When we create a belly cast we first put a tarp down on the floor to catch any drips. Then the mom takes off her blouse and bra and coats her belly, chest, underarms, and down her sides with Vaseline or lotion. Plastic wrap is tucked inside the top of her skirt or pants to protect them from the plaster. We use plaster-coated gauze sheeting that comes in strips, the kind that was once used to cast broken limbs. After dipping a sheet into warm water it is layered on until her whole belly and chest up to her collarbone is covered. I usually lay on two layers, smoothing out any wrinkles as we go. Within ten minutes it dries and pulls away from her skin. We gently lay it down on the tarp to finish drying while she washes off with fresh warm water and soap.
Many women paint their belly casts. Some decorate them with henna patterns. Others bring their belly casts to their baby showers and have everyone write wishes or blessings on them. The possibilities are endless.
Miruts was not due for over two more weeks, so I was surprised when her husband Tamirat called me at 5:30 a.m. two days after we had done her belly cast. He was quite upset as he explained that his wife was bleeding and they had called 911. I asked if she was having any contractions and he said no, none. I asked if it was just a little blood, like spotting or a bloody show, and he said no, the blood was all the way to the bathroom and back again and on the bed. I stopped breathing. All I could think of was, Why them? Then he told me that the 911 dispatcher had told him that bleeding is normal at birth, but he kept insisting this was an emergency. Since his English is limited they thought he was just an anxious father and had tried to reassure him. I learned later that when the ambulance finally arrived (they took their time) the paramedics were absolutely mortified and flew into action.
Miruts and Tamirat had come to the U.S. less than a year before from Ethiopia, seeking a better future for their children. They were learning English and working hard to assimilate. I had really enjoyed getting to know this little family and had looked forward to this baby with them the last few months.
I raced to the hospital, praying the whole way. I’ve often wondered if we can alter a divine plan, if such a thing exists, by prayer, but this was one of those times I was certainly going to try. All the causes of early bleeding were racing through my mind—placenta abruption (also called simply “an abruption”) was uppermost. That is when the placenta begins to detach from the inner wall of the uterus before the birth of the baby. Sometimes just a portion of it comes off, causing bleeding, but the remaining part is still able to deliver blood and oxygen to the baby through the umbilical cord. Should it completely detach from the uterus, oxygen is cut off and the baby cannot survive. It is one of the causes of a stillbirth. Another possibility was placenta previa, where the placenta has attached to the uterine lining near or over the cervix itself, close to the opening of the uterus. A more remote possibility was a uterine rupture, in which there is a tear in the uterus at a weak spot, though this is more common, although still rare, when there has been a previous C-section, and the strength of the contractions stress that area. That can also cause bleeding, even hemorrhage.
At that point, all I knew was that I was scared, more scared than I had been in a very, very long time, and I could hear Tamirat’s fear too. When I arrived at the hospital Miruts’s midwife was watching the baby’s fetal heart tones on the monitor by the bed. They checked out okay, which was a huge relief. The monitor also showed us contractions coming at regular intervals, though Miruts wasn’t feeling them yet. The midwife then checked to see if Miruts was dilating, which produced a fresh gush of blood, not a good sign. The midwife left to call the obstetrician on duty while I tried to tell Miruts that the baby still looked good and that they had done the right thing coming in so soon. She was not panicking up until then, but the midwife leaving to call the doctor alarmed her and she started crying.
When the doctor first came in he reviewed the readout from the monitors and agreed that the baby was still doing fine, though the heartbeat was fairly unchanged throughout, what is called “non-variable.” He ordered an ultrasound, hoping to get a look inside the uterus and maybe find a clue as to what was going on, but the baby appeared to be toward the front of the uterus, covering a posterior placenta, meaning it was attached to the back wall, or closest to the mother’s back, which made it impossible to view. Due to this, he also couldn’t tell how high or low it was.
The doctor suggested breaking the bag of water. His rationale was that it would inform him further if the baby was feeling stressed, in which case he might consider a C-section if baby was not okay, or we could continue to wait a bit longer.
When babies are not doing well, or are feeling stressed, as might happen when less oxygen is being delivered to them, they often poop in the water before birth and the amniotic fluid turns greenish, or sometimes has dark particles. Artificially rupturing the bag of water at this point could also possibly help hasten labor along. The doctor explained that the baby needed to be born sooner rather than later today, and though the baby looked fine at that point, he was continuing to weigh his options. He could do an emergency C-section, but the risks of major surgery were a serious consideration, especially when the mom was bleeding already. A vaginal birth was still the ideal option and might pose less of a threat to the baby and mother.
This doctor was weighing the pros and cons minute by minute and I could visibly see his concern. He spoke about using Pitocin should the contractions not pick up or the baby’s status changed. But first he went ahead and broke the water—a simple procedure the mom doesn’t feel. An amnihook, a sterile plastic probe, is used to snag the amniotic sac. A small hole will allow the fluid to seep out a little at a time if the baby’s head is not entirely engaged. Care must be taken to not be too aggressive, which could tear a larger hole in the bag, allowing for a more forceful gush of fluid and the potential of bringing the umbilical cord down with it, which could conceivably pinch off the flow of oxygen to the baby before birth.
