We are actually changing the term from “due date” to “guess date.” In the past, doctors have induced babies rather routinely that were still not showing any intention of coming out in their forty-first week. They were worried about things that might happen when babies are truly overdue and their placentas are no longer working at 100% capacity, but babies who “cook” until forty-two weeks are more often than not perfectly healthy and do very well. Babies are mature and viable, as we say, after thirty-seven weeks, though they do even better if they arrive during their fortieth week. So, without knowing a true guess date, babies have been induced far too early due to miscalculations and it becomes apparent that they are even premature, not at all overdue. The medical community is taking a new look at induction at this time, with good reason.
Jeannie called me the day after she reached her forty-week guess date. That morning she had seen her doctor, who had insisted that they go ahead with an induction the following day and possibly a scheduled C-section. Her doctor cited the reason was that the baby “appears rather large.” Jeannie had given birth to two other children but the doctor was worried about a host of “risk factors” surrounding post-date babies. Jeannie’s first baby had been born by C-section, though baby number two was a successful VBAC (Vaginal Birth After Cesarean) at only twenty-eight weeks. Another baby, a beautiful little girl, was born in 2010 but was also very premature and did not survive.
When she called, Jeannie was crying, understandably upset with all that the obstetrician had laid out for them the next morning. She had gone home and told her husband and asked him what they should do. Lonnie’s answer was, “Call Stephanie. She’ll know what to do.” So she was on the phone asking for advice and much-needed support.
It is important to explain that as a doula I do not make decisions for anyone. I don’t tell them which is the best of all the options they are offered, but I will help them explore the possibilities and give them as much information as I have or call someone else if I don’t know. She asked if there was anything they could do to encourage labor and avoid being induced.
I told her that they could have sex, for one. It has worked for some moms. The thought is that the male hormones assist with “turning on” labor, and that orgasm simulates blood flow and the uterus often follows suit. Sex can be quite comfortable if your partner is behind you while you are lying on your side. Being on top of him may not feel quite as good if the baby is well engaged low in the pelvis. Foreplay alone is another option. Nipple stimulation (also with help from a willing partner or available toddler who is still nursing) often works. Rolling your nipples manually or using a breast pump has also been suggested. It has been long thought that being “turned on” is what got the baby in there in the first place and that there is a place for it here, too.
Some women have tried the notorious castor oil cocktail, which works by stimulating the bowel and in turn, if irritated enough, triggers a response by the uterus, and thus labor. Some practices do not advocate this method at all. A mom-to-be could become quite ill and not go into labor anyway. Riding a bike or taking a drive on a long dirt road has supposedly worked on occasion, too.
“Stripping the membranes” is when a midwife or doctor separates the cervix from the bag of water by sweeping a finger around the baby’s head just inside the cervix. It also tips off the hormones that labor should soon follow but that can only be done if the cervix is dilated one to two centimeters already.
An Amish friend of mine told me her method when I was “overdue”: “You get in your buggy and go visit a friend and that will start labor, rather than sitting at home hoping.” I guess lifting three or four little kids up into a buggy, riding along bumpy back roads and then lifting the kiddies back down at the friend’s house, with all the snacks and coats and all, and hauling myself up and down on the buckboard would have worked for me.
Instead of suggesting a buggy ride, I said to Jeannie, “You should take some quiet time and connect with your baby. Tell her it seems to be time and you don’t want a C-section or any drugs, for that matter, so maybe you two can work out some kind of a deal.” She agreed and thanked me and promised to call the next day.
The phone rang at midnight. Jeannie and her family had spent a quiet day at home together, took a nap, and then went to a barbeque at a friend’s house. Just as they finished eating, Wham! The contractions started on their own. She was euphoric, but told me they were going to head right to the hospital because she didn’t think there was time to go home and pick up her baby bag first.
The nurse was checking Jeannie when I got to the hospital. Six centimeters already! We gave high fives all around.
Then she told me one of the strangest stories I had ever heard. While they were settling down for their nap earlier in the day, she was talking to her baby, connecting as she fell asleep like I had suggested. She had a dream, describing it as “totally real.” In the dream she was talking to her baby, whom they were planning to call Camilla, and the baby was telling her, “Well, actually, I’m not coming out unless you agree to name me Veronica. No way!”
So, in Jeannie’s words, “I said, ‘Okay, anything you want. You got it,’” and the dream ended. They told their other kids about it and all agreed that Veronica it would be, though they had never given that name a thought.
Then Veronica’s older sister said, “It should be Veronica Jordan. I am sure.” Jeannie and Lonnie looked at each other and decided that their kids seemed to know a whole lot more about it than they did, so Veronica Jordan it would be.
About half an hour after the nurse checked her, Jeannie said she was feeling a bit “pushy.” The nurse checked again and she was ten centimeters. The nurse ran out, crashing into another nurse coming into the room and both raced to get the room set up with a warmer, instrument tray, and all the other paraphernalia that is part of a hospital birth these days.
