“I want this baby to come while my mom is here.”
“I can’t do that. Your baby will come when he is ready,” her midwife replied.
“But if I am really overdue you could induce me, so why can’t you now?”
The midwife tried to explain that there has to be a good reason to induce babies and that her mom being here for a short time wasn’t one of them. This did not sit well. Tiana left shaking her head while Zion practically danced out of the clinic, singing a little made-up rap, “I’m gonna be a daddy, YES! I’m gonna be a papa . . .”
That night I got a call from Tiana asking if there was anything she could do to bring on labor. I explained that she could ask the midwife what she thought about what we call “stripping the membranes” where, if her cervix has started to dilate, the midwife can sweep a finger around the cervix while gently separating the bag of water from just inside the cervix. Sometimes this will trigger the uterus into thinking it is time for early labor. I also told her how I had gotten on a bike one day and rode for an hour up and down a dirt road when my twins were due and it worked. She asked about Pitocin. Again I said that there had to be a true medical reason to induce. I also encouraged her to keep in touch with her midwife, who might have other suggestions or tricks up her sleeve.
Well, the guess date came and went. Then two days later, at 4:00 a.m., the phone rang. Tiana was having contractions! I asked her to call the midwife and let me know what she said. She called me back and said they wanted her to wait until she had contractions five minutes apart for two hours. She told me they were already unbearable. I suggested she get in a hot tub or shower and keep me posted. An hour later I received a text that she was on her way to the hospital. I was off, too.
The hospital she had chosen had a triage unit where moms first go to be assessed. Too often women enter the hospital in very early labor and are encouraged to return home, where they can labor in familiar surroundings, resting and eating until labor is truly established. In triage the baby and the contractions are monitored and if everything looks good they can be reassured that they are doing well, that labor will pick up exactly at the right moment, and they should not be discouraged.
The midwives assured Tiana that her body was getting ready, that this was all perfectly normal for a first-time mom, and that her baby sounded great, but that early labor could go on for another day and they really thought she would be more comfortable at home. Zion, however, was not phased. He was dancing around the room singing another original rap about his son whom he couldn’t wait to meet.
Tiana’s stepmother, Imani, was helping her dress to go home when we all heard a tiny wet splat. Tiana looked down and exclaimed, “Ewww!” There on the floor was her mucus plug and water was running down her legs, filling her slippers.
“That’s so damn grossss!” was her next expletive.
I laughed and said, “Your water broke! Congratulations! See? Your body knows exactly what to do.”
Her reply, as I grabbed some gloves and paper towels to wipe it up before anyone slipped was, “Ewwwgross!”
Imani steered Tiana into the bathroom to clean up as I cleaned up the floor, skirting Zion as he tiptoed around the room humming his little song. I told the nurse that it appeared Tiana’s water just broke. She went back to the nurses’ station and got a test swab to confirm that it indeed had. By the time Tiana was dressed, the contractions had picked up appreciably and the nurse put her back on the monitor. No one was going home. We were going to have a baby.
Soon we were in a proper birthing room. I got a birth ball and filled a pitcher with ice water. Zion had texted his mom and sister and before I knew it I was being introduced to Alexi, Naveah, Jayla, Kiara, Tiana’s sisters Trinity and Onieda, and cousin Melida. Then her brothers arrived. As we got settled and hung up coats and collected more folding chairs from the other rooms, I found a quiet corner and parked on an exam stool to update my paperwork. Everyone got comfortable while Zion wrestled with the lounge chair, trying to figure out which knobs to pull to turn it into a daybed. He was ready for a nap, having been up since 3:00 a.m. I poked around the cupboards in the room until I found some sheets and a pillow and helped him make up the bed.
As relatives continued to arrive and greet one another, I tried to get near the bed. I wanted Tiana to know that everything was going really well. The contractions were picking up and their baby sounded wonderful. I reminded her to breathe slowly and remember to relax her face, throat, then shoulders and legs. I massaged her hands during the next contractions and then as her mother-in-law took over the hand massages I moved down to her feet. She said that all helped her relax. During the next hour Tiana asked to just be allowed to rest in bed. She was tired.
At shift change I wiped the whiteboard in the room and updated it with our new nurse’s name, the new midwife’s name and under the title “Goals” wrote, “Have Baby Boy!” I invited Tiana’s sisters to fill in the rest of the box marked “Companions.” They managed to squeeze all fourteen names in the box.
One of her cousins busied herself with Tiana’s make-up. She wanted her to look her best for the pictures they all planned to take. The cousin suggested only above-the-waist photos before the baby came and maybe a few as he was crowning. Tiana wasn’t sure about that. They continued discussing pictures while Tiana had her eyebrows sculpted. Lip gloss completed the process. I noticed how relaxed she was while being made up, no complaints about the contractions or rushes. Hmm.
Suddenly about six cameras started clicking and flashes started going off, now that the star of the show had on her make-up. It looked like a scene on the news of some diva rock singer as she steps out of her limo onto the red carpet at the Grammy Awards. I had been wondering when her midwife would comment on the sheer number of people in the room, and now she did.