Usually we don’t like to see this or any other intervention used, and the parents could have refused it, but in this case and at this time it seemed warranted. These are tough decisions. Many have planned an unmedicated natural birth and never even entertained a thought otherwise.
When births don’t go as planned—remember, we never have complete control over our births—and parents find themselves on a totally different “planet,” I am often asked what I would do in their case. I pull out my “Welcome to Parenthood” talk, which goes like this:
“Welcome to Parenthood! You must find out what is right for you, not me, not the doctor or midwife, not your mother or mother-in-law. You must go into your hearts and together find out what is best for you, for your family. You’ll make lots of mistakes in the next eighteen years or so. This is only your first test. You can’t ask anyone else what to do. You have to decide this one for yourselves. You will know. And we will support you.”
Fortunately, Mirut’s fluid was clear, indicating that at the moment, at least, her baby was not exhibiting signs of stress. At that point Tamirat asked to see me in the hall. He was beside himself with worry. Their first baby had been born in Sweden the year before as they waited for visas to enter the U.S. The birth had taken place in a birthing room with a midwife, a natural birth lasting only five hours. This birth process was very different and he was losing it.
First, he didn’t understand why he wasn’t being consulted on every decision that was being made, and he didn’t understand why a C-section was being mentioned at all. In his country, he told me, an elder, or at least a husband, would be consulted by the doctor, and the patient was rarely advised on all the aspects of her condition, partly to spare her worry or concern but also because she might not be in the best position to make decisions.
I explained that in the U.S. we have innumerable laws giving the patient complete rights over her own body and, subsequently, her own treatment. Only when she agrees to it is her husband or p
artner or family brought into the discussion. His English was adequate, but he was trying to bridge the whole cultural barrier. I was able to go over each point that the doctor was concerned about until Tamirat was satisfied that everyone really was trying to find the very best course of action for his wife and baby.
Very soon after, the contractions picked up, which often happens after the water breaks, triggering a hormonal response in the brain. This was a good sign, and the baby continued to tolerate the stronger contractions very well. I couldn’t give Miruts juice or even water since they were still leaving the Cesarean option open as a possibility, but I did succeed in getting her nurse to give us some ice chips, which was better than nothing at this point. Miruts was breathing well with the contractions and getting up to the bathroom. She was dilated to five centimeters the next time the nurse came in and the bleeding seemed to have slowed down—all good news.
The nurse left us alone at this point. She had other patients and, of course, could follow the monitors back at the nurses’ station should anything change. The next time she came in she surprised us when she announced that the cervix was now at eight centimeters. It had only been about half an hour since the last check. She scurried out to let the doctor know. I took one look at Miruts and knew she was already thinking about pushing. I hit the nurses’ light on the bedrail as I put on a pair of gloves and sure enough, Miruts took a deep breath and gave it all she had with the next contraction. I helped her slow down her breathing just a bit as the nurse ran in. She started to put on a glove as the little head crowned. I picked up the other glove she had dropped on the bed and held it open and she shoved her hand into it, barely in time to catch a very plump little baby. The doctor walked in just then and, seeing that the baby had been born, stayed in the doorway. I saw the nurse trying to unwrap the cord, which was around the baby’s arm and chest so I moved in and held the baby by the hips so she could unwind the cord. At the same moment the doctor came up behind me and gently told me to hold the baby’s hips even higher, which I did, basically turning the baby head-down, which would drain any fluids, extra blood included, before she took a breath. Then the doctor gave the nurse the umbilical clip and hemostat clamps and handed the scissors to Tamirat. Most of this had taken place in complete silence.
At that moment, the baby let out a huge screech. When he heard his baby, Tamirat started sobbing, relieved that his wife and baby were out of danger. He blinked back tears as he cut the cord. Then the nurse turned to him and asked, “Well, what is it? A boy or a girl?” Earlier, I had clued-in the nurse that they didn’t know the baby’s sex, and I thought it would be nice if we left it to Dad to announce.
“It’s a girl,” he proclaimed.
With the advent of sophisticated ultrasounds today, it’s rare that we don’t know the baby’s sex, so when this happens I let the father or partner have the honor of making this announcement. I did this with one couple from Kenya. The midwife had caught their baby and in one fluid movement plopped it onto the mom’s stomach. All the father saw was the backside of their baby, but thought that was enough. He started dancing around the room yelling, “I have a boy! I have a son!” He even called relatives in Kenya with the announcement during the next twenty minutes or so. Finally, the mother asked me to take the baby so she could sit up and get cleaned up and when I did, I noticed something. I nudged her and whispered, “Look here,” and she laughed out loud. They had a girl! The dad had never seen a baby girl, it turned out, and just assumed baby boys looked like that, from behind at least. He had to call Kenya back.
Miruts’s placenta followed right away with a little more bleeding. It was over. We all breathed a huge collective sigh of relief. Tamirat went from kissing his brave wife to thanking the doctor and nurses, to crying and kissing his wife again. Of course the nurses offered to weigh the baby right away, but we had already discussed this and put in the birth plan that they preferred to just bond and put off everything else for a couple of hours. I find that nurses are generally relieved when they hear this; it takes the pressure off of them to hurry through the list of things they are required to do before the end of their shift. They simply chart, “Mom refused” and are off the hook. The next shift has the whole day to fit it in.