I helped Jeannie focus on breathing and get into a comfortable squat on the bed while Dad picked up all the coats, the birth ball, and clothes strewn around us. In the rush, someone asked if the doctor had been called. She hadn’t, until just then. Jeannie and I just grinned at each other. Another doctor was on the floor and quickly gowned up and stood at the end of the bed, hands ready to catch. As the little head crowned, Jeannie’s doctor rushed into the room, and the other doctor stepped aside so she could catch the rest of Veronica Jordan as she slid out. It was all and more than we could have wished for.
An interesting aside is that another baby girl was born to a family down the block from Veronica’s house about the same time. They did not know the family but found out later that they named their baby Camilla.
Veronica Jordan.
“Women’s strongest feelings [in terms of their birthings], positive and negative, focus on the way they were treated by their caregivers.”
~Annie Kennedy & Penny Simkin
Chapter 7: Everybody Loves . . . Babies!
My Ethiopian mama was on her way to our last appointment. I usually see ladies four times before their guess dates. Our plan was that I would go with Farhia to her birth, helping her labor at home first. I would see her at home again for the final postpartum visit, usually two days after the birth. She was expecting her first baby, a girl.
When she arrived she told me that her iron had been low in spite of taking iron pills. I took the opportunity to discuss nutrition. Her diet was very good, full of fresh fruits and vegetables, but I reminded her that liver and red meat is also good and beans and dark leafy greens are just as beneficial. I told her about a recent study that found that even those who eat an iron-rich diet might need to include some dairy at each meal, which in turn helps the iron bond and be better assimilated. I told her that yogurt, kefir, milk, cottage cheese, and ice cream were good choices. I also suggested prunes and prune juice, which she had never heard of, so I got out the prune juice and she discovered she liked it very much.
Then we watched the movie Everybody Loves . . . Babies. Without a lot of words, this award-winning film clearly shows the benefits of maternal-infant and parent-infant attachment. The babies shown in poorer countries actually seem happier and become more confident little people without toys or early educational programs compared to the babies in the Western cultures who have every advantage but appear bored, frustrated, and whiny. I use this film in my childbirth education course to point out the blatantly different styles of parenting across cultures and the resultant levels of bonding.
Filmmaker Thomas Balmes offers a glimpse at the first phase of life in this film that follows four newborn babies through their first year of life. Ponijao, Bayar, Mari, and Hattie were born in Namibia, Mongolia, Japan, and California, respectively. By capturing their earliest stages of development on camera, Balmes reveals just how much we all have in common, despite being born to different parents and raised in different cultures. What is not said, however, is that all the toys, gadgets, enrichment classes, and numerous other choices presented by parents, actually don’t make our babies smarter, more self-assured, or more prepared for life.
The converse appears true: babies in the so-called “Third World” are simply part of the family or society’s ongoing continuum of daily survival and work. They aren’t singled out for special baby activities, or coddled, and seem to have greater self-esteem and are more independent earlier than Western babies (and less work). Likewise, in her recent book, Parenting Without Borders: Surprising Lessons Parents Around the World Can Teach Us, Christine Gross-Loh repeatedly points out how our Western views and models of parenting actually undermine the self-esteem we are hoping to instill in our children.
Next I met with a couple expecting twins who heard about me from another couple who hired me as their doula for their twins’ birth. I hadn’t met them before, so this was just a consultation or information session with no obligations. Couples actually should interview several doulas before they find one that is right for them, and I encourage them to do so when they come to meet me.
I like to start a first appointment with a beautiful little DVD that the Childbirth Collective in Minneapolis produced in 2012, called Doula: A Documentary by Emily Rumsey. It tells better than I could what a doula is and isn’t. It presents a look at water birth, home birth, hospital birth, and C-sections.
Since this couple was expecting their first babies, I offered to show the DVD of my twins’ birth with Ina May Gaskin at The Farm, filmed in 1982. They had lots of questions, actually the same questions I had over thirty years ago when I found out I was carrying twins and realized that the whole land of birth as I knew it with a singleton two years earlier had suddenly changed. We visited for over an hour.
My next appointment was with a Somali mom at her home in the housing projects that have been dubbed “the Cages.” It is thirty floors of tiny airless apartments with only one elevator as access, which is known to frequently break down. I have never tried walking up thirty flights of stairs; I hope I never have to. It was like a scene right out of Rachel and Her Children by Jonathan Kozol.
Fatima was one of my clients the year before when she birthed her fourth little girl. Her youngest, Hikmet, was now eight months old and the continuum bonding that her mother practiced was obvious. A bright, inquisitive baby who was never far from her mother, little Hikmet enjoyed life as it was meant for babies. She had no need to cry for what she wants. Her earliest cues were noticed and answered, whether it be for food, affection, or the need to be changed or kept warm. I was visiting to drop off a breast pump and show Fatima how to use it, though I hoped she was able to put off going back to work for a little longer.
