Dakota and Moriah had moved to Minnesota from Mississippi to be closer to family and friends, but had not been able to get an apartment in time for the birth.
“Ma Doula, how do I get this stuff off ma hands?” Moriah asked. I directed her to gently rub them together in the bowl of warm water until it all came off.
“Ma Doula, do I get tah paint it, too?”
Dakota had had enough. “Girl! What’s youz callin’ her, anyway?”
Before Moriah could answer, it dawned on Dakota. Talking to her mother and sisters on the phone earlier that day, and several times earlier in the week, she told them that she was “goin’ tah see ma doula.” Moriah thought it was my name!
I could hear Mary and Debby, my supervisors, giggling from their nearby offices every time Moriah called me that. It is ma new nickname at work: Ma Doula.
“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
~Maya Angelou
Chapter 10: Bonding
Zoë was a very courageous single mother. She called me sometime during the night on a Friday, one day after her guess date. I rarely look at the clock anymore when the phone rings. My night is over no matter how much or how little I’ve slept, so I let the adrenaline take over. I am blessed with being asked to attend yet another miracle. I am grateful and a bit in awe each time, even after thirty years. It is actually the most important event at this moment in the entire universe, and I get to see it.
Instead of the clock, my eyes automatically look to see whether or not I laid out a clean set of clothes on the chair the night before and that my packed bag is standing by the door.
Zoë’s contractions, or rushes, were strong enough that she couldn’t sleep, but nothing else was going on. Her water had not broken. Zoë’s visit with her midwife the day before confirmed that she was starting to dilate. The midwife was concerned that the baby didn’t appear to be very big and might not have grown in the last couple of weeks. She ordered an ultrasound, during which the technician guessed the baby was about six and a half pounds and said that all looked well in there. There was also some concern that Zoë’s blood pressure was slightly higher than they would like. Zoë’s midwife had already started talking about inducing her should her blood pressure stay too high, or if the baby appeared to have stopped growing and might do better outside rather than in at this point.
I told her that it sounded like this might be the night and encouraged her to try to sleep, even if she just dozed. I told her that if she slept and the rushes went away then we would know it was just early labor. If they picked up and became more regular or her water broke, then we’d have the real thing. I also advised her to let her midwife know about the rushes and to let me know if the midwife wanted Zoë to go to the hospital yet. I went back to sleep and didn’t hear anything from Zoë the rest of the night, so I assumed things had settled down.
I texted her about noon and she replied that the rushes were still very sporadic but she was visiting friends and walking a lot. Later that night she called asking if she might be seeing the mucus plug, or bloody show, which I confirmed. I told her it was all completely normal and that she should try to nap and to keep eating.
Finally at 10:00 p.m. Zoë called to report that the rushes were about five minutes apart and that she couldn’t keep it together alone at home anymore. I suggested she call her midwife and to let me know if she would be going to the hospital. I offered to hang out with her at home, too, if she wanted to do that. She called back within minutes and said they wanted her to go to the hospital. She suggested calling me after she got there to see if they really were going to keep her or send her home. A bit later she called again and said she was at three centimeters but that her blood pressure was high and they wanted to keep her and monitor it. I was on my way.
During the night the nurses had her stay in bed, hoping her blood pressure would come down. It did for a little while, but then when the rushes got more intense it rose again. We tried different positions in bed that might help the baby labor down even if she was not able to walk around. Sitting up in bed cross-legged, on all fours, on her knees with her arms resting on the raised head of the bed, and lying down with a peanut ball between her knees were all used to encourage the baby’s descent.
Finally she got to eight centimeters around dawn. We were able to move to the tub at that point, which Zoë said felt wonderful compared to the bed, but even after more than two hours, she was still at eight centimeters. The midwife suggested breaking her water to help the baby’s head press against the cervix, hopefully encouraging the last two centimeters. There was some meconium in the water, so at the midwife’s insistence, we went back to the bed and the monitor to see if baby was okay. The fetal heart tones were not ideal, so they watched them for a while. The blood pressure was still too high for comfort, but the midwife was quite relaxed and didn’t suggest any interventions, which surprised me. Most of the other hospitals I have worked at would have been talking about a C-section at that point if not before. As a doula it is not my call, so I shelved that one.
The nurses’ shift changed. New nurses fluttered in and out of the room. By 8:30 a.m. Zoë had been up two nights and three days and announced that she was done in. She asked for something for pain or something that would let her rest for a while. The nurse called the anesthesia department and set up the room for an epidural. I got Zoë up to go to the bathroom and suggested she stay there for a bit. Sitting on a toilet is an ideal position to labor in, and she felt better being up so we hung out there. When she returned, the anesthesiologist quickly ran through his list of dire side effects, had her sign the consent form, and then sped through the screening questions. At one point he asked, “Normal blood pressure?” and since Zoë was in the middle of a rush, the new nurse answered for her, “Yes.”