Miruts and Tamirat needed time to take everything in. It had been intense. It was only three hours from the time they had come in by ambulance. This labor was even shorter than their first baby’s had been. A fast labor like that, called “precipitous labor,” can be very overwhelming, especially for the mom. We wrapped her in warm blankets and I got some juice for her. Finally she could drink. She would need to replace all the blood she had lost and regain her strength. She was soon feeling much better and talking to her sweet little girl. Tamirat checked again as I replaced the baby’s damp blankets and hat with fresh warm ones and confirmed that they indeed had another girl. Little Selam would be pleased to have a baby sister. They named her Negasi. I think we were all still stunned that she was here and that she and her mommy were okay.
Tamirat asked if I would stay with his wife while he went home for clean clothes and to get the car. He had come with her in the ambulance and didn’t have their hospital bag or other items. We relaxed and ordered a huge breakfast that was delivered shortly. Miruts told me she was actually feeling good, even after such a traumatic morning. Tamirat soon returned with roses and a big pink balloon with “IT’S A GIRL!” written on it, and a teddy bear “for Negasi to give to Selam when she visits” he explained. And then he handed me a small brown bag with organic dates and a soy milkshake from a nearby co-op. I was stunned! He had remembered what I had carried with me and ate a month earlier when we met over the lunch hour for a home visit.
The next day I went back to the hospital. We again talked about the birth. They were trying to process all that had happened. It takes time to take it all in and consider how it could have been different (it couldn’t, really) or better (we were very, very fortunate).
During our prenatal visits I often brought my laptop along and shared some of the DVDs I have on baby-led breastfeeding, labor, or natural birth. The last one I had shown Miruts, which was filmed in Brazil, was about a midwife there who has discovered a way to foster the gentle birth continuum with her method of gently bathing newborns. It really is amazing. The midwife slowly submerges the day-old baby while running water over his head, until only his nose is above the water. His ears, eyes, and body are under water and each baby in the video seems to really like it and becomes very calm, then closes his eyes and actually goes to sleep. I had been introducing this to new mothers and have had the same results with each and every newborn baby. Miruts was anxious to try it, so we did, right there in the hospital the second morning. Just like in the video, her baby loved it, closed her eyes, and actually went to sleep while floating in the tub! Some of the nurses asked to watch us bathe Negasi and I am sure it was a first for them, too. Gone are the days that we subject newborns to the bed bath, scrubbing them from head to toe with a rough, damp washcloth, taking extra care not to get the umbilicus wet (never mind that it was submerged in water for the last nine months, anyway) or their ears (ditto). We patted the umbilical stump dry and didn’t put anything else on it.
As in the video, Miruts massaged her baby slowly with almond oil while still on her towel. She enjoyed that, too, though she decided it was time for lunch—now!—so we wrapped her in a dry blanket without any clothes and got her mom dry and back in bed, also without a gown (she had climbed in the bath first). Negasi fussed until she was latched on and then blissfully went back to sleep. She even smiled for us at that point.
Think about it: we are the only mammals who dress our babies after birth. We are also the only mammals who ask ourselves, “Where will my baby sleep?” and “What should my baby eat?” Last year I found a wonderful talk by my favorite U.K. midwife, Carolyn Flint, who said that we “ . . . should go home, if we aren’t already there after the birth, and take all
of our clothes off, and all of our baby’s clothes off (nappies or diapers allowed) and go to bed for fourteen days with our little mammal.” Just consider, this gives mom time to recover and rest; baby can establish a good milk supply by nursing on demand; bonding is optimum when there is uninterrupted skin-to-skin contact; and the family can bond in the sacred space they have created in their bedroom.
Britain’s best-known midwife, Caroline Flint. (Photo © Do Book Company.)
“We are made to do this work and it is not easy . . . I would say that pain is part of the glory, or the tremendous mystery of life. And that if anything, it’s a kind of privilege to stand so close to such an incredible miracle.”
~Simone Taylor
Chapter 9: Ma Doula
We weren’t sure what she was trying to say. I was making a belly cast of her mama’s incredibly beautiful eight and a half-month belly and had invited Moriah, Dakota’s little five-year-old, to join us. Moriah hopped off the chair I had designated for her and asked, “Ma Doula, can I do that?” then “Ma Doula, I wanna help.” So I told her where to smooth out the plaster and gave her the job of holding up the gauze strips before I dipped them into the warm water to soften them.
“Ma Doula, can I have a belly cast, too?” she asked. I told her she could when she was bigger and there was a baby in her tummy.
Then her mom said, “Baby, what’s you keep callin’ her?” Moriah ignored her mom, too engrossed in smoothing out microscopic wrinkles in the gauze as I laid it on, layer upon layer. Dakota and I let it go and kept chatting about finally getting to meet her son and how stressful the time had been, especially since she and Moriah were homeless.
Ma Doula Page 6