I let Hikmet initiate a visit to my lap when she was ready to explore beyond her mother’s safe bubble. Continuum babies will tell us when they are confident enough to wander beyond the safe place that is their right. Then they will venture further and further away, secure in the fact that a parent will be there when they have the need to check back in again. Continuum babies actually become very independent little people earlier than babies who were separated shortly after birth and forced to sleep in a crib or cradle and self-soothe themselves during intervals throughout the day.
When I got home after my last appointment, I remembered I needed to call a client’s clinic on the other side of town. I had seen her the day before for a prenatal doula visit and was shocked at the enormous amount of swelling that hadn’t been there when I saw her the week before. She assured me she was seeing her doctor later in the morning, but I wanted to let her provider know of my concern. My client’s English wasn’t all that great. She could speak some English, but Amharic, her native language, doesn’t always translate well, especially with medical terms. As a doula I don’t do anything clinical that her provider does, but I could let the provider know when I noticed something that may have literally been lost in the translation.
Also, she wore a floor-length hijab or robe that completely covered her legs and ankles, potentially hiding any problematic swellings. She also told me she stopped taking her prenatal vitamins and extra iron because of constipation. I told her to be sure to let her midwife or doctor know this too, so they could discuss it. I suggested making a list of questions before going to the appointment so all of her concerns could be discussed.
My last appointment of the day was with a first-time mom, also a recent immigrant to the U.S. She couldn’t attend our breastfeeding class so I offered to visit her at her home and go through the material with her. I enjoy this class very much. I wish I had even half the information we now have when I was nursing my babies in the 1980s and ’90s. La Leche League was available for support groups or by phone, but we didn’t know then what we know now about latch, positioning the baby(ies), cracked nipples, or many of the basics.
In my breastfeeding classes I first like to show Breastfeeding: the Why-to, How-to, Can-do videos. Each one runs about twenty minutes and is packed with information that is presented in a confidence-building way.
For my classes I made my own demo breast out of an old white t-shirt. I dyed one piece of t-shirt cotton in tea water overnight, and another piece in a brew of cocoa and coffee. Without rinsing them I dried and then ironed the two swatches to set the colors. I sewed and stuffed the main tea-dyed “breast” and then hand sewed on the darker coffee-and-cocoa-dyed “nipple.”
My cloth breast comes in handy when demonstrating things like how to make a “sandwich” of your nipple to help a newborn latch on. It also shows clearly what Nature had in mind: the darker nipple and areola is actually a “bull’s-eye” that your baby can see and is therefore directed toward as his first destination after birth. I can also demonstrate massaging and expressing that will come in handy should a mom become engorged.
Next I bring out Tofiq (pronounced: toe-FEEK), my anatomically correct seven-pound boy baby doll that I use to have parents practice nursing positions. When we were having our babies two and three decades ago, many of us did not know that they should be lying on their sides to nurse and not flat on their backs with their heads craning around to reach the nipple. We didn’t know how to keep them nursing when they fell asleep or how to burp or not burp them. We didn’t know about the side-lying position, crossover hold, cradle hold, or football hold. I can also demonstrate baby-led or baby-initiated breast crawl and latch with Tofiq. He has also been bathed to show how to safely bathe a newborn.
Finally it was time to go home and make dinner. It was a long but satisfying day in the life of this doula.
“A healthy woman who delivers spontaneously performs a job that cannot be improved upon.”
~Aiden MacFarlane, author of The Psychology of Childbirth
Chapter 8: A Just-In-Time Belly Cast
Miruts came in for her last prenatal meeting before her due date. We offer belly casting as part of our doula services at Everyday Miracles for our expectant moms and I had reserved
the belly cast room for Miruts.
Everyday Miracles in Minneapolis has been my employer the last few years. About thirty doulas of several nationalities meet moms and their families in the offices for prenatal classes, yoga, car seat and baby-wearing clinics, and general support, especially for low-income mothers. Our doulas are Hispanic, Somali, Hmong, and a melting pot of Americans who see women from the whole Twin Cities metro area and attend their births at any of the hospitals in the area. As doulas we also follow up with postpartum visits to ensure they are doing well and that mom and baby are getting the hang of breastfeeding.
I am not sure when the art form called belly casting came into being. It can be one way to help an otherwise overwhelmed young woman bond with her baby before birth. Some call it taking pride in their changing body or “bonding with their bump.”
Part of the job of a doula is to emotionally support a mother-to-be and help her fall in love with her baby if she isn’t already in love. Numerous distractions can threaten to obliterate this fragile connection. A young woman often has to face questions of employment, schooling, even where she will live with her baby. Relationships often become brittle as the reality of a baby sets in. The responsibility for a new little person can affect all the different parts of a woman’s life.
Sometimes our job is to try to find ways to gently steer attention back to this connection or bond with her baby. We try to find ways to celebrate the life that is growing within each new mother. One way is to create a belly cast toward the end of her pregnancy. It is also a chance for the doula and the mom to share some special time together before labor and delivery. We will be working together once labor starts and will need to know each other quite well to work as a team.
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