I was surprised and hesitantly added, “Um, no.” He turned to the nurse, who explained that it was high when she came in but it was fine now. I was shocked, knowing that it was higher than any protocol that was in place when I was still a practicing midwife, so I ventured out again, though I still thought perhaps I was mistaken, and said, “Well, actually, it is not normal. It has not come down. The last one was in the 150s.”
The nurse huffed; the doctor looked at her and back at me, quite befuddled. Then he said, “Okay, let me see the [monitor] strips then.” He carefully unfolded the strips from the previous night and noted the elevated numbers and announced, “No way!”
The nurse looked too and said, “But no one told me!”
It obviously got missed during the shift-change report. She should have been alerted but wasn’t. I wasn’t overly upset; I knew we were all part of a team wanting the best for Zoë and we needed to look out and cover for each other. The doctor ordered a blood test that would tell him if she was indeed pre-eclamptic, which could be quite serious. I knew she wanted some pain relief so I asked him if he could recommend something while we waited for the blood tests to come back, which I knew could be quite awhile. He suggested fentanyl along with another drug for the blood pressure, which the nurse ran to get. Zoë was still trying to work with the rushes and trying to follow my breathing but was very impatient at this point for some kind of a break.
The fentanyl didn’t do anything. Zilch! I had never seen that. It usually helps women relax almost immediately and some people actually feel rather happy or even goofy on it. I tell them that I promise not to repeat anything they might say, since it is known for its somewhat drunk-like-inducing properties. It doesn’t take away the pain, but it does take the edge off for an hour, or sometimes two, and then can be given again if needed.
But this time we had to work with each rush just like we had been doing. This was a first for me. We both concentrated on staying connected and I reminded her to rest between each contraction. While we kept dealing with ea
ch rush and then resting, the doctor left, the lab people left, and the nurses all filed out, leaving us alone.
Looking back, I wonder if her full bladder had slowed things at eight centimeters or if just getting up and sitting on the toilet at that particular time did it, but as soon as the room was cleared (taking with them all the concerns and negative vibes) Zoë went back to the bed and announced she wanted to push. I completely trusted her instincts on this one, even though she was supposedly only eight centimeters five minutes earlier. I suggested just some tiny nudges on the next rush. She tried that and I could see the baby’s long black hair.
I called the nurse, who hit the “Come all” button on the wall as soon as she saw it, too. Two more pushes and the baby was on the bed. Zoë reached for her, crying and overcome with joy. Baby’s cord was too short to let her be lifted up to Zoë’s chest, but as soon as it stopped pulsing the midwife cut it and baby was with her mama. She nursed shortly after, without anyone even showing her how. Little Jazelle was six pounds, five ounces, and nineteen inches long, not overdue at all. Her fingernails were not long and she had plenty of vernix, the creamy coating that prevents babies from turning into little prunes from living in water for nine months. It is a waxy white protective substance covering the skin of a fetus, short for “vernix caseosa.” Some have suggested we collect, encapsulate and patent it, using it instead of diaper ointments and lotions. It really is an absolutely amazing substance—nature’s own recipe. Jazelle’s little ears were still stuck flat against her head, another sign of prematurity, or in this case, not being “overdone.” Overdue babies’ ears often stick out and the placenta will also show signs of aging if truly overdue.
We had worked out a birth plan ahead of time that stipulated she would like to be with her baby for at least two hours after the birth. After that, any care would be done on the bed and her baby would not be removed to the warmer or nursery. So that is what we did. We just hung out and got to know Jazelle.
Zoë hadn’t been able to eat during the night, which is unfortunately still standard procedure for labor and delivery units, especially when they have concerns like meconium or high blood pressure, which puts the mom on a fast track to the possibility of a C-section and moms can’t have any food in their stomachs for that, so it is pretty common to have to switch to ice chips and water when interventions first appear in the conversation. Needless to say, Zoë was ready for a couple thousand calories; after all, she had just spent as many calories as she would have running a marathon. We called down an order for just about everything from the breakfast menu, which arrived a short time later.
I finally got ready to go. I packed up my tea lights, massage tools, snack boxes, and juice bottles and hugged Zoë goodbye. I whispered in her ear, “You got the natural birth you wanted in spite of everything. I am so very proud of you!” We agreed to get together again as soon as she got home.
I left another happy motherbaby couple. We are actually beginning to write “motherbaby” as one word. Stop and think about it: they have been one for so many months and that bonding continuum should be ongoing during the next weeks and months. Our babies are not born mature enough to be without us at all. They are totally helpless, far more vulnerable than any other baby mammal at birth. Zero separation is what Mother Nature had in mind. We should listen to her.
Have you ever wondered why we as humans have such large brains? It’s obvious: we are smarter than any other animal. But our babies are more helpless than other mammals at birth. Have you ever wondered why? Part of the reason is that, yes, we are the most intelligent species, but our babies are born unprepared for survival. Our brains grow so fast before we are born that, if they kept growing until the rest of the body caught up and was as mature as, say, a calf is at birth, our heads would be far too large for the birth canal. Since our brains are so advanced, they grow faster in the first year than the brains of any other species. If we waited another four to five months to deliver our babies, their heads would be too big to fit our frames. So Mother Nature had a toss-up: make mothers’ hips even bigger than we have now (horrors!) or have babies born sooner than they are, in reality, ready. Thus they are not as mature as other little mammals and do need us constantly, even more than the offspring of other species.