“Maybe you can put away all the cameras and phones for now, at least until the baby is born, so we can work around the bed and help Tiana relax.” She was very diplomatic.
I sat next to the bed and encouraged Tiana through each rush. After another hour she asked how much longer this could go on. I explained that for a first baby we expect about one centimeter of dilation every hour, or sometimes every two hours. I also said that she would feel a whole lot better doing anything other than being on her back in bed. We finally helped her up and she walked down the long halls with Zion. I demonstrated, with his cooperation, how to lock her hands behind his neck and hang that way during the rushes and that moving her hips from side to side and in a spiral or circular motion would also help the baby move down.
After one lap around the fourth floor she was back, heading for the bed. I grabbed the birth ball and firmly but gently suggested she stay upright awhile longer sitting on the birth ball at the edge of the bed, which I raised up to her shoulder height once she was seated. I positioned a pillow in front of her on the bed so she could really rest in between rushes. After awhile, though she admitted the birth ball had helped, she asked about pain medication. I suggested she call the nurse and discuss her options together. The nurse told her it was still pretty early in the labor, and strongly urged she try a hot bath. They discussed this back and forth for a while until Tiana agreed to try it. Once she was ensconced in the tub with the lights out and tiny pin lights glowing around the edges of the tub, she relaxed. I got a pitcher and slowly poured a little stream of water over her belly. After a few minutes, I asked Zion if I could show him how to do it. He bounded in, humming a new little tune, and quickly got the hang of pouring a steady stream of water over Tiana. They stayed like that for almost an hour. When she got out the nurse checked her. She was at three centimeters—not too fast, but definitely progress. We tried the birth ball again and I had Zion behind her on a chair rubbing her lower back with a massage ball. I assured her that back pain was a good sign that her baby was moving down into her pelvis. He was still sounding wonderful when the nurse intermittent
ly checked his heart tones with a Doppler.
While Tiana was in the tub the sisters had gone down to the cafeteria and returned with covered plates full of eggs, sausages, biscuits, and toast and passed those all around. Another sister came back with a tray of coffee in paper cups. They knew how to feed a crowd. This group knew how to “do family,” I thought as I watched in wonder. I had also been figured into the breakfast count, bless their hearts!
Another aunt came in during breakfast and announced that since it was such an auspicious day, the day of their little man’s birth, she had gotten lottery tickets, the scratch-off kind, and passed them around. Someone was sure to get lucky today, she explained.
As breakfast was wrapping up, Zion went around the room picking up all the paper plates and cups and generally tidying up the room. About that time Tiana asked one of the nurses if they might have an even larger room available. The nurse left to check and soon came back saying that one other mom had just gone home and they had called housekeeping to clean it right away. Within an hour we moved into our new, bigger, temporary home.
Sometime around five centimeters, Tiana decided she wanted an epidural. When the anesthesiologist arrived, I took the lead and announced that we all had to leave so he could set up. I promptly escorted the crowd into the hall, where the conversations continued about who was bringing what for the family’s Thanksgiving dinner.
Around 5:00 p.m. another aunt appeared with her two daughters. They were toting bags of fried chicken, dinner rolls, bottles of soda, chips and . . . Halloween candy. A few minutes later I left Tiara’s bedside to get more ice water. On the way out the door I passed several cousins and brothers, all big macho guys, with Zion in the middle, still happily humming. Each had a lollipop in his mouth.
Only a few minutes later the nurse announced that Tiana was ten centimeters and we were going to set up the bed for the delivery. With his mouth full of chicken, Zion looked at me with a pained expression and asked, “Now? I can’t even eat fried chicken?”
I laughed and said, “I think Tiana needs you over here just now.”
Zion gulped down some more chicken and stood by Tiana’s head, wiping his fingers off on a napkin before he reach for her hand. I was by the head of the bed on the other side, showing her how to hold her legs behind her knees. The baby warmer was turned on and the sterile pack of instruments was being unwrapped at the other end of the bed. About eight ladies were lined up behind that, cameras and cell phones ready. I looked over this scene and thought, What is wrong with this picture? I left Tiana’s side and walked to the end of the bed and suggested that the ladies might want to stand closer to the windows to give Tiana a little privacy at the end of the bed where the nurses were helping her position her legs on two trough-like stirrups. The epidural had rendered her legs numb and as heavy as tree trunks.
I returned to my position and encouraged Tiana during the next rush. She did not have an urge to push because the epidural blocked any sensations there, but the midwife was ready to offer directions from down below where she was now stationed. I was too far up near the head of the bed to see what was going on down there but could tell from the midwife’s responses that things were going very well and she could see the baby’s curly black hair even after just the first push. I whispered to Tiana that she could rest for a bit and when the midwife said to push, I would help her take a deep breath, then let it out as the contraction built and, with another deep breath, put her chin down to her chest, hold it . . . and . . . push . . . and again . . .
The baby’s head was out. Just like that. It was the shortest second stage of labor in a first-time mom I had ever seen. The midwife said the same thing. Another push and all of him was out. The ladies had migrated once again to the end of the bed in those few minutes (it was nearly impossible to keep the paparazzi away) and the flashes started again amidst crying and hugs.
