written "better birth plan. but great job!" Personally, I think if two people, on separate occasions, noted and brought up points from her birth plan, then it was a pretty well-written one! The obstetrician wrote, "be a little more vocal w/ coaching during final stages of delivery." I was purposely NOT coaching her because she was doing exactly what she needed to do, and she hadn't wanted directed pushing. She told me later that she thinks the OB telling her to bear down and her complying is the moment she tore. So to that I say - have faith in women's instincts!
Baby was weighed and found to be 7 lbs 11 ounces. He was born 2 days shy of 40 weeks gestation. He had Apgars of 9 and 9. I took some photos of dad and son, and then the father asked me if I'd like to hold the baby. How could I say no? He took a photo of me with the baby (I'll post it when I get it from them). I noticed the baby was putting his hands in his mouth - a sign of a desire to nurse! So we helped mom get positioned to try breastfeeding. Unfortunately I think most first time moms don't know much about breastfeeding, and its not a part of most childbirth education courses. I helped her get the baby in a good position, explained how to encourage baby to latch, what a good latch will look like, how to tell if baby is drinking, told her she could do breast compressions to expel more milk if baby stops drinking, gave her advice and reassured her that even if baby's latch wasn't perfect now it would be. The nurse helped too and told her they have great lactation consultants and I encouraged her to ask lots of questions! After sitting with you for about another half hour I decided to head out, at about 8:45 am.
I realized I wasn't even tired - I was on such a high from your incredible birth!
Some things I've learned from these two doula births:
1. "Regular" or "progressing" contractions in true early labor can vary up to a minute in either direction in minutes apart, and several seconds in length.
2. A multip who is already considerably dilated and effaced before going into labor can have a very very very fast birth.
3. There are hospital OBs who will let you squat to deliver your baby - insist on it!!
4. A birth wish list/birth plan with only about 15 bullet points on with the things most important to you will be remembered by good hospital staff.
5. Even a primip can progress quickly without you knowing it by look and sound. Make sure I ask her to tell me when she's feeling an urge to push, and pay attention to anything that sounds like any form of grunting.
6. I need to figure out the fine line between knowing when to let the laboring woman be in her zone without interruption and knowing when to offer up comfort measures. Sometimes I may have simply been annoying in my attempts to help when they weren't needed, but how do I know if she might really need help but not be asking for it? I think this is something that is learned.
7. Sometimes I'll end up helping dad-to-be a lot more than mom-to-be!
8. Bring lots and lots of snacks.
9. Every birth experience, whether it counts for DONA or not, is worthwhile. I am learning SO MUCH. I am helping these women and they are helping me. I'm loving my doula journey!