Nature knows this. Babies know this. Do adults? We don’t act like we know it. Nature knew also, by the way, that baby elephants would not survive if they couldn’t walk and keep up with the rest of the herd shortly after birth. They would be eaten by other animals if left behind, so elephant mamas are pregnant for two years or until baby Babar can walk! And we complain about our nine months’ gestation.
Our babies are just about as immature at birth as our foremother Lucy’s were over three million years ago. Consider cave mama Lucy (who currently resides in the Ethiopian National Museum in Addis Ababa, Ethiopia), whose babies had to be carried, and in constant contact with her, twenty-four hours a day for at least two years or until they could walk. He (I am just guessing it was a first-born son) had constant skin-to-skin contact, was in constant proximity for eye contact with his mother or whatever member of the clan his mother was interacting with throughout the day, at an adult’s eye level, incidentally, not lower as in a crib or stroller where faces suddenly appear to loom above his and just as quickly disappear. He nursed on demand. He had no need to cry. A grunt or his reaching for a breast would be enough of a sign. His mother had enough time connected to him that she could easily “read” any signals coming from him. He listened to his mother interacting with others all day long. We don’t know when she began speaking directly to him, though. Perhaps it began when he spoke first, having listened to adult speech and figured out how it worked.
We now know that bonding is reciprocal. Even into the twenty-first century, however, we can read books written by some authors who still consider bonding a mother-led phenomenon, whereas it is actually reciprocal. When a baby searches his mother’s face, he is seeking her gaze in return. If her gaze is not there more times than it is there, she is giving him a clear message that this is not how we humans interact, though she gives him no alternative solution. When he reaches out to touch her, he expects his hand will be held or caressed. When he first coos, a rewarding sound from his mother will encourage more early speech.
When parents are engaged elsewhere, mentally or literally—interacting with a cell phone or texting, for example—and those overtures from their babies are ignored, it too is a message: he isn’t being answered. Perhaps his voice may be the best way to communicate after all. He’ll have another try at it first: cry louder, perhaps, to get the needed response. He’ll do something, anything, to get attention. In Lucy’s day, bonding was essential for survival. Had she put her babies down, they would have been mauled or eaten. And we would not be here today.
I visited Zoë a couple of days later and didn’t recognize Jazelle. I had only seen her while she was still nursing, before she had been cleaned up after her birth. They both looked great. Zoë had support from her family and friends and was still floating on cloud nine. She could not believe how intense and how incredibly amazing Jazelle’s birth was.
Mothers-to-be can watch dozens of videos about birth and read all sorts of books but nothing really prepares them for the experience. I told her I knew she could do it and that now she knew it too—she could do anything. It was a very empowering experience for her. She will need that inner strength to raise her baby girl on her own.
“The effort to separate the physical experience of childbirth from the mental, emotional and spiritual aspects of this event has served to disempower and violate women.”
~Mary Rucklos Hampton
Chapter 11: Nature Makes No Mistakes… Or Does She?
My mantra has always been “Nature makes no mistakes,” so how could I understand this birth? Perhaps we are not meant to know all of nature’s secrets in this life. Maybe it will be given in the next. I can’t exp
lain what we witnessed. I can only wonder.
Leslie and Fred’s first baby had died at five months’ gestation. It was a nightmare, finding out that their baby was no longer living, having to say goodbye, but still deliver him.
There was little explanation as to why it happened, but in the process of sorting out what little they did know, several chronic medical concerns with Leslie’s health did come to light and those were what she could focus on and improve. Thus began their journey into holistic and alternative medicine, which enabled Leslie to regain her health.
It had been a huge learning curve, but a much needed one. Physically, she was now in a better place than she had ever been, caring for herself and addressing issues she had tried to ignore for decades. But five years later, she was still not pregnant. She and Fred figured they were not meant to have their own children in the usual way and decided to adopt. Surely there were babies out there who were waiting for a family, their family.
They had also put in their time at a university fertility clinic. They took tests and tried scopes, dyes, charting, sex-on-schedule, everything medicine could offer or could think up, but nothing worked.
And then Leslie was pregnant. The biggest hurdle was to hope without setting themselves up for that raw disappointment again. It was inevitable that they would hold their breaths every day, every hour, until they got past the sixth-month mark this time. They tried not to put too much stock in hoping for a successful pregnancy, but at the same time, anyone in their situation is going to hope.
But as her belly grew and the days moved into months . . . six . . . then seven . . . and eight . . . they hesitantly allowed themselves to become excited. The “what ifs” never went away completely, but it seemed that Someone had indeed smiled upon them and this baby was meant to be with them. They knew it was a boy and promptly named him. They found a doctor they felt they could trust who would work with them on their terms. And they decided to hire a doula.
Ma Doula Page 7