I looked up to see Zion wiping his eyes and shaking his head in disbelief. One lady moved over nearer to me and said, “I am twenty-nine years old and I have never seen a birth before. This is so awesome!” It really was.
I whispered into Tiana’s ear, “You did it! I knew you could! You are amazing and I am so very, very proud of you!” She was crying, too. As soon as Zion cut the cord, the baby was put onto Tiana’s chest and a fresh warm blanket was laid over him. She instinctively held him there with both hands and, seeing his warm little bum sticking up under the blanket she proceeded to pat it with both hands. She couldn’t say anything yet but just looked over at me beaming. Tears rolled down into her ears. Her make-up was still perfect.
The family continued taking pictures from every angle, including the end of the bed where the midwife was waiting for the placenta. I don’t know how I could have managed crowd control any better. Tiana seemed completely unperturbed by it, so I just let her lead the way. I had let her know early on that she could tell me if at any point she wanted me to thin out the audience and send a few people out but she said it was all good. She had such an amazing family and support network. They were really good at this.
The next day I emailed a friend/RN/aspiring Certified Nurse Midwife (CNM) in St. Paul, asking her what her hospital’s policies were when it came to families. She wrote back: “Our hospital does not have a specific number, but leaves this to the physician and nurses’ discretion. If the room is big enough, and the family is respectful, we can allow many people to stay. If they have a big family, I try to lay a ground rule early on that only two or three people fit in the room, and appoint a gatekeeper (another family member) to do crowd control. There have been times we have needed to invent a unit-wide rule for the sake of getting obnoxious and unwelcome family out of the room, but only if they are truly interfering or causing a safety risk—there are even times we have had to call security to control a crowd for us when there are twenty family members trying to take over a room. If we can’t get a bed past them out to an OR, or a neonatal crash team into the room, it’s not safe and they need to move. If they are making unhelpful comments or being rude to me or any of the identified birth team, I’ll boot them.”
She continued, “I once had a teen mom where I was certain that the six people she had identified on her birth plan to come would cause me grief all day. They were loud, discussing sports or their own births, and kept repeating untruths about birth and reproduction. I resolved that I would need to thin the crowd as she moved to active labor. But then her friends and family moved to interact with her, every one of them taking a task and becoming the most beautiful team of doulas I have ever witnessed. They all stayed as the baby was born, and they were sensitive and respectful, aware of the space the physician and I needed to work, and quietly efficient! Loved it!”
Another friend wrote back saying, “Each hospital sets its own number. Here in New Jersey it is five. You know the saying: the more people in the room the more dysfunctional the family.”
While Tiana was being cleaned up and wrapped in pre-warmed blankets and her baby boy was nursing like a real pro, I packed up my things from all around the room, quite ready to catch up on missed sleep. The room had thinned out appreciably and I assumed the family had started going home. I was wrong. It was time to eat again. They all came back in, this time toting submarine sandwiches for everyone. As I prepared to leave after hugging everyone goodbye, I made my way down to the hospital lobby. One group of brothers and boyfriends of sisters and cousins who were not with the sandwich crowd were just coming back into the hospital as I reached the front doors.
“I thought you all left,” I said.
Zion answered for them, “No, we just went out for a smoke.”
I couldn’t help it. I hugged him goodbye and whispered in his ear, “I hope you can give this up—smoking—it’s not good for your baby. Even second-hand smoke is really dangerous, you know.”
All I got was a half-hearted, “I know.”
The next day the crowd
was smaller. One of the aunties was changing the baby’s diaper. I mentioned that I had just run across a new gadget for babies that they had to see. I got out my phone and showed the website for a soft little cover (a Pee-pee Teepee; see resource section) that can be put on a baby boy’s penis while his diaper is being changed to protect his clothes and the changer’s from any unexpected geysers. They thought it was the funniest thing they’d ever seen.
I finished up my paperwork and hugged Tiana goodbye. I would miss her and her big, loud, loving family.
“It’s not just the making of babies, but the making of mothers that midwives [and doulas] see as the miracle of birth.”
~Barbara Katz Rothman
Chapter 3: A Christmas Baby
It was Christmas. My husband and I had gone to the midnight service extra early to hear the special hymns and carol singing. It was beautiful and inspiring. The crèche at the church was stunning; it was close to life-size, camels and all. Christmas has always been a special time for me.
When we finally got home and crawled into bed at 2:00 a.m., I gave thanks for all that was well with the world, especially our deliciously cozy featherbed, and was quickly sound asleep. Soon I was dreaming that the phone was ringing. Why didn’t it stop? It just kept ringing. My husband nudged me. I rolled over and looked at the clock: 4:00 a.m. The phone continued to ring.
Why would someone call me now? Oh, duh. I am a doula. But none of my moms-to-be was due for two more weeks at the earliest.
I picked up the phone. “Hello?”
The caller was laughing! I didn’t like this joke. “Isn’t this funny?” the voice giggled.
“Um, not really,” I answered.
“I’m gonna have a Christmas baby!”
“Who is this?” I demanded, still half-asleep and thinking it was a prank call.
Ma Doula Page 